SEAM M4 Exam New 2025 Version Best Studying Material
with Questions from Actual Exam and 100% Correct
Answers
"A 3 year old girl presents after accidentally ingesting an alkali drain cleaner. Which of the
following statements regarding her management is true?
A. Neutralization therapy using a strong acid is warranted
B. Gastric lavage should be performed immediately to reduce gastric injury
C. Endoscopy is useful in the assessment of injury
D. Activated charcoal should be administered" ------------- Correct Answer ---------- "C.
Endoscopy is useful in the assessment of injury
The answer is C. Gastric lavage and ipecac therapy are contraindicated due to concern regarding
recurrent injury to the esophagus from a second contact with the caustic ingestant. Activated
charcoal is contraindicated because it obscures endoscopic assessment (and doesn't work at
binding caustics). Neutralization with milk or water may be indicated in caustic ingestions
without perforation, but strong acids/alkali should not be used. Endoscopic assessment should be
performed early as the risk of procedurally-induced perforation increases with delayed
endoscopy."
"Severe lead toxicity can commonly result in which of the following clinical symptoms
A. Stocking glove peripheral neuropathy
B. Constipation
C. Dermatitis
D. Memory loss" ------------- Correct Answer ---------- "D. Memory loss
The answer is D. Lead toxicity affects a variety of systems. The central nervous system effects
are many and range from encephalopathy and seizure to sleep disturbance and memory deficits.
The peripheral nervous system can also be involved, with paresthesias and wrist drop being
common. Colicky abdominal pain is often present. While dermatitis is not common in lead
poisoning, you can see bluish lead lines on the gingiva."
"A 55 year-old man is brought down from the outpatient procedures clinic after becoming
severely short of breath during an endoscopy under light sedation. His pulse oximeter is reading
100% on a non-rebreather mask. You notice an interesting discoloration of his blood when it is
drawn. What antidote should be administered?
A. Deferoxamine
B. Methylene blue
C. Hydroxycobalamin
D. Amyl nitrite" ------------- Correct Answer ---------- "B. Methylene blue
The answer is B. Nitrates/nitrites, local anesthetics, dapsone, and phenazopyridine are the
common causes of methemoglobinemia. Methemoglobinemia causes the oxygen dissociation
curve to shift to the left, making the remaining hemoglobin less likely to give up oxygen to the
,tissues. Blood from patients with methemoglobinemia is a chocolate brown color. Methylene
blue is the antidote. Pulse oximetry is unreliable in patients with methemoglobinemia, since the
pulse oximeter cannot differentiate oxyhemoglobin from methemoglobinemia."
A 58 year old construction worker who has no primary care doctor comes to the emergency
department because of a non-pruritic rash above his ankles (see Figure). Physical examination
reveals bilateral erythematous and swollen ankles that are mildly warm but non-tender to touch.
His overlying skin of both legs show mild scaling and thickened skin. There is no puncture site
or visible opening in the skin, although he has prominent varicose veins bilaterally (see Figure).
His temperature is 37C (98.6F). He appears to be in no acute distress. What is the most likely
diagnosis?
[image]
Figure courtesy of eMedicine.com
A. necrotizing fasciitis
B. stasis dermatitis
C. eczema
D. cellulitis
E. psoriasis ------------- Correct Answer ---------- B. stasis dermatitis
The answer is B. This patient's presentation may be confused with cellulitis but is in fact stasis
dermatitis. The facts that his rash is bilateral and associated with varicose veins and lack of fever
increase the likelihood of a long-term process such as stasis dermatitis (chronic inflammation of
the skin due to venous insufficiency). Microvascular changes hinder the delivery of oxygen to
the skin and subcutaneous tissues. A secondary bacterial infection can be superimposed upon
stasis dermatitis. Necrotizing fasciitis is more likely characterized by a rapid progression of
extreme pain and blister/bullae formation that represents widespread tissue destruction; patients
often are visibly toxic. The hallmark of eczema is pruritis, and psoriasis would appear as white or
silvery, flaky patches, neither of which are present.
A patient with no medical history presents to the emergency department for a second opinion.
Nearly a week ago, there was a rapid onset of malaise, headache, backache, and fever. A rash
began to appear on the leg a few days after the initial symptoms and the patient presented to a
hospital-affiliated walk-in clinic for assessment. The patient had no respiratory symptoms but
was noted to have some lesions on the tongue. At the time of his assessment at the walk-in clinic,
the fever had resolved and the patient was diagnosed as having a viral syndrome. At the walk-in
clinic, a digital photograph of the rash was taken and inserted into his computer records (see top
of Figure). It is now 3 days after the initial walk-in clinic visit. You are working in the
emergency department where the patient presents complaining of a recurrence of high fevers and
a spread of the rash which now involves the face, extremities, and torso ------------- Correct
Answer ---------- D. smallpox
The answer is D. The clinical presentation is more consistent with smallpox than any of the other
etiologies. Insect bites may have been possible with the initial skin presentation but are much
less likely given the spread of the process and the other symptoms. Erythema multiforme is
rendered unlikely by the absence of drug ingestion. With chickenpox, fever occurs with the onset
of the rash, which is characterized by simultaneous existence of individual lesions at differing
,stages. Also with chickenpox, the eruption is concentrated over the torso, and given the time
course of this example, crusting should have been present if the patient had chickenpox.
