SAEM EXAM AND PRACTICE EXAM NEWEST 2026/
2027 TEST BANK| SAEM FINAL EXAM PREP WITH
COMPLETE 950 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ (MOST RECENT!!)
19 year old man is brought in to the emergency department by EMS
after being found obtunded in his apartment by a friend. No additional
history is available. On arrival, the patient is minimally responsive with
sonorous respirations and a palpable rapid pulse. The most appropriate
initial diagnostic test would be
A. Arterial blood gas
B. Electrocardiogram
C. Fingerstick glucose
D. Urine drug screen - Correct Answer - C. Fingerstick glucose
Hypoglycemia is a common and readily treatable cause for altered
mental status. An ABG is unlikely to be diagnostic and more likely to
reflect secondary abnormalities caused by respiratory depression. While
a urine drug screen may show positives, it cannot quantitate the amount
of a substance or the time period in which the exposure occurred so a
positive screen may not reflect cause and effect. An EKG, while a part of
a toxicology evaluation, is not an appropriate initiate screening test for
an unstable patient until airway and readily reversible causes have been
addressed.
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
pg. 1
,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. pyloric stenosis - Correct Answer - D. pyloric stenosis
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.
pg. 2
, D. Ultrasound is the study of choice for detecting small ureteral calculi.
- Correct Answer - C. Helical CT scan greater than 95% sensitive and
specific for renal calculi.
Helical CT scan has been shown to be both highly sensitive and specific
in the diagnosis of renal calculi. It is the preferred modality for
evaluation in many centers. Although urinalysis typically demonstrates
hematuria in patients with renal calculi, hematuria is not specific enough
to confirm the diagnosis, and imaging is warranted in all first-time
presenters. KUB detects approximately 60-70% of calculi (though
studies addressing this issue are somewhat methodologically flawed).
Ultrasound is not reliable for detecting small calculi, but is 85-94%
sensitive and 100% specific at demonstrating hydronephrosis. IVP is
contraindicated in patients with renal insufficiency due to the dye load
necessary to perform the study.
A 50 year old man presents with 1 day of gradually worsening,
intermittent, left lower quadrant pain associated with loose stools. He
has had no fevers or bloody bowel movements. Similar symptoms in the
past were self-limited. All vital signs lie within normal limits. Physical
examination shows mild tenderness in the left lower quadrant, normal
active bowel sounds and neither masses nor peritoneal signs. His
primary-care physician can see him tomorrow in his clinic. What should
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 - Correct Answer - B.
Discharge home on high-fiber diet, laxatives and stool softeners
This patient has classic diverticulosis (saclike protrusions of colonic
mucosa through the muscularis) without signs of acute diverticulitis
(inflammation of diverticula). Usually these patients can be managed as
pg. 3
, outpatients with a high-fiber diet and treatments to decrease intestinal
spasm. If the patient develops fever or pain increases he may need
further evaluation to rule out abscess formation. Diverticulitis is treated
with antibiotics, bowel rest and analgesics.
A 53 year old obese woman presents to the emergency department,
accompanied by three of her children, complaining of severe abdominal
pain that began this afternoon after lunch. Physical exam reveals marked
RUQ tenderness. Likely findings on this patient would include all of the
following EXCEPT:
A. positive sonographic Murphy's sign
B. pain in the right scapula
C. leukocytosis with left shift
D. marked inguinal lymphadenopathy
E. aminotransferases and bilirubin within normal limits - Correct
Answer - D. marked inguinal lymphadenopathy
This woman is likely suffering from acute cholecystitis. Predisposing
factors include female gender, obesity, increased age and increased
parity. Inflammation of the gallbladder causes RUQ pain and
sonographic Murphy's sign (inspiratory arrest, due to pain, while the
ultrasound probe is positioned over the gallbladder). Pain may radiate to
the right scapula. Lab studies usually show leukocytosis with or without
a left shift, and aminotransferases and bilirubin are usually within
normal limits.
A 45 year old woman presents with right upper quadrant pain and fever.
