Saem Test Missed Questions With Correct Answers

Saem Test Missed Questions With Correct Answers 1 An elderly female presents to the emergency department with vomiting and abdominal pain. She has a history of a cholecystectomy about 5 years ago. On exam, she is significantly uncomfortable and nauseated. Lung and cardiovascular exam is normal. Abdominal exam shows diffuse tenderness, some distention with tympany, and an empty rectal vault. Vital signs are: HR 102 BP 145/86 RR 24 SpO2 96% RA Temp 99.9F You order an acute abdominal series, which is read by the radiologist as "nonspecific bowel gas pattern, no perforation." What is your management plan? A. IV fluids, pain medication, consult vascular surgery for serial exams B. IV fluids, pain medication, CT abdomen C. IV fluids, pain medication, consult vascular surgery D. IV fluids, pain medication, discharge if improved - Answer ️️ -B A 70 year old female presents to the Emergency Department with 3 days of intermittent right- sided abdominal pain. The patient has had associated symptoms of nausea and vomiting. On physical examination, the patient is exquisitely tender in the right side of the abdomen with mild distension. Xray films of the abdomen show pneumobilia and multiple air-fluid levels. What of the following is the most likely diagnosis? A. Ascending cholangitis B. Gallstone ileus C. Cecal volvulus D. Acalculous cholecystitis - Answer ️️ -B A 38 year old man with sudden severe central abdominal pain for the last hour presents to the ED. He is ill appearing, febrile and has a rigid board-like abdomen. A bedside ultrasound reveals no fluid collections or aneurysm and a plain upright portable chest xray reveals no pneumoperitoneum. Your surgical consultant wants to take the patient for a laparotomy. What percentage of patients have no pneumoperitoneum who go to the operating room with this entity: A. 10% B. 25% C. 50% D. 75% - Answer ️️ -C A 25 year old previously healthy male presents 7 hours after a rattlesnake bite to his right lower leg. You confirm it is a pit viper based on a photo taken by his friend. Exposing the affected leg reveals a grossly edematous, tender, ecchymotic and tense calf with small bullae forming near the bite. There are preserved pulses and paresthesias in his foot. There is intense pain with passive ranging of the ankle. Which of the following is the most appropriate management of this patient's condition? A. Immediate decompressive fasciotomy in the OR, along with administration of FabAV antivenin B. Immediate application of a proximal tourniquet to prevent systemic spread of toxin, FabAV antivenin, and surgical consult in the Emergency department C. IV mannitol and elevation of the extremity with ICU admission D. Immediate administration of the FabAV antivenin with ICU admission and surgical consult - Answer ️️ -A An unconscious 8 year old boy was pulled out of a freshwater lake. It was unknown how long he had been submerged in the water or how much water he had aspirated. The water temperature was 20C at the time he was pulled out of the water. He was found to be hypoxic upon removal and quickly given 100% oxygen. Which of the following is correct with regards to this drowning scenario? A. Adults develop hypothermia more quickly than children in cold water B. Initial treatment of fresh water and salt water drowning are different C. Significant ingestion of freshwater will cause hypernatremia D. Hypoxia is based on volume of water aspirated and not water content - Answer ️️ -D A 65 year old male with a history of COPD presents to the emergency department with increasing dyspnea, rhinorrhea, cough, and sputum production over the last three days. He denies fever or chest pain. His last acute health visit was 6 months ago. His vital signs are as follows: BP 135/75, HR 85, RR 19, SpO2 95%, Oral temp 98.0 °F. His exam is significant for a diffuse expiratory wheeze and prolonged expiratory time. His chest X-ray and EKG are unchanged from baseline and your patient responds to your ED medical therapy. In addition to an inhaled beta agonist your patient's recommended outpatient pharmacotherapy includes: A. A mucokinetic such as guaifenesin B. A methylxanthine such as theophyline C. A high-dose oral corticosteroid such as prednisone D. An antibiotic such as doxycycline - Answer ️️ -D A 39-year-old diabetic man with hypertension and cirrhosis, presents to the ED with an infected tattoo resulting in cellulitis encompassing his entire left arm and forearm. His vital signs are 40.0 C, pulse 140, respirations 28, blood pressure 120/50. His last admission reveals his usual blood pressures to be systolic values of 180-190. To which level of care should he be admitted? A. Intensive care unit with IV antibiotics B. Observation unit until vital signs normalize and can tolerate oral antibiotics C. Discharge home with daily ED wound checks and oral antibiotics D. General medical/surgical ward with IV antibiotics - Answer ️️ -A A 17 year old male presents to the emergency department complaining of excruciating groin pain that woke him from sleep. This pain is associated with nausea and radiation into the abdomen. On examination his right testicle is firm, exquisitely tender, and there is unilateral absence of the cremasteric reflex. A bedside diagnostic and therapeutic maneuver would be to: A. Rotate his right testicle in a medial to lateral rotation (540 degrees) B. Perform a bedside scrotal ultrasound C. Transilluminate the right testicle D. Elevate the left testicle - Answer ️️ -A A child presents after falling off the monkey bars onto an outstretched hand. What type of pediatric radius fracture is seen in the F