SAEM M4 FINAL EXAM NEWEST ACTUAL EXAM COMPLETE 120
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A
1. True or false: gastric distension due to excessive volume or rate of ventilation
impairing ventilatory function is a reason to intubate a neonate: false
2. Management for nursemaid elbow injury: apply pressure to the radial head while
flexing and supinating elbow
3. A 17 year old boy injured his right shoulder playing football. He tried to arm-
tackle a player when his right arm was pulled away from his body and back
(abducted and extended). He felt a sudden pain in his shoulder. He presents to
the emergency department holding his arm in slight abduction and external
rotation by his good arm. He has severe pain with adduction or internal rotation.
What is the most common fracture associated with this injury?: compression
fracture of the posteriolateral aspect of the humeral head (hill-sachs deformity)
4. What are most common heart rhythms seen in pediatric arrest?: bradycardia or
asystole
5. Risk factors for neonatal resuscitation: prematurity
Iugr
Multiple
gestation
thick
meconium
6. In the post-arrest setting, which of the following is the drug of choice in treating
hypotension in a child:: epi
7. Low body temperatures in newborns can lead to severe physiologic consequences,
which include all except:
Answers:
1. Metabolic acidosis
2. Increased oxygen consumption
3. Hypoglycemia
4. Apnea
5. Hyperglycemia: 3. Hypoglycemia
8. In a newborn, bradycardia is most commonly an indicator of:: hypoxemia
9. All the following are signs of hypoxemia in a newborn, except:
,Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
5.bradycardia: 3. Tachycardia
10. A newborn presents to the emergency department a few days after hospital
discharge. The infant has been noted to be drooling, choking, and coughing, and
the mother reports seeing bubbles at the baby's mouth. Which is the most likely
explanation?
Answers:
1.osteogenesis imperfecta
2.inborn error of metabolism
3.congenital diaphragmatic hernia
4.foreign body
5.tracheoesophageal fistula: 5. Tracheoesophageal fistula
11. Which of the following pairs of maneuvers are consistent with current
recommendations for emergency care for a choking 5-month-old infant?
Answers:
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then heimlich maneuver
4.heimlich maneuver then blind finger sweep
5.heimlich maneuver then chest thrust: 2.back blow then chest thrust
12. All of these steps are involved in pediatric rapid sequence intubation (rsi)
Except:
Answers:
1.if administering succinylcholine, pretreatment with atropine is always indicated in
children under age 10.
2.lidocaine pretreatment is usually provided to children with head trauma.
3.when deciding which size endotracheal tube to use, one may approximate by using
the size of the small finger or nares as a reference.
4.due to the fragility of the pediatric c-spine, a cervical collar should always be
placed prior to intubation for children under age ten.
,5.uncuffed endotracheal tubes are the preferred devices used in children under 6-8
years of age.: 4.due to the fragility of the pediatric c-spine, a cervical collar should
always be placed prior to intubation for children under age ten.
13. A 23 year old woman is dropped off by her boyfriend after an unknown
overdose. You notice that she is has very large pupils and is sweating profusely.
Her respiratory rate, blood pressure and heart rate are elevated. Which of the
following is the most likely agent to have caused her symptoms?
Answers:
1.jimson weed
2.cocaine
3.heroin
4.insulin: 2. Cocaine
14. A mother brings in her 4 year old child who was happily eating "blackberries"
from weeds in the garden and is now acting strangely. She has identified them
as belladonna from a quick internet search. Which physical examination
finding might you also expect to find in this child?
Answers:
1.diaphoresis
2.flushed skin
3.miosis
4.urinary incontinence: 2. Flushed skin
15. For which of the following cases is activated charcoal therapy most
appropriate?
Answers:
1.acetaminophen overdose
2.drain cleaner ingestion
3.iron supplement overdose
4.lithium overdose: 1. Acetaminophen overdose
16. A 45 year-old is brought in 8 hours after a large overdose of his lithium.
What is the best treatment method for this overdose?
Answers:
1.activated charcoal
2.gastric lavage
, 3.hemodialysis
4.whole bowel irrigation: 3.hemodialysis
17. A 42 year-old woman presents with an overdose of her xanax (alprazolam) that
her family indicates she has been taking for years to help with her anxiety. The
bottle indicates that the prescription was filled yesterday with 90 pills and is
now empty. The patient is minimally responsive to painful stimuli and does not
react when you suction secretions out of her posterior pharynx. What is your
next management step?
Answers:
1.administration of flumazenil
2.administration of narcan
3.close observation
4.intubation for airway support: 4.intubation for airway support
18. A 72 year-old presents with an intentional overdose of a bottle of aspirin about
3 hours prior to presentation in the ed. Which of the following arterial blood
gas results would you expect to come from this patient?
Answers:
1.ph 7.14 pco2 68 po2 102 hco3 23 2.ph
7.33 pco2 48 po2 58 hco3 29
3.ph 7.45 pco2 21 po2 124 hco3 14
4.ph 7.47 pco2 31 po2 96 hco3 25: 3.ph 7.45 pco2 21 po2 124 hco3 14 19. A teenager
presents one hour after ingesting a "handful" of acetaminophen tablets. Which of
the following statements is true?
Answers:
1.an acetaminophen level drawn at hour four dictates need for antidotal therapy.
2.serial liver function tests are indicated in all acetaminophen ingestions.
3.renal sequelae are expected.
4.the intravenous formulation of n-acetylcysteine is safer than oral n-acetylcysteine.:
1.an acetaminophen level drawn at hour four dictates need for antidotal therapy.
20. A 2 year old child presents with an overdose of her mother's iron containing
multivitamins. What antidote should you consider for iron toxicity?
