SAEM EXAM QUESTIONS 2026
ACTUAL EXAM 400 REAL EXAM
QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
"Regarding the diagnosis of acute appendicitis, all "A. Vital signs are usually abnormal, even early in the course of
acute the following are true EXCEPT: appendicitis.
A. Vital signs are usually abnormal, even early in
the course of acute appendicitis. The answer is A. The presentation of acute appendicitis varies
B.Rebound is usually elicited only after the tremendously. Early in its course, vital signs including temperature may
appendix has ruptured or infarcted. be normal. Once perforation has occurred, the rate of low-grade fever
C. Rovsing's sign is pain in the right lower quadrant (<38 C) increases to about 40%. Other variations in presentation include
upon palpation of the left lower quadrant. pain in the right upper quadrant, typically from a retrocecal or retroiliac
D.The obturator sign is pain upon flexion and appendix."
internal rotation of the hip.
E.The psoas sign is pain upon extension of
the hip."
,"Rosving's sign is described as: "E. Pain in the right lower quadrant when left lower quadrant is palpated.
A. Tenderness in the right upper quadrant that is
worse with inspiration. The answer is E. Rosving's sign is pain in the right lower quadrant when
B.Pelvic pain upon flexion of the thigh while the the left lower quadrant is palpated. Rebound tenderness occurs
patient is supine. with the release of pressure. The iliopsoas sign is pain associated with
C. Pelvic pain upon internal and external thigh flexion. The obturator sign is pain that occurs with thigh
rotation of the thigh with the knee flexed. rotation. All of these signs are associated with appendicitis. Murphy's
D.Pain that increases with the release of pressure sign is cessation of inspiration during palpation of the right upper
of palpation. quadrant and is associated with acute cholecystitis."
E. Pain in the right lower quadrant when left
lower quadrant is palpated."
"In establishing a differential diagnosis of
"D. The onset of pain prior to the occurrence of nausea and vomiting is
abdominal pain, which of the following is true?
more often suggestive of a surgical etiology.
A. Radiation of pain to the scapula is suggestive
of acute hepatitis.
The answer is D. Pain prior to nausea and vomiting is often suggestive
B.Cervical motion tenderness is a useful
of a surgical etiology of the pain, such as small bowel obstruction.
physical finding for differentiating women with
Cervical motion tenderness has been noted in up to 25% of women
or without acute appendicitis.
with acute appendicitis. Patients with sickle cell anemia are prone to
C. In patients with sickle cell anemia who
Salmonella infections. Radiation of pain to the scapula is classically
present with abdominal pain and diarrhea,
present in acute choleycystitis. Diverticulitis pain is generally located
shigellosis should be a top consideration.
in the left lower quadrant."
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."
"Of the following pain patterns, which is the least
"C. unrelenting pain over a period of weeks
likely associated with diagnosis of peptic ulcer
disease?
The answer is C. Pain from peptic ulcer disease typically occurs in
A. non-radiating, burning epigastric pain
periods of exacerbation and remission. Unrelenting pain over weeks or
B.pain that awakens a patient in the middle of
months should suggest an alternative diagnosis. Pain is classically
the night
described as non-radiating, burning epigastric pain. Some patients may
C. unrelenting pain over a period of weeks
also complain of chest or back pain. Pain is frequently severe enough to
D.relief of abdominal pain with antacids
awaken patients from sleep in early morning hours but is often not
E. pain that is worse preceding a meal"
present upon waking in the morning, as gastric acid secretion
peaks around 2 a.m. and nadirs upon awakening."
"A 78 year old female presents to the E.D. with
The answer is D. A patient with this general picture is most likely to have
a sensation of left-lower quadrant abdominal
diverticulitis, which is revealed on the CT scan as diverticular disease
pain, accompanied by some irregular bowel
with inflammation (wall thickening and stranding).
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"
, "A mother brings her 6 week old boy to the "E. pyloric stenosis
emergency room. She states the baby has
been vomiting everything she's tried to feed him The answer is E. Hypertrophic pyloric stenosis typically presents in the
for the past 12 hours. She states that he usually second to sixth week of life and is four times more common in
eats readily and completes an entire feeding, but males than females. Infants with hypertrophic pyloric stenosis
he is unable to keep anything down. The emesis typically are vigorous eaters but shortly afterward regurgitate the
is non-bloody and non-bilious, however it is entire feeding contents in a projectile fashion. The emesis is non-
projectile in nature. What is the most likely bilious. The classic finding on exam is an "olive" palpable in the
condition in this patient? abdomen, and diagnosis is typically via ultrasound. Intussusception
A. viral gastroenteritis typically presents between the ages of 5 and 12 months.
B.constipation Gastroenteritis is characterized by diarrhea as well as vomiting.
