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SAEM EXAM LATEST 2025/2026 UPDATE
ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES
"A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
The answer is A. The presentation of acute appendicitis varies tremendously. Early in its
course, vital signs including temperature may be normal. Once perforation has occurred, the
rate of low-grade fever (<38 C) increases to about 40%. Other variations in presentation include
pain in the right upper quadrant, typically from a retrocecal or retroiliac appendix."
"Regarding the diagnosis of acute appendicitis, all the following are true EXCEPT:
A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
B. Rebound is usually elicited only after the appendix has ruptured or infarcted.
C. Rovsing's sign is pain in the right lower quadrant upon palpation of the left lower quadrant.
D. The obturator sign is pain upon flexion and internal rotation of the hip.
E. The psoas sign is pain upon extension of the hip."
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"E. Pain in the right lower quadrant when left lower quadrant is palpated.
The answer is E. Rosving's sign is pain in the right lower quadrant when the left lower quadrant
is palpated. Rebound tenderness occurs with the release of pressure. The iliopsoas sign is pain
associated with thigh flexion. The obturator sign is pain that occurs with thigh rotation. All of
these signs are associated with appendicitis. Murphy's sign is cessation of inspiration during
palpation of the right upper quadrant and is associated with acute cholecystitis."
"Rosving's sign is described as:
A. Tenderness in the right upper quadrant that is worse with inspiration.
B. Pelvic pain upon flexion of the thigh while the patient is supine.
C. Pelvic pain upon internal and external rotation of the thigh with the knee flexed.
D. Pain that increases with the release of pressure of palpation.
E. Pain in the right lower quadrant when left lower quadrant is palpated."
"D. The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of
a surgical etiology.
The answer is D. Pain prior to nausea and vomiting is often suggestive of a surgical etiology of
the pain, such as small bowel obstruction. Cervical motion tenderness has been noted in up to
25% of women with acute appendicitis. Patients with sickle cell anemia are prone to Salmonella
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infections. Radiation of pain to the scapula is classically present in acute choleycystitis.
Diverticulitis pain is generally located in the left lower quadrant."
"In establishing a differential diagnosis of abdominal pain, which of the following is true?
A. Radiation of pain to the scapula is suggestive of acute hepatitis.
B. Cervical motion tenderness is a useful physical finding for differentiating women with or
without acute appendicitis.
C. In patients with sickle cell anemia who present with abdominal pain and diarrhea, shigellosis
should be a top consideration.
D. The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of
a surgical etiology.
E. Diverticulitis tends to cause pain in the right upper quadrant."
"C. unrelenting pain over a period of weeks
The answer is C. Pain from peptic ulcer disease typically occurs in periods of exacerbation and
remission. Unrelenting pain over weeks or months should suggest an alternative diagnosis. Pain
is classically described as non-radiating, burning epigastric pain. Some patients may also
complain of chest or back pain. Pain is frequently severe enough to awaken patients from sleep
in early morning hours but is often not present upon waking in the morning, as gastric acid
secretion peaks around 2 a.m. and nadirs upon awakening."
"Of the following pain patterns, which is the least likely associated with diagnosis of peptic ulcer
disease?
A. non-radiating, burning epigastric pain
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B. pain that awakens a patient in the middle of the night
C. unrelenting pain over a period of weeks
D. relief of abdominal pain with antacids
E. pain that is worse preceding a meal"
The answer is D. A patient with this general picture is most likely to have diverticulitis, which is
revealed on the CT scan as diverticular disease with inflammation (wall thickening and
stranding).
"A 78 year old female presents to the E.D. with a sensation of left-lower quadrant abdominal
pain, accompanied by some irregular bowel movements and loss of appetite. Her abdominal CT
(two images) is shown in the Figure. What is the most likely diagnosis?
