Emergency Medicine SAEM exam test bank_2023/2024-complete with rationale

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. Vital signs are usually abnormal, even early in the course of acute appendicitis. The answer is A. 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. 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, howev