SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
SAEM EXAM QUESTIONS 2024-2025
ACTUAL EXAM 400 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
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."
Correct 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."
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,SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Question 2
"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."
Correct 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."
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."
Correct 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."
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,SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
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"
Correct 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."
Question 5
"A 78 year old female presents to the E.D. with a sensation of left-lower quadrant
abdominal pain, accompanied by some irregular bowel movements and loss of
appetite. 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"
Correct Answer
The answer is D. A patient with this general picture is most likely to have
diverticulitis, which is revealed on the CT scan as diverticular disease with
inflammation (wall thickening and stranding).
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, SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Question 6
"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"
Correct Answer
"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)."
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DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
SAEM EXAM QUESTIONS 2024-2025
ACTUAL EXAM 400 REAL EXAM QUESTIONS
AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
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."
Correct 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."
Page 1 of 595
1/595
,SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Question 2
"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."
Correct 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."
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."
Correct 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."
Page 2 of 595
2/595
,SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
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"
Correct 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."
Question 5
"A 78 year old female presents to the E.D. with a sensation of left-lower quadrant
abdominal pain, accompanied by some irregular bowel movements and loss of
appetite. 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"
Correct Answer
The answer is D. A patient with this general picture is most likely to have
diverticulitis, which is revealed on the CT scan as diverticular disease with
inflammation (wall thickening and stranding).
Page 3 of 595
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, SAEM EXAM QUESTIONS 2024-2025 ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
Question 6
"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"
Correct Answer
"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)."
Page 4 of 595
4/595
