Emergency Medicine SAEM exam test bank_2023/2024.
Course
SAEM
1. A 32-year-old male presents with chest pain radiating to his left arm. He is
diaphoretic and has a blood pressure of 160/95 mmHg. An ECG shows ST
elevation in leads II, III, and aVF. What is the most likely diagnosis?
A) Pulmonary embolism
B) Acute pericarditis
C) Acute inferior myocardial infarction
D) Aortic dissection
Answer: C) Acute inferior myocardial infarction
Rationale: ST elevation in leads II, III, and aVF is indicative of an inferior myocardial
infarction. Aortic dissection may present with chest pain but does not typically show ST
elevation in these leads. Pulmonary embolism can present with chest pain, but the ECG
typically shows sinus tachycardia or right heart strain. Acute pericarditis may cause ST
elevation, but it is usually diffuse across multiple leads.
2. A 22-year-old female presents to the ED with severe lower abdominal pain,
vaginal bleeding, and a positive urine pregnancy test. What is the most
appropriate next step in management?
A) Administer methotrexate
B) Order pelvic ultrasound
C) Administer Rho(D) immune globulin
D) Perform pelvic examination
Answer: B) Order pelvic ultrasound
Rationale: The most important first step in a patient with a positive pregnancy test and
abdominal pain or vaginal bleeding is to evaluate for an ectopic pregnancy. Pelvic ultrasound
is the preferred imaging to determine the location of the pregnancy. Administering
methotrexate or Rho(D) immune globulin may be appropriate later depending on findings,
but the immediate step is diagnostic imaging.
3. A 45-year-old male presents with sudden onset, severe "thunderclap"
headache. His blood pressure is 180/100 mmHg. What is the most appropriate
diagnostic test?
A) Non-contrast head CT
B) MRI brain
C) Lumbar puncture
D) Carotid ultrasound
Answer: A) Non-contrast head CT
Rationale: A sudden onset, severe "thunderclap" headache is concerning for a subarachnoid
hemorrhage (SAH). The best initial test is a non-contrast head CT, which can quickly identify
,bleeding. If the CT is negative and suspicion remains high, a lumbar puncture may be
performed to assess for xanthochromia. MRI is not the first choice in an emergency setting
for acute bleeding.
4. A 30-year-old male is brought in after a motor vehicle accident. He has an
obvious right femur fracture, hypotension (BP 88/56 mmHg), and tachycardia
(HR 120 bpm). Which of the following is the most likely cause of his
hypotension?
A) Tension pneumothorax
B) Hypovolemic shock from internal bleeding
C) Cardiac tamponade
D) Spinal shock
Answer: B) Hypovolemic shock from internal bleeding
Rationale: In trauma patients, hypotension and tachycardia are most commonly due to
hypovolemic shock from blood loss. A femur fracture can result in significant hemorrhage.
Tension pneumothorax and cardiac tamponade can also cause hypotension, but there is no
clinical evidence of chest trauma in this scenario.
5. A 60-year-old female presents with new onset confusion and a sodium level
of 110 mEq/L. What is the most appropriate initial treatment?
A) Fluid restriction
B) Hypertonic saline
C) Dextrose 5% in water
D) Normal saline
Answer: B) Hypertonic saline
Rationale: Severe hyponatremia (sodium <120 mEq/L) with neurologic symptoms
(confusion) should be treated with hypertonic saline to raise sodium levels. Rapid correction
should be avoided, as it can cause osmotic demyelination syndrome, but hypertonic saline is
the appropriate choice for initial management of symptomatic hyponatremia. Fluid restriction
is used in chronic or mild hyponatremia without symptoms.
6. A 19-year-old male presents to the ED with fever, headache, and a petechial
rash. What is the most appropriate initial step in management?
A) Administer ceftriaxone
B) Order a lumbar puncture
C) Administer steroids
D) Obtain blood cultures
Answer: A) Administer ceftriaxone
Rationale: This patient presents with signs of meningococcemia, a life-threatening infection
caused by Neisseria meningitidis. Immediate administration of antibiotics (e.g., ceftriaxone)
is critical to improve outcomes. Blood cultures and lumbar puncture should be done, but
antibiotic therapy should not be delayed.
