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SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400
REAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
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Terms in this set (1040)
"Regarding the diagnosis of acute appendicitis, all the "A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
following are true EXCEPT:
A. Vital signs are usually abnormal, even early in the The answer is A. The presentation of acute appendicitis varies tremendously. Early
course of acute appendicitis. in its course, vital signs including temperature may be normal. Once perforation
B. Rebound is usually elicited only after the appendix has has occurred, the rate of low-grade fever (<38 C) increases to about 40%. Other
ruptured or infarcted. variations in presentation include pain in the right upper quadrant, typically from a
C. Rovsing's sign is pain in the right lower quadrant upon retrocecal or retroiliac appendix."
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."
"Rosving's sign is described as: "E. Pain in the right lower quadrant when left lower quadrant is palpated.
A. Tenderness in the right upper quadrant that is worse
with inspiration. The answer is E. Rosving's sign is pain in the right lower quadrant when the left
B. Pelvic pain upon flexion of the thigh while the patient is lower quadrant is palpated. Rebound tenderness occurs with the release of
supine. pressure. The iliopsoas sign is pain associated with thigh flexion. The obturator
C. Pelvic pain upon internal and external rotation of the sign is pain that occurs with thigh rotation. All of these signs are associated with
thigh with the knee flexed. appendicitis. Murphy's sign is cessation of inspiration during palpation of the right
D. Pain that increases with the release of pressure of upper quadrant and is associated with acute cholecystitis."
palpation.
E. Pain in the right lower quadrant when left lower
quadrant is palpated."
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, "In establishing a differential diagnosis of abdominal pain, "D. The onset of pain prior to the occurrence of nausea and vomiting is more
which of the following is true? often suggestive of a surgical etiology.
A. Radiation of pain to the scapula is suggestive of acute
hepatitis. The answer is D. Pain prior to nausea and vomiting is often suggestive of a surgical
B. Cervical motion tenderness is a useful physical finding etiology of the pain, such as small bowel obstruction. Cervical motion tenderness
for differentiating women with or without acute has been noted in up to 25% of women with acute appendicitis. Patients with
appendicitis. sickle cell anemia are prone to Salmonella infections. Radiation of pain to the
C. In patients with sickle cell anemia who present with scapula is classically present in acute choleycystitis. Diverticulitis pain is generally
abdominal pain and diarrhea, shigellosis should be a top located in the left lower quadrant."
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, which is the least likely "C. unrelenting pain over a period of weeks
associated with diagnosis of peptic ulcer disease?
A. non-radiating, burning epigastric pain The answer is C. Pain from peptic ulcer disease typically occurs in periods of
B. pain that awakens a patient in the middle of the night exacerbation and remission. Unrelenting pain over weeks or months should
C. unrelenting pain over a period of weeks suggest an alternative diagnosis. Pain is classically described as non-radiating,
D. relief of abdominal pain with antacids burning epigastric pain. Some patients may also complain of chest or back pain.
E. pain that is worse preceding a meal" 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 78 year old female presents to the E.D. with a sensation The answer is D. A patient with this general picture is most likely to have
of left-lower quadrant abdominal pain, accompanied by diverticulitis, which is revealed on the CT scan as diverticular disease with
some irregular bowel movements and loss of appetite. inflammation (wall thickening and stranding).
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 boy to the emergency "E. pyloric stenosis
room. She states the baby has been vomiting everything
she's tried to feed him for the past 12 hours. She states The answer is E. Hypertrophic pyloric stenosis typically presents in the second to
that he usually eats readily and completes an entire sixth week of life and is four times more common in males than females. Infants
feeding, but he is unable to keep anything down. The with hypertrophic pyloric stenosis typically are vigorous eaters but shortly
emesis is non-bloody and non-bilious, however it is afterward regurgitate the entire feeding contents in a projectile fashion. The
projectile in nature. What is the most likely condition in emesis is non-bilious. The classic finding on exam is an "olive" palpable in the
this patient? abdomen, and diagnosis is typically via ultrasound. Intussusception typically
