Emergency Medicine SAEM exam test
bank_2024/2025.
Course
SAEM
1. A 65-year-old male presents with acute-onset chest pain radiating to his back.
His blood pressure is 180/100 mmHg in both arms. What is the most likely
diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
✅ Answer: B) Aortic dissection
Explanation:
Aortic dissection presents with "tearing" chest pain radiating to the back, hypertension,
and sometimes unequal arm pressures. Immediate imaging (CT angiography or
transesophageal echocardiography) is required.
2. A 24-year-old woman presents with palpitations, shortness of breath, and a
heart rate of 160 bpm with a narrow QRS complex. Vagal maneuvers fail to
terminate the rhythm. What is the next best step?
A) Atropine
B) Amiodarone
C) Adenosine
D) Magnesium sulfate
✅ Answer: C) Adenosine
Explanation:
This is likely supraventricular tachycardia (SVT), which is best treated with adenosine (6
mg IV push, followed by 12 mg if needed) after failed vagal maneuvers.
3. A 30-year-old male presents with confusion, tachycardia, dry mucous
membranes, and dilated pupils. Which toxin is most likely responsible?
,A) Organophosphates
B) Beta-blockers
C) Anticholinergics
D) Opioids
✅ Answer: C) Anticholinergics
Explanation:
Anticholinergic toxicity presents with "mad as a hatter, hot as a hare, dry as a bone, blind
as a bat, and red as a beet" due to muscarinic blockade. Treatment is supportive, with
physostigmine as an antidote in severe cases.
4. A 55-year-old male with a history of liver cirrhosis presents with fever,
abdominal pain, and worsening ascites. What is the most appropriate diagnostic
test?
A) Abdominal ultrasound
B) CT scan of the abdomen
C) Diagnostic paracentesis
D) Serum ammonia level
✅ Answer: C) Diagnostic paracentesis
Explanation:
Spontaneous bacterial peritonitis (SBP) should be suspected in cirrhotic patients with fever
and worsening ascites. Diagnostic paracentesis with ascitic fluid analysis showing PMN
>250 cells/mm³ confirms the diagnosis.
5. A 72-year-old female presents with right hip pain after a fall. Her right leg is
shortened and externally rotated. What is the most likely diagnosis?
A) Hip dislocation
B) Femoral neck fracture
C) Pelvic fracture
D) Acetabular fracture
✅ Answer: B) Femoral neck fracture
Explanation:
A shortened, externally rotated leg suggests a femoral neck fracture, commonly seen in
elderly patients after a fall. X-ray or CT confirms the diagnosis.
,6. A 4-year-old boy presents after ingesting a household cleaner. He has stridor,
drooling, and respiratory distress. What is the most appropriate next step?
A) Activated charcoal
B) Endoscopy
C) Emergent intubation
D) Gastric lavage
✅ Answer: C) Emergent intubation
Explanation:
Caustic ingestions (alkali or acid) can cause airway edema. Airway protection (intubation)
is the priority, followed by endoscopy within 24 hours to assess damage. Activated charcoal
and gastric lavage are contraindicated.
7. A 28-year-old female presents with fever, tachycardia, hypotension, and a
diffuse macular rash involving the palms and soles. She recently had nasal
packing for a nosebleed. What is the most likely diagnosis?
A) Kawasaki disease
B) Toxic shock syndrome
C) Rocky Mountain spotted fever
D) Meningococcemia
✅ Answer: B) Toxic shock syndrome
Explanation:
Toxic shock syndrome is caused by Staphylococcus aureus exotoxins and presents with
fever, hypotension, rash, and multi-organ dysfunction. It is associated with tampons,
surgical wounds, or nasal packing.
8. A 50-year-old male with a history of alcoholism presents with confusion,
ataxia, and ophthalmoplegia. What is the best initial treatment?
A) IV glucose
B) IV thiamine
C) IV fluids
D) IV benzodiazepines
, ✅ Answer: B) IV thiamine
Explanation:
This is Wernicke’s encephalopathy (due to thiamine deficiency). Thiamine must be given
before glucose to prevent worsening neurological symptoms.
9. A 7-year-old boy presents after falling with an outstretched hand. His elbow is
swollen and tender. X-ray shows a posterior fat pad sign. What is the most likely
diagnosis?
A) Nursemaid’s elbow
B) Supracondylar fracture
C) Radial head dislocation
D) Olecranon fracture
✅ Answer: B) Supracondylar fracture
Explanation:
A posterior fat pad sign is highly suggestive of a supracondylar fracture in children.
Immediate orthopedic consultation is needed to prevent compartment syndrome or
brachial artery injury.
10. A 35-year-old male presents after a motor vehicle crash with jugular venous
distension, muffled heart sounds, and hypotension. What is the most appropriate
next step?
A) Chest X-ray
B) Pericardiocentesis
C) IV fluids and observation
D) CT scan of the chest
✅ Answer: B) Pericardiocentesis
Explanation:
This is cardiac tamponade (Beck’s triad: hypotension, JVD, muffled heart sounds).
Immediate pericardiocentesis is lifesaving.
11. A 30-year-old male with a history of sickle cell disease presents with severe chest pain,
fever, and hypoxia. What is the best initial treatment?
bank_2024/2025.
