SAEM Quick Review QUESTIONS AND ANSWERS ALL CORRECT
Management of Large Subungual Hematoma Correct Answer: Drainage (18-Gauge) or Hot Micro-
Cauterization
Reason to Avoid Suction in Ear Foreign Body Removal Correct Answer: Perforation of Tympanic
Membrane
Management of Skin Abscess Correct Answer: Linear Incision for Non-Face vs. Needle Drainage for Face
Catheter for Bartholin Cyst Correct Answer: Word
Grading of Laryngeal Opening Correct Answer: Cormack-Lehane
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects Correct Answer: Ketamine
Induction Agent Avoided in Sepsis Due To Adrenal Suppression Correct Answer: Etomidate
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia Correct Answer:
Epidural Hematoma
Presentation of Adhesive Arachnoiditis Correct Answer: Progressive Neuropathy
Tom, Dick, and Very Nervous Harry Correct Answer: Anterior to Posterior of Medial Ankle: Tibialis
Posterior, Digitorum Longus, Vein, Nerve, Hallucis Longus
Absolute Contra-Indication to Crico-Thyrotomy Correct Answer: Age Under 5
Anesthesia for Suturing Distal Right Index Finger in Patient with Underlying Vascular Disease Correct
Answer: Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis, Nose
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg) Correct Answer: 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). Correct Answer: Palm
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form) Correct Answer:
Fentanyl (Effects Not Always Reversed by Naloxone)
Management of Long-Lasting L.P. Headache Correct Answer: Autologous Blood Patch
Timing of Tetanus Prophylaxis Correct Answer: Within First Few Days (Suture Within First 24 Hours)
Normal C.S.F.-to-Blood Glucose Ratio Correct Answer: 0.6
,Size of Needle Decompression Needle Correct Answer: 14 Gauge (2nd Intercostal at Midclavicular Line)
Large Paronychia and Cellulitis Correct Answer: Removal of Affected Nail Under Digital Block and
Antiobiotics
Signs of Acute Appendicitis Correct Answer: 1. Rovsing: Right Lower from Left Lower.
2. Psoas: Extension.
3. Obturator: Rotation.
Suggested by Abdominal Pain Preceding Nausea and Vomiting Correct Answer: Surgery (Small Bowel
Obstruction)
Peak of Gastric Acid Secretion at Rest Correct Answer: 2 A.M.
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception (Bilious)
Correct Answer: 4 Weeks vs. 8 Months
Over 95% Sensitive and Specific for Renal Calculi Correct Answer: Helical C.T.
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up Correct
Answer: Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing Correct Answer: Rectus
Sheath Hematoma
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons. Correct Answer: Risk Factors for Cecal Volvulus
Possible Chest X-Ray Finding of Hepatic Abscess Correct Answer: Right-Sided Effusion and Elevated
Hemi-Diaphragm
Referred Pain from Ureteral Colic Correct Answer: Inguinal (Ovarian Torsion Does Not Cause Sacral Pain)
Elderly Patient, Diverticulitis Without Perforation (Peritonitis) Correct Answer: I.V. Fluids (Elderly), Anti-
Biotics, and Bowel Rest
Proximal vs. Distal Esophageal Perforation Correct Answer: Iatrogenic vs. Spontaneous
Lead Pipe Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic
Dysfunction (Diaphoresis, Incontinence, Dysrhythmia) Correct Answer: Dantrolene (Or Bromocriptine,
Amantadine, Lorazepam) for Neuroleptic Malignant Syndrome
Indicated by Temperature over 105 Correct Answer: Non-Infectious
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth Correct Answer: Tardive
Dyskinesia
, Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back (Opisthotonus)
Correct Answer: Benztropine (2mg Cogentin) or Diphenhydramine (25mg) for Dystonia
Extra-Pyramidal: Restlessness Correct Answer: Beta-Blocker for Akathisia
E.C.G. Finding of Haloperidol Toxicity Correct Answer: Long Q.T.
Drug Causing Vertical Nystagmus Correct Answer: Phencyclidine (PCP)
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects) Correct
Answer: Haloperidol (5mg IM q30); B-52 is Benadryl, 5 Milligrams of Haloperidol, and 2 Milligrams of
Lorazepam
Risk of Protracted Struggle in Restraints Correct Answer: Metabolic Acidosis
Risk of Flumazenil in Chronic Benzodiazepine User Correct Answer: Withdrawal Seizures
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis Correct Answer: Isopropyl Alcohol - iso gives
*iso* (equal) gap metabolic acidosis
Glucose and Magnesium Recommendations for Altered Alcoholic Correct Answer: 1. Thiamine Before
