SAEM EXAM |LATEST UPDATED 2026/2027 |A
COMPLETE SOLUTION WITH VERIFIED QUESTIONS
AND ANSWERS WITH RATIONALES |GET IT 100%
CORRECT |GRADED A+
"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."
"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."
"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."
,"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."
"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"
"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 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"
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 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"
"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."
COMPLETE SOLUTION WITH VERIFIED QUESTIONS
AND ANSWERS WITH RATIONALES |GET IT 100%
CORRECT |GRADED A+
"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."
"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."
"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."
,"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."
"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"
"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 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"
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 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"
"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."
