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SAEM Set 1 questions with 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" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "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" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "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
C. Rapid sequence intubation using paralytic agent D. Emergency craniotomy E. Administration of 2 liters NS bolus" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "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" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "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" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "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" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "E. tenderness over the talus
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: A. ascertainment of intraocular pressure via tonometry B. administration of broad spectrum antibiotic therapy C. visual acuity assessment D. ascertainment of tetanus status E. ophthalmology consultation" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "A. ascertainment of intraocular pressure via tonometry The answer is A. Tonometry should not be performed in patients with suspected ruptured globe, as application of the Tono-Pen pressure to the eye may cause the vitreous humor to exude from the eye, thereby complicating the injury. Tetanus status is important to check, as ocular injuries, like skin injuries, may be a portal for tetanus exposure. Broad-spectrum antibiotic therapy is indicated. Anti-emetic therapy may be helpful in preventing the elevations in intraocular pressure associated with vomiting. Visual acuity assessment is important and ophthalmology consultation is critical." "Following a motor vehicle crash, a 25 year old man presents complaining of a painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye. The right eye protrudes from
the orbit and the patient has right eye pain with extraocular movement. What is the most likely cause of his symptoms? A. retrobulbar hematoma B. chemosis C. hyphema D. orbital blow-out fracture E. ruptured globe" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "A. retrobulbar hematoma The answer is A. Traumatic proptosis with impaired extraocular movements is classic for retrobulbar hematoma. Sequelae include optic nerve ischemia and secondary visual impairment. A ruptured globe presents with enophthalmos, not proptosis, as vitreous humor leaks out of the eye. Neither hyphema nor chemosis causes proptosis. Orbital blowout fractures can cause inferior rectus muscle entrapment and secondary pain with impairment of extraocular movement. Yet, they do not present with proptosis - unless complicated by retrobulbar pathology." "Following a brawl at a local bar, a gentleman presents with an impressive right-sided periorbital ecchymosis. All of the following physical examination findings would suggest an orbital blowout fracture EXCEPT: A. diplopia with upward gaze B. right-sided infraorbital subcutaneous emphysema C. right-sided epistaxis D. proptosis E. anesthesia of the right infraorbital region" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "D. proptosis
and iritis (inflammation of the iris) are not indicated by the arrows. A pterygium is a growth which is visible on the sclera, and which crosses the limbus onto the cornea." "The patient in the figure sustained minor blunt trauma to the eye, and has a normal head/orbital computed tomography (CT) scan. Ophthalmological examination is normal, other than the blood as shown in the figure (the blood does not cross the limbus). Of the choices below, which diagnosis is the most likely based upon the figure? [image] A. foreign body B. ruptured anterior chamber C. subconjunctival hemorrhage D. hyphema E. globe rupture" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "C. subconjunctival hemorrhage The answer is C. The subconjunctival blood as depicted in this patient, can be expected to resorb without intervention over days to weeks. The figure does not suggest rupture of anterior chamber or hyphema; globe rupture and foreign body are less likely given the normal examination and CT scan." "A patient presents with a self-inflicted wound, with resultant loss of vision in the right eye. With regard to the figure, which of the following statements is most likely true? [image] A. Medial canthotomy should be performed immediately.
B. If ambulance providers contact medical control about a patient with this injury, they should be directed to replace the globe back into the orbit. C. Search for other self-inflicted injuries (or ingestions) is paramount. D. Life-threatening hemorrhage is a major risk with this injury. E. The patient will probably recover visual function." - .... 🔰 VERIFIED ANSWERS.... ✔✔ "C. Search for other self-inflicted injuries (or ingestions) is paramount. The answer is C. The patient is unlikely to recover any visual function, which renders more important parallel efforts to identify (treatable) injuries or ingestions that are less obvious than the ocular avulsion. Lateral (not medial) canthotomy is an emergency procedure that may be indicated in some patients with ocular injury and retrobulbar hematoma (with resultant traction on the optic nerve), but the procedure is unlikely to help this patient. Since manipulation of an injured globe risks further trauma and extrusion of vitreous humor, prehospital recommendations for eye trauma are limited to protection of the injured eye and expedited transport to definitive care. Life- threatening hemorrhage is not a major risk with this type of injury." "What is the most common cause of death in Americans aged 20 to 40 years? A. Drug overdose B. Trauma C. Cancer D. AIDS-related illness
The remainder of his neurological exam is normal. What is the most appropriate management for this patient? A. Administration of IV steroids and ordering of cervical MRI B. Immediate neurosurgical decompression C. Flexion and extention radiographs to rule out ligamentous injury D. Discharge home with a hard cervical collar with neurosurgical follow-up E. Reassurance and discharge with NSAIDs given the non- anatomical distribution of weakness" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "A. Administration of IV steroids and ordering of cervical MRI The answer is A. Central cord syndrome results from a hyperextension injury, typically in elderly patients with significant degenerative joint disease. The ligamentum flavum buckles into the cord, resulting in a contusion of the cord's central portion." "A 46 year old construction worker falls 6 feet off a ladder onto a concrete surface and has sudden and severe low back pain. The pain radiates down his right leg and he develops numbness over the anterior shin and dorsum of the foot. On physical exam he has decreased sensation to pinprick over the dorsum of the right foot (medially) and some weakness in right foot dorsiflexion. At which level is a protruding intervertebral disc most likely? A. L1-L B. L2-L C. L3-L D. L4-L
