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SAEM M4 CURRICULUM 2 EXAM TEST
BANK NEWEST EDITION 2025-2026.
QUESTIONS & CORRECT ANSWERS.
GRADED A
______% of cardiac contusion develop โ ANS 40%; dec CO _____can occur with lbunt abd trauma? side? timeline โ ANS diaphragm rupture on left. can present weeks later 1st line tx seizure secnd third โ ANS -benzo (lorazepam) -fosphenyton/phenobarbital/valproate 3rd: versed/pentobarbital/propofol 2 clues its tension pneumo if intubated โ ANS -extreme difficulty in bagging or high airway pressures 2 decision tools for head ct - ANS-canadian (83% sensitive, 38% specific). meant to detect things can itnervene -new orleans (100% sensitivty, 5% specific). meant to detect any abnormality 2 downsides of lavage - ANS-does not eval retroperitoneum
-can result in many unneeded lapraopotmies 2 indications icu - ANS-PPV -intubation 2 meds often used in agitation - ANS-benzo -antipsych (often give benztropine or diphenhydramine to prevent EPS sx) 2 most common ages get torsion - ANS1st year of life and in puberty 2 most common bacteria - ANS-strep pneumo -n menigitis 2 trauma issues that can cause sieuzre - ANS-intracraial hemorrhage -brain injury 3 categories of aortic injury - ANS-dead at scene -hemodynamic unstable -stable 3 causes of meningitis - ANStrauma, surgery, or a contiguous infection such as sinusitis or otitis media. 3 kinds of forces in blunt abd trauma. define - ANS-shearing forces that occur due to rapid deeleration causing tearing at fixed pots of attachment -crushing forces
4 types of intracranial hemorrhages - ANS-epidural -subdural -subarachnoid -intracerebral 4 when suspect ecalmpsia - ANS-vision complaints -edema of face hands and feet -rpoteinuria on UA -htn 5 diff presentations of lacunar syndromes - ANS-pure motor hemipareiss -sensorimotor troke -ataxic hemiparesis -pure sensory -dysathria-clumsy hand syndrome aca stroke sx - ANS-LE>UE (weak and sensory loss) adult over 50 - ANS-dexxamaethasone (maybe fore abx) -cefotaxime/ceftriazone -and vanco -and ampicillin after TPA what must do - ANSstricktly keep b p under 180/105 to prevent hemorrhage
agitation is a sx of 3 - ANS-delirium -dementia =psychosis albuterol onset of action and duration - ANS-5 min -6hr alcohol withdraw sx - ANS-anxiety -tremors -ams -tachy everything and htn all must be trume to remove c collar 5 - ANS-alert -absence of neck pain -absence of midline neck tenderness -absence of distracting injury -absence of sensory or motor ocmpaint always consdier - ANShypoglycemia and trauma (c collar) another clue ptx - ANSsubq air another, simpler tool cap - ANScurb 65 score of 2 or more=admit
-infection -traumatic tap blunt abd trauma needs - ANSabx blunt injuries do NOT get - ANSthoracotomy blunt trauma - ANSrefers to mechanisms casuing inc intrathoracic pressure brudzinski - ANSpassive flexion of neck causes flexion oh hip bugs of aspiration pna - ANS-enterobacteria -pseduomonas -s aureus bugs of hcap - ANS-pseudocmonas -e coli -klebisella careful with US: - ANSimportant to note that the presence of Doppler blood flow does not exclude the diagnosis of torsion causes of decomepnsation of copd - ANS-infection -smoking -noncomplaince -ptx
causes of seizure - ANSGAINCUCOHMW -low glucose -anatomic -infection -low or high Na -low calcuim -uremia -cocaine -low o -hepatic fail -low mag -withdrawal central transtentorial hernation - ANS-occurs from midline lesions of the frontal or temporal lobes with downward displacement of the parenchyma through the tentorium. -sx: b/l pinpoint pulpils, b/l babinski, inc muscle tone cerebello tonsillar hernation - ANS-cerebellar tonsils are displaced through the foramen magnum, -resulting in bilateral pinpoint pupils, flaccid paralysis, and sudden death cerebral contusions prognosis - ANS-may convert to intracerbral hemorrhage several days after initial injsry so any new neuro signs neeeds another ct
-paraodxical movement -splitning with secondary hypoventilation clues its seizure - ANS-tongue trauma -urinary or bowel incontenince clues to pseudoseizure - ANS-rhthymic, controlled shaking activity -ability to talk or follow commands during seizure -lack of postical colors of blood on ct by time - ANS-white if acute -3-14d then same color as brain -after 2 weeks=hypodense common ekg features in copd - ANS-low voltage -right anxis deviatio -p pulmonale: peakedp waves in 2, 3 , aVF -right atrial hypertrophy -tachycardia common exam findings pid - ANS-b/l adenexal tenderness -cervical d/c cervical motion tenderness -uterine tender -lower abd tenderness common sx meningitis - ANSseizure
complication of TPA - ANSintracranial hemorrhage complications of pid - ANS-chronic pelvic pain -infertility -ectopic -toa -fitz-hiugh curtis concern with intbuat eand ventilate - ANSpatients can develop high lung pressures because they are unable to expire a full breathe. This may result in barotrauma, pneumothorax or hypotension from decreased venous return concern with laryngeal injurry - ANSswelling after presenraton can cause resp comproise consequence of flail chest - ANS-pulm contusion control inc ICP 5 - ANS-lower BP -elevate head of bed 30degrees -provide adequate sedation and analgesia -consider mannitol -or higer ventilation (goal CO2 around 30) copd d/c with steroid isntruciton 1 - ANS10-14days of prednisone that gets tapered off