A. viral gastroenteritis presents between the ages of 5 and 12 months. Gastroenteritis is characterized by
B. constipation diarrhea as well as vomiting. Neither constipation nor appendicitis typically
C. appendicitis present with protracted vomiting, though the latter condition tends to present
D. intussusception atypically in young children (and elderly adults)."
E. pyloric stenosis"
To get the actual and other Exams contact ()
, "A 46 year old woman presents to the emergency "C. Helical CT scan greater than 95% sensitive and specific for renal calculi.
department complaining of abrupt onset of intermittent
severe pain in the left flank and abdomen that woke her The answer is C. Helical CT scan has been shown to be both highly sensitive and
from sleep. She is pacing around the stretcher and specific in the diagnosis of renal calculi. It is the preferred modality for evaluation
appears extremely uncomfortable. She has never in many centers. Although urinalysis typically demonstrates hematuria in patients
experienced this type of pain previously and denies with renal calculi, hematuria is not specific enough to confirm the diagnosis, and
fevers or other symptoms. Renal calculus is suspected. imaging is warranted in all first-time presenters. KUB detects approximately 60-
Which of the following is true regarding the diagnosis of 70% of calculi (though studies addressing this issue are somewhat
renal calculi in this patient? methodologically flawed). Ultrasound is not reliable for detecting small calculi,
A. Urinalysis demonstrating hematuria confirms the but is 85-94% sensitive and 100% specific at demonstrating hydronephrosis. IVP is
diagnosis. contraindicated in patients with renal insufficiency due to the dye load necessary
B. KUB detects less than 10% of calculi. to perform the study."
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."
"A 50 year old man presents with 1 day of gradually "B. Discharge home on high-fiber diet, laxatives and stool softeners
worsening, intermittent, left lower quadrant pain
associated with loose stools. He has had no fevers or The answer is B. This patient has classic diverticulosis (saclike protrusions of
bloody bowel movements. Similar symptoms in the past colonic mucosa through the muscularis) without signs of acute diverticulitis
were self-limited. All vital signs lie within normal limits. (inflammation of diverticula). Usually these patients can be managed as
Physical examination shows mild tenderness in the left outpatients with a high-fiber diet and treatments to decrease intestinal spasm. If
lower quadrant, normal active bowel sounds and neither the patient develops fever or pain increases he may need further evaluation to
masses nor peritoneal signs. His primary-care physician rule out abscess formation. Diverticulitis is treated with antibiotics, bowel rest and
can see him tomorrow in his clinic. What should be done analgesics."
next in the E.D.?
A. Discharge home after a single dose of IV antibiotics
B. Discharge home on high-fiber diet, laxatives and stool
softeners
C. Gastroenterology consult for endoscopy
D. Admit for observation and serial examinations"
"You are treating a 25 year old male with the recent "D. There is a small increased risk of colon cancer
diagnosis of Crohn's disease in the ED. Regarding Crohn's
disease, you know that: The answer is D. Although Crohn's disease may involve the entire bowel tract, the
A. Lesions are typically contiguous rectum is rarely involved. Involved areas are typically non-contiguous (known as
B. Small bowel involvement is rare "skip lesions") and the inflammation involves all of the layers of the bowel wall--
C. Bleeding is common due to superficial bowel wall resulting in many of the complications of Crohn's such as abscess and fistula
inflammation formation, intestinal obstruction, and perforation. The risk of colon cancer is only
D. There is a small increased risk of colon cancer" slightly elevated above baseline. In contrast, Ulcerative colitis begins in the
rectum and may spread to the upper parts of the colon but never involves the
small intestine. The ulcerations are contiguous and involve only the colonic
mucosa. The incidence of colon cancer may be increased up to 30 times over
baseline."
