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SAEM Quick Review Q's 2024/2025 | Actual Questions and Answers Latest
Updated 2024/2025 (Graded A+)
Management of Large Subungual Hematoma - ✔✔Drainage (18-Gauge) or Hot Micro-Cauterization Reason to Avoid Suction in Ear Foreign Body Removal - ✔✔Perforation of Tympanic Membrane Management of Skin Abscess - ✔✔Linear Incision for Non-Face vs. Needle Drainage for Face Catheter for Bartholin Cyst - ✔✔Word Grading of Laryngeal Opening - ✔✔Cormack-Lehane Preferred Induction Agent in Reactive Airway Disease for Dilation Effects - ✔✔Ketamine Induction Agent Avoided in Sepsis Due To Adrenal Suppression - ✔✔Etomidate Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia - ✔✔Epidural Hematoma Presentation of Adhesive Arachnoiditis - ✔✔Progressive Neuropathy Tom, Dick, and Very Nervous Harry - ✔✔Anterior to Posterior of Medial Ankle: Tibialis Posterior, Digitorum Longus, Vein, Nerve, Hallucis Longus Absolute Contra-Indication to Crico-Thyrotomy - ✔✔Age Under 5
Anesthesia for Suturing Distal Right Index Finger in Patient with Underlying Vascular Disease - ✔✔Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis, Nose Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg) - ✔✔Lightheadedness (Also Peri-Oral Numbness, Tinnitus, Visual and Auditory Disturbances, Shivering, Twitching, and Generalized Tonic-Clonic Seizures) (1) Avoid Vertical Mattress Sutures. (2) Avoid Topical Skin Adhesives (Risk of Dehiscence from Sweating). - ✔✔Palm Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form) - ✔✔Fentanyl (Effects Not Always Reversed by Naloxone) Management of Long-Lasting L.P. Headache - ✔✔Autologous Blood Patch Timing of Tetanus Prophylaxis - ✔✔Within First Few Days (Suture Within First 24 Hours) Normal C.S.F.-to-Blood Glucose Ratio - ✔✔0. Size of Needle Decompression Needle - ✔✔14 Gauge (2nd Intercostal at Midclavicular Line) Large Paronychia and Cellulitis - ✔✔Removal of Affected Nail Under Digital Block and Antiobiotics Signs of Acute Appendicitis - ✔✔1. Rovsing: Right Lower from Left Lower.
- Psoas: Extension.
- Obturator: Rotation. Suggested by Abdominal Pain Preceding Nausea and Vomiting - ✔✔Surgery (Small Bowel Obstruction) Peak of Gastric Acid Secretion at Rest - ✔✔2 A.M.
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth - ✔✔Tardive Dyskinesia Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back (Opisthotonus) - ✔✔Benztropine (2mg Cogentin) or Diphenhydramine (25mg) for Dystonia Extra-Pyramidal: Restlessness - ✔✔Beta-Blocker for Akathisia E.C.G. Finding of Haloperidol Toxicity - ✔✔Long Q.T. Drug Causing Vertical Nystagmus - ✔✔Phencyclidine (PCP) Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects) - ✔✔Haloperidol (5mg IM q30); B-52 is Benadryl, 5 Milligrams of Haloperidol, and 2 Milligrams of Lorazepam Risk of Protracted Struggle in Restraints - ✔✔Metabolic Acidosis Risk of Flumazenil in Chronic Benzodiazepine User - ✔✔Withdrawal Seizures Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis - ✔✔Isopropyl Alcohol - iso gives iso (equal) gap metabolic acidosis Glucose and Magnesium Recommendations for Altered Alcoholic - ✔✔1. Thiamine Before Glucose; and,
- Give Magnesium Regardless of Magnesium Level (Low Stores). Global Inability to Relate to Environment and Process Sensory Input (Increased Alertness and Psychomotor Activity) - ✔✔Delirium Most Common Dementia - ✔✔Alzheimer More Common Than Vascular Dementia
