ROSH REVIEW Emergency Medicine Questions and
Answers with complete solutions 100% Correct
A h14-year-old hboy hpresents hcomplaining hof hintense hpruritus hin hhis hgroin, haxillae, hand hbetween hhis
hfingers hafter hreturning hhome hfrom hsummer hcamp h1 hweek hago. hHe hreports hseveral hother hcampers
hhad hsimilar hsymptoms. hOn hexam, hyou hnote hexcoriations hin hthe hinguinal hregion hand haxillae
hsurrounding hscattered, herythematous hpapules. hWhich hof hthe hfollowing his hthe hmost happropriate
htreatment?
Ketoconazole
Lindane
Permethrin
Prednisone h- hCorrect h hAnswer h- hCorrect hAnswer h( hC h)
Explanation:
This hpatient hhas hscabies; ha hpruritic hdermatitis hcaused hby hcutaneous hinfection hwith hthe hmite
hSarcoptes hscabei, hvar hhominis. hScabies his hspread hby hskin-to-skin hcontact hand hshould hbe hconsidered
hin hpatients hwith hgeneralized hpruritus, hespecially hwhen hexposure hto hothers hwith hsimilar hsymptoms his
hreported. hThe hrash hof hscabies hinvolves hpapules, hwhich hare hoften hexcoriated. hBurrows hare
hpathognomonic hbut hnot huniformly hpresent. hUnless hpreviously hinfected, hpruritus hgenerally htakes h3-6
hweeks hto hdevelop hbecause hsymptoms hare hdue hto hdelayed h(Type hIV) hsensitivity hreaction. hThe
hpruritus his hclassically hworse hat hnight hand haffects hthe hweb hspaces hof hthe hfingers, hflexor haspect hof
hthe hwrists, haxillae, hgroin, hnipples, hand hthe hperiumbilical hregion. hExcept hin hcases hinvolving han
himmunocompromised hhost, hthe hscalp hand hface hare hgenerally hspared. hDiagnosis his hclinical hbut hcan
hbe hconfirmed hby hplacing hscrapings hcollected hwith ha h#15 hblade hscalpel hin hmineral hoil hfor
hmicroscopic hexamination. hThe htreatment hof hchoice hfor hprimary hscabies hinfection his hthe happlication
hof htopical hscabicidal hagents, hwith hrepeat happlication hin h7 hdays. hThe htreatment hof hchoice his
hpermethrin h5% hlotion. hIndividuals haffected hby hscabies hshould havoid hskin-to-skin hcontact hwith
hothers. hPatients hwith htypical hscabies hmay hreturn hto hschool hor hwork h24 hhours hafter hthe hfirst
htreatment.
,Should hfamily hmembers hof han hinfected hindividual halso hbe htreated hfor hscabies? h- hCorrect h hAnswer h-
hYes, hfamily hmembers hand hsexual hcontacts.
Scabies h- hCorrect h hAnswer h- hSarcoptes hscabiei
Pruritic hrash hworse hat hnight
Linear hburrows
Interdigital hspaces hof hhands/feet, hpenis, hbreasts
Permethrin h(first hline)
Ivermectin
**head hand hback hare hsparred h
(head hinvolved hin hchildren)
An h18-month-old hboy hpresents hto hthe hemergency hdepartment hwith hworsening hshortness hof hbreath.
hThe hparents hreport hhe hhas hhad ha hcough, hrunny hnose, hand hfussiness hfor hthe hpast hfive hdays. hOn
hexam, hthe hpatient hdemonstrates hsubcostal hretractions, htachypnea, hand hdiffuse hwheezing. hThe
hpatient his hgiven han halbuterol hnebulizer htreatment hwithout hany himprovement hof hhis hwheezing. hChest
hX-ray hdoes hnot hshow hany habnormality. hWhich hof hthe hfollowing horganisms his hthe hmost hlikely hcause
hof hhis hsymptoms? h
Bordetella hpertussis
Haemophilus hinfluenzae
Parainfluenza hvirus
Respiratory hsyncytial hvirus h- hCorrect h hAnswer h- hCorrect hAnswer h( hD h)
Explanation:
The hpatient hhas hbronchiolitis, hwhich his hthe hmost hcommon hlower hrespiratory htract hinfection hin
hpatients hless hthan htwo hyears hof hage. hIt hremains hthe hleading hcause hfor hhospitalization hin hinfants
hunder hone hyear hof hage. hBronchiolitis his hmost hcommonly hcaused hby hrespiratory hsyncytial hvirus h(RSV),
hbut hmay hbe hcaused hby hother hviral hagents. hBronchiolitis his hinflammation hof hthe hlower hrespiratory
htract, hwhich hinvolves hedema, hepithelial hcell hnecrosis, hbronchospasm, hand hincreased hmucus
hproduction. hThe hresultant hlower hairway hobstruction hcauses hincreased hwork hof hbreathing hand
hwheezing. hBronchiolitis his ha hclinical hdiagnosis hbased hon hage hunder htwo hyears hold, hrhinorrhea,
htachypnea, hand hwheezing. hUnlike hasthma hor hreactive hairway hdisease, hthere his hoften hno hsignificant
,himprovement hwith halbuterol. hThere his hoften ha hhistory hof hseveral hdays hof hupper hrespiratory
hsymptoms, hsuch has hrhinorrhea, hmild hcough, hand hmild hfever. hRapid hantigen htests, hblood hwork, hand
hradiographs hare hnot husually hneeded. hRadiographs hmay hdemonstrate hhyperinflation hand hatelectasis,
hbut hdo hnot hshow hany hfocal hinfiltrates hlike hwith hpneumonia. hBronchiolitis his husually hself-limited,
hwith hrespiratory hstatus htypically himproving hover h2-5 hdays. hManagement hinvolves hsupportive hcare.
