Page 1 of 235
SAEM EXAM TEST BANK NEWEST UPDATE
2026-2027 ALL 500 QUESTIONS AND
DETAILED SOLUTIONS
Question: Which of the following pairings of referred pain and causal disease is least likely to be
encountered?
A. sacral pain—ovarian torsion
B. inguinal pain—ureteral colic
C. epigastric pain—myocardial infarction
D. shoulder pain—ruptured spleen
E. thoracic back pain—pancreatitis - CORRECT ANSWER✔✔A. sacral pain—ovarian torsion
Ovarian torsion may cause lower abdominal pain, pelvic pain, adnexal tenderness, and cervical
motion tenderness, but it is not known to cause sacral pain.
Question: A 72 year old man with a history of diverticulosis presents with vague abdominal
pain for the past day. His physical exam is notable for normal vital signs, left lower quadrant
abdominal tenderness without rebound or guarding, and guaiac positive brown stool. Work-up
including KUB and abdominal/pelvic CT scan reveals diverticulitis without perforation. Of the
following choices, which is the most appropriate management of this patient?
A. type and cross two units of packed red blood cells
B. immediate surgical intervention
C. discharge on oral pain medications
D. barium enema to evaluate for carcinoma of the colon
, Page 2 of 235
E. admission for intravenous antibiotics and fluids - CORRECT ANSWER✔✔E. admission for
intravenous antibiotics and fluids
For mild episodes of diverticulitis in which there is no evidence of perforation or peritonitis,
there is no indication for immediate surgical intervention. Conservative management with
intravenous fluids and antibiotics as well as bowel rest is typically first attempted. Although
colon carcinoma may be a precipitating factor in the development of diverticulitis, barium
enema should be avoided in the acute period due to high risk of bowel perforation. Although
some patients with mild cases of diverticulitis may be discharged home with conservative
treatment, the elderly are at higher risk of perforation and should be admitted. *Guaiac positive
stool* in seen in up to *50%* of patients with diverticulitis. There is no reason to suspect acute
blood loss requiring transfusion in diverticulitis.
Question: Regarding esophageal perforation, which of the following is INCORRECT:
A. Esophageal perforation has been reported as a complication of nasogastric tube placement,
endotracheal intubation, and esophagotracheal Combitube intubation.
B. Esophageal perforation may result from forceful vomiting, coughing, childbirth or heavy
lifting.
C. Over 80% of esophageal perforations are iatrogenic, usually as complications of upper
endoscopy, dilation, or sclerotherapy.
D. Over 90% of spontaneous esophageal perforations occur in the proximal esophagus.
E. Iatrogenic perforations of the esophagus usually occur in the proximal esophagus or
esophagogastric junction. - CORRECT ANSWER✔✔D. Over 90% of spontaneous esophageal
perforations occur in the proximal esophagus.
Over 90% of spontaneous esophageal perforations occur in the *distal* esophagus, whereas
iatrogenic perforations are frequently at the pharyngoesophageal junction or the
esophagogastric junction. Foreign body or caustic substance ingestion, severe blunt injury or
penetrating trauma, and carcinoma are other causes of esophageal perforation.
, Page 3 of 235
Question: Working in the ED, you have identified a bony object wedged in the mid-esophagus
of a 45 year old patient. Failure to promptly remove a foreign body impacted in the esophagus
could result in:
A. Esophageal perforation and mediastinitis
B. Epiglottal edema and airway obstruction
C. The rapid development of xerostomia
D. Barrett's esophagitis - CORRECT ANSWER✔✔A. Esophageal perforation and mediastinitis
The complications of esophageal foreign bodies are rare but serious. They include esophageal
erosion and perforation, mediastinitis, esophagus-to-trachea or esophagus-to-vasculature
fistula formation, stricture formation, diverticuli formation, and tracheal compression (from
both the esophageal foreign body and resultant edema or infection). Air trapping is a sign of a
foreign body of the airway. Rarely, airway foreign bodies act as one-way valves that could cause
hyperinflation of a lung segment, with resultant bleb rupture and pneumothorax formation.
Question: A mother brings her 35 year old son to the emergency department because of
tremor and mutism for the past three days. His mother found him in his room this morning lying
stiffly in his bed, soiled with urine and feces. He appears confused and will not respond to
questions. He was diagnosed with schizophrenia last year and has been on several medications.
Last month after his most recent hospital admission for schizophrenia, he was discharged with a
prescription for haloperidol. On physical exam, he is visibly diaphoretic and has vital signs as
follows: T 102.7, BP 140/98, P 112, R 12. His neuromuscular exam shows extremely rigid
extremities, and his laboratory values are notable for a white blood cell count of 15000/mm3
and abnormally elevated creatine phosphokinase levels. What is the most likely explanation for
these findings?