To get the actual and other Exams contact ()
SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400
REAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
31 studiers today Leave the first rating
Students also studied
Terms in this set (1040)
"Regarding the diagnosis of acute appendicitis, all the "A. Vital signs are usually abnormal, even early in the course of acute appendicitis.
following are true EXCEPT:
A. Vital signs are usually abnormal, even early in the The answer is A. The presentation of acute appendicitis varies tremendously. Early
course of acute appendicitis. in its course, vital signs including temperature may be normal. Once perforation
B. Rebound is usually elicited only after the appendix has has occurred, the rate of low-grade fever (<38 C) increases to about 40%. Other
ruptured or infarcted. variations in presentation include pain in the right upper quadrant, typically from a
C. Rovsing's sign is pain in the right lower quadrant upon retrocecal or retroiliac appendix."
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."
"Rosving's sign is described as: "E. Pain in the right lower quadrant when left lower quadrant is palpated.
A. Tenderness in the right upper quadrant that is worse
with inspiration. The answer is E. Rosving's sign is pain in the right lower quadrant when the left
B. Pelvic pain upon flexion of the thigh while the patient is lower quadrant is palpated. Rebound tenderness occurs with the release of
supine. pressure. The iliopsoas sign is pain associated with thigh flexion. The obturator
C. Pelvic pain upon internal and external rotation of the sign is pain that occurs with thigh rotation. All of these signs are associated with
thigh with the knee flexed. appendicitis. Murphy's sign is cessation of inspiration during palpation of the right
D. Pain that increases with the release of pressure of upper quadrant and is associated with acute cholecystitis."
palpation.
E. Pain in the right lower quadrant when left lower
quadrant is palpated."
To get the actual and other Exams contact ()
, "In establishing a differential diagnosis of abdominal pain, "D. The onset of pain prior to the occurrence of nausea and vomiting is more
which of the following is true? often suggestive of a surgical etiology.
A. Radiation of pain to the scapula is suggestive of acute
hepatitis. The answer is D. Pain prior to nausea and vomiting is often suggestive of a surgical
B. Cervical motion tenderness is a useful physical finding etiology of the pain, such as small bowel obstruction. Cervical motion tenderness
for differentiating women with or without acute has been noted in up to 25% of women with acute appendicitis. Patients with
appendicitis. sickle cell anemia are prone to Salmonella infections. Radiation of pain to the
C. In patients with sickle cell anemia who present with scapula is classically present in acute choleycystitis. Diverticulitis pain is generally
abdominal pain and diarrhea, shigellosis should be a top located in the left lower quadrant."
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, which is the least likely "C. unrelenting pain over a period of weeks
associated with diagnosis of peptic ulcer disease?
A. non-radiating, burning epigastric pain The answer is C. Pain from peptic ulcer disease typically occurs in periods of
B. pain that awakens a patient in the middle of the night exacerbation and remission. Unrelenting pain over weeks or months should
C. unrelenting pain over a period of weeks suggest an alternative diagnosis. Pain is classically described as non-radiating,
D. relief of abdominal pain with antacids burning epigastric pain. Some patients may also complain of chest or back pain.
E. pain that is worse preceding a meal" 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 78 year old female presents to the E.D. with a sensation The answer is D. A patient with this general picture is most likely to have
of left-lower quadrant abdominal pain, accompanied by diverticulitis, which is revealed on the CT scan as diverticular disease with
some irregular bowel movements and loss of appetite. inflammation (wall thickening and stranding).
