1 | Page
SAEM Practice Questions and
Answers Latest 2026
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. Ans:
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.
© 2025 All rights reserved
, 2 | Page
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. Ans: 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.
© 2025 All rights reserved
, 3 | Page
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. Ans: 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
© 2025 All rights reserved
, 4 | Page
C. unrelenting pain over a period of weeks
D. relief of abdominal pain with antacids
E. pain that is worse preceding a meal Ans: 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, however it is
projectile in nature. What is the most likely condition in
this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
© 2025 All rights reserved
SAEM Practice Questions and
Answers Latest 2026
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. Ans:
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.
© 2025 All rights reserved
, 2 | Page
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. Ans: 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.
© 2025 All rights reserved
, 3 | Page
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. Ans: 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
© 2025 All rights reserved
, 4 | Page
C. unrelenting pain over a period of weeks
D. relief of abdominal pain with antacids
E. pain that is worse preceding a meal Ans: 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, however it is
projectile in nature. What is the most likely condition in
this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
© 2025 All rights reserved