A. neuroleptic-induced acute dystonia
B. neuroleptic malignant syndrome
C. schizophren - CORRECT ANSWER✔✔B. neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is an idiosyncratic, life-threatening reaction to
antipsychotic medications, with haloperidol being the most common cause. It is characterized
by elevated temperatures, "lead pipe" muscle rigidity, altered mental status, choreoathetosis,
, Page 4 of 235
tremors, and autonomic dysfunction (e.g., diaphoresis, labile blood pressure, incontinence,
dysrhythmias). While this patient's temperature is only 102.7, students should note that any
patients with temperatures greater than 105 most likely have non-infectious etiologies for
temperature elevation. NMS is thought to be due to too much D2 blockade in the substantia
nigra and hypothalamus. Treatment consists of stopping the causative agent and providing
supportive care. Medications such as *dantrolene, bromocriptine, amantadine, and lorazepam*
are also often used. Tardive dyskinesia is a chronic movement disorder that results from
prolonged use of antipsychotics and can include involuntary and periodic movements of the
tongue or lips, mouth puckering, or flailing movements either of the extremities or of the spine.
Neuroleptic-induced acute dystonia is an acute spasm of a muscle or muscle group associated
with the use of antipsychotic agents. It presents with patients complaining of neck twisting
(torticollis), fixed upper gaze, facial muscle spasms, or dysarthria from tongue protrusions. In a
similar family with dystonia, neuroleptic-induced akathisia is an extrapyramidal syndrome that is
manifest by agitation and restlessness. Schizophrenia, catatonic type, a diagnosis of exclusion,
usually does not present with this degree of impairment.
Question: A 25 year old man returns to the ED, 24 hours after being released from the hospital
with a new diagnosis of schizophrenia. He has recently started to take haloperidal for his
psychotic symptoms. In the ED he is noted to have involuntary contractions of the muscles of
the face, a protruding tongue, deviation of the head to one side, and sustained upward
deviation of the eyes. Vital signs are stable, and initial labs show no electrolyte or hematological
abnormalities. Of the following choices, the preferred medication for this condition is:
A. diphenhydramine
B. lorazepam
C. phenobarbital
D. metoprolol - CORRECT ANSWER✔✔A. diphenhydramine
Acute dystonia, the most common adverse effect seen with neuroleptic agents, occurs in up to
5% of patients. Dystonic reactions, which can occur at any point during long-term therapy and
up to 48 hours after administration of neuroleptics in the emergency department, involve the
sudden onset of involuntary contraction of the muscles in the face, neck, or back. The patient
may have protrusion of the tongue (buccolingual crisis), deviation of the head to one side (acute
torticollis), sustained upward deviation of the eyes (oculogyric crisis), extreme arching of the
back (opisthotonos), or rarely laryngospasm. These symptoms tend to fluctuate, decreasing
with voluntary activity and increasing under emotional stress, which occasionally misleads
SAEM EXAM TEST BANK NEWEST UPDATE
2026-2027 ALL 500 QUESTIONS AND
DETAILED SOLUTIONS
Question: Which of the following pairings of referred pain and causal disease is least likely to be
encountered?
A. sacral pain—ovarian torsion
B. inguinal pain—ureteral colic
C. epigastric pain—myocardial infarction
D. shoulder pain—ruptured spleen
E. thoracic back pain—pancreatitis - CORRECT ANSWER✔✔A. sacral pain—ovarian torsion
Ovarian torsion may cause lower abdominal pain, pelvic pain, adnexal tenderness, and cervical
motion tenderness, but it is not known to cause sacral pain.
Question: A 72 year old man with a history of diverticulosis presents with vague abdominal
pain for the past day. His physical exam is notable for normal vital signs, left lower quadrant
abdominal tenderness without rebound or guarding, and guaiac positive brown stool. Work-up
including KUB and abdominal/pelvic CT scan reveals diverticulitis without perforation. Of the
following choices, which is the most appropriate management of this patient?
A. type and cross two units of packed red blood cells
B. immediate surgical intervention
C. discharge on oral pain medications
D. barium enema to evaluate for carcinoma of the colon
, Page 2 of 235
E. admission for intravenous antibiotics and fluids - CORRECT ANSWER✔✔E. admission for
intravenous antibiotics and fluids
For mild episodes of diverticulitis in which there is no evidence of perforation or peritonitis,
there is no indication for immediate surgical intervention. Conservative management with
intravenous fluids and antibiotics as well as bowel rest is typically first attempted. Although
colon carcinoma may be a precipitating factor in the development of diverticulitis, barium
enema should be avoided in the acute period due to high risk of bowel perforation. Although
some patients with mild cases of diverticulitis may be discharged home with conservative
treatment, the elderly are at higher risk of perforation and should be admitted. *Guaiac positive
stool* in seen in up to *50%* of patients with diverticulitis. There is no reason to suspect acute
blood loss requiring transfusion in diverticulitis.
Question: Regarding esophageal perforation, which of the following is INCORRECT:
A. Esophageal perforation has been reported as a complication of nasogastric tube placement,
endotracheal intubation, and esophagotracheal Combitube intubation.
B. Esophageal perforation may result from forceful vomiting, coughing, childbirth or heavy
lifting.
C. Over 80% of esophageal perforations are iatrogenic, usually as complications of upper
endoscopy, dilation, or sclerotherapy.
