SAEM Practice 2026 Exam study guide COMPLETE
EXAM Questions and Answers (Verified Answers)
(Latest Update 2026) UPDATE!!
All of the following factors predispose to cecal volvulus EXCEPT:
A. pregnancy
B. age 25-35
C. prior abdominal surgery
D. marathon running
E. severe chronic constipation
E. severe chronic constipation
Cecal volvulus occurs as a result of abnormal fixation of the right colon
and increased mobility of the cecum. Depending on the degree of
rotation around the mesenteric axis, cecal volvulus can lead to twisting
of the mesentery and its blood vessels. Cecal volvulus occurs most
commonly in people 25-35 years old and should be suspected in cases
of bowel obstruction without known risk factors. Prior abdominal
surgery and pregnancy predispose to obstruction or cecal volvulus;
however, chronic constipation is not known to predispose to cecal
volvulus. Interestingly, marathon runners have been found to have a
higher incidence of cecal volvulus, perhaps from having a thin, flexible
mesentery that more easily permits rotation of the cecum around the
mesenteric pedicle.
,Which of the following pairings of referred pain and causal disease is
least likely to be encountered?
A. sacral pain—ovarian torsion
B. inguinal pain—ureteral colic
C. epigastric pain—myocardial infarction
D. shoulder pain—ruptured spleen
E. thoracic back pain—pancreatitis
A. sacral pain—ovarian torsion
Ovarian torsion may cause lower abdominal pain, pelvic pain, adnexal
tenderness, and cervical motion tenderness, but it is not known to cause
sacral pain.
,A 72 year old man with a history of diverticulosis presents with vague
abdominal pain for the past day. His physical exam is notable for normal
vital signs, left lower quadrant abdominal tenderness without rebound
or guarding, and guaiac positive brown stool. Work-up including KUB
and abdominal/pelvic CT scan reveals diverticulitis without perforation.
Of the following choices, which is the most appropriate management of
this patient?
A. type and cross two units of packed red blood cells
B. immediate surgical intervention
C. discharge on oral pain medications
D. barium enema to evaluate for carcinoma of the colon
E. admission for intravenous antibiotics and fluids
E. admission for intravenous antibiotics and fluids
For mild episodes of diverticulitis in which there is no evidence of
perforation or peritonitis, there is no indication for immediate surgical
intervention. Conservative management with intravenous fluids and
antibiotics as well as bowel rest is typically first attempted. Although
colon carcinoma may be a precipitating factor in the development of
diverticulitis, barium enema should be avoided in the acute period due
to high risk of bowel perforation. Although some patients with mild
cases of diverticulitis may be discharged home with conservative
treatment, the elderly are at higher risk of perforation and should be
admitted. Guaiac positive stool in seen in up to 50% of patients with
diverticulitis. There is no reason to suspect acute blood loss requiring
transfusion in diverticulitis.
, Regarding esophageal perforation, which of the following is
INCORRECT:
A. Esophageal perforation has been reported as a complication of
nasogastric tube placement, endotracheal intubation, and
esophagotracheal Combitube intubation.
B. Esophageal perforation may result from forceful vomiting, coughing,
childbirth or heavy lifting.
C. Over 80% of esophageal perforations are iatrogenic, usually as
complications of upper endoscopy, dilation, or sclerotherapy.
D. Over 90% of spontaneous esophageal perforations occur in the
proximal esophagus.
E. Iatrogenic perforations of the esophagus usually occur in the
proximal esophagus or esophagogastric junction.
D. Over 90% of spontaneous esophageal perforations occur in the
proximal esophagus.
Over 90% of spontaneous esophageal perforations occur in the distal
esophagus, whereas iatrogenic perforations are frequently at the
pharyngoesophageal junction or the esophagogastric junction. Foreign
body or caustic substance ingestion, severe blunt injury or penetrating
trauma, and carcinoma are other causes of esophageal perforation.
EXAM Questions and Answers (Verified Answers)
(Latest Update 2026) UPDATE!!
All of the following factors predispose to cecal volvulus EXCEPT:
A. pregnancy
B. age 25-35
C. prior abdominal surgery
D. marathon running
E. severe chronic constipation
E. severe chronic constipation
Cecal volvulus occurs as a result of abnormal fixation of the right colon
and increased mobility of the cecum. Depending on the degree of
rotation around the mesenteric axis, cecal volvulus can lead to twisting
of the mesentery and its blood vessels. Cecal volvulus occurs most
commonly in people 25-35 years old and should be suspected in cases
of bowel obstruction without known risk factors. Prior abdominal
surgery and pregnancy predispose to obstruction or cecal volvulus;
however, chronic constipation is not known to predispose to cecal
volvulus. Interestingly, marathon runners have been found to have a
higher incidence of cecal volvulus, perhaps from having a thin, flexible
mesentery that more easily permits rotation of the cecum around the
mesenteric pedicle.
,Which of the following pairings of referred pain and causal disease is
least likely to be encountered?
A. sacral pain—ovarian torsion
B. inguinal pain—ureteral colic
C. epigastric pain—myocardial infarction
D. shoulder pain—ruptured spleen
E. thoracic back pain—pancreatitis
A. sacral pain—ovarian torsion
Ovarian torsion may cause lower abdominal pain, pelvic pain, adnexal
tenderness, and cervical motion tenderness, but it is not known to cause
sacral pain.
,A 72 year old man with a history of diverticulosis presents with vague
abdominal pain for the past day. His physical exam is notable for normal
vital signs, left lower quadrant abdominal tenderness without rebound
or guarding, and guaiac positive brown stool. Work-up including KUB
and abdominal/pelvic CT scan reveals diverticulitis without perforation.
Of the following choices, which is the most appropriate management of
this patient?
A. type and cross two units of packed red blood cells
B. immediate surgical intervention
C. discharge on oral pain medications
D. barium enema to evaluate for carcinoma of the colon
E. admission for intravenous antibiotics and fluids
E. admission for intravenous antibiotics and fluids
For mild episodes of diverticulitis in which there is no evidence of
perforation or peritonitis, there is no indication for immediate surgical
intervention. Conservative management with intravenous fluids and
antibiotics as well as bowel rest is typically first attempted. Although
colon carcinoma may be a precipitating factor in the development of
diverticulitis, barium enema should be avoided in the acute period due
to high risk of bowel perforation. Although some patients with mild
cases of diverticulitis may be discharged home with conservative
treatment, the elderly are at higher risk of perforation and should be
admitted. Guaiac positive stool in seen in up to 50% of patients with
diverticulitis. There is no reason to suspect acute blood loss requiring
transfusion in diverticulitis.
, Regarding esophageal perforation, which of the following is
INCORRECT:
A. Esophageal perforation has been reported as a complication of
nasogastric tube placement, endotracheal intubation, and
esophagotracheal Combitube intubation.
B. Esophageal perforation may result from forceful vomiting, coughing,
childbirth or heavy lifting.
C. Over 80% of esophageal perforations are iatrogenic, usually as
complications of upper endoscopy, dilation, or sclerotherapy.
D. Over 90% of spontaneous esophageal perforations occur in the
proximal esophagus.
E. Iatrogenic perforations of the esophagus usually occur in the
proximal esophagus or esophagogastric junction.
D. Over 90% of spontaneous esophageal perforations occur in the
proximal esophagus.
Over 90% of spontaneous esophageal perforations occur in the distal
esophagus, whereas iatrogenic perforations are frequently at the
pharyngoesophageal junction or the esophagogastric junction. Foreign
body or caustic substance ingestion, severe blunt injury or penetrating
trauma, and carcinoma are other causes of esophageal perforation.