Bronchiolitis h- hCorrect h hAnswer h- h
What hmonths hof hthe hyear hcontain hthe hpeak hincidence hof hRSV hin hNorth hAmerica? h- hCorrect h hAnswer
h- hNovember hto hMarch.
A h76-year-old hman hpresents hto hthe hemergency hdepartment hwith hshortness hof hbreath hand
hlightheadedness. hVital hsigns hinclude hblood hpressure h70/56 hmm hHg, hheart hrate h124 hbeats/minute,
hrespiratory hrate h22 hbreaths/minute, hand htemperature h37.6°C. hHe hhas hdistended hneck hveins hand
hoccasional hdropped hradial hbeats. hHis hlungs hare hclear hto hauscultation, hbut hhis hheart hsounds hare
hdistant. hHe hhas hsome hfullness hto hpalpation hof hthe hright hupper hquadrant hof hhis habdomen. hWhich hof
hthe hfollowing his hthe hmost happropriate hdiagnostic htest? h
Bedside hechocardiography
Chest hradiograph
Computed htomography hangiogram hof hthe hchest
Electrocardiogram h- hCorrect h hAnswer h- hCorrect hAnswer h( hA h)
Explanation:
This hpatient hpresents hwith ha hclinical hpicture hconsistent hwith hobstructive hshock. hHis hdistended hneck
hveins, hfull hright hupper hquadrant, hmuffled hheart hsounds, hand hhypotension hare hall hconsistent hwith
hpericardial htamponade. hA hpericardial hsac hslowly haccumulating hfluid hcan hstretch hwithout hobstructing
hcardiac hfunction. hTamponade hoccurs hwhen hrapid hfluid haccumulation hresults hin helevated hpressures
hthat hinhibit hvenous hreturn. hThis his ha hdynamic hprocess hover hthe hcourse hof hthe hcardiac hcycle,
htherefore hbedside hechocardiography his hthe hdiagnostic htest hof hchoice. hFluid haround hthe hheart hwith
hevidence hof hright hatrial hcompression hand hright hventricular hdiastolic hcollapse hare hdiagnostic hof
hpericardial htamponade.
Pericardial hEffusion h- hCorrect h hAnswer h- h
What his hthe hemergent htreatment hof hpericardial htamponade? h- hCorrect h hAnswer h- hPericardiocentesis.
An h8-year-old hAfrican-American hgirl hwith ha hhistory hof hsickle hcell hanemia hpresents hwith hdiffuse hpain
hconsistent hwith han hacute hsickle hcell hpain hcrisis. hWhile hin hthe hemergency hdepartment, hshe hdevelops
, hacute honset hheadache, hright hsided hfacial hdroop hand hright harm hweakness. hA hCT hscan hconfirms hthe
hdiagnosis. hWhich hof hthe hfollowing his hthe hnext hbest hstep hin hmanagement? h
Alteplase
Exchange htransfusion
MRI hbrain
Tranexamic hacid h- hCorrect h hAnswer h- hCorrect hAnswer h( hB h)
Explanation:
Cerebrovascular hevents hare ha hpotential hcomplication hof hsickle hcell hdisease. hThis hpatient hdeveloped
hsymptoms hconcerning hfor hacute hischemic hstroke. hFor hpediatric hpatients hwith hacute hischemic hstroke
hin hthe hsetting hof hsickle hcell hdisease, hexchange htransfusion his hthe htreatment hof hchoice. hTransfusion
hgoals hinclude hdecreasing hhemoglobin hS hlevels hto hless hthan h30% hand hobtaining ha htotal hhemoglobin
hlevel hof h10 hg/dL. hFor hadults hwith hacute hischemic hstroke hin hthe hsetting hof hsickle hcell hdisease,
hconsider htissue hplasminogen hactivator h(tPA). htPA his hnot hindicated hor happroved hfor huse hin hpediatric
hpatients
Tranexamic hacid h(D) his han hantifibrinolytic hagent hused hin hthe hmanagement hof hhemorrhage.
hIndications hinclude hacute htraumatic hhemorrhage, hintraoperative hblood hloss, hand hobstetric
hhemorrhage. hTranexamic hacid his hnot hused hfor hischemic hevents
Manage hSickle hCell h- hCorrect h hAnswer h- h
What his hthe hmost hcommon hbacterial hcause hof hacute hchest hsyndrome hin hadults hwith hsickle hcell
hdisease? h- hCorrect h hAnswer h- hAtypical hbacteria hsuch has hChlamydia hpneumoniae, hMycoplasma
hpneumoniae, hMycoplasma hhominis.
Correct hAnswer h( hB h)
Explanation:
The hpatient hhas hatrial hfibrillation hwith hrapid hventricular hresponse. hAtrial hfibrillation hresults hwhen
hmultiple hareas hof hthe hatrial hmyocardium hsimultaneously hdepolarize hand hcontract. hAs ha hresult, hthe
hatrial hwalls hdo hnot hcontract hin ha hcoordinated hfashion, hbut hrather h"quiver" hor h"fibrillate." hThe
helectrocardiographic hhallmarks hof hatrial hfibrillation hare ha hnarrow, hcomplex, hirregularly hirregular
hrhythm hand hno hdiscernible hP hwaves. hThe hrate hmay hbe hslow, hnormal, hor hfast. hAtrial hfibrillation his
husually hassociated hwith hischemic hor hvalvular hheart hdisease, hand hcan halso hbe hseen hin
