Emergency Medicine SAEM Exam
Study Guide 2026–2027 | National
EM Clerkship Practice Questions,
Verified Answers & Detailed
THIS Rationales
EXAM CONTAINS:
• Emergency Medicine practice questions
• Verified answers with detailed rationales
• Trauma and Advanced Trauma Life Support (ATLS) concepts
• ECG interpretation
• Imaging and diagnostic studies
• Emergency pharmacology
• Clinical decision-making and disposition
• High-yield emergency medicine review
, Emergency Medicine SAEM Exam Study Guide 2026–2027 |
National EM Clerkship Practice Questions, Verified Answers &
Detailed Rationales
Question 1
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
Answer: A
Explanation: 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.
Question 2
Rovsing'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
Explanation: Rovsing'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.
Question 3
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
Explanation: 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
cholecystitis. Diverticulitis pain is generally located in the left lower
quadrant.
Question 4
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
Explanation: 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.
Question 5
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
Study Guide 2026–2027 | National
EM Clerkship Practice Questions,
Verified Answers & Detailed
THIS Rationales
EXAM CONTAINS:
• Emergency Medicine practice questions
• Verified answers with detailed rationales
• Trauma and Advanced Trauma Life Support (ATLS) concepts
• ECG interpretation
• Imaging and diagnostic studies
• Emergency pharmacology
• Clinical decision-making and disposition
• High-yield emergency medicine review
, Emergency Medicine SAEM Exam Study Guide 2026–2027 |
National EM Clerkship Practice Questions, Verified Answers &
Detailed Rationales
Question 1
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
Answer: A
Explanation: 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.
Question 2
Rovsing'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
Explanation: Rovsing'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.
Question 3
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
Explanation: 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
cholecystitis. Diverticulitis pain is generally located in the left lower
quadrant.
Question 4
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
Explanation: 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.
Question 5
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
