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saem m4 curriculum 2 Exam Most Recent Exam 2026
Actual Complete Real Verified Exam Questions And
Verified Answers | 100% Correct Answers | Already
Graded A+ || Newest Exam!!!
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? - Answer-pyloric stenosis
The answer is C. 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
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appendicitis typically present with protracted vomiting,
though the latter condition tends to present atypically in
young children (and elderly adults).
What is the best diagnostic test (KUB, IVP, Helical CT,
U/S)?
How helpful is a Urinalysis? - Answer-Helical CT scan is
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.
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50 yo M p/w 1 day of gradually worsening, intermittent,
LLQ pain a/w loose stools. No fevers or bloody bowel
movements. Similar sxs in the past were self-limited. Vital
signs wnl. PE shows mild tenderness in LLQ, +BS and no
masses or peritoneal signs. His PCP can see him
tomorrow in his clinic. What should be done next in the
E.D.? - Answer-Discharge home on high-fiber diet,
laxatives and stool softeners
what is the obturator sign? what diagnosis is it associated
with? - Answer-a/w appendicitis
what is Rovsing's sign? what diagnosis is it associated
with? - Answer-a/w appendicitis
Early in the course of acute appendicitis, are vital signs
usually abnormal? - Answer-no - 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%.
what is the psoas sign? what diagnosis is it associated
with? - Answer-a/w appendicitis
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explain what rebound in the setting of acute appendicitis
means - Answer-Rebound is usually elicited only after the
appendix has ruptured or infarcted.
In establishing a differential diagnosis of abdominal pain,
the onset of PAIN prior to the occurrence of N/V is more
often suggestive of - Answer-surgical etiology of the pain,
such as small bowel obstruction
what bug should you think of in patients with sickle cell
anemia who present with abdominal pain and diarrhea? -
Answer-salmonella (not shigellosis)
Radiation of pain to the scapula is suggestive of - Answer-
acute choleycystitis (NOT hepatitis)
Diverticulitis pain is generally located - Answer-in the LLQ
Describe the pain patterns a/w with peptic ulcer disease
(PUD) - Answer-pain that is worse preceding a meal
non-radiating, burning epigastric pain
pain that awakens a patient in the middle of the night
saem m4 curriculum 2 Exam Most Recent Exam 2026
Actual Complete Real Verified Exam Questions And
Verified Answers | 100% Correct Answers | Already
Graded A+ || Newest Exam!!!
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? - Answer-pyloric stenosis
The answer is C. 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
,2|Page
appendicitis typically present with protracted vomiting,
though the latter condition tends to present atypically in
young children (and elderly adults).
What is the best diagnostic test (KUB, IVP, Helical CT,
U/S)?
How helpful is a Urinalysis? - Answer-Helical CT scan is
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.
,3|Page
50 yo M p/w 1 day of gradually worsening, intermittent,
LLQ pain a/w loose stools. No fevers or bloody bowel
movements. Similar sxs in the past were self-limited. Vital
signs wnl. PE shows mild tenderness in LLQ, +BS and no
masses or peritoneal signs. His PCP can see him
tomorrow in his clinic. What should be done next in the
E.D.? - Answer-Discharge home on high-fiber diet,
laxatives and stool softeners
what is the obturator sign? what diagnosis is it associated
with? - Answer-a/w appendicitis
what is Rovsing's sign? what diagnosis is it associated
with? - Answer-a/w appendicitis
Early in the course of acute appendicitis, are vital signs
usually abnormal? - Answer-no - 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%.
what is the psoas sign? what diagnosis is it associated
with? - Answer-a/w appendicitis
, 4|Page
explain what rebound in the setting of acute appendicitis
means - Answer-Rebound is usually elicited only after the
appendix has ruptured or infarcted.
In establishing a differential diagnosis of abdominal pain,
the onset of PAIN prior to the occurrence of N/V is more
often suggestive of - Answer-surgical etiology of the pain,
such as small bowel obstruction
what bug should you think of in patients with sickle cell
anemia who present with abdominal pain and diarrhea? -
Answer-salmonella (not shigellosis)
Radiation of pain to the scapula is suggestive of - Answer-
acute choleycystitis (NOT hepatitis)
Diverticulitis pain is generally located - Answer-in the LLQ
Describe the pain patterns a/w with peptic ulcer disease
(PUD) - Answer-pain that is worse preceding a meal
non-radiating, burning epigastric pain
pain that awakens a patient in the middle of the night
