SAEM QUESTIONS AND ANSWERS GRADED A
subungual hematoma
drane using 18 guage needle and discharge home Correct Answer: diagnosis and management
etomidate (Cardioprotective) Correct Answer: induction agent of choice when decreased myocardial
contractility is a concern
etomidate Correct Answer: induction agent known to cause transient adrenal suppression, causing its
use in septic patients to be controversial
heel (sural nerve block) Correct Answer: portion of plantar aspect of foot not anesthetized by posterior
tibial nerve block
age (somewhere between 5-12, controversial) Correct Answer: only absolute contraindication to
cricothyrotomy
lightheadedness and diziness Correct Answer: first signs of lidocaine toxicity
can place deep structures at risk Correct Answer: reason why vertical mattress sutures are not
recommended for the palm
fentanyl (reverse with naloxone, if not effective may need neuromuscular blockade and intubation)
Correct Answer: analgesic which can cause respiratory depression, chest wall rigidity and glottic spasm
mallampati
Class 1 = full visualization of epiglottis
Class 2: mostly full
Class 3: barely visualized
Class 4 = no visualization of epiglottis Correct Answer: scale which allows communication of ability to
visualize structures of the posterior pharynx as a means of estimating intubation difficulty
headache Correct Answer: most common complication of LP
paronchyia
digital block, surgical intervention (partiial removal of nail, and abx) Correct Answer: diagosis and
management
panic disorder Correct Answer: psychiatric disease with highest risk of suicide
silent suicide Correct Answer: act of slowly killing oneself by nonviolent means, such as starvation or
non compliance with essential medical treatment
occult suicide Correct Answer: self destructive acts disguised as an accident
,C. elderly and caucasian Correct Answer: Suicidal risk is increased in this patient population:
A. patients who have not been involuntarily committed
b. patients who directly questioned about suicide
c. elderly and caucasian
D. patients taking lithium for bipolar disorder
flexion and supination of elbow (imaging usually not needed if pain resolves after reduction) Correct
Answer: management of radial head subluxation (nurse maids elbow)
hill sachs deformity (compression fracture of the posterior lateral aspect of the humeral head) Correct
Answer: most common fracture associated with shoulder dislocation
asystole (followed by bradycardia) Correct Answer: most common rhythm seen in pediatric arrest
1. dry, warm, position, suction, stimulate
2. oxygen
3. ventilation
4. chest compressions
5. medications Correct Answer: order of operations for neonatal resuscitation
maternal blood (ask about bleeding from nipples) Correct Answer: one possible cause of blood in vomit
of a healthy appearing infant
hypoxemia Correct Answer: most likely underlying cause of bradycardia in a newborn
tube mm = (16 + age) /4 Correct Answer: equation for estimating endotrachael tube size
4 back blows
If still obstructed 4 chest compressions
If still obstructed jaw thrust, mouth inspected and removal of visual FB
If still obstructed, mouth to mouth ventilation
Repeat Correct Answer: management of choking infant under 1 year of age
Childs nares
childs little finger
Body length broselow conversionn
Age in years + Correct Answer: 4 different methods for estimating pediatric endotracheal tube
size
hypovolemia Correct Answer: most common cause of shock in the pediatric population
B. gastric distension due to excessive volume or rate of ventilation impairing ventilatory function
The answer is B. Early placement of a nasogastric tube to facilitate decompression of the stomach will
help to prevent further impairment of ventilation. The rest are indications for endotrachael intubation in
,the pediatric trauma patient. Correct Answer: All of the following are generally accepted indications for
endotracheal intubation of the pediatric trauma patient, EXCEPT:
A. GCS score less than or equal 9, to secure airway and provide controlled hyperventilation
B. gastric distension due to excessive volume or rate of ventilation impairing ventilatory function
C. any inability to ventilate by bag-valve-mask methods or the need for prolonged control of the airway
D. respiratory failure from hypoxia or hypoventilation
E. any trauma patient in decompensated shock and resistant to initial fluid resuscitation
B. Salter II Correct Answer: A 7 year old boy falls off his bike onto his outstretched arm and sustains a
supracondylar fracture. The fracture originates in the metaphysis and a portion of it extends into the
physis (growth plate) without extending through to the epiphysis. How is this fracture classified?
A. Salter I
B. Salter II
C. Salter III
D. Salter IV
E. Salter V
SALTR
type 1 - slipped - fracture plane passes through growth plate only
type 2 - above - fracture passes through growth plate and metaphysis
type 3 - lower - fracture plane passes through growth plate and epiphysis
type 4 - through - fracture passes through eiphysis, growth plate and metaphysis
type 5 - ruined - no fracture, but growth plate damaged from crush injury Correct Answer: Salter Harris
Fracture CLasifcation
The answer is C. Chest compressions should be started when an infant's heart rate is less than 60 bpm
only if oxygen and adequate ventilation have first been tried and failed to increase the heart rate. The
other choices are all correct regarding the use of chest compressions in the infant.