Management of Hypertension in Eclampsia (Seizure) - ✔✔Magnesium; Consider Anti-Hypertensive Medication for Diastolic Over 110 After Seizure Stops Relationship Between Alcohol and Seizures - ✔✔Direct Toxicity vs. Withdrawal vs. Head Injury from Fall Most Common Cause of Delirium in Elderly - ✔✔Medications Tooth Fracture of Enamel and Dentin, Yellowish Tinge, No Blood - ✔✔Ellis 2 Dental Fracture Requires Dental Consultation to Prevent Abscess Formation Obvious Nasal Bone Deformity After Blunt Trauma, Bleeding Controlled by Pressure; No Bone Tenderness, Cranial Nerves Intact; Swollen and Bruised Tender Septum - ✔✔Incision and Drainage of Septal Hematoma Followed by Nasal Packing Eye Blunt Trauma, Pain, Double Vision from Upward Gaze - ✔✔Entrapment of Inferior Rectus from Inferior Orbital Wall Fracture Head Blunt Trauma, Loss of Consciousness, Currently Seizing; Previous Confusion, Vomiting, and Headache - ✔✔R.S.I. with Paralytic (Before Addressing Intracranial Pressure) Tension Pneumothorax; Hemodynamically Unstable - ✔✔Needle in 2nd Intercostal Mid-Clavicular (Anterior) or 4th Intercostal Mid-Axillary (Lateral), Before X-Ray (Chest Tube Takes Too Long) Most Sensitive Bedside Test for Finger Nerve Injury - ✔✔Two-Point Discrimination Wrinkling of Digit in Warm Water Indicates Intact Nerve - ✔✔O'Riain Test Ottawa Ankle Rules (Any Positive Requires X-Ray) - ✔✔1. Inability to Walk 4 Steps At Time of Injury or Currently.
- Tenderness Over Either Malleolus.
Management of Hemodynamically-Stable Liver Laceration from Trauma - ✔✔Conservative Management; No Emergency Laparotomy Trauma Patient with Bloody Foley - ✔✔C.T. Abdomen and Pelvis with I.V. and Trans-Urethral Contrast Chest G.S.W., Unconscious and Pulseless, Systolic of 60 - ✔✔Emergency Thoracotomy (Lower Success Rates for Blunt Trauma) In Breast, Out Axilla; Hemodynamically-Stable and Clear Breath Sounds Bilaterally; I.V. Access Obtained - ✔✔(1) Bedside Ultrasound. (2) Intubation and Chest Tube. (3) Portable X-Ray; and, (4) Admit to I.C.U. Stab Wound in 10th Intercostal Space, Absent Breath Sounds; Dyspnea But Hemodynamically-Stable - ✔✔(1) Chest Tube. (2) Portable X-Ray. (3) Abdominal C.T. Decreased Sensation Over Thenar Eminence - ✔✔Median Nerve Injury from Distal Radius Fracture Leg Externally-Rotated (And Abducted) - ✔✔Femoral Neck Fracture (ER = RE) Leg Internally-Rotated - ✔✔Posterior Hip Dislocation; pINT - pt drank a PINT of alcohol --> MVA --> hi force, posterior hip dislocation Popliteal Impact on Planted Foot; Pale Cold Foot, No Distal Pulses - ✔✔Sedate and Reduce Without X- Rays
Eikenella corrodens - ✔✔Aggressive Mouth Flora Requiring Prophylactic Antibiotic Coverage After Human Bite (Lactam-Lactamase) Definitively Determines Entry and Exit Wound - ✔✔Forensic Specialist (Emergency Department Must Describe Wounds But Never Speculate) Small Pneumothorax on Chest C.T.; Hemodynamically-Stable - ✔✔100% Oxygen Flexion and Compression of Vertebral Body Resulting in Paralysis and Loss of Pain and Temperature Sensation Below - ✔✔Anterior Cord from Anterior Spinal Artery Injury Severe Burns of Hands (Or Skull) and Heels; Risk of Cardiac Arrest or Loss of Consciousness - ✔✔Deep Burns Distinguish Electrical Injury from Lightning Hepatitis C Medication, Risk of Depression - ✔✔S.S.R.I. Pretreatment for Interferon Alpha Psychiatric Risk Associated with Breast Implants - ✔✔Suicide SAD PERSONS - ✔✔1. Male (Caucasian).
- Age Under 20 or Over 50.
- Depression.
- Previous Attempt.
- Ethanol or Drugs.
- Rational Thought Loss (Psychosis).
- Social Support Issues.
- Organized Plan.
- No Spouse or Significant Other (1 Point, All Others 2 Points).