C. appendicitis Neither constipation nor appendicitis typically present with protracted
D.intussusception vomiting, though the latter condition tends to present atypically in
E. pyloric stenosis" young children (and elderly adults)."
"A 46 year old woman presents to the emergency "C. Helical CT scan greater than 95% sensitive and specific for renal
department complaining of abrupt onset of calculi.
intermittent severe pain in the left flank and
abdomen that woke her from sleep. She is pacing The answer is C. Helical CT scan has been shown to be both highly
around the stretcher and appears extremely sensitive and specific in the diagnosis of renal calculi. It is the preferred
uncomfortable. She has never experienced this modality for evaluation in many centers. Although urinalysis typically
type of pain previously and denies fevers or other demonstrates hematuria in patients with renal calculi, hematuria is not
symptoms. Renal calculus is suspected. Which of specific enough to confirm the diagnosis, and imaging is warranted in
the following is true regarding the diagnosis of all first-time presenters. KUB detects approximately 60-70% of calculi
renal calculi in this patient? (though studies addressing this issue are somewhat methodologically
A. Urinalysis demonstrating hematuria confirms the flawed). Ultrasound is not reliable for detecting small calculi, but is 85-
diagnosis. 94% sensitive and 100% specific at demonstrating hydronephrosis. IVP is
B.KUB detects less than 10% of calculi. contraindicated in patients with renal insufficiency due to the dye
C. Helical CT scan greater than 95% sensitive and load necessary to perform the study."
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."
"A 50 year old man presents with 1 day of gradually "B. Discharge home on high-fiber diet, laxatives and stool softeners
worsening, intermittent, left lower quadrant pain
associated with loose stools. He has had no fevers The answer is B. This patient has classic diverticulosis (saclike protrusions
or bloody bowel movements. Similar symptoms in of colonic mucosa through the muscularis) without signs of acute
the past were self-limited. All vital signs lie diverticulitis (inflammation of diverticula). Usually these patients can be
within normal limits. Physical examination shows managed as outpatients with a high-fiber diet and treatments to
mild tenderness in the left lower quadrant, decrease intestinal spasm. If the patient develops fever or pain
normal active bowel sounds and neither masses increases he may need further evaluation to rule out abscess
nor peritoneal signs. His primary-care physician formation. Diverticulitis is treated with antibiotics, bowel rest and
can see him tomorrow in his clinic. What should analgesics."
be done next in the E.D.?
A. Discharge home after a single dose of IV
antibiotics
B.Discharge home on high-fiber diet, laxatives
and stool softeners
C. Gastroenterology consult for endoscopy
D.Admit for observation and serial examinations"
ACTUAL EXAM 400 REAL EXAM
QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
"Regarding the diagnosis of acute appendicitis, all "A. Vital signs are usually abnormal, even early in the course of
acute the following are true EXCEPT: appendicitis.
A. Vital signs are usually abnormal, even early in
the course of acute appendicitis. The answer is A. The presentation of acute appendicitis varies
B.Rebound is usually elicited only after the tremendously. Early in its course, vital signs including temperature may
appendix has ruptured or infarcted. be normal. Once perforation has occurred, the rate of low-grade fever
C. Rovsing's sign is pain in the right lower quadrant (<38 C) increases to about 40%. Other variations in presentation include
upon palpation of the left lower quadrant. pain in the right upper quadrant, typically from a retrocecal or retroiliac
D.The obturator sign is pain upon flexion and appendix."
internal rotation of the hip.
E.The psoas sign is pain upon extension of
the hip."
,"Rosving's sign is described as: "E. Pain in the right lower quadrant when left lower quadrant is palpated.
A. Tenderness in the right upper quadrant that is
worse with inspiration. The answer is E. Rosving's sign is pain in the right lower quadrant when
B.Pelvic pain upon flexion of the thigh while the the left lower quadrant is palpated. Rebound tenderness occurs
patient is supine. with the release of pressure. The iliopsoas sign is pain associated with
C. Pelvic pain upon internal and external thigh flexion. The obturator sign is pain that occurs with thigh
rotation of the thigh with the knee flexed. rotation. All of these signs are associated with appendicitis. Murphy's
D.Pain that increases with the release of pressure sign is cessation of inspiration during palpation of the right upper
of palpation. quadrant and is associated with acute cholecystitis."
E. Pain in the right lower quadrant when left
lower quadrant is palpated."
"In establishing a differential diagnosis of
"D. The onset of pain prior to the occurrence of nausea and vomiting is
abdominal pain, which of the following is true?
more often suggestive of a surgical etiology.
A. Radiation of pain to the scapula is suggestive
of acute hepatitis.
The answer is D. Pain prior to nausea and vomiting is often suggestive
B.Cervical motion tenderness is a useful
of a surgical etiology of the pain, such as small bowel obstruction.
physical finding for differentiating women with
Cervical motion tenderness has been noted in up to 25% of women
or without acute appendicitis.
with acute appendicitis. Patients with sickle cell anemia are prone to
C. In patients with sickle cell anemia who
Salmonella infections. Radiation of pain to the scapula is classically
present with abdominal pain and diarrhea,
present in acute choleycystitis. Diverticulitis pain is generally located
shigellosis should be a top consideration.
in the left lower quadrant."