Glucose; and,
2. Give Magnesium Regardless of Magnesium Level (Low Stores).
Global Inability to Relate to Environment and Process Sensory Input (Increased Alertness and
Psychomotor Activity) Correct Answer: Delirium
Most Common Dementia Correct Answer: Alzheimer More Common Than Vascular Dementia
Management of Hypertension in Eclampsia (Seizure) Correct Answer: Magnesium; Consider Anti-
Hypertensive Medication for Diastolic Over 110 After Seizure Stops
Relationship Between Alcohol and Seizures Correct Answer: Direct Toxicity vs. Withdrawal vs. Head
Injury from Fall
Most Common Cause of Delirium in Elderly Correct Answer: Medications
Tooth Fracture of Enamel and Dentin, Yellowish Tinge, No Blood Correct Answer: 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 Correct Answer: Incision and
Drainage of Septal Hematoma Followed by Nasal Packing
Eye Blunt Trauma, Pain, Double Vision from Upward Gaze Correct Answer: Entrapment of Inferior
Rectus from Inferior Orbital Wall Fracture
Management of Large Subungual Hematoma Correct Answer: Drainage (18-Gauge) or Hot Micro-
Cauterization
Reason to Avoid Suction in Ear Foreign Body Removal Correct Answer: Perforation of Tympanic
Membrane
Management of Skin Abscess Correct Answer: Linear Incision for Non-Face vs. Needle Drainage for Face
Catheter for Bartholin Cyst Correct Answer: Word
Grading of Laryngeal Opening Correct Answer: Cormack-Lehane
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects Correct Answer: Ketamine
Induction Agent Avoided in Sepsis Due To Adrenal Suppression Correct Answer: Etomidate
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia Correct Answer:
Epidural Hematoma
Presentation of Adhesive Arachnoiditis Correct Answer: Progressive Neuropathy
Tom, Dick, and Very Nervous Harry Correct Answer: Anterior to Posterior of Medial Ankle: Tibialis
Posterior, Digitorum Longus, Vein, Nerve, Hallucis Longus
Absolute Contra-Indication to Crico-Thyrotomy Correct Answer: Age Under 5
Anesthesia for Suturing Distal Right Index Finger in Patient with Underlying Vascular Disease Correct
Answer: Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis, Nose
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg) Correct Answer: 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). Correct Answer: Palm
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form) Correct Answer:
Fentanyl (Effects Not Always Reversed by Naloxone)
Management of Long-Lasting L.P. Headache Correct Answer: Autologous Blood Patch
Timing of Tetanus Prophylaxis Correct Answer: Within First Few Days (Suture Within First 24 Hours)
Normal C.S.F.-to-Blood Glucose Ratio Correct Answer: 0.6
,Size of Needle Decompression Needle Correct Answer: 14 Gauge (2nd Intercostal at Midclavicular Line)
Large Paronychia and Cellulitis Correct Answer: Removal of Affected Nail Under Digital Block and
Antiobiotics
Signs of Acute Appendicitis Correct Answer: 1. Rovsing: Right Lower from Left Lower.
2. Psoas: Extension.
3. Obturator: Rotation.
Suggested by Abdominal Pain Preceding Nausea and Vomiting Correct Answer: Surgery (Small Bowel
Obstruction)
Peak of Gastric Acid Secretion at Rest Correct Answer: 2 A.M.
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception (Bilious)
Correct Answer: 4 Weeks vs. 8 Months
Over 95% Sensitive and Specific for Renal Calculi Correct Answer: Helical C.T.
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up Correct
Answer: Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing Correct Answer: Rectus
Sheath Hematoma
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons. Correct Answer: Risk Factors for Cecal Volvulus
Possible Chest X-Ray Finding of Hepatic Abscess Correct Answer: Right-Sided Effusion and Elevated
Hemi-Diaphragm
Referred Pain from Ureteral Colic Correct Answer: Inguinal (Ovarian Torsion Does Not Cause Sacral Pain)
Elderly Patient, Diverticulitis Without Perforation (Peritonitis) Correct Answer: I.V. Fluids (Elderly), Anti-
Biotics, and Bowel Rest
Proximal vs. Distal Esophageal Perforation Correct Answer: Iatrogenic vs. Spontaneous
Lead Pipe Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic
Dysfunction (Diaphoresis, Incontinence, Dysrhythmia) Correct Answer: Dantrolene (Or Bromocriptine,
Amantadine, Lorazepam) for Neuroleptic Malignant Syndrome
Indicated by Temperature over 105 Correct Answer: Non-Infectious
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth Correct Answer: Tardive
Dyskinesia
, Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back (Opisthotonus)
Correct Answer: Benztropine (2mg Cogentin) or Diphenhydramine (25mg) for Dystonia
Extra-Pyramidal: Restlessness Correct Answer: Beta-Blocker for Akathisia
E.C.G. Finding of Haloperidol Toxicity Correct Answer: Long Q.T.
Drug Causing Vertical Nystagmus Correct Answer: Phencyclidine (PCP)
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects) Correct
Answer: Haloperidol (5mg IM q30); B-52 is Benadryl, 5 Milligrams of Haloperidol, and 2 Milligrams of
Lorazepam
Risk of Protracted Struggle in Restraints Correct Answer: Metabolic Acidosis
Risk of Flumazenil in Chronic Benzodiazepine User Correct Answer: Withdrawal Seizures
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis Correct Answer: Isopropyl Alcohol - iso gives
*iso* (equal) gap metabolic acidosis
Glucose and Magnesium Recommendations for Altered Alcoholic Correct Answer: 1. Thiamine Before
Glucose; and,
2. Give Magnesium Regardless of Magnesium Level (Low Stores).
Global Inability to Relate to Environment and Process Sensory Input (Increased Alertness and
Psychomotor Activity) Correct Answer: Delirium
Most Common Dementia Correct Answer: Alzheimer More Common Than Vascular Dementia
Management of Hypertension in Eclampsia (Seizure) Correct Answer: Magnesium; Consider Anti-
Hypertensive Medication for Diastolic Over 110 After Seizure Stops
Relationship Between Alcohol and Seizures Correct Answer: Direct Toxicity vs. Withdrawal vs. Head
Injury from Fall
Most Common Cause of Delirium in Elderly Correct Answer: Medications
Tooth Fracture of Enamel and Dentin, Yellowish Tinge, No Blood Correct Answer: 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 Correct Answer: Incision and
Drainage of Septal Hematoma Followed by Nasal Packing
Eye Blunt Trauma, Pain, Double Vision from Upward Gaze Correct Answer: Entrapment of Inferior
Rectus from Inferior Orbital Wall Fracture
