SAEM EMERGENCY MEDICINE EXAM TEST BANK 2026/2027
| Complete Questions and Answers | EM Certification Prep |
Pass Guaranteed - A+ Graded
A comprehensive assessment aligned with ABEM Model of Clinical Practice, SAEM
content outline, and current ACLS/ATLS/PALS guidelines
Cardiovascular Emergencies
Acute coronary syndromes, dysrhythmias, heart failure, and vascular catastrophes
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. ECG shows 2 mm ST elevation in leads V2-V4. Which
reperfusion strategy is most appropriate if the patient is at a PCI-capable hospital with a
door-to-balloon time of 65 minutes?
A. Thrombolytics immediately, followed by rescue PCI if needed — this is appropriate for
non-PCI centers or when PCI delay >120 minutes
B. Primary PCI within 90 minutes of first medical contact — this correctly describes the
preferred strategy with acceptable door-to-balloon time [CORRECT]
C. Transfer to another facility for cardiac surgery — this delays definitive reperfusion
,D. Medical management with heparin and clopidogrel only — this is inferior to
reperfusion therapy
Correct Answer: B
Rationale: STEMI guidelines recommend primary PCI within 90 minutes of first medical
contact when door-to-balloon <90 minutes. This patient's 65-minute door-to-balloon
time meets criteria. Thrombolytics are reserved for PCI delays >120 minutes or when
PCI unavailable. Option A is second-line, C delays care, and D denies reperfusion.
Q2: A 45-year-old female with atrial fibrillation and rapid ventricular rate (HR 165)
presents with hypotension (SBP 78) and altered mental status. Which management is
most appropriate?
A. Metoprolol 5 mg IV push — this would worsen hypotension
B. Diltiazem 0.25 mg/kg IV — this would worsen hypotension
C. Immediate synchronized cardioversion with 100-200 J — this correctly addresses
unstable AF with RVR [CORRECT]
D. Amiodarone 150 mg IV over 10 minutes — this is appropriate for stable patients but
delays definitive therapy
Correct Answer: C
,Rationale: Unstable AF (hypotension, altered mental status, ischemia, heart failure)
requires immediate synchronized cardioversion. Rate control agents (metoprolol,
diltiazem) worsen hypotension. Amiodarone is for stable patients or chemical
cardioversion. Option C is definitive for instability.
Q3: A 72-year-old male presents with syncope. He has a history of CHF and diabetes. On
examination, he has a normal neurologic exam, no signs of trauma, and an ECG
showing a normal sinus rhythm with left bundle branch block. Which risk stratification
tool is most appropriate to determine his need for admission?
A. HEART score — this is for chest pain, not syncope
B. San Francisco Syncope Rule (SFSR) — this correctly identifies high-risk features
requiring admission [CORRECT]
C. Wells criteria — this is for DVT/PE risk stratification
D. CHA₂DS₂-VASc score — this is for stroke risk in AF, not syncope
Correct Answer: B
Rationale: SFSR identifies high-risk syncope patients needing admission: abnormal ECG,
SOB, SBP <90, hematocrit <30%, or CHF history. This patient has CHF and abnormal
ECG (LBBB), meeting criteria. Option A is chest pain, C is thrombosis, and D is AF stroke
risk.
, Q4: A 68-year-old female presents with tearing chest pain radiating to her back. She is
hypertensive (BP 210/120) with unequal radial pulses. Which study is the initial imaging
of choice to confirm the diagnosis?
A. Transthoracic echocardiogram — this has limited sensitivity for aortic
arch/descending aorta
B. CT angiography of chest/abdomen/pelvis — this correctly provides rapid,
comprehensive aortic imaging [CORRECT]
C. Chest X-ray — this may show mediastinal widening but is insufficient for diagnosis
D. MRI aortography — this is excellent but too slow for unstable patient
Correct Answer: B
Rationale: CTA is the initial test of choice for suspected aortic dissection: rapid, widely
available, high sensitivity/specificity. TTE misses arch/descending segments. CXR is
screening only. MRI is for stable patients or follow-up. Option B provides definitive
diagnosis.
Q5: A patient presents with acute decompensated heart failure, severe dyspnea, and
hypoxemia. BP is 210/130. Which initial management is most appropriate?