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 boy to the emergency "E. pyloric stenosis
room. She states the baby has been vomiting everything
she's tried to feed him for the past 12 hours. She states The answer is E. Hypertrophic pyloric stenosis typically presents in the second to
that he usually eats readily and completes an entire sixth week of life and is four times more common in males than females. Infants
feeding, but he is unable to keep anything down. The with hypertrophic pyloric stenosis typically are vigorous eaters but shortly
emesis is non-bloody and non-bilious, however it is afterward regurgitate the entire feeding contents in a projectile fashion. The
projectile in nature. What is the most likely condition in emesis is non-bilious. The classic finding on exam is an "olive" palpable in the
this patient? abdomen, and diagnosis is typically via ultrasound. Intussusception typically
A. viral gastroenteritis presents between the ages of 5 and 12 months. Gastroenteritis is characterized by
B. constipation diarrhea as well as vomiting. Neither constipation nor appendicitis typically
C. appendicitis present with protracted vomiting, though the latter condition tends to present
D. intussusception atypically in young children (and elderly adults)."
E. pyloric stenosis"
To get the actual and other Exams contact ()
, "A 46 year old woman presents to the emergency "C. Helical CT scan greater than 95% sensitive and specific for renal calculi.
department complaining of abrupt onset of intermittent
severe pain in the left flank and abdomen that woke her The answer is C. Helical CT scan has been shown to be both highly sensitive and
from sleep. She is pacing around the stretcher and specific in the diagnosis of renal calculi. It is the preferred modality for evaluation
appears extremely uncomfortable. She has never in many centers. Although urinalysis typically demonstrates hematuria in patients
experienced this type of pain previously and denies with renal calculi, hematuria is not specific enough to confirm the diagnosis, and
fevers or other symptoms. Renal calculus is suspected. imaging is warranted in all first-time presenters. KUB detects approximately 60-
Which of the following is true regarding the diagnosis of 70% of calculi (though studies addressing this issue are somewhat
renal calculi in this patient? methodologically flawed). Ultrasound is not reliable for detecting small calculi,
A. Urinalysis demonstrating hematuria confirms the but is 85-94% sensitive and 100% specific at demonstrating hydronephrosis. IVP is
diagnosis. contraindicated in patients with renal insufficiency due to the dye load necessary
B. KUB detects less than 10% of calculi. to perform the study."
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."
"A 50 year old man presents with 1 day of gradually "B. Discharge home on high-fiber diet, laxatives and stool softeners
worsening, intermittent, left lower quadrant pain
associated with loose stools. He has had no fevers or The answer is B. This patient has classic diverticulosis (saclike protrusions of
bloody bowel movements. Similar symptoms in the past colonic mucosa through the muscularis) without signs of acute diverticulitis
were self-limited. All vital signs lie within normal limits. (inflammation of diverticula). Usually these patients can be managed as
Physical examination shows mild tenderness in the left outpatients with a high-fiber diet and treatments to decrease intestinal spasm. If
lower quadrant, normal active bowel sounds and neither the patient develops fever or pain increases he may need further evaluation to
masses nor peritoneal signs. His primary-care physician rule out abscess formation. Diverticulitis is treated with antibiotics, bowel rest and
can see him tomorrow in his clinic. What should be done analgesics."
next in the E.D.?
A. Discharge home after a single dose of IV antibiotics
B. Discharge home on high-fiber diet, laxatives and stool
softeners
C. Gastroenterology consult for endoscopy
D. Admit for observation and serial examinations"
"You are treating a 25 year old male with the recent "D. There is a small increased risk of colon cancer
diagnosis of Crohn's disease in the ED. Regarding Crohn's
disease, you know that: The answer is D. Although Crohn's disease may involve the entire bowel tract, the
A. Lesions are typically contiguous rectum is rarely involved. Involved areas are typically non-contiguous (known as
B. Small bowel involvement is rare "skip lesions") and the inflammation involves all of the layers of the bowel wall--
C. Bleeding is common due to superficial bowel wall resulting in many of the complications of Crohn's such as abscess and fistula
inflammation formation, intestinal obstruction, and perforation. The risk of colon cancer is only
D. There is a small increased risk of colon cancer" slightly elevated above baseline. In contrast, Ulcerative colitis begins in the
rectum and may spread to the upper parts of the colon but never involves the
small intestine. The ulcerations are contiguous and involve only the colonic
mucosa. The incidence of colon cancer may be increased up to 30 times over
baseline."
To get the actual and other Exams contact ()
