EMERGENCY MEDICINE SAEM EXAM
ACADEMIC PREP SCRIPT 2026 TESTED
KNOWLEDGE VERIFIED ANSWERS
◉ 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. 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.
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.
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
E. pain that is worse preceding a meal 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 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 Answer: 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.
ACADEMIC PREP SCRIPT 2026 TESTED
KNOWLEDGE VERIFIED ANSWERS
◉ 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. 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.
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.
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
E. pain that is worse preceding a meal 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 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 Answer: 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.