A. Immediate beta-blocker for afterload reduction — this is contraindicated in acute
decompensated HF
| Complete Questions and Answers | EM Certification Prep |
Pass Guaranteed - A+ Graded
A comprehensive assessment aligned with ABEM Model of Clinical Practice, SAEM
content outline, and current ACLS/ATLS/PALS guidelines
Cardiovascular Emergencies
Acute coronary syndromes, dysrhythmias, heart failure, and vascular catastrophes
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. ECG shows 2 mm ST elevation in leads V2-V4. Which
reperfusion strategy is most appropriate if the patient is at a PCI-capable hospital with a
door-to-balloon time of 65 minutes?
A. Thrombolytics immediately, followed by rescue PCI if needed — this is appropriate for
non-PCI centers or when PCI delay >120 minutes
B. Primary PCI within 90 minutes of first medical contact — this correctly describes the
preferred strategy with acceptable door-to-balloon time [CORRECT]
C. Transfer to another facility for cardiac surgery — this delays definitive reperfusion
,D. Medical management with heparin and clopidogrel only — this is inferior to
reperfusion therapy
Correct Answer: B
Rationale: STEMI guidelines recommend primary PCI within 90 minutes of first medical
contact when door-to-balloon <90 minutes. This patient's 65-minute door-to-balloon
time meets criteria. Thrombolytics are reserved for PCI delays >120 minutes or when
PCI unavailable. Option A is second-line, C delays care, and D denies reperfusion.
Q2: A 45-year-old female with atrial fibrillation and rapid ventricular rate (HR 165)
presents with hypotension (SBP 78) and altered mental status. Which management is
most appropriate?
A. Metoprolol 5 mg IV push — this would worsen hypotension
B. Diltiazem 0.25 mg/kg IV — this would worsen hypotension
C. Immediate synchronized cardioversion with 100-200 J — this correctly addresses
unstable AF with RVR [CORRECT]
D. Amiodarone 150 mg IV over 10 minutes — this is appropriate for stable patients but
delays definitive therapy
Correct Answer: C
,Rationale: Unstable AF (hypotension, altered mental status, ischemia, heart failure)
requires immediate synchronized cardioversion. Rate control agents (metoprolol,
diltiazem) worsen hypotension. Amiodarone is for stable patients or chemical
cardioversion. Option C is definitive for instability.
Q3: A 72-year-old male presents with syncope. He has a history of CHF and diabetes. On
examination, he has a normal neurologic exam, no signs of trauma, and an ECG
showing a normal sinus rhythm with left bundle branch block. Which risk stratification
tool is most appropriate to determine his need for admission?
A. HEART score — this is for chest pain, not syncope
B. San Francisco Syncope Rule (SFSR) — this correctly identifies high-risk features
requiring admission [CORRECT]
C. Wells criteria — this is for DVT/PE risk stratification
D. CHA₂DS₂-VASc score — this is for stroke risk in AF, not syncope
Correct Answer: B
Rationale: SFSR identifies high-risk syncope patients needing admission: abnormal ECG,
SOB, SBP <90, hematocrit <30%, or CHF history. This patient has CHF and abnormal
ECG (LBBB), meeting criteria. Option A is chest pain, C is thrombosis, and D is AF stroke
risk.
, Q4: A 68-year-old female presents with tearing chest pain radiating to her back. She is
hypertensive (BP 210/120) with unequal radial pulses. Which study is the initial imaging
of choice to confirm the diagnosis?
A. Transthoracic echocardiogram — this has limited sensitivity for aortic
arch/descending aorta
B. CT angiography of chest/abdomen/pelvis — this correctly provides rapid,
comprehensive aortic imaging [CORRECT]
C. Chest X-ray — this may show mediastinal widening but is insufficient for diagnosis
D. MRI aortography — this is excellent but too slow for unstable patient
Correct Answer: B
Rationale: CTA is the initial test of choice for suspected aortic dissection: rapid, widely
available, high sensitivity/specificity. TTE misses arch/descending segments. CXR is
screening only. MRI is for stable patients or follow-up. Option B provides definitive
diagnosis.
Q5: A patient presents with acute decompensated heart failure, severe dyspnea, and
hypoxemia. BP is 210/130. Which initial management is most appropriate?
A. Immediate beta-blocker for afterload reduction — this is contraindicated in acute
decompensated HF
