EMERGENCY MEDICINE SAEM EXAM T EST

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EMERGENCY MEDICINE SAEM EXAM T EST

BANK Regarding the diagnosis of acute appendicitis, all the following

are true EXCEPT:

Question 1: Which of the following is not true regarding the

diagnosis of acute appendicitis?

• Vital signs are usually abnormal, even early in the course of

acute appendicitis.

• Rebound is usually elicited only after the appendix has

ruptured or infarcted.

• Rovsing's sign is pain in the right lower quadrant upon

palpation of the left lower quadrant.

• The obturator sign is pain upon flexion and internal rotation

of the hip.

• 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.

Rosving's sign is described as:

Question 2: How is Rovsing's sign described?

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• Tenderness in the right upper quadrant that is worse with

inspiration.

• Pelvic pain upon flexion of the thigh while the patient is

supine.

• Pelvic pain upon internal and external rotation of the thigh

with the knee flexed.

• Pain that increases with the release of pressure of palpation.
• 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.

In establishing a differential diagnosis of abdominal pain, which of the following is true?

Question 3: Which of the following is true in establishing a

differential diagnosis of abdominal pain?

• Radiation of pain to the scapula is suggestive of acute

hepatitis.

• Cervical motion tenderness is a useful physical finding for

differentiating women with or without acute appendicitis.

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• In patients with sickle cell anemia who present with

abdominal pain and diarrhea, shigellosis should be a top consideration.

• The onset of pain prior to the occurrence of nausea and

vomiting is more often suggestive of a surgical etiology.

• 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.

Of the following pain patterns, which is the least likely associated with diagnosis of peptic ulcer disease?

Question 4: Which of the following pain patterns is least likely

associated with the diagnosis of peptic ulcer disease?

• non-radiating, burning epigastric pain
• pain that awakens a patient in the middle of the night
• unrelenting pain over a period of weeks
• relief of abdominal pain with antacids
• pain that is worse preceding a meal

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CORRECT ANSWER : C. unrelenting pain over a period of

weeks

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.

Question 5: What is the most likely condition in this patient?

• viral gastroenteritis
• constipation
• appendicitis
• intussusception
• pyloric stenosis

CORRECT ANSWER : E. pyloric stenosis

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