- Sickness or Injury. Psychiatric Disorder With Greatest Risk of Suicide - ✔✔Panic Disorder
Vomiting, Diarrhea, Fatigue, and Yellow-Green Halos Around Objects - ✔✔Digoxin Mimics Clonidine Toxicity - ✔✔Opioid Toxicity (Hypotension, Bradycardia, Bradypnea, Miosis) Vin Rose Urine - ✔✔De-Feroxamine (I.V. or I.M.) for Iron Toxicity Antidote for Isoniazid vs. Beta-Blocker (Also CCB or Insulin) - ✔✔Pyridoxine vs. Glucagon (1) Encephalopathy, Seizure, Sleep Disturbance, or Memory Deficits. (2) Paresthesias or Wrist Drop. (3) Colicky Abdominal Pain. - ✔✔Lead Toxicity; Check for Lead Lines Chocolate Brown Blood After Nitrites, Local Anesthetics, Dapsone, or Phenazopyridine - ✔✔Methylene Blue for Met-Hemoglobinemia (1) Tall and Young. (2) Smoking. (3) Asthma. (4) C.O.P.D. (5) Interstitial Lung Disease. (6) Connective Tissue Disease. (7) Lung Cancer. - ✔✔Risk Factors for Spontaneous Pneumothorax Endo-Tracheal Tube Depth (Lip Line) - ✔✔23 Centimeters for Males and 22 Centimeters for Females Populations At Higher Risk for Asthma - ✔✔Male Children vs. Female Adults vs. African-Americans
10 Millimeter Fall in Systolic Pressure During Inspiration - ✔✔Severe Asthma vs. Pericardial Tamponade; pulsus paradoxus: right compression leads to septal deviation to left --> decreased filling of left ventricle, decreased SV = 10mmg drop Steroid Route for Asthma Exacerbation - ✔✔I.V. Steroids Effect of Mucokinetic Agent (N-Acetylcysteine) on C.O.P.D. Exacerbation - ✔✔Increases Work of Breathing Pathogen Coverage Required for Community-Acquired Pneumonia - ✔✔Co-Infection of Gram-Positive (Streptococcus) and Gram-Negative (Chlamydia) Common (1) Over 65. (2) Alcohol. (3) Diabetes or Immune Suppression. (4) Cardiovascular Disease. (5) Splenectomy. (6) Sickle Cell. (7) Malignancy. - ✔✔Risk Factors for Streptococcus Pneumonia Manifestation of Varicella Zoster in Adult Smokers or Pregnant Women (Contrast to Rash in Children) - ✔✔Pneumonia Currant Jelly Sputum, Empyema or Abscess - ✔✔Klebsiella Pneumonia Chest X-Ray Findings of Food Aspiration - ✔✔Right Middle Lobe Atelectasis or Right Lung Hyperinflation Percentage of P.E. Patients with D.V.T. vs. Percentage of D.V.T. Patients with Asymptomatic P.E. - ✔✔33% vs. 50%
