SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
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. - (ANSWERS)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. -
,SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
(ANSWERS)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. -
(ANSWERS)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
,SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
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 - (ANSWERS)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.
, SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
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 - (ANSWERS)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).
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
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. - (ANSWERS)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. -
,SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
(ANSWERS)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. -
(ANSWERS)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
,SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
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 - (ANSWERS)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.
, SAEM Practice 2026 Exam study guide COMPLETE EXAM
Questions and Answers (Verified Answers) (Latest Update
2026) UPDATE!!
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 - (ANSWERS)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).