Since smallpox has been eradicated worldwide, any cases that do occur (e.g. secondary to
terrorist activity) are likely to be misdiagnosed as clinicians are unfamiliar with the disease.
After a mean incubation period of 1.5-2 weeks, there is a 2-3 day prodromal phase characterized
by abrupt onset of severe headache, backache, and fever. The temperature subsides over 2-3
days. An enanthema over the tongue, mouth, and oropharynx precedes the skin rash by a day.
The skin rash begins as small, reddish macules, which become papules with a diameter of 2 to 3
mm over a period of one or two days; after an additional 1-2 days, the papules become vesicles
with a diameter of 2 to 5 mm. The lesions occur first on the face and extremities but gradually
spread to cover the body. Pustules that are 4 to 6 mm in diameter develop about four to seven
days after the onset of the rash and remain for five to eight days, followed by umbilication and
crusting. As occurred in this example case, there may be a second, less pronounced temperature
spike five to eight days after the onset of the rash, especially if the patient has a secondary
bacterial infection. Smallpox lesions have
A patient develops a rash that starts as multiple bilateral target-like macules and papules on the
palms and soles. It progresses to widespread sloughing of the skin requiring admission to the
burn unit. Which of the following etiologic agents has NOT been implicated in this syndrome?
A. recent immunization
B. barbiturates
C. penicillins
D. sulfa antibiotics
E. corticosteroids ------------- Correct Answer ---------- E. corticosteroids
The answer is E. The syndrome described is the spectrum of erythema multiforme/Stevens-
Johnson syndrome/toxic epidermal necrolysis. Although the etiology is not always clear, many
drugs (including sulfa antibiotics, penicillins, and barbiturates), viral or Mycoplasma infections,
and recent immunization have been implicated. Corticosteroids are a controversial adjunct in
treatment, but have not been implicated as a cause of the disease.
A 53 year old man with non-insulin dependent diabetes mellitus presents with pain, redness, and
swelling of the right foot and lower leg, accompanied by a temperature of 102. X-rays reveal no
subcutaneous gas and show no evidence of osteomyelitis. The patient has been admitted on three
previous occasions for cellulitis of the right foot and notes that this episode is identical. Which of
the following antibiotics is the most appropriate initial therapy for a presumed diagnosis of
cellulitis?
A. oral dicloxacillin
B. intravenous nafcillin
C. intravenous gentamicin
D. intravenous ampicillin-sulbactam
E. intravenous cefazolin ------------- Correct Answer ---------- D. intravenous ampicillin-
sulbactam
The answer is D. Gram-positive bacteria (Streptococcus species and S. aureus) most commonly
, cause cellulitis in non-diabetic hosts. Penicillinase-resistant penicillins (e.g. dicloxacillin,
nafcillin, oxacillin) or 1st-generation cephalosporins (cephalexin, cefazolin) can effectively treat
cellulitis. However, in diabetics with recurrent cellulitis, the infection is more likely to be
polymicrobial and involve gram-negative organisms. A broader-spectrum antibiotic (e.g.
ampicillin-sulbactam) with coverage of gram-positive and gram-negative bacteria is
recommended. Gentamicin alone is not effective against gram-positive bacteria.
Which of the following is FALSE regarding the common skin disorder, seborrheic dermatitis?
A. characterized by erythema and waxy scaling
B. uncommon between infancy and puberty
C. differential diagnosis includes Tinea capitis, psoriasis of scalp, cutaneous lupus
erythematosus
D. initial therapy often consists of high dose topical steroids
E. found in skin folds and hair-bearing of face scalp, chest and groin ------------- Correct Answer
---------- D. initial therapy often consists of high dose topical steroids
The answer is D. Initial therapy for seborrheic dermatitis is application of anti-dandruff shampoo
lathered onto the area and left on for 5-10 minutes. Shampoos can contain zinc pyrethrin (Head
and Shoulders), selenium sulfide (Selsun Blue), salicylic acid (Neutrogena T-Sal) or tar (Polytar
or Neutrogena T-Gel). The other answers are all correct regarding seborrheic dermatitis.
"A 27 year old woman is brought into the emergency department by her roommate 30 minutes
after ingesting a bottle of aspirin in a suicide attempt. Which of the following acid-base disorders
is most likely to be present in this patient?
A. Primary metabolic acidosis with compensatory respiratory alkalosis
B. Respiratory acidosis due to somnolence causing decreased respiratory drive
C. Respiratory alkalosis due to stimulation of the respiratory center and increased CO2
production
D. Primary respiratory acidosis with compensatory metabolic alkalosis" ------------- Correct
Answer ---------- "Key is 30 minutes...
C. Respiratory alkalosis due to stimulation of the respiratory center and increased CO2
production
The answer is C. Aspirin, a salicylate, directly stimulates the medullary chemoreceptor trigger
zone and respiratory center, leading to increased CO2 production and increased respiratory rate,
causing a primary respiratory alkalosis. A primary metabolic acidosis typically develops as well.
Salicylates are absorbed from the stomach and bowel wall and typically have onset of action
within 30 minutes."
"During opiate withdrawal which of the following symptoms would you expect to find?
A. Urinary retention
B. Tachypnea
C. Pruritis
D. Constipation" ------------- Correct Answer ---------- "B. Tachypnea
