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SAEM EXAM QUESTIONS 2024-2025
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"Regarding the diagnosis of "A. Vital signs are usually abnormal, even early in the course of
acute appendicitis, all the acute appendicitis.
following are true EXCEPT:
A. Vital signs are usually The answer is A. The presentation of acute appendicitis varies
abnormal, even early in the tremendously. Early in its course, vital signs including
course of acute appendicitis. temperature may be normal. Once perforation has occurred, the
B. Rebound is usually elicited rate of low-grade fever (<38 C) increases to about 40%. Other
only after the appendix has variations in presentation include pain in the right upper
ruptured or infarcted. quadrant, typically from a retrocecal or retroiliac appendix."
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."
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"Rosving's sign is described as: "E. Pain in the right lower quadrant when left lower quadrant is
A. Tenderness in the right upper palpated.
quadrant that is worse with
inspiration. The answer is E. Rosving's sign is pain in the right lower quadrant
B. Pelvic pain upon flexion of when the left lower quadrant is palpated. Rebound tenderness
the thigh while the patient is occurs with the release of pressure. The iliopsoas sign is pain
supine. associated with thigh flexion. The obturator sign is pain that
C. Pelvic pain upon internal and occurs with thigh rotation. All of these signs are associated with
external rotation of the thigh appendicitis. Murphy's sign is cessation of inspiration during
with the knee flexed. palpation of the right upper quadrant and is associated with
D. Pain that increases with the acute cholecystitis."
release of pressure of palpation.
E. Pain in the right lower
quadrant when left lower
quadrant is palpated."
"In establishing a differential "D. The onset of pain prior to the occurrence of nausea and
diagnosis of abdominal pain, vomiting is more often suggestive of a surgical etiology.
which of the following is true?
A. Radiation of pain to the The answer is D. Pain prior to nausea and vomiting is often
scapula is suggestive of acute suggestive of a surgical etiology of the pain, such as small bowel
hepatitis. obstruction. Cervical motion tenderness has been noted in up to
B. Cervical motion tenderness is 25% of women with acute appendicitis. Patients with sickle cell
a useful physical finding for anemia are prone to Salmonella infections. Radiation of pain to
differentiating women with or the scapula is classically present in acute choleycystitis.
without acute appendicitis. Diverticulitis pain is generally located in the left lower quadrant."
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."
"Of the following pain patterns, "C. unrelenting pain over a period of weeks
which is the least likely
associated with diagnosis of The answer is C. Pain from peptic ulcer disease typically occurs
peptic ulcer disease? in periods of exacerbation and remission. Unrelenting pain over
A. non-radiating, burning weeks or months should suggest an alternative diagnosis. Pain is
epigastric pain classically described as non-radiating, burning epigastric pain.
B. pain that awakens a patient in Some patients may also complain of chest or back pain. Pain is
the middle of the night frequently severe enough to awaken patients from sleep in early
C. unrelenting pain over a morning hours but is often not present upon waking in the
period of weeks morning, as gastric acid secretion peaks around 2 a.m. and nadirs
D. relief of abdominal pain with upon awakening."
antacids
E. pain that is worse preceding a
meal"
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"A 78 year old female presents The answer is D. A patient with this general picture is most likely
to the E.D. with a sensation of to have diverticulitis, which is revealed on the CT scan as
left-lower quadrant abdominal diverticular disease with inflammation (wall thickening and
pain, accompanied by some stranding).
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"
"A mother brings her 6 week old "E. pyloric stenosis
boy to the emergency room.
She states the baby has been The answer is E. Hypertrophic pyloric stenosis typically presents
vomiting everything she's tried in the second to sixth week of life and is four times more
to feed him for the past 12 hours. common in males than females. Infants with hypertrophic pyloric
She states that he usually eats stenosis typically are vigorous eaters but shortly afterward
readily and completes an entire regurgitate the entire feeding contents in a projectile fashion. The
feeding, but he is unable to emesis is non-bilious. The classic finding on exam is an "olive"
keep anything down. The emesis palpable in the abdomen, and diagnosis is typically via
is non-bloody and non-bilious, ultrasound. Intussusception typically presents between the ages
however it is projectile in nature. of 5 and 12 months. Gastroenteritis is characterized by diarrhea
What is the most likely condition as well as vomiting. Neither constipation nor appendicitis
in this patient? typically present with protracted vomiting, though the latter
A. viral gastroenteritis condition tends to present atypically in young children (and
B. constipation elderly adults)."
C. appendicitis
D. intussusception
E. pyloric stenosis"
Page 3 Page 3 of 407 3 of 407
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"A 46 year old woman presents "C. Helical CT scan greater than 95% sensitive and specific for
to the emergency department renal calculi.
complaining of abrupt onset of
intermittent severe pain in the The answer is C. Helical CT scan has been shown to be both
left flank and abdomen that highly sensitive and specific in the diagnosis of renal calculi. It is
woke her from sleep. She is the preferred modality for evaluation in many centers. Although
pacing around the stretcher and urinalysis typically demonstrates hematuria in patients with renal
appears extremely calculi, hematuria is not specific enough to confirm the diagnosis,
uncomfortable. She has never and imaging is warranted in all first-time presenters. KUB detects
experienced this type of pain approximately 60-70% of calculi (though studies addressing this
previously and denies fevers or issue are somewhat methodologically flawed). Ultrasound is not
other symptoms. Renal calculus reliable for detecting small calculi, but is 85-94% sensitive and
is suspected. Which of the 100% specific at demonstrating hydronephrosis. IVP is
following is true regarding the contraindicated in patients with renal insufficiency due to the dye
diagnosis of renal calculi in this load necessary to perform the study."
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."
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