1|Page
YEAR 3 SAEM QUESTIONS WITH
QUESTIONS AND ANSWERS 100%
VERIFIED
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. - correct answer_ 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.
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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. - correct 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.
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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. -
correct 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
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E. pain that is worse preceding a meal - correct 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 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 - correct answer_ 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).
YEAR 3 SAEM QUESTIONS WITH
QUESTIONS AND ANSWERS 100%
VERIFIED
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. - correct answer_ 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.
,2|Page
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. - correct 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.
,3|Page
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. -
correct 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
, 4|Page
E. pain that is worse preceding a meal - correct 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 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 - correct answer_ 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).