2 Electrolytes Appearing Normal On D.K.A. Labs Despite Total Body Depletion, In Addition to Potassium - ✔✔1. Magnesium.
- Phosphorous. Contra-Indicated During Hyperglycemic Seizures Due to Impairment of Endogenous Insulin Release - ✔✔Phenytoin Timing of Fluid Resuscitation for Hyper-Glycemic Hyper-Osmolar State - ✔✔Half in 1st 8 Hours; Other Half Over 24 Hours Risk of Rapid Correction of Hyper-Osmolarity, Especially in Children - ✔✔Cerebral Edema; Change in Mental Status During D.K.A. Treatment Requires Mannitol (Avoid Glucogenic Steroids) (1) Ineffective for Alcoholic Hypoglycemia (Inadequate Glycogen Stores). (2) Dangerous In Unexplained Pediatric Hypoglycemia (Possible Glycogen Storage Disease). - ✔✔Glucagon Glucose Level Required for Symptoms - ✔✔Under 50 (Seek Other Causes Otherwise) 2 Common Causes of Hypoglycemia in Type 1 Diabetes, In Addition to Increased Insulin Use - ✔✔Increased Activity or Skipped Meals Observation Period for Overdose on Oral Hypoglycemic - ✔✔24 Hours Contrast Physical Exam of Moderate Hypothermia and Mild Hypothermia - ✔✔Altered Mental Status and Loss of Shivering Below 32 Degrees (Bradycardia and Bradypnea) Management of Frostbite - ✔✔Warm Immersion (Pain Returns)
Seasonal Timing of Presentation of Hypo-Thyroidism - ✔✔Winter Due To Cold Intolerance C.B.C. and B.M.P. Findings Supporting Diagnosis of Hypo-Thyroidism - ✔✔Normo-Cytic Anemia and Hypo-Natremic Respiratory Acidosis from Hypo-Ventilation (Also Hypercholesterolemia) Calcium Level in Adrenal Insufficiency - ✔✔Normal or High (Unknown Etiology) Management of Suspected Adrenal Insufficiency - ✔✔Dexamethasone (4 Milligrams IV q6) and A.C.T.H. Stimulation Test (Not Affected by Dexamethasone) (1) Untreated Pneumothorax (Including C.O.P.D. Blebs). (2) Doxorubicin, Cisplatin, Bleomycin, Disulfira, and Mafenide Acetate. (3) Otitis Media. - ✔✔Contra-Indications for Hyperbaric Oxygen Therapy (1) Carbon Monoxide Poisoning. (2) Decompression Sickness. (3) Necrotizing Fasciitis. (4) Air or Gas Embolism. (5) Crush Injury. (6) Compartment Syndrome. - ✔✔Indications for Hyperbaric Oxygen Management of Mild Acute Mountain Sickness (Not Life-Threatening) - ✔✔1. Avoid Higher Altitudes.
- Acetazolamide, Oxygen, and Ibuprofen (Headache) for Current Altitude. (1) Alcohol. (2) Thyroid. (3) Rheumatic Heart. (4) Ischemia. (5) Atrial Myxoma.
(4) Iodide. (5) Cupric Sulfate. (6) Bromide. - ✔✔False Positive Guaiac Test (1) Bile. (2) Ingestion of Magnesium-Containing Antacids. (3) Ascorbic Acid (Vitamin C). - ✔✔False Negative Guaiac Test Thumbprinting on X-Ray - ✔✔Submucosal Edema and Hemorrhage; ischemic colitis, mesenterischemia, inflam bowel dz 2 Most Common Causes of Lower G.I. Bleeding in Adults - ✔✔Diverticulosis and Angiodysplasia 2 Most Common Causes of Upper G.I. Bleeding in Adults (Higher Mortality Than Lower GI Bleeding) - ✔✔PUD (Gastric Erosions) or Varices Most Common Cause of Upper G.I. Bleed in Children - ✔✔Esophagitis Painful Hemorrhoids - ✔✔External Most Common Cause of Food Poisoning in U.S. - ✔✔Clostridium 2, 3, and F - ✔✔Inferior from Right Coronary Artery Criteria for Acute Myocardial Infarction - ✔✔ 2 of 3: 20 Minutes Duration, E.C.G, or Positive Enzymes; for STEMI ST elevation in 2 contiguous leads of new LBBB Management of Acute Myocardial Infarction Before Catheterization or Thrombolytics - ✔✔1. Nitroglycerin, and Morphine Increases Oxygen Delivery.
- Aspirin and Clopidogrel.
- Beta-Blocker Decreases Myocardial Oxygen Requirement.