A. ovarian cyst
B. volvulus
C. appendicitis
D. diverticulitis
E. gastroenteritis"
"E. pyloric stenosis
Page 4SAEM
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SAEM EXAM LATEST 2025/2026 UPDATE
ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES
"A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
The answer is A. The presentation of acute appendicitis varies tremendously. Early in its
course, vital signs including temperature may be normal. Once perforation has occurred, the
rate of low-grade fever (<38 C) increases to about 40%. Other variations in presentation include
pain in the right upper quadrant, typically from a retrocecal or retroiliac appendix."
"Regarding the diagnosis of acute appendicitis, all the following are true EXCEPT:
A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
B. Rebound is usually elicited only after the appendix has ruptured or infarcted.
C. Rovsing's sign is pain in the right lower quadrant upon palpation of the left lower quadrant.
D. The obturator sign is pain upon flexion and internal rotation of the hip.
E. The psoas sign is pain upon extension of the hip."
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"E. Pain in the right lower quadrant when left lower quadrant is palpated.
The answer is E. Rosving's sign is pain in the right lower quadrant when the left lower quadrant
is palpated. Rebound tenderness occurs with the release of pressure. The iliopsoas sign is pain
associated with thigh flexion. The obturator sign is pain that occurs with thigh rotation. All of
these signs are associated with appendicitis. Murphy's sign is cessation of inspiration during
palpation of the right upper quadrant and is associated with acute cholecystitis."
"Rosving's sign is described as:
A. Tenderness in the right upper quadrant that is worse with inspiration.
B. Pelvic pain upon flexion of the thigh while the patient is supine.
C. Pelvic pain upon internal and external rotation of the thigh with the knee flexed.
D. Pain that increases with the release of pressure of palpation.
E. Pain in the right lower quadrant when left lower quadrant is palpated."
"D. The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of
a surgical etiology.
The answer is D. Pain prior to nausea and vomiting is often suggestive of a surgical etiology of
the pain, such as small bowel obstruction. Cervical motion tenderness has been noted in up to
25% of women with acute appendicitis. Patients with sickle cell anemia are prone to Salmonella
Page 2SAEM
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,Page 3SAEM
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infections. Radiation of pain to the scapula is classically present in acute choleycystitis.
Diverticulitis pain is generally located in the left lower quadrant."
"In establishing a differential diagnosis of abdominal pain, which of the following is true?
A. Radiation of pain to the scapula is suggestive of acute hepatitis.
B. Cervical motion tenderness is a useful physical finding for differentiating women with or
without acute appendicitis.
C. In patients with sickle cell anemia who present with abdominal pain and diarrhea, shigellosis
should be a top consideration.
D. The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of
a surgical etiology.
E. Diverticulitis tends to cause pain in the right upper quadrant."
"C. unrelenting pain over a period of weeks
The answer is C. Pain from peptic ulcer disease typically occurs in periods of exacerbation and
remission. Unrelenting pain over weeks or months should suggest an alternative diagnosis. Pain
is classically described as non-radiating, burning epigastric pain. Some patients may also
complain of chest or back pain. Pain is frequently severe enough to awaken patients from sleep
in early morning hours but is often not present upon waking in the morning, as gastric acid
secretion peaks around 2 a.m. and nadirs upon awakening."
"Of the following pain patterns, which is the least likely associated with diagnosis of peptic ulcer
disease?
A. non-radiating, burning epigastric pain
Page 3SAEM
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B. pain that awakens a patient in the middle of the night
C. unrelenting pain over a period of weeks
D. relief of abdominal pain with antacids
E. pain that is worse preceding a meal"
The answer is D. A patient with this general picture is most likely to have diverticulitis, which is
revealed on the CT scan as diverticular disease with inflammation (wall thickening and
stranding).
"A 78 year old female presents to the E.D. with a sensation of left-lower quadrant abdominal
pain, accompanied by some irregular bowel movements and loss of appetite. Her abdominal CT
(two images) is shown in the Figure. What is the most likely diagnosis?
A. ovarian cyst
B. volvulus
C. appendicitis
D. diverticulitis
E. gastroenteritis"
"E. pyloric stenosis
Page 4SAEM
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