SAEM Practice 2024 Exam with complete solutions

SAEM Practice 2024 Exam with complete solutions "Silent Suicide" is defined as: A. an act of slowly killing oneself by nonviolent means, such as starvation or non-compliance with essential medical treatment B. an attempted suicide C. suicide involving a number of willing and sometimes not so willing participants D. a self-destructive act disguised as an accident E. recurrent self-destructive acts, such as heavy drinking in the presence of alcoholic liver disease - Answer ️️ -A. an act of slowly killing oneself by nonviolent means, such as starvation or non-compliance with essential medical treatment The answer is A. "Silent Suicide" is most common in elderly patients and frequently goes unrecognized. Such patients may present to the emergency department repeatedly because of non-compliance with treatment of their medical disorders. "Occult Suicide" is applied to self- destructive acts disguised as accidents and should be suspected in those who have "accidental" self-inflicted gun shot wounds, and in those who "unintentionally" overdose, or who fall from a height. "Chronic Suicidal Behavior" consists of recurrent self-destructive acts. "Mass or Group Suicide" is suicide involving a number of people. "Parasuicide" is an attempted suicide, which is seen more as a gesture than a serious act. 6What does the dotted line in the figure depict? [image] Figure used with permission from Hamilton et al, Emergency Medicine: An approach to clinical problem-solving A. Placement site for skin clamps. B. The needle entry angle that optimizes eversion of sutured skin edges. C. The approach for subcuticular suture. D. The injection plane for local anesthesia infiltration. E. Use of a "finder needle" to mark suture entry points. - Answer ️️ -B. The needle entry angle that optimizes eversion of sutured skin edges. The answer is B. Eversion of the skin edges is maximized by directing the needle entry as shown in the figure. Injection for local anesthesia should usually be performed through the wound, rather than through intact skin. Use of skin clamps can damage tissue; in cases where skin stabilization is needed gentle forceps application is preferred. Subcuticular sutures are placed deep to the skin. 19 year old man is brought in to the emergency department by EMS after being found obtunded in his apartment. No additional history is available. On arrival, the patient is minimally responsive with sonorous respirations and a palpable rapid pulse. The most appropriate initial diagnostic test would be A. Arterial blood gas B. Electrocardiogram C. Fingerstick glucose D. Urine drug screen - Answer ️️ -C. Fingerstick glucose The answer is C. Hypoglycemia is a common and readily treatable cause for altered mental status. An ABG is unlikely to be diagnostic and more likely to reflect secondary abnormalities caused by respiratory depression. While a urine drug screen may show positives, it cannot quantitate the amount of a substance or the time period in which the exposure occurred so a positive screen may not reflect cause and effect. An EKG, while a part of a toxicology evaluation, is not an appropriate initiate screening test for an unstable patient until airway and readily reversible causes have been addressed. 56 year old male presents with sub-sternal chest pain for 4 hours with worsening shortness of breath for the last 2 hours. The patient's heart rate is 108 beats per minute, respiratory rate of 24 breaths per minute, and oxygenation saturation of 94% on room air. On physical examination, the patient appears dyspneic. On auscultation, he has a harsh II/VI systolic murmur with rales midway up bilateral lung fields. A bedside echocardiogram is done which shows papillary muscle rupture. Which valve's regurgitation is responsible for this patient's shortness of breath? A. Mitral valve B. Aortic valve C. Pulmonic valve D. Tricuspid valve - Answer ️️ -A. Mitral valve 60 year old male presents to the emergency department with chest pain. His monitor strip, shown below, reveals: [image: looks like a type 2 2nd degree with 2:1 block but its not...] A. first degree AV block B. complete heart block C. second degree AV block Mobitz Type 1 D. second degree AV block Mobitz Type 2 - Answer ️️ -D. second degree AV block Mobitz Type 2 The answer is D. Mobitz type 2 is characterized by an unexpected, non-conducted atrial impulses. The R-R interval and P-R intervals are constant. -- For further reading, see Tintinalli, et al., Emergency Medicine: A Comprehensive Study Guide, 5th edition, page 184. A "BLS" ambulance differs from an "ALS" ambulance in that the BLS ambulance: