SAEM Practice 2024 questions and
answers
Regarding the diagnosis of acute appendicitis, all the following are true EXCEPT:
A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
B. Rebound is usually elicited only after the appendix has ruptured or infarcted....
SAEM Set 1questions and answers
"The chest X-ray in the Figure was taken in an intoxicated patient who is conversant,
but an unreliable historian. The X-ray findings are best described as indicating:
[image]
A. Esophageal foreign body
B. Intratracheal foreign body
C. mediastinitis from esophageal perforation
D. normal chest"✔✔"A. Esophageal foreign body
The answer is A. The film reveals a classic appearance of a round foreign body (in
this case, a pull-top from a beer can) in the esophagus. The foreign body appears to
lie outside the tracheal shadow. There is no sign of mediastinal air (which would be
expected with penetrating trauma). The X-ray reveals no signs of mediastinitis, but
the risk of esophageal perforation and ultimate mediastinitis prompts endoscopic
intervention in this patient."
"An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary
canine tooth. He brings the severed piece of tooth with him. On physical exam, the
tooth is fractured halfway between the tip and the gumline. The root of the tooth is
still firmly intact. The exposed fracture site has a yellowish tinge without blood. Of the
following choices, which is the most appropriate management for this patient?
A. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental follow-
up
C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint"✔✔"D. Immediate dental consult
to avoid abscess formation
The answer is D. Ellis II dental fracture involves enamel and dentin. The fracture site
typically has a yellowish tinge. Ellis III dental fractures are characterized by exposure
of pinkish pulp and often blood. These fractures require immediate dental
consultation to prevent abscess formation."
"A 22 year old man is punched in the nose during a fight. He presents to the
emergency department with obvious nasal bone deformity. Pressure controls the
bleeding. Physical exam reveals no maxillary bone or orbital rim tenderness, intact
vision and extraocular movement. The oropharynx and mandible are unremarkable.
Nasal inspection reveals a swollen, ecchymotic, tender nasal septum. Which of the
following is the most appropriate initial step?
A. Outpatient follow-up with an ENT specialist to surgically correct a deviated
septum
B. Plastic surgery consult for immediate reduction of nasal fracture
C. Facial CT scan to rule out more serious facial fractures
D. Incision and drainage of the septal hematoma followed by nasal packing
E. Needle aspiration of the septal hematoma"✔✔"D. Incision and drainage of the
septal hematoma followed by nasal packing"
,"A 24 year old woman is playing racquetball and sustains a direct blow from the ball
to the right eye. She presents to the emergency department complaining of eye pain
and double vision. On exam, her right eye does not track properly with upward gaze.
This finding suggests which of the following injuries?
A. Inferior orbital wall fracture
B. Superior orbital rim fracture
C. Ethmoid fracture
D. Zygomatic arch fracture
E. Inferior orbital rim fracture"✔✔"A. Inferior orbital wall fracture
The answer is A. The patient most likely has an orbital floor fracture with
entrapment."
"A 32 year old man is struck several times in the head with a baseball bat. Upon
emergency medical service arrival, he is mildly confused, vomits once, and
complains of a severe headache. The emergency medical technicians establish two
large-bore IVs. Prior to arrival at the emergency department, he loses consciousness
and begins to seize. He is actively seizing when he is brought into the trauma bay.
What should be the first step in the management of this patient?
A. Administration of phenytoin 1000mg IV
B. Administration of mannitol 50 g IV
C. Rapid sequence intubation using paralytic agent
D. Emergency craniotomy
E. Administration of 2 liters NS bolus"✔✔"C. Rapid sequence intubation using
paralytic agent
The answer is C. The airway should be managed as the first priority in this patient.
The other maneuvers may be helpful but are secondary to securing an airway and
providing oxygenation/ventilation. Airway comes first!"
"A 46 year old man is brought in by EMS after a motor vehicle collision in which he
was an unrestrained driver. Although he has no obvious injury to his head or neck,
he complains of chest pain and appears very short of breath. His vital signs are: T
99.2 F, BP 85/57, HR 123, RR 36, SpO2 95% on non-rebreather. The CXR
demonstrates a
tension pneumothorax. Of the following, which is the most appropriate next step in
this man's care?
A. Placement of a chest tube followed by a chest xray to determine proper
placement
B. Transfusion of 2 units of O-negative packed red blood cells
C. Performance of a chest CT scan to further delineate the pathology
D. Placement of a needle decompression device, followed by repeat CXR"✔✔"D.
Placement of a needle decompression device, followed by repeat CXR
This patient needs emergent chest decompression and this is rapidly done by needle
thoracostomy. A chest CT may be performed, but only once he is stabilized. A formal
chest tube will be placed, but placement may not be rapid enough and he may
decompensate in the meantime. Transfusion of blood does nothing to correct the
physiology of a tension pneumothorax"
, "The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination"✔✔"E. two-point discrimination
The correct answer is E. Light touch is a good screening test, but two-point
discrimination is more sensitive and should be used routinely in evaluating injuries to
digits. The O'Riain wrinkle test involves placing the digit in warm water and looking
for wrinkling of the digital pulps. Presence of wrinkling indicates the nerve is intact."
"Which is not part of the Ottawa ankle rules?
A. inability to walk 4 steps at the time of the injury
B. inability to walk 4 steps in the emergency department
C. tenderness over the lateral malleolus
D. tenderness over the medial malleolus
E. tenderness over the talus"✔✔"E. tenderness over the talus
The correct answer is E. The Ottawa ankle rules are a validated (for adults) set of
physical exam findings to determine if an ankle X-ray is needed after an injury. If any
of the first 4 answers is present or if there is tenderness over the navicular or base of
the 5th metatarsal, an X-ray should be obtained. If the correct answer to all
questions is no, then an X-ray is not needed."
"Choose the INCORRECT statement regarding thoracentesis from the anterior
approach (needle decompression):
A. An upright chest X-ray should always be performed following a thoracentesis to
confirm the successful relief of a tension pneumothorax and the absence of
hemothorax or other complications.
B. A 14- to 20-gauge needle is inserted perpendicularly over the superior edge of
the rib.
C. The recommended insertion site is the second intercostal space, midaxillary line.
D. After the needle is inserted into the pleural space, a rush of air confirms the
presence of a tension pneumothorax.
E. If a tension pneumothorax is confirmed via needle decompression, then a
thoracostomy tube should be placed as soon as possible."✔✔"C. The recommended
insertion site is the second intercostal space, midaxillary line.
The answer is C. The recommended insertion site for needle decompression of
tension pneumothoraces is the second intercostal space along the midclavicular line.
If a lateral approach is needed, the recommended insertion site is the fourth or fifth
intercostal space in the midaxillary line. The lateral approach poses a greater risk of
parenchymal injury. The needle should always be inserted over the superior edge of
the rib as the neurovascular bundle runs along the inferior margin (answer B). The
remaining answers are all correct statements regarding thoracentesis (answers C, D,
E)."
"In a patient with a suspected ruptured globe from penetrating trauma to the eye, all
of the following should be performed EXCEPT:
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