-- For further reading, see Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th edition, page
105. Correct Answer: All of the following are true regarding chest compressions in the infant EXCEPT:
A. Compressions should be performed at a rate of 90 per minute.
B. Chest compressions should be accompanied by a ventilatory rate of 30 per minute.
C. Chest compressions should be initiated whenever an infant's heart rate is less than 60 bpm.
D. An appropriate position for performing chest compressions is to encircle the chest with both hands
and place the thumbs side by side on the sternum.
E. Correct depth of compressions is one-third the anteroposterior diameter of the chest.
B Digoxin
, The answer is B. The drugs which may be given by endotracheal route can be remembered by the
mnemonic "LEAN" — lidocaine, epinephrine, atropine, naloxone. Up to 10 times the IV dose diluted to
5mls and followed by 3-5 positive pressure breaths is necessary to achieve equivalent plasma
concentrations. Digoxin must be given by the IV route. Correct Answer: In pediatric resuscitation the
following drugs may be given by the endotracheal route, EXCEPT:
A. atropine
B. digoxin
C. lidocaine
D. epinephrine
E. naloxone
E. Hyperglycemia
Due to low fat stores, inability to generate heat by shivering, and relatively large surface-to-volume area,
the newborn infant is not easily able to maintain body temperature. Metabolic acidosis, increased
oxygen consumption, hypoglycemia, and apnea are all physiologic consequences of hypothermia.
Correct Answer: Low body temperatures in newborns can lead to severe physiologic consequences,
which include all EXCEPT:
A. increased oxygen consumption
B. hypoglycemia
C. apnea
D. metabolic acidosis
E. hyperglycemia
A. maternal drugs
The answer is A. Mucus, blood, meconium, the tongue, and pulmonary prematurity are the most
frequent reasons for airway obstruction (and subsequent arrest) in the neonate. Maternal drugs can
cause respiratory depression, not primary airway obstruction. Correct Answer: Which of the following is
NOT a frequent cause of airway obstruction in the neonate?
A. maternal drugs
B. tongue
C. meconium
D. mucus
E. blood
C. 6mm'
C. The correct endotracheal tube size can be approximated by using a simple formula: Inside diameter
(ID) in mm = (16 + age in years) / 4. As this is an estimate, it is prudent to have the next smaller and
larger size endotracheal tubes available as well. Estimation of tube size based on the size of the patient's
fifth finger is less accurate. The tube size may also need to be modified based upon the etiology of the
arrest (e.g. airway narrowing from infectious disease) Correct Answer: Approximately what inside
diameter size endotracheal tube is appropriate for an 8 year old child?
A. 10 mm
subungual hematoma
drane using 18 guage needle and discharge home Correct Answer: diagnosis and management
etomidate (Cardioprotective) Correct Answer: induction agent of choice when decreased myocardial
contractility is a concern
etomidate Correct Answer: induction agent known to cause transient adrenal suppression, causing its
use in septic patients to be controversial
heel (sural nerve block) Correct Answer: portion of plantar aspect of foot not anesthetized by posterior
tibial nerve block
age (somewhere between 5-12, controversial) Correct Answer: only absolute contraindication to
cricothyrotomy
lightheadedness and diziness Correct Answer: first signs of lidocaine toxicity
can place deep structures at risk Correct Answer: reason why vertical mattress sutures are not
recommended for the palm
fentanyl (reverse with naloxone, if not effective may need neuromuscular blockade and intubation)
Correct Answer: analgesic which can cause respiratory depression, chest wall rigidity and glottic spasm
mallampati
Class 1 = full visualization of epiglottis
Class 2: mostly full
Class 3: barely visualized
Class 4 = no visualization of epiglottis Correct Answer: scale which allows communication of ability to
visualize structures of the posterior pharynx as a means of estimating intubation difficulty
headache Correct Answer: most common complication of LP
paronchyia
digital block, surgical intervention (partiial removal of nail, and abx) Correct Answer: diagosis and
management
panic disorder Correct Answer: psychiatric disease with highest risk of suicide
silent suicide Correct Answer: act of slowly killing oneself by nonviolent means, such as starvation or
non compliance with essential medical treatment
occult suicide Correct Answer: self destructive acts disguised as an accident
,C. elderly and caucasian Correct Answer: Suicidal risk is increased in this patient population:
A. patients who have not been involuntarily committed
b. patients who directly questioned about suicide
c. elderly and caucasian
D. patients taking lithium for bipolar disorder
flexion and supination of elbow (imaging usually not needed if pain resolves after reduction) Correct
Answer: management of radial head subluxation (nurse maids elbow)
hill sachs deformity (compression fracture of the posterior lateral aspect of the humeral head) Correct
Answer: most common fracture associated with shoulder dislocation
asystole (followed by bradycardia) Correct Answer: most common rhythm seen in pediatric arrest
1. dry, warm, position, suction, stimulate
2. oxygen
3. ventilation
4. chest compressions
5. medications Correct Answer: order of operations for neonatal resuscitation
maternal blood (ask about bleeding from nipples) Correct Answer: one possible cause of blood in vomit
