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SAEM Practice 2024 Exam Questions with Verified Answers
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SAEM Practice 2024 Exam Questionswith Verified Answers
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. - -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. - -
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. - -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 - -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
D. intussusception
E. pyloric stenosis - -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).
-A 46 year old woman presents to the emergency department complaining
of abrupt onset of intermittent severe pain in the left flank and abdomen that
woke her from sleep. She is pacing around the stretcher and appears
extremely uncomfortable. She has never experienced this type of pain
previously and denies fevers or other symptoms. Renal calculus is suspected.
Which of the following is true regarding the diagnosis of renal calculi in this
patient?
A. Urinalysis demonstrating hematuria confirms the diagnosis.
B. KUB detects less than 10% of calculi.
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. - -C. Helical CT scan greater than 95% sensitive and specific
for renal calculi.
Helical CT scan has been shown to be both highly sensitive and specific in
the diagnosis of renal calculi. It is the preferred modality for evaluation in
many centers. Although urinalysis typically demonstrates hematuria in
patients with renal calculi, hematuria is not specific enough to confirm the
diagnosis, and imaging is warranted in all first-time presenters. KUB detects
approximately 60-70% of calculi (though studies addressing this issue are
somewhat methodologically flawed). Ultrasound is not reliable for detecting
small calculi, but is 85-94% sensitive and 100% specific at demonstrating
hydronephrosis. IVP is contraindicated in patients with renal insufficiency due
to the dye load necessary to perform the study.
-A 50 year old man presents with 1 day of gradually worsening, intermittent,
left lower quadrant pain associated with loose stools. He has had no fevers or
bloody bowel movements. Similar symptoms in the past were self-limited. All
vital signs lie within normal limits. Physical examination shows mild
tenderness in the left lower quadrant, normal active bowel sounds and
neither masses nor peritoneal signs. His primary-care physician can see him
tomorrow in his clinic. What should be done 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 - -B. Discharge home on
high-fiber diet, laxatives and stool softeners
This patient has classic diverticulosis (saclike protrusions of colonic mucosa
through the muscularis) without signs of acute diverticulitis (inflammation of
diverticula). Usually these patients can be managed as outpatients with a
high-fiber diet and treatments to decrease intestinal spasm. If the patient
develops fever or pain increases he may need further evaluation to rule out
abscess formation. Diverticulitis is treated with antibiotics, bowel rest and
analgesics.
-You are treating a 25 year old male with the recent diagnosis of Crohn's
disease in the ED. Regarding Crohn's disease, you know that:
A. Lesions are typically contiguous
B. Small bowel involvement is rare
C. Bleeding is common due to superficial bowel wall inflammation
D. There is a small increased risk of colon cancer - -D. There is a small
increased risk of colon cancer
Although Crohn's disease may involve the entire bowel tract, the rectum is
rarely involved. Involved areas are typically non-contiguous (known as "skip
lesions") and the inflammation involves all of the layers of the bowel wall--
resulting in many of the complications of Crohn's such as abscess and fistula
formation, intestinal obstruction, and perforation. The risk of colon cancer is
only 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.
-A 53 year old obese woman presents to the emergency department,
accompanied by three of her children, complaining of severe abdominal pain
that began this afternoon after lunch. Physical exam reveals marked RUQ
tenderness. Likely findings on this patient would include all of the following
EXCEPT:
A. positive sonographic Murphy's sign
B. pain in the right scapula
C. leukocytosis with left shift
D. marked inguinal lymphadenopathy
E. aminotransferases and bilirubin within normal limits - -D. marked inguinal
lymphadenopathy
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