D. Over 90% of spontaneous esophageal perforations occur in the proximal esophagus.
E. Iatrogenic perforations of the esophagus usually occur in the proximal esophagus or
esophagogastric junction. - CORRECT ANSWER✔✔D. Over 90% of spontaneous esophageal
perforations occur in the proximal esophagus.
Over 90% of spontaneous esophageal perforations occur in the *distal* esophagus, whereas
iatrogenic perforations are frequently at the pharyngoesophageal junction or the
esophagogastric junction. Foreign body or caustic substance ingestion, severe blunt injury or
penetrating trauma, and carcinoma are other causes of esophageal perforation.
, Page 3 of 235
Question: Working in the ED, you have identified a bony object wedged in the mid-esophagus
of a 45 year old patient. Failure to promptly remove a foreign body impacted in the esophagus
could result in:
A. Esophageal perforation and mediastinitis
B. Epiglottal edema and airway obstruction
C. The rapid development of xerostomia
D. Barrett's esophagitis - CORRECT ANSWER✔✔A. Esophageal perforation and mediastinitis
The complications of esophageal foreign bodies are rare but serious. They include esophageal
erosion and perforation, mediastinitis, esophagus-to-trachea or esophagus-to-vasculature
fistula formation, stricture formation, diverticuli formation, and tracheal compression (from
both the esophageal foreign body and resultant edema or infection). Air trapping is a sign of a
foreign body of the airway. Rarely, airway foreign bodies act as one-way valves that could cause
hyperinflation of a lung segment, with resultant bleb rupture and pneumothorax formation.
Question: A mother brings her 35 year old son to the emergency department because of
tremor and mutism for the past three days. His mother found him in his room this morning lying
stiffly in his bed, soiled with urine and feces. He appears confused and will not respond to
questions. He was diagnosed with schizophrenia last year and has been on several medications.
Last month after his most recent hospital admission for schizophrenia, he was discharged with a
prescription for haloperidol. On physical exam, he is visibly diaphoretic and has vital signs as
follows: T 102.7, BP 140/98, P 112, R 12. His neuromuscular exam shows extremely rigid
extremities, and his laboratory values are notable for a white blood cell count of 15000/mm3
and abnormally elevated creatine phosphokinase levels. What is the most likely explanation for
these findings?
A. neuroleptic-induced acute dystonia
B. neuroleptic malignant syndrome
C. schizophren - CORRECT ANSWER✔✔B. neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is an idiosyncratic, life-threatening reaction to
antipsychotic medications, with haloperidol being the most common cause. It is characterized
by elevated temperatures, "lead pipe" muscle rigidity, altered mental status, choreoathetosis,
, Page 4 of 235
tremors, and autonomic dysfunction (e.g., diaphoresis, labile blood pressure, incontinence,
dysrhythmias). While this patient's temperature is only 102.7, students should note that any
patients with temperatures greater than 105 most likely have non-infectious etiologies for
temperature elevation. NMS is thought to be due to too much D2 blockade in the substantia
nigra and hypothalamus. Treatment consists of stopping the causative agent and providing
supportive care. Medications such as *dantrolene, bromocriptine, amantadine, and lorazepam*
are also often used. Tardive dyskinesia is a chronic movement disorder that results from
prolonged use of antipsychotics and can include involuntary and periodic movements of the
tongue or lips, mouth puckering, or flailing movements either of the extremities or of the spine.
Neuroleptic-induced acute dystonia is an acute spasm of a muscle or muscle group associated
with the use of antipsychotic agents. It presents with patients complaining of neck twisting
(torticollis), fixed upper gaze, facial muscle spasms, or dysarthria from tongue protrusions. In a
similar family with dystonia, neuroleptic-induced akathisia is an extrapyramidal syndrome that is
manifest by agitation and restlessness. Schizophrenia, catatonic type, a diagnosis of exclusion,
usually does not present with this degree of impairment.
Question: A 25 year old man returns to the ED, 24 hours after being released from the hospital
with a new diagnosis of schizophrenia. He has recently started to take haloperidal for his
psychotic symptoms. In the ED he is noted to have involuntary contractions of the muscles of
the face, a protruding tongue, deviation of the head to one side, and sustained upward
deviation of the eyes. Vital signs are stable, and initial labs show no electrolyte or hematological
abnormalities. Of the following choices, the preferred medication for this condition is:
A. diphenhydramine
B. lorazepam
C. phenobarbital
D. metoprolol - CORRECT ANSWER✔✔A. diphenhydramine
Acute dystonia, the most common adverse effect seen with neuroleptic agents, occurs in up to
5% of patients. Dystonic reactions, which can occur at any point during long-term therapy and
up to 48 hours after administration of neuroleptics in the emergency department, involve the
sudden onset of involuntary contraction of the muscles in the face, neck, or back. The patient
may have protrusion of the tongue (buccolingual crisis), deviation of the head to one side (acute
torticollis), sustained upward deviation of the eyes (oculogyric crisis), extreme arching of the
back (opisthotonos), or rarely laryngospasm. These symptoms tend to fluctuate, decreasing
with voluntary activity and increasing under emotional stress, which occasionally misleads