curb 65 - ANSconfusion bun>= resp rate>= systolic < age >= cushings triad= - ANShtn -brady -abnormal resp patterns cxr tampoande - ANSenlarged card silhoeutte cxr timeline - ANSxray may be normal in first 6-12hrs d/c asthma with - ANSsteroids and albuterol d/c with PID need what testing - ANStest for other STD ddx delirium - ANSdimtops Drugs-intoxication, poisoning or withdrawal Infections-UTI, pneumonia, meningitis/encephalitis, and others Metabolic Disturbance-Glucose and other endocrine derangements as well as electrolyte disorders Trauma-Head injury Oxygen-Hypoxia Postictal State
Space Occupying Lesion-Intracranial Tumor deep sulcus sign= - ANSanterior ptx definitive dx testicle torsion - ANSOR definitively dx torsion - ANSOR dementia - ANSchronic progressive decline in intellectual ability, behavior and perosnality describe whats going on in ovarian torsion - ANSovary, and often the fallopian tube as well (adnexal torsion) become twisted around their vascular pedicle. diagnostic pathway of sah - ANS-CT -then LP if after 6hrs of start of sx diagnostic peritoneal lavage when pos. what do if pos? - ANSd positive if there is aspiration of 10 mL of gross blood or gastrointestinal contents, or the presence >100,000 RBC/mm3, >500 WBC/mm3, or vegetable matter in the liter of saline infused. -surgery diffuse axonal injury results frm? caused by - ANSshearing forces on axonal fibers of white matter and brain stem -caused by sudden deceleration
-2 sx -cremasteric reflex -exam shows -2 labs -US shows -tx -outcome - ANS-over days -fever, dysuria -present -Epididymal tenderness with or without testicular tenderness -wbc and nitrites -Body of testis similar to asymptomatic side with hypoechoic epididymis -abx -Possible scarring, possible impaired fertility epidural hematoma patho - ANS-trauma causes fracture of temporal bone to rupture middlemeningeal artery epidural on ct - ANSlens epidural v. subdrual hematoma - ANSepidural does not cross suture lines exam - ANS-testicle is tender and swollen -sits higher in sac -sits in transverse lie -loss of cremasteric reflex (rise hihgerthan .5cm)
exclusion criteria of tpa - ANS-signficant head trauma or stroke in last 3 mo -sx suggest hemorrhage -hx of previous intracrnail hemorrhage -structural issues in brain -recent surgery -BP>185/ -platelet under 100k -elevated PTT -INR>1. -PT? -CT shows multilobular infarction expect abg to show - ANS-resp aljalosis and hypoxia factors that predict pna on cxr 5 (2 vs, 2 exam, 1 abset) - ANS-fever -tachy > -no asthma -rales -locally dec breath sounds on auscultation frank hypodensity on CT - ANSindicative of completed stroke and may be a contraindication to thrombolytic therapy gold standard for larynx injury assessment (2) - ANSCT. add CTA if vascualr injury is suspected good way to decide dispo for copd - ANSambulatory sat
how decide asthma dispo - ANS-not severitiy of intiial presentaion but their response to tx as measured by PEFR or FEV how decide tidal vol - ANS4-5 ml/kg of ideal body weight (per height) how do needle thoracomoty - ANSPlace a 14-gauge angiocatheter into the 2nd intercostal space at the midclavicular lin how dx - ANScxr shows wide mediastinum -cta is diangostic how get meningitis - ANSpathogens often invade the host through the upper airway by infecting the mucosa, bloodstream, and ultimately crossing the blood-brain barrier how giev epi - ANSIM how give ipratropium v. albuterol - ANS-ipra is given every 4 hrs, not in stacked or repeated doses like albuterol how give o2 in copd - ANS-venturi mask or nasal cannula. try to avoid nonrebreather bc in someone with chronic co2 retention, high flow o2 may cause resp depression how interepret pft - ANSinterpreted using standard tables listing the normal values expected based on the sex, age and height of the patient.
how know its traumatic tap - ANSif fourth tube has almost no lbood in it how know twist right way - ANS-if hard to untwist, try twisting the other way how score sad persons - ANS-everything 1 except the following are 2 -depression/hopelessness -organzied or serious attempt -stated future attmept how tx if stable v. unstable - ANS-periocardiocentesis if stable -if unstable go to OR hx of testicular torsion - ANSairly sudden, severe unilateral testicular pain, sometimes radiating into the abdomen, associated with nausea and vomiting -may have urgency, freuqency, dysuria if albuterol not working waht do (onset) 3 - ANS-steroids: onset in 4-6h -epi -terbutaline if bleed on CT what do - ANSreerse anticoags if cardiac contusion need - ANSformal echo to measure ef -at least 24 hr telemetry bc at risk of dysrthmias and cadiogenic shock