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."
"Of the following pain patterns, which is the least
"C. unrelenting pain over a period of weeks
likely associated with diagnosis of peptic ulcer
disease?
The answer is C. Pain from peptic ulcer disease typically occurs in
A. non-radiating, burning epigastric pain
periods of exacerbation and remission. Unrelenting pain over weeks or
B.pain that awakens a patient in the middle of
months should suggest an alternative diagnosis. Pain is classically
the night
described as non-radiating, burning epigastric pain. Some patients may
C. unrelenting pain over a period of weeks
also complain of chest or back pain. Pain is frequently severe enough to
D.relief of abdominal pain with antacids
awaken patients from sleep in early morning hours but is often not
E. pain that is worse preceding a meal"
present upon waking in the morning, as gastric acid secretion
peaks around 2 a.m. and nadirs upon awakening."
"A 78 year old female presents to the E.D. with
The answer is D. A patient with this general picture is most likely to have
a sensation of left-lower quadrant abdominal
diverticulitis, which is revealed on the CT scan as diverticular disease
pain, accompanied by some irregular bowel
with inflammation (wall thickening and stranding).
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"
, "A mother brings her 6 week old boy to the "E. pyloric stenosis
emergency room. She states the baby has
been vomiting everything she's tried to feed him The answer is E. Hypertrophic pyloric stenosis typically presents in the
for the past 12 hours. She states that he usually second to sixth week of life and is four times more common in
eats readily and completes an entire feeding, but males than females. Infants with hypertrophic pyloric stenosis
he is unable to keep anything down. The emesis typically are vigorous eaters but shortly afterward regurgitate the
is non-bloody and non-bilious, however it is entire feeding contents in a projectile fashion. The emesis is non-
projectile in nature. What is the most likely bilious. The classic finding on exam is an "olive" palpable in the
condition in this patient? abdomen, and diagnosis is typically via ultrasound. Intussusception
A. viral gastroenteritis typically presents between the ages of 5 and 12 months.
B.constipation Gastroenteritis is characterized by diarrhea as well as vomiting.
C. appendicitis Neither constipation nor appendicitis typically present with protracted
D.intussusception vomiting, though the latter condition tends to present atypically in
E. pyloric stenosis" young children (and elderly adults)."
"A 46 year old woman presents to the emergency "C. Helical CT scan greater than 95% sensitive and specific for renal
department complaining of abrupt onset of calculi.
intermittent severe pain in the left flank and
abdomen that woke her from sleep. She is pacing The answer is C. Helical CT scan has been shown to be both highly
around the stretcher and appears extremely sensitive and specific in the diagnosis of renal calculi. It is the preferred
uncomfortable. She has never experienced this modality for evaluation in many centers. Although urinalysis typically
type of pain previously and denies fevers or other demonstrates hematuria in patients with renal calculi, hematuria is not
symptoms. Renal calculus is suspected. Which of specific enough to confirm the diagnosis, and imaging is warranted in
the following is true regarding the diagnosis of all first-time presenters. KUB detects approximately 60-70% of calculi
renal calculi in this patient? (though studies addressing this issue are somewhat methodologically
A. Urinalysis demonstrating hematuria confirms the flawed). Ultrasound is not reliable for detecting small calculi, but is 85-
diagnosis. 94% sensitive and 100% specific at demonstrating hydronephrosis. IVP is
B.KUB detects less than 10% of calculi. contraindicated in patients with renal insufficiency due to the dye
C. Helical CT scan greater than 95% sensitive and load necessary to perform the study."
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."
"A 50 year old man presents with 1 day of gradually "B. Discharge home on high-fiber diet, laxatives and stool softeners
worsening, intermittent, left lower quadrant pain
associated with loose stools. He has had no fevers The answer is B. This patient has classic diverticulosis (saclike protrusions
or bloody bowel movements. Similar symptoms in of colonic mucosa through the muscularis) without signs of acute
the past were self-limited. All vital signs lie diverticulitis (inflammation of diverticula). Usually these patients can be
within normal limits. Physical examination shows managed as outpatients with a high-fiber diet and treatments to
mild tenderness in the left lower quadrant, decrease intestinal spasm. If the patient develops fever or pain
normal active bowel sounds and neither masses increases he may need further evaluation to rule out abscess
nor peritoneal signs. His primary-care physician formation. Diverticulitis is treated with antibiotics, bowel rest and
can see him tomorrow in his clinic. What should analgesics."
be done next in the E.D.?
A. Discharge home after a single dose of IV
antibiotics
B.Discharge home on high-fiber diet, laxatives
and stool softeners
C. Gastroenterology consult for endoscopy
D.Admit for observation and serial examinations"
