SAEM EXAM QUESTIONS 2023-2024 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+

SAEM EXAM QUESTIONS 2023-2024 ACTUAL EXAM 400

REAL EXAM QUESTIONS AND CORRECT DETAILED

ANSWERS WITH RATIONALES (VERIFIED ANSWERS)

|ALREADY GRADED A+

An 80 year old nursing home patient is brought to the emergency department with

an acute onset of confusion. Which of the following metabolic abnormalities is the

most likely explanation?

A. hypocalcemia

B. hypokalemia

C. hypernatremia

D. hyperphosphatemia - ANSWER- C. hypernatremia

Rationale: The differential diagnosis of acute confusional states is lengthy. It

includes many metabolic/nutritional abnormalities including hypoglycemia, hypo-

/hypernatremia, and hypercalcemia. Hypokalemia alone, however, is not a

common cause of altered mental status.

Which factor is least reliable in differentiating between organic and inorganic

causes of confusion?

A. acute versus chronic onset

B. Vital sign abnormalities

C. Presence of attention deficit

D. Signs of trauma - ANSWER- C. Presence of attention deficit

Rationale: Presence of an attention deficit is common to all confusional states. All

the other options may be used to differentiate organic versus non-organic causes of

confusion. Characteristics of organic causes include acute onset, abnormal vital

signs, fluctuating level of consciousness, possibly signs of trauma, and/or focal

neurologic signs. Inorganic (functional) causes commonly illustrate chronic onset,

stable vital signs, absence of trauma or focal neurologic symptoms, and/or

delusions and illusions.

With regard to specific causes of hypertension, which of the following is true?

A. Hypertensive encephalopathy is more likely than hypertensive stroke in

patients whose mental status changes are reversible

B. Hypertensive encephalopathy causes adverse outcomes over days or weeks,

rather than hours

C. Patients with stroke syndromes must have blood pressure normalized as quickly

as possible to reduce the risks of worsening neurological deficit

D. Laboratory analysis is rarely useful in cases of confirmed pediatric

hypertension

E. Laboratory analysis is rarely useful in cases of confirmed hypertension in

pregnant patients - ANSWER- A. Hypertensive encephalopathy is more likely than

hypertensive stroke in patients whose mental status changes are reversible

Rationale: Hypertensive encephalopathy is a true medical emergency, and can

cause coma and death over hours; however, encephalopathy due to hypertension is

more likely reversible than encephalopathy from other causes. Avoidance of

overzealous blood pressure lowering is particularly critical for patients with

strokes. Laboratory analysis can be important in cases of hypertension in pediatric

patients (for whom renal/renovascular or pheochromocytoma may be identified)

and in pregnant patients (for whom laboratory testing can help establish diagnoses

such as the HELLP syndrome).

A 29 year old woman is found seizing by her husband and is rushed to the

emergency department. On presentation, she is noted to have a BP of 162/112, is

still seizing, and looks puffy all over. Her husband tells you that they are expecting

their first child in a few months. Which of the following is the next best step in this

patient's care?

A. Control the seizures with magnesium sulfate.

B. Draw blood to check CBC, LFT's, BUN, and creatinine.

C. Notify the labor floor that the patient is in the emergency department.

D. Perform a CT scan of head if seizures persist.

E. Start hydralazine to decrease the patient's blood pressure. - ANSWER- A.

Control the seizures with magnesium sulfate.

Rationale: Antihypertensive therapy is only indicated in eclampsia if the diastolic

blood pressure remains > 110 mm Hg after seizures are controlled because rapid

lowering of blood pressure can result in uterine hypoperfusion. All the other

choices (A-D) are appropriate in the management of the patient with eclampsia.

Which of the following is *not* a feature of febrile seizures?

A. generalized tonic-clonic seizure

B. duration less than 15 minutes

C. associated with a rapid rise in body temperature

D. occurs in children ages 3 months to 5 years

E. associated with postictal state of 30 minutes - ANSWER- E. associated with

postictal state of 30 minutes

Rationale: Febrile seizure is not associated with a postictal period. The child

usually rapidly regains alertness. Intracranial mass or infection should be a concern

if the duration of seizure is greater than 15 minutes or if altered mental status

persists after the cessation of seizure activity.

A 47 year old man with a history of alcohol abuse presents to the ED after having a

seizure. His past includes both seizures and blackouts. His last alcoholic drink was

the previous evening. This morning he experienced palpitations, diaphoresis, and

dizziness before losing consciousness and having a seizure lasting under a minute.

Which of the following is *true* statement with to alcohol and its association with

seizures?

A. In people with an underlying seizure disorder, excessive alcohol intake is a

risk-factor for seizure due to increased likelihood of head injury, predisposition to

metabolic disorders, and lowered seizure threshold.

B. Alcohol intake itself can precipitate seizures due to the neurotoxic effects of

alcohol and its metabolites.

C. Cessation of alcohol can precipitate seizures as part of the alcohol withdrawal

syndrome.

D. All of the above statements are true.

E. All of the above statements are false. - ANSWER- D. All of the above

statements are true.

A 68 year old diabetic male, previously living independently, is brought in by his

family. He has been acting abnormally for two days. The family reports he is

awake all night and sleepy during the day. He is confused about where he is and

the time of day, and sometimes doesn't recognize his daughter and son-in-law. At

other times he appears and acts almost normally. Which of the following is *true*

regarding his condition?

A. Infection is an unlikely cause of his condition unless his temperature is > 102°.

B. Dementia is the most likely cause of his condition and the family must be

counseled.

C. Medications are an unlikely cause of this condition in the elderly.

D. Patients can be agitated and combative, or calm and quiet in this condition.

E. Treatment includes maximizing sensory input. - ANSWER- D. Patients can be

agitated and combative, or calm and quiet in this condition.