The pain is worse after eating. On physical exam she has a Murphy's
sign. The most likely diagnosis is:
A. Appendicitis
B. Diverticulitis
pg. 4
2027 TEST BANK| SAEM FINAL EXAM PREP WITH
COMPLETE 950 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+ (MOST RECENT!!)
19 year old man is brought in to the emergency department by EMS
after being found obtunded in his apartment by a friend. No additional
history is available. On arrival, the patient is minimally responsive with
sonorous respirations and a palpable rapid pulse. The most appropriate
initial diagnostic test would be
A. Arterial blood gas
B. Electrocardiogram
C. Fingerstick glucose
D. Urine drug screen - Correct Answer - C. Fingerstick glucose
Hypoglycemia is a common and readily treatable cause for altered
mental status. An ABG is unlikely to be diagnostic and more likely to
reflect secondary abnormalities caused by respiratory depression. While
a urine drug screen may show positives, it cannot quantitate the amount
of a substance or the time period in which the exposure occurred so a
positive screen may not reflect cause and effect. An EKG, while a part of
a toxicology evaluation, is not an appropriate initiate screening test for
an unstable patient until airway and readily reversible causes have been
addressed.
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
pg. 1
,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. pyloric stenosis - Correct Answer - D. pyloric stenosis
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.
pg. 2
, D. Ultrasound is the study of choice for detecting small ureteral calculi.
- Correct Answer - C. Helical CT scan greater than 95% sensitive and
specific for renal calculi.
Helical CT scan has been shown to be both highly sensitive and specific
in the diagnosis of renal calculi. It is the preferred modality for
evaluation in many centers. Although urinalysis typically demonstrates
hematuria in patients with renal calculi, hematuria is not specific enough
to confirm the diagnosis, and imaging is warranted in all first-time
presenters. KUB detects approximately 60-70% of calculi (though
studies addressing this issue are somewhat methodologically flawed).
Ultrasound is not reliable for detecting small calculi, but is 85-94%
sensitive and 100% specific at demonstrating hydronephrosis. IVP is
contraindicated in patients with renal insufficiency due to the dye load
necessary to perform the study.
A 50 year old man presents with 1 day of gradually worsening,
intermittent, left lower quadrant pain associated with loose stools. He
has had no fevers or bloody bowel movements. Similar symptoms in the
past were self-limited. All vital signs lie within normal limits. Physical
examination shows mild tenderness in the left lower quadrant, normal
active bowel sounds and neither masses nor peritoneal signs. His
primary-care physician can see him tomorrow in his clinic. What should
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 - Correct Answer - B.
Discharge home on high-fiber diet, laxatives and stool softeners
This patient has classic diverticulosis (saclike protrusions of colonic
mucosa through the muscularis) without signs of acute diverticulitis
(inflammation of diverticula). Usually these patients can be managed as
pg. 3
, outpatients with a high-fiber diet and treatments to decrease intestinal
spasm. If the patient develops fever or pain increases he may need
further evaluation to rule out abscess formation. Diverticulitis is treated
with antibiotics, bowel rest and analgesics.
A 53 year old obese woman presents to the emergency department,
accompanied by three of her children, complaining of severe abdominal
pain that began this afternoon after lunch. Physical exam reveals marked
RUQ tenderness. Likely findings on this patient would include all of the
following EXCEPT:
A. positive sonographic Murphy's sign
B. pain in the right scapula
C. leukocytosis with left shift
D. marked inguinal lymphadenopathy
E. aminotransferases and bilirubin within normal limits - Correct
Answer - D. marked inguinal lymphadenopathy
This woman is likely suffering from acute cholecystitis. Predisposing
factors include female gender, obesity, increased age and increased
parity. Inflammation of the gallbladder causes RUQ pain and
sonographic Murphy's sign (inspiratory arrest, due to pain, while the
ultrasound probe is positioned over the gallbladder). Pain may radiate to
the right scapula. Lab studies usually show leukocytosis with or without
a left shift, and aminotransferases and bilirubin are usually within
normal limits.
A 45 year old woman presents with right upper quadrant pain and fever.
The pain is worse after eating. On physical exam she has a Murphy's
sign. The most likely diagnosis is:
A. Appendicitis
B. Diverticulitis
pg. 4