Course
SAEM
1. A 65-year-old male presents with acute-onset chest pain radiating to his back.
His blood pressure is 180/100 mmHg in both arms. What is the most likely
diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
✅ Answer: B) Aortic dissection
Explanation:
Aortic dissection presents with "tearing" chest pain radiating to the back, hypertension,
and sometimes unequal arm pressures. Immediate imaging (CT angiography or
transesophageal echocardiography) is required.
2. A 24-year-old woman presents with palpitations, shortness of breath, and a
heart rate of 160 bpm with a narrow QRS complex. Vagal maneuvers fail to
terminate the rhythm. What is the next best step?
A) Atropine
B) Amiodarone
C) Adenosine
D) Magnesium sulfate
✅ Answer: C) Adenosine
Explanation:
This is likely supraventricular tachycardia (SVT), which is best treated with adenosine (6
mg IV push, followed by 12 mg if needed) after failed vagal maneuvers.
3. A 30-year-old male presents with confusion, tachycardia, dry mucous
membranes, and dilated pupils. Which toxin is most likely responsible?
,A) Organophosphates
B) Beta-blockers
C) Anticholinergics
D) Opioids
✅ Answer: C) Anticholinergics
Explanation:
Anticholinergic toxicity presents with "mad as a hatter, hot as a hare, dry as a bone, blind
as a bat, and red as a beet" due to muscarinic blockade. Treatment is supportive, with
physostigmine as an antidote in severe cases.
4. A 55-year-old male with a history of liver cirrhosis presents with fever,
abdominal pain, and worsening ascites. What is the most appropriate diagnostic
test?
A) Abdominal ultrasound
B) CT scan of the abdomen
C) Diagnostic paracentesis
D) Serum ammonia level
✅ Answer: C) Diagnostic paracentesis
Explanation:
Spontaneous bacterial peritonitis (SBP) should be suspected in cirrhotic patients with fever
and worsening ascites. Diagnostic paracentesis with ascitic fluid analysis showing PMN
>250 cells/mm³ confirms the diagnosis.
5. A 72-year-old female presents with right hip pain after a fall. Her right leg is
shortened and externally rotated. What is the most likely diagnosis?
A) Hip dislocation
B) Femoral neck fracture
C) Pelvic fracture
D) Acetabular fracture
✅ Answer: B) Femoral neck fracture
Explanation:
A shortened, externally rotated leg suggests a femoral neck fracture, commonly seen in
elderly patients after a fall. X-ray or CT confirms the diagnosis.
,6. A 4-year-old boy presents after ingesting a household cleaner. He has stridor,
drooling, and respiratory distress. What is the most appropriate next step?
A) Activated charcoal
B) Endoscopy
C) Emergent intubation
D) Gastric lavage
✅ Answer: C) Emergent intubation
Explanation:
Caustic ingestions (alkali or acid) can cause airway edema. Airway protection (intubation)
is the priority, followed by endoscopy within 24 hours to assess damage. Activated charcoal
and gastric lavage are contraindicated.
7. A 28-year-old female presents with fever, tachycardia, hypotension, and a
diffuse macular rash involving the palms and soles. She recently had nasal
packing for a nosebleed. What is the most likely diagnosis?
A) Kawasaki disease
B) Toxic shock syndrome
C) Rocky Mountain spotted fever
D) Meningococcemia
✅ Answer: B) Toxic shock syndrome
Explanation:
Toxic shock syndrome is caused by Staphylococcus aureus exotoxins and presents with
fever, hypotension, rash, and multi-organ dysfunction. It is associated with tampons,
surgical wounds, or nasal packing.
8. A 50-year-old male with a history of alcoholism presents with confusion,
ataxia, and ophthalmoplegia. What is the best initial treatment?
A) IV glucose
B) IV thiamine
C) IV fluids
D) IV benzodiazepines
, ✅ Answer: B) IV thiamine
Explanation:
This is Wernicke’s encephalopathy (due to thiamine deficiency). Thiamine must be given
before glucose to prevent worsening neurological symptoms.
9. A 7-year-old boy presents after falling with an outstretched hand. His elbow is
swollen and tender. X-ray shows a posterior fat pad sign. What is the most likely
diagnosis?
A) Nursemaid’s elbow
B) Supracondylar fracture
C) Radial head dislocation
D) Olecranon fracture
✅ Answer: B) Supracondylar fracture
Explanation:
A posterior fat pad sign is highly suggestive of a supracondylar fracture in children.
Immediate orthopedic consultation is needed to prevent compartment syndrome or
brachial artery injury.
10. A 35-year-old male presents after a motor vehicle crash with jugular venous
distension, muffled heart sounds, and hypotension. What is the most appropriate
next step?
A) Chest X-ray
B) Pericardiocentesis
C) IV fluids and observation
D) CT scan of the chest
✅ Answer: B) Pericardiocentesis
Explanation:
This is cardiac tamponade (Beck’s triad: hypotension, JVD, muffled heart sounds).
Immediate pericardiocentesis is lifesaving.
11. A 30-year-old male with a history of sickle cell disease presents with severe chest pain,
fever, and hypoxia. What is the best initial treatment?