Answers:
1.deferoxamine
2.glucagon
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A
1. True or false: gastric distension due to excessive volume or rate of ventilation
impairing ventilatory function is a reason to intubate a neonate: false
2. Management for nursemaid elbow injury: apply pressure to the radial head while
flexing and supinating elbow
3. A 17 year old boy injured his right shoulder playing football. He tried to arm-
tackle a player when his right arm was pulled away from his body and back
(abducted and extended). He felt a sudden pain in his shoulder. He presents to
the emergency department holding his arm in slight abduction and external
rotation by his good arm. He has severe pain with adduction or internal rotation.
What is the most common fracture associated with this injury?: compression
fracture of the posteriolateral aspect of the humeral head (hill-sachs deformity)
4. What are most common heart rhythms seen in pediatric arrest?: bradycardia or
asystole
5. Risk factors for neonatal resuscitation: prematurity
Iugr
Multiple
gestation
thick
meconium
6. In the post-arrest setting, which of the following is the drug of choice in treating
hypotension in a child:: epi
7. Low body temperatures in newborns can lead to severe physiologic consequences,
which include all except:
Answers:
1. Metabolic acidosis
2. Increased oxygen consumption
3. Hypoglycemia
4. Apnea
5. Hyperglycemia: 3. Hypoglycemia
8. In a newborn, bradycardia is most commonly an indicator of:: hypoxemia
9. All the following are signs of hypoxemia in a newborn, except:
,Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
5.bradycardia: 3. Tachycardia
10. A newborn presents to the emergency department a few days after hospital
discharge. The infant has been noted to be drooling, choking, and coughing, and
the mother reports seeing bubbles at the baby's mouth. Which is the most likely
explanation?
Answers:
1.osteogenesis imperfecta
2.inborn error of metabolism
3.congenital diaphragmatic hernia
4.foreign body
5.tracheoesophageal fistula: 5. Tracheoesophageal fistula
11. Which of the following pairs of maneuvers are consistent with current
recommendations for emergency care for a choking 5-month-old infant?
Answers:
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then heimlich maneuver
4.heimlich maneuver then blind finger sweep
5.heimlich maneuver then chest thrust: 2.back blow then chest thrust
12. All of these steps are involved in pediatric rapid sequence intubation (rsi)
Except:
Answers:
1.if administering succinylcholine, pretreatment with atropine is always indicated in
children under age 10.
2.lidocaine pretreatment is usually provided to children with head trauma.
3.when deciding which size endotracheal tube to use, one may approximate by using
the size of the small finger or nares as a reference.
4.due to the fragility of the pediatric c-spine, a cervical collar should always be
placed prior to intubation for children under age ten.
,5.uncuffed endotracheal tubes are the preferred devices used in children under 6-8
years of age.: 4.due to the fragility of the pediatric c-spine, a cervical collar should
always be placed prior to intubation for children under age ten.
13. A 23 year old woman is dropped off by her boyfriend after an unknown
overdose. You notice that she is has very large pupils and is sweating profusely.
Her respiratory rate, blood pressure and heart rate are elevated. Which of the
following is the most likely agent to have caused her symptoms?
Answers:
1.jimson weed
2.cocaine
3.heroin
4.insulin: 2. Cocaine
14. A mother brings in her 4 year old child who was happily eating "blackberries"
from weeds in the garden and is now acting strangely. She has identified them
as belladonna from a quick internet search. Which physical examination
finding might you also expect to find in this child?
Answers:
1.diaphoresis
2.flushed skin
3.miosis
4.urinary incontinence: 2. Flushed skin
15. For which of the following cases is activated charcoal therapy most
appropriate?
Answers:
1.acetaminophen overdose
2.drain cleaner ingestion
3.iron supplement overdose
4.lithium overdose: 1. Acetaminophen overdose
16. A 45 year-old is brought in 8 hours after a large overdose of his lithium.
What is the best treatment method for this overdose?
Answers:
1.activated charcoal
2.gastric lavage
, 3.hemodialysis
4.whole bowel irrigation: 3.hemodialysis
17. A 42 year-old woman presents with an overdose of her xanax (alprazolam) that
her family indicates she has been taking for years to help with her anxiety. The
bottle indicates that the prescription was filled yesterday with 90 pills and is
now empty. The patient is minimally responsive to painful stimuli and does not
react when you suction secretions out of her posterior pharynx. What is your
next management step?
Answers:
1.administration of flumazenil
2.administration of narcan
3.close observation
4.intubation for airway support: 4.intubation for airway support
18. A 72 year-old presents with an intentional overdose of a bottle of aspirin about
3 hours prior to presentation in the ed. Which of the following arterial blood
gas results would you expect to come from this patient?
Answers:
1.ph 7.14 pco2 68 po2 102 hco3 23 2.ph
7.33 pco2 48 po2 58 hco3 29
3.ph 7.45 pco2 21 po2 124 hco3 14
4.ph 7.47 pco2 31 po2 96 hco3 25: 3.ph 7.45 pco2 21 po2 124 hco3 14 19. A teenager
presents one hour after ingesting a "handful" of acetaminophen tablets. Which of
the following statements is true?
Answers:
1.an acetaminophen level drawn at hour four dictates need for antidotal therapy.
2.serial liver function tests are indicated in all acetaminophen ingestions.
3.renal sequelae are expected.
4.the intravenous formulation of n-acetylcysteine is safer than oral n-acetylcysteine.:
1.an acetaminophen level drawn at hour four dictates need for antidotal therapy.
20. A 2 year old child presents with an overdose of her mother's iron containing
multivitamins. What antidote should you consider for iron toxicity?
Answers:
1.deferoxamine
2.glucagon
