SAEM EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES.
"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."
"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."
"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."
"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."
"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).
"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
DETAILED ANSWERS WITH RATIONALES.
"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."
"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."
"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."
"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."
"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).
"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