E. L5-S1" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "D. L4-L
The answer is D. Sensation of the dorsal aspect of the foot and dorsiflexion of the foot are functions of the L5 nerve root. Herniation of the L4-5 disc would result in compression of L5." "Which of the following cervical spine fractures is considered stable? A. Transverse process fracture B. Flexion teardrop fracture C. Bilateral facet dislocation D. Hangman's fracture of C E. Jefferson fracture of C1" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "A. Transverse process fracture The answer is A. A transverse process fracture involves only one of the supporting spinal columns (the posterior column) and is therefore stable." "A 23 year old man is stabbed in the anterior neck with a 3-inch knife during a street fight. At the scene, there is some bleeding, which is controlled with direct pressure. He presents to the emergency department breathing comfortably and in no distress. His pulse is 88, blood pressure 126/76, and oxygen saturation 99% on room air. There is a 1cm laceration 2cm above the right sternoclavicular junction, lateral to the trachea. There is mild oozing and no obvious underlying hematoma. There is no obvious
E. All of the above" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "E. All of the above The answer is E. The diaphragm can rise to as high a level as the fourth intercostal space and can be injured by stab wounds at this level. Unsuspected injuries are common in high speed motor vehicle crashes. Pelvic injuries are associated with intra- abdominal injuries and can distract a patient from such an injury. Therefore, all of these patients need an evaluation of their abdomens." "Which of the following trauma patients can be managed conservatively without immediate laparotomy in the OR? A. 27 year old man with hemoperitoneum by bedside ultrasound; hypotensive B. 19 year old man with splenic laceration; peritoneal signs on exam C. 24 year old man with liver laceration; hemodynamically stable D. 30 year old man with a gunshot wound to the epigastrium E. All of the above should go to the OR for exploratory laparotomy." - .... 🔰 VERIFIED ANSWERS.... ✔✔ "C. 24 year old man with liver laceration; hemodynamically stable" "Which of the following is an accurate statement? A. Bedside ultrasound is the test of choice for diagnosing solid organ injury. B. Diagnostic peritoneal lavage usually cannot identify the presence of hemoperitoneum. C. Bedside ultrasound can image the retroperitoneum.
D. Bedside ultrasound can reliably determine the etiology of hemoperitoneum. E. Diagnostic peritoneal lavage cannot determine the etiology of hemoperitoneum." - .... 🔰 VERIFIED ANSWERS.... ✔✔ "E. Diagnostic peritoneal lavage cannot determine the etiology of hemoperitoneum. The answer is E. Diagnostic peritoneal lavage is extremely sensitive for the detection of hemoperitoneum and can lead to many negative laparotomies. Neither bedside ultrasound nor diagnostic peritoneal lavage can identify the source of the hemorrhage though. A trauma ultrasound at the bedside can only identify fluid in the peritoneal cavity, and CT scan is the test of choice for diagnosing solid organ injury." "A 36 year old man is a restrained driver involved in a high speed MVA where his car is struck on the driver's side door with significant intrusion. His physical exam is significant for a large contusion on his left flank. His abdominal exam is benign and rectal exam reveals a normal prostate. A Foley catheter is placed with return of gross hematuria. Which test is indicated to evaluate for the presence of urologic injury? A. CT abdomen / pelvis with IV and transurethral contrast B. Ultrasound of the bladder C. CT abdomen / pelvis without contrast D. Ultrasound of the kidneys E. CT abdomen / pelvis with IV contrast alone" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "A. CT abdomen / pelvis with IV and transurethral contrast"
department intoxicated and yelling. Her vitals include a pulse of 92, blood pressure of 134/84, and oxygen saturation of 97%. She has clear breath sounds bilaterally. The entrance wound is just above the right breast and an exit wound is noted in the right axilla. What is the most appropriate management of this patient? A. IV access, endotracheal intubation and simultaneous placement of a right chest tube, bedside ultrasound, portable chest X-ray, and admission to the ICU if stable B. IV access, portable chest X-ray, tube thoracostomy, and exploratory thoracotomy in the OR to search for cardiac or pulmonary vascular injury C. IV access, endotracheal intubation, emergency department thoracotomy to search for cardiac or pulmonary vascular injury D. IV access, portable chest X-ray, right c - .... 🔰 VERIFIED ANSWERS.... ✔✔ "A. IV access, endotracheal intubation and simultaneous placement of a right chest tube, bedside ultrasound, portable chest X-ray, and admission to the ICU if stable" "During a bar fight, a 42 year old man is stabbed in the left side with an unknown weapon. He presents to the emergency department with dyspnea, pulse of 108, blood pressure of 138/92, and oxygen saturation of 94% on room air. He has absent breath sounds on the left side; you note a small puncture wound in the midaxillary line at the level of the 10th rib. His abdominal exam is normal. Two large-bore IVs are established. What is the appropriate management of this patient? A. Left-sided chest tube, portable chest x-ray, and admission B. Left-sided chest tube, portable chest x-ray, diagnostic peritoneal lavage, and admission
C. Endotracheal intubation, left-sided chest tube, portable chest x-ray, and admission D. Endotracheal intubation, portable chest x-ray, exploratory laparotomy in the OR, and admission E. Left-sided chest tube, portable chest x-ray, and abdominal CT scan" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "E. Left-sided chest tube, portable chest x-ray, and abdominal CT scan" "Which is the most common associated neurological finding with a distal radius fracture? A. Weakness with flexion at the finger MCP joints B. Wrist drop C. Decreased sensation over the hypothenar eminance D. Weakness of finger adduction E. Decreased sensation over the thenar eminance" - .... 🔰 VERIFIED ANSWERS.... ✔✔ "E. Decreased sensation over the thenar eminance The answer is E. This finding is due to median nerve injury." "An 82 year old woman with osteoporosis slips and falls onto her right hip. She cannot get up and is brought to the emergency department by ambulance. As you enter the room you notice her right leg is abducted and externally rotated. What type of injury does she most likely have? A. Subtrochanteric femur fracture B. Intertrochanteric femur fracture C. Femoral neck fracture