A. is stocked with different supplies and equipment B. operates under off-line, as opposed to on-line, medical control C. arrives at the patient first D. is staffed by one EMT crew member (and one driver) rather than two EMTs E. is a smaller "van"-type ambulance - Answer ️️ -A. is stocked with different supplies and equipment A 2 and a half year old girl is brought in to the emergency department by her mother for "loud breathing" and a fever. The mother states the child has been previously healthy and is up to date on all her vaccines. Initial evaluation of the child reveals an ill-appearing child with her head propped upright, who is drooling and making stridorous noises. Her vital signs are notable for a temperature of 104.2 F. Which of the following is most likely in this child? A. Chlamydia pneumonia B. choanal atresia C. viral upper respiratory tract infection D. Stapholococcus aureus retropharyngeal abscess E. viral croup - Answer ️️ -D. Stapholococcus aureus retropharyngeal abscess The answer is D. This patient exhibits several classic symptoms of retropharyngeal abscess including fever, neck stiffness, and drooling, as well as her generally toxic appearance. Retropharyngeal abscess in children is often associated with foreign body ingestion leading to perforation of the hypopharynx or esophagus. Pneumonia, viral croup and upper respiratory tract infection are unlikely to cause airway obstruction, which is suggested by this patient's drooling. Choanal atresia is typically diagnosed in infancy. Another consideration in this patient would be epiglottitis; however, given her vaccination history, she would be less likely to contract epiglottitis from H. influenzae Type b, which is the most common causative organism. A 2 year old child presents with an overdose of her mother's iron containing multivitamins. What antidote should you consider for iron toxicity? A. Pyridoxine B. Glucagon C. Deferoxamine D. Methylene blue - Answer ️️ -C. Deferoxamine The answer is C. Deferoxamine binds directly to free iron and thus is the antidote for iron toxicity. It is given intramuscularly or intravenously and often causes the patient's urine to turn color (vin rosé urine). Methylene blue is an antidote for methemoglobinemia. N-acetylcysteine is the antidote for acetaminophen. Pyridoxine is the antidote for isoniazid toxicity and glucagon can serve as an antidote for beta blocker, calcium channel blocker, or insulin overdoses. A 2 year old is brought in to the emergency department by his mother for difficulty breathing. The mother thinks he might have swallowed or aspirated something. In regards to this patient, which of the following is TRUE regarding foreign body aspiration or ingestion? A. Large objects in the upper airway typically present with mild symptoms B. Small objects in the lower airways typically present with the most severe symptoms C. The most difficult objects to remove are stiff, non-conformable objects D. Objects lodged in the proximal airway have the worst prognosis - Answer ️️ -D. Objects lodged in the proximal airway have the worst prognosis The answer is D. Large objects in upper airway and trachea have the worst prognosis and typically present with the most severe symptoms. A 2 year old male is brought to the ED in status epilepticus. He has not responded to adequate doses of benzodiazepines. Which of the following possible causes of a seizure must be evaluated for in the emergency department? A. Hypoxia B. Hypoglycemia C. Toxic ingestion D. Head trauma E. All of the above possible causes must be evaluated for - Answer ️️ -E. All of the above possible causes must be evaluated for The answer is E. Seizures have a number of secondary causes, which must be identified and corrected before the seizure will end. Hypoxemia and hypoglycemia are easily detected by pulse oximetry and bedside measurement of glucose, respectively. Toddlers may ingest many toxins accidentally, such as INH, tricyclic antidepressants, and camphor. Trauma must be considered, too, including child abuse. Sickle cell disease, SLE, and leukemia are some of the medical causes of seizures and status epilepticus. 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 - 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. A 3-week old presents to the emergency department with a fever of 100.8. The child is otherwise well appearing. After blood culture, the best management of the options below is: A. Check WBC before further management. B. UA plus urine culture, LP, antibiotics, and admit C. Discharge home D. ampicillin and discharge E. Admit for observation. - Answer ️️ -B. UA plus urine culture, LP, antibiotics, a