of a healthy appearing infant
hypoxemia Correct Answer: most likely underlying cause of bradycardia in a newborn
tube mm = (16 + age) /4 Correct Answer: equation for estimating endotrachael tube size
4 back blows
If still obstructed 4 chest compressions
If still obstructed jaw thrust, mouth inspected and removal of visual FB
If still obstructed, mouth to mouth ventilation
Repeat Correct Answer: management of choking infant under 1 year of age
Childs nares
childs little finger
Body length broselow conversionn
Age in years + Correct Answer: 4 different methods for estimating pediatric endotracheal tube
size
hypovolemia Correct Answer: most common cause of shock in the pediatric population
B. gastric distension due to excessive volume or rate of ventilation impairing ventilatory function
The answer is B. Early placement of a nasogastric tube to facilitate decompression of the stomach will
help to prevent further impairment of ventilation. The rest are indications for endotrachael intubation in
,the pediatric trauma patient. Correct Answer: All of the following are generally accepted indications for
endotracheal intubation of the pediatric trauma patient, EXCEPT:
A. GCS score less than or equal 9, to secure airway and provide controlled hyperventilation
B. gastric distension due to excessive volume or rate of ventilation impairing ventilatory function
C. any inability to ventilate by bag-valve-mask methods or the need for prolonged control of the airway
D. respiratory failure from hypoxia or hypoventilation
E. any trauma patient in decompensated shock and resistant to initial fluid resuscitation
B. Salter II Correct Answer: A 7 year old boy falls off his bike onto his outstretched arm and sustains a
supracondylar fracture. The fracture originates in the metaphysis and a portion of it extends into the
physis (growth plate) without extending through to the epiphysis. How is this fracture classified?
A. Salter I
B. Salter II
C. Salter III
D. Salter IV
E. Salter V
SALTR
type 1 - slipped - fracture plane passes through growth plate only
type 2 - above - fracture passes through growth plate and metaphysis
type 3 - lower - fracture plane passes through growth plate and epiphysis
type 4 - through - fracture passes through eiphysis, growth plate and metaphysis
type 5 - ruined - no fracture, but growth plate damaged from crush injury Correct Answer: Salter Harris
Fracture CLasifcation
The answer is C. Chest compressions should be started when an infant's heart rate is less than 60 bpm
only if oxygen and adequate ventilation have first been tried and failed to increase the heart rate. The
other choices are all correct regarding the use of chest compressions in the infant.
-- For further reading, see Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th edition, page
105. Correct Answer: All of the following are true regarding chest compressions in the infant EXCEPT:
A. Compressions should be performed at a rate of 90 per minute.
B. Chest compressions should be accompanied by a ventilatory rate of 30 per minute.
C. Chest compressions should be initiated whenever an infant's heart rate is less than 60 bpm.
D. An appropriate position for performing chest compressions is to encircle the chest with both hands
and place the thumbs side by side on the sternum.
E. Correct depth of compressions is one-third the anteroposterior diameter of the chest.
B Digoxin
, The answer is B. The drugs which may be given by endotracheal route can be remembered by the
mnemonic "LEAN" — lidocaine, epinephrine, atropine, naloxone. Up to 10 times the IV dose diluted to
5mls and followed by 3-5 positive pressure breaths is necessary to achieve equivalent plasma
concentrations. Digoxin must be given by the IV route. Correct Answer: In pediatric resuscitation the
following drugs may be given by the endotracheal route, EXCEPT:
A. atropine
B. digoxin
C. lidocaine
D. epinephrine
E. naloxone
E. Hyperglycemia
Due to low fat stores, inability to generate heat by shivering, and relatively large surface-to-volume area,
the newborn infant is not easily able to maintain body temperature. Metabolic acidosis, increased
oxygen consumption, hypoglycemia, and apnea are all physiologic consequences of hypothermia.
Correct Answer: Low body temperatures in newborns can lead to severe physiologic consequences,
which include all EXCEPT:
A. increased oxygen consumption
B. hypoglycemia
C. apnea
D. metabolic acidosis
E. hyperglycemia
A. maternal drugs
The answer is A. Mucus, blood, meconium, the tongue, and pulmonary prematurity are the most
frequent reasons for airway obstruction (and subsequent arrest) in the neonate. Maternal drugs can
cause respiratory depression, not primary airway obstruction. Correct Answer: Which of the following is
NOT a frequent cause of airway obstruction in the neonate?
A. maternal drugs
B. tongue
C. meconium
D. mucus
E. blood
C. 6mm'
C. The correct endotracheal tube size can be approximated by using a simple formula: Inside diameter
(ID) in mm = (16 + age in years) / 4. As this is an estimate, it is prudent to have the next smaller and
larger size endotracheal tubes available as well. Estimation of tube size based on the size of the patient's
fifth finger is less accurate. The tube size may also need to be modified based upon the etiology of the
arrest (e.g. airway narrowing from infectious disease) Correct Answer: Approximately what inside
diameter size endotracheal tube is appropriate for an 8 year old child?
A. 10 mm