,7. A 70-year-old man presents with sudden vision loss in his right eye and a
cherry-red spot on fundoscopy. What is the most likely diagnosis?
A) Retinal detachment
B) Central retinal artery occlusion
C) Optic neuritis
D) Temporal arteritis
Answer: B) Central retinal artery occlusion
Rationale: Sudden, painless loss of vision with a cherry-red spot on fundoscopy is
characteristic of central retinal artery occlusion. Retinal detachment typically causes a
curtain-like loss of vision. Optic neuritis is associated with pain and often occurs in younger
patients with multiple sclerosis. Temporal arteritis can cause vision loss, but it is associated
with systemic symptoms like headache and jaw claudication.
8. A 28-year-old male presents with confusion, slurred speech, and ataxia. His
friends report heavy alcohol use over the past week. What is the most likely
deficiency causing his symptoms?
A) Vitamin B6 deficiency
B) Thiamine deficiency
C) Folate deficiency
D) Vitamin B12 deficiency
Answer: B) Thiamine deficiency
Rationale: This patient has signs and symptoms consistent with Wernicke’s encephalopathy,
which is caused by a deficiency of thiamine (vitamin B1), typically seen in chronic alcohol
users. The triad includes confusion, ataxia, and ophthalmoplegia. Thiamine replacement
should be initiated promptly to prevent progression to irreversible damage.
9. A 40-year-old male presents with severe epigastric pain radiating to the
back. He has a history of alcohol abuse. What is the most likely diagnosis?
A) Cholecystitis
B) Peptic ulcer disease
C) Pancreatitis
D) Esophageal rupture
Answer: C) Pancreatitis
Rationale: Severe epigastric pain radiating to the back in the context of a history of alcohol
abuse is most consistent with acute pancreatitis. Cholecystitis usually presents with right
upper quadrant pain, peptic ulcer disease is associated with more localized burning pain, and
esophageal rupture presents with severe chest pain and may be associated with vomiting.
10. A 16-year-old male presents with a painful, swollen knee after a soccer
game. He cannot bear weight and has a positive Lachman test. What is the
most likely diagnosis?
A) Anterior cruciate ligament (ACL) tear
, B) Meniscal tear
C) Patellar dislocation
D) Medial collateral ligament (MCL) tear
Answer: A) Anterior cruciate ligament (ACL) tear
Rationale: A positive Lachman test is highly sensitive and specific for an ACL tear. This
injury often occurs with sudden deceleration or change of direction, common in soccer.
Meniscal tears often present with locking or catching, and MCL tears with medial pain and
instability. Patellar dislocation presents with lateral displacement of the patella and inability
to extend the knee.
11. A 56-year-old female presents to the ED with shortness of breath and
pleuritic chest pain. She recently had surgery for a hip fracture. Vital signs
include a heart rate of 115 bpm, respiratory rate of 22, and oxygen saturation
of 89%. What is the most likely diagnosis?
A) Acute coronary syndrome
B) Pneumonia
C) Pulmonary embolism
D) Pneumothorax
Answer: C) Pulmonary embolism
Rationale: Recent surgery, particularly orthopedic surgery, increases the risk of deep vein
thrombosis and pulmonary embolism (PE). Tachycardia, hypoxemia, and pleuritic chest pain
are classic signs of PE. Pneumonia can present similarly but is less likely given the context of
recent surgery.
12. A 7-year-old boy presents with sudden onset of difficulty breathing and
stridor after playing with toys. He is afebrile and in respiratory distress. What
is the next best step in management?
A) Obtain a chest X-ray
B) Administer racemic epinephrine
C) Perform direct laryngoscopy
D) Administer albuterol
Answer: C) Perform direct laryngoscopy
Rationale: The child likely has an upper airway obstruction due to a foreign body aspiration.
Direct visualization and removal of the foreign body via laryngoscopy or bronchoscopy is the
priority. Chest X-ray may be done afterward, but prompt intervention is needed to secure the
airway.
13. A 25-year-old female presents with palpitations and lightheadedness. Her
ECG shows a narrow complex tachycardia at 180 bpm. What is the most
appropriate initial treatment?
