ROSH BOOST EMERGENCY MEDICINE
Exam Questions and Correct Answers
(Verified Answers) Latest Version
Inability to extend the wrist
A 59-year-old woman with a history of hyperlipidemia presents to
the emergency department via EMS for evaluation of right arm
pain. She was walking her dog when the dog pulled on the leash
quickly, causing the patient to fall on an outstretched arm. She
states she felt her arm “snap.” She reports some tingling on her
dorsal palm, located near her thumb. She has no shoulder, elbow,
or wrist pain. On physical examination, she is cradling her right
arm. There is a mild deformity noted in her upper arm and
associated moderate swelling. Vital signs are heart rate of 96
bpm, blood pressure of 142/86 mm Hg, respiratory rate of 16/min,
and oxygen saturation of 99% on room air. Radiographs are
shown above. Which physical exam finding should make you
suspicious for the most likely associated nerve injury?
AInability to abduct fingers
BInability to extend the wrist
CInability to flex the wrist
DInability to make an OK sign
Short-acting beta-agonist and supplemental oxygen to SpO2
88-92%
A 64-year-old man presents to the emergency department with
reports of worsening productive cough for the past 3 days. He
states he has had a persistent wet cough on a regular basis for
the last 2 years, but it has been aggravated over the last few
days. He also notes an increase in sputum production. He reports
no alleviating or aggravating factors. His medical history is
significant for hypertension controlled with metoprolol. He has a
,20 pack-year history of smoking. Vital signs include an HR of 89
bpm, BP of 130/82 mm Hg, RR of 24/min, SpO2 of 87% on room
air, and T of 98.6°F. On physical examination, rhonchi and
prolonged expiration are noted. What is the initial management for
this patient’s current condition?
AAdministration of ceftriaxone and azithromycin
BEndotracheal intubation
CIV methylprednisolone
DShort-acting beta-agonist and supplemental oxygen to SpO2
88–92%
Neomycin-polymyxin B-hydrocortisone otic drops
A 35-year-old woman presents to the emergency department
reporting right ear pain, yellow discharge, and difficulty hearing
out of the right ear for the last 5 days. She reports no cold
symptoms such as cough, fever, or sore throat. She believes the
pain began about a day after she used a cotton swab to clean her
right ear. The pain is a 7/10 intensity. She is currently taking
ibuprofen 400 mg as needed for the pain, which helps, but the
pain comes back once the medication wears off. Vital signs
include HR of 80 bpm, BP of 120/80 mm Hg, T of 99.2°F, RR of
16/min, BMI of 22.0 kg/m2, and SpO2 of 99% on room air. Her
physical exam reveals tenderness over the right tragus and
auricle when moved. The right inner ear canal appears
edematous and erythematous. The right tympanic membrane is
intact without erythema and is mobile upon insufflation. The left
ear exam is normal. Which medication should be administered to
the patient?
AAcetic acid-hydrocortisone otic drops
BAmoxicillin-clavulanