SAEM CERTIFICATION EVALUATION TEST
PAPER QUESTIONS AND SOLUTIONS
VERIFIED COMPLETE
●● 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.
Answer: 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.
●● 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.
Answer: 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 infections. Radiation of pain to the scapula is classically
present in acute choleycystitis. Diverticulitis pain is generally located in
the left lower quadrant.
●● Of the following pain patterns, which is the least likely associated
with diagnosis of peptic ulcer disease?
A. non-radiating, burning epigastric pain
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
Answer: 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.
●● A mother brings her 6 week old boy to the emergency room. She
states the baby has been vomiting everything she's tried to feed him for
the past 12 hours. She states that he usually eats readily and completes
an entire feeding, but he is unable to keep anything down. The emesis is
non-bloody and non-bilious, however it is projectile in nature. What is
the most likely condition in this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
D. intussusception
E. pyloric stenosis
Answer: E. pyloric stenosis
, The answer is E. Hypertrophic pyloric stenosis typically presents in the
second to sixth week of life and is four times more common in males
than females. Infants with hypertrophic pyloric stenosis typically are
vigorous eaters but shortly afterward regurgitate the entire feeding
contents in a projectile fashion. The emesis is non-bilious. The classic
finding on exam is an "olive" palpable in the abdomen, and diagnosis is
typically via ultrasound. Intussusception typically presents between the
ages of 5 and 12 months. Gastroenteritis is characterized by diarrhea as
well as vomiting. Neither constipation nor appendicitis typically present
with protracted vomiting, though the latter condition tends to present
atypically in young children (and elderly adults).
●● A 46 year old woman presents to the emergency department
complaining of abrupt onset of intermittent severe pain in the left flank
and abdomen that woke her from sleep. She is pacing around the
stretcher and appears extremely uncomfortable. She has never
experienced this type of pain previously and denies fevers or other
symptoms. Renal calculus is suspected. Which of the following is true
regarding the diagnosis of renal calculi in this patient?
A. Urinalysis demonstrating hematuria confirms the diagnosis.
B. KUB detects less than 10% of calculi.
C. Helical CT scan greater than 95% sensitive and specific for renal
calculi.
D. Ultrasound is the study of choice for detecting small ureteral calculi.
E. Intravenous pyelogram (IVP) may be used in patients with renal
insufficiency.
PAPER QUESTIONS AND SOLUTIONS
VERIFIED COMPLETE
●● 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.
Answer: 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.
●● 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.
Answer: 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 infections. Radiation of pain to the scapula is classically
present in acute choleycystitis. Diverticulitis pain is generally located in
the left lower quadrant.
●● Of the following pain patterns, which is the least likely associated
with diagnosis of peptic ulcer disease?
A. non-radiating, burning epigastric pain
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
Answer: 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.
●● A mother brings her 6 week old boy to the emergency room. She
states the baby has been vomiting everything she's tried to feed him for
the past 12 hours. She states that he usually eats readily and completes
an entire feeding, but he is unable to keep anything down. The emesis is
non-bloody and non-bilious, however it is projectile in nature. What is
the most likely condition in this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
D. intussusception
E. pyloric stenosis
Answer: E. pyloric stenosis
, The answer is E. Hypertrophic pyloric stenosis typically presents in the
second to sixth week of life and is four times more common in males
than females. Infants with hypertrophic pyloric stenosis typically are
vigorous eaters but shortly afterward regurgitate the entire feeding
contents in a projectile fashion. The emesis is non-bilious. The classic
finding on exam is an "olive" palpable in the abdomen, and diagnosis is
typically via ultrasound. Intussusception typically presents between the
ages of 5 and 12 months. Gastroenteritis is characterized by diarrhea as
well as vomiting. Neither constipation nor appendicitis typically present
with protracted vomiting, though the latter condition tends to present
atypically in young children (and elderly adults).
●● A 46 year old woman presents to the emergency department
complaining of abrupt onset of intermittent severe pain in the left flank
and abdomen that woke her from sleep. She is pacing around the
stretcher and appears extremely uncomfortable. She has never
experienced this type of pain previously and denies fevers or other
symptoms. Renal calculus is suspected. Which of the following is true
regarding the diagnosis of renal calculi in this patient?
A. Urinalysis demonstrating hematuria confirms the diagnosis.
B. KUB detects less than 10% of calculi.
C. Helical CT scan greater than 95% sensitive and specific for renal
calculi.
D. Ultrasound is the study of choice for detecting small ureteral calculi.
E. Intravenous pyelogram (IVP) may be used in patients with renal
insufficiency.