A) Vagal maneuvers
B) Intravenous adenosine
C) Synchronized cardioversion
Course
SAEM
1. A 32-year-old male presents with chest pain radiating to his left arm. He is
diaphoretic and has a blood pressure of 160/95 mmHg. An ECG shows ST
elevation in leads II, III, and aVF. What is the most likely diagnosis?
A) Pulmonary embolism
B) Acute pericarditis
C) Acute inferior myocardial infarction
D) Aortic dissection
Answer: C) Acute inferior myocardial infarction
Rationale: ST elevation in leads II, III, and aVF is indicative of an inferior myocardial
infarction. Aortic dissection may present with chest pain but does not typically show ST
elevation in these leads. Pulmonary embolism can present with chest pain, but the ECG
typically shows sinus tachycardia or right heart strain. Acute pericarditis may cause ST
elevation, but it is usually diffuse across multiple leads.
2. A 22-year-old female presents to the ED with severe lower abdominal pain,
vaginal bleeding, and a positive urine pregnancy test. What is the most
appropriate next step in management?
A) Administer methotrexate
B) Order pelvic ultrasound
C) Administer Rho(D) immune globulin
D) Perform pelvic examination
Answer: B) Order pelvic ultrasound
Rationale: The most important first step in a patient with a positive pregnancy test and
abdominal pain or vaginal bleeding is to evaluate for an ectopic pregnancy. Pelvic ultrasound
is the preferred imaging to determine the location of the pregnancy. Administering
methotrexate or Rho(D) immune globulin may be appropriate later depending on findings,
but the immediate step is diagnostic imaging.
3. A 45-year-old male presents with sudden onset, severe "thunderclap"
headache. His blood pressure is 180/100 mmHg. What is the most appropriate
diagnostic test?
A) Non-contrast head CT
B) MRI brain
C) Lumbar puncture
D) Carotid ultrasound
Answer: A) Non-contrast head CT
Rationale: A sudden onset, severe "thunderclap" headache is concerning for a subarachnoid
hemorrhage (SAH). The best initial test is a non-contrast head CT, which can quickly identify
,bleeding. If the CT is negative and suspicion remains high, a lumbar puncture may be
performed to assess for xanthochromia. MRI is not the first choice in an emergency setting
for acute bleeding.
4. A 30-year-old male is brought in after a motor vehicle accident. He has an
obvious right femur fracture, hypotension (BP 88/56 mmHg), and tachycardia
(HR 120 bpm). Which of the following is the most likely cause of his
hypotension?
A) Tension pneumothorax
B) Hypovolemic shock from internal bleeding
C) Cardiac tamponade
D) Spinal shock
Answer: B) Hypovolemic shock from internal bleeding
Rationale: In trauma patients, hypotension and tachycardia are most commonly due to
hypovolemic shock from blood loss. A femur fracture can result in significant hemorrhage.
Tension pneumothorax and cardiac tamponade can also cause hypotension, but there is no
clinical evidence of chest trauma in this scenario.
5. A 60-year-old female presents with new onset confusion and a sodium level
of 110 mEq/L. What is the most appropriate initial treatment?
A) Fluid restriction
B) Hypertonic saline
C) Dextrose 5% in water
D) Normal saline
Answer: B) Hypertonic saline
Rationale: Severe hyponatremia (sodium <120 mEq/L) with neurologic symptoms
(confusion) should be treated with hypertonic saline to raise sodium levels. Rapid correction
should be avoided, as it can cause osmotic demyelination syndrome, but hypertonic saline is
the appropriate choice for initial management of symptomatic hyponatremia. Fluid restriction
is used in chronic or mild hyponatremia without symptoms.
6. A 19-year-old male presents to the ED with fever, headache, and a petechial
rash. What is the most appropriate initial step in management?
A) Administer ceftriaxone
B) Order a lumbar puncture
C) Administer steroids
D) Obtain blood cultures
Answer: A) Administer ceftriaxone
Rationale: This patient presents with signs of meningococcemia, a life-threatening infection
caused by Neisseria meningitidis. Immediate administration of antibiotics (e.g., ceftriaxone)
is critical to improve outcomes. Blood cultures and lumbar puncture should be done, but
antibiotic therapy should not be delayed.
,7. A 70-year-old man presents with sudden vision loss in his right eye and a
cherry-red spot on fundoscopy. What is the most likely diagnosis?
A) Retinal detachment
B) Central retinal artery occlusion
C) Optic neuritis
D) Temporal arteritis
Answer: B) Central retinal artery occlusion
Rationale: Sudden, painless loss of vision with a cherry-red spot on fundoscopy is
characteristic of central retinal artery occlusion. Retinal detachment typically causes a
curtain-like loss of vision. Optic neuritis is associated with pain and often occurs in younger
patients with multiple sclerosis. Temporal arteritis can cause vision loss, but it is associated
with systemic symptoms like headache and jaw claudication.
8. A 28-year-old male presents with confusion, slurred speech, and ataxia. His
friends report heavy alcohol use over the past week. What is the most likely
deficiency causing his symptoms?
A) Vitamin B6 deficiency
B) Thiamine deficiency
C) Folate deficiency
D) Vitamin B12 deficiency
Answer: B) Thiamine deficiency
Rationale: This patient has signs and symptoms consistent with Wernicke’s encephalopathy,
which is caused by a deficiency of thiamine (vitamin B1), typically seen in chronic alcohol
users. The triad includes confusion, ataxia, and ophthalmoplegia. Thiamine replacement
should be initiated promptly to prevent progression to irreversible damage.
9. A 40-year-old male presents with severe epigastric pain radiating to the
back. He has a history of alcohol abuse. What is the most likely diagnosis?
A) Cholecystitis
B) Peptic ulcer disease
C) Pancreatitis
D) Esophageal rupture
Answer: C) Pancreatitis
Rationale: Severe epigastric pain radiating to the back in the context of a history of alcohol
abuse is most consistent with acute pancreatitis. Cholecystitis usually presents with right
upper quadrant pain, peptic ulcer disease is associated with more localized burning pain, and
esophageal rupture presents with severe chest pain and may be associated with vomiting.
10. A 16-year-old male presents with a painful, swollen knee after a soccer
game. He cannot bear weight and has a positive Lachman test. What is the
most likely diagnosis?
A) Anterior cruciate ligament (ACL) tear
, B) Meniscal tear
C) Patellar dislocation
D) Medial collateral ligament (MCL) tear
Answer: A) Anterior cruciate ligament (ACL) tear
Rationale: A positive Lachman test is highly sensitive and specific for an ACL tear. This
injury often occurs with sudden deceleration or change of direction, common in soccer.
Meniscal tears often present with locking or catching, and MCL tears with medial pain and
instability. Patellar dislocation presents with lateral displacement of the patella and inability
to extend the knee.
11. A 56-year-old female presents to the ED with shortness of breath and
pleuritic chest pain. She recently had surgery for a hip fracture. Vital signs
include a heart rate of 115 bpm, respiratory rate of 22, and oxygen saturation
of 89%. What is the most likely diagnosis?
A) Acute coronary syndrome
B) Pneumonia
C) Pulmonary embolism
D) Pneumothorax
Answer: C) Pulmonary embolism
Rationale: Recent surgery, particularly orthopedic surgery, increases the risk of deep vein
thrombosis and pulmonary embolism (PE). Tachycardia, hypoxemia, and pleuritic chest pain
are classic signs of PE. Pneumonia can present similarly but is less likely given the context of
recent surgery.
12. A 7-year-old boy presents with sudden onset of difficulty breathing and
stridor after playing with toys. He is afebrile and in respiratory distress. What
is the next best step in management?
A) Obtain a chest X-ray
B) Administer racemic epinephrine
C) Perform direct laryngoscopy
D) Administer albuterol
Answer: C) Perform direct laryngoscopy
Rationale: The child likely has an upper airway obstruction due to a foreign body aspiration.
Direct visualization and removal of the foreign body via laryngoscopy or bronchoscopy is the
priority. Chest X-ray may be done afterward, but prompt intervention is needed to secure the
airway.
13. A 25-year-old female presents with palpitations and lightheadedness. Her
ECG shows a narrow complex tachycardia at 180 bpm. What is the most
appropriate initial treatment?
A) Vagal maneuvers
B) Intravenous adenosine
C) Synchronized cardioversion
