SAEM QUESTIONS AND ANSWERS WITH

SAEM QUESTIONS AND ANSWERS WITH

COMPLETE SOLUTIONS

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 D.I.P. of 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) 1 / 3

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; Start Antibiotics 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 Stones - 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 (Cross-Country) 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) 2 / 3

Elderly Patient, Diverticulitis Without Perforation (Without Peritonitis) - Correct Answer I.V. Fluids (Elderly), Antibiotics, and Bowel Rest (Peritonitis Requires Surgery) Proximal vs. Distal Esophageal Perforation - Correct Answer Iatrogenic vs.Spontaneous Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic Dysfunction (Diaphoresis, Incontinence, Arrhythmia) - 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 Benadryl (25mg) for Dystonia from Typical Anti-Psychotics

Extra-Pyramidal: Restlessness - Correct Answer Beta-Blocker for Akathisia

E.C.G. Finding of Haloperidol Toxicity - Correct Answer Long Q.T.Illicit 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 (50 Milligrams), 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 Glucose and Magnesium Recommendations for Altered Alcoholic - Correct Answer 1.Thiamine Before Glucose; and,

• Give Magnesium Regardless of Magnesium Level (Low Stores).

Waxing and Waning 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

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