- Heparin Once Dissection Ruled Out. V1, More Elevation in 3 Than 2 - ✔✔Confirmed by S.T. Elevation in V3R to V6R on Right-Sided E.C.G.; Give Fluids and Avoid Vaso-Dilators (Nitroglycerin) M.I. Symptoms, E.C.G. Shows No S.T. Elevation, But Right Bundle Branch Block and Fascicle Block - ✔✔Pacemaker Prevents Complete Block S.T. Elevation in V5 and V6 - ✔✔Lateral M.I. from Left Circumflex Perfusion of S.A. Node - ✔✔Right Coronary Artery Management of Likely Aortic Dissection - ✔✔Beta-Blocker Decreases Shearing Forces on Aorta (Systole) and Sodium Nitroprusside Lowers Pressure (More Titratable Than Nitroglycerin); Consult Cardiothoracic Surgery and Consider Morphine Second-Degree Type 1 - ✔✔Widening Wenckebach Management of Pheo-Chromocytoma - ✔✔Phentolamine High Blood Pressure and Optic Disk Edema (Or Encephalopathy, Intracerebral Hemorrhage, Retinopathy, Heart Failure, ACS, Acute Renal Failure, Aortic Dissection, and Eclampsia) - ✔✔Malignant or Emergent Hypertensive Crisis (1) Valsalva. (2) Barotrauma. (3) Asthma. (4) Cocaine Inhalation from Positive Pressure Devices. - ✔✔Risk Factors for Pneumo-Pericardium; Check for Hamman's Sign (Mediastinal Crunch Over Precordium)
Complete Unilateral Facial Droop (Inability to Raise Forehead) - ✔✔Acyclovir and Prednisone; Suggest Eye Patch and Moisturizing Drops for Lacrimal Gland Dysfunction Contrast Presentation of Vestibular Neuronitis to Labyrinthitis - ✔✔No Sensori-Neural Hearing Loss from Vestibular Neuronitis Suggested by Cranial Nerve Deficit (Diplopia) in Vertigo Patient - ✔✔Central Etiology Management of Vertigo from Benign Positional Vertigo - ✔✔Benzodiazepine (Sedation of Limbic System and Thalamus) or Anti-Cholinergic (Diphenhydramine, Meclizine, or Promethazine) Mid-Back Pain (Urinary Retention) and Progressive Leg Weakness; Fever, Absent Reflexes, Tenderness to Palpation - ✔✔Start Broad-Spectrum Anti-Biotics and Consult Neuro-Surgery; Foley and Analgesics to Relieve Pain Initial Management of Myasthenic Crisis (Previously Diagnosed by Edrophonium Test) - ✔✔Intubation Risk of Nitro-Prusside in Renal Failure Patients or Pregnancy - ✔✔Cyanide Toxicity Management of Hypertensive Emergency (Urgency + End-Organ Damage) - ✔✔25% in First Hour by I.V. (Esmolol 100 to 500 Micrograms / Kilogram Load) 1st Step in Management of Atrial Fibrillation - ✔✔Rate Control Before Anti-Coagulation Termination of A.V. Nodal Re-Entry Tachycardia - ✔✔Adenosine (99% Effective) Location of Second-Degree Type 2 Block (Requires Pacing) - ✔✔His-Purkinje System Location of Second-Degree Type 1 Block from Vagal Tone or Drug Effect - ✔✔A.V. Node
Long Q.R.S., Terminal R Wave in V1 and Slurred S in 1 and V6 - ✔✔Right Bundle Branch Block Linear or Flame-Shaped Hemorrhages, Cotton-Wool Patches, Copper or Silver Discoloration of Arterioles, Hard (Lipid) Exudates from Abnormal Vascular Permeability - ✔✔Longstanding Hypertension (Optic Disk Edema Indicates Emergent Malignant Hypertensive Crisis)
- ✔✔ Beta-Blocker That Also Blocks Alpha Receptors - ✔✔Labetalol Reason to Avoid Beta-Blocker in Pheo-Chromocytoma or Cocaine Toxicity - ✔✔Blood Pressure Increase from Alpha-Mediated Vaso-Constriction Management of Shingles - ✔✔Analgesic and Acyclovir (Prevents Post-Herpetic Neuralgia) Umbilicating Vesicles Covering Body and Fever; Recent (Days Ago) Papules on Extremities and Face; Started As Oral Rash and Severe Febrile Headache and Backache One Week Ago - ✔✔Smallpox Skin Sloughing After Target Macules on Palms and Soles from Penicillin or Sulfa Drugs (Also Barbiturates, Immunization, or Mycoplasma) - ✔✔Erythema Multiforme vs. Stevens-Johnson vs. Toxic Epidermal Necrolysis Cellulitis Treatment in Diabetic; History of Recurrent Cellulitis - ✔✔Gram-Positive and Gram-Negative (Ampicillin-Sulbactam) Management of Seborrheic Dermatitis (Tinea-Like Erythema and Waxy Scaling on Hairy Surfaces Before Infancy or After Puberty) - ✔✔Shampoo Containing Zinc Pyrethrin, Selenium, Salicylic Acid, or Tar Contrast Color Under Wood's Light of Tinea Versicolor vs. Erythrasma - ✔✔Yellow-Green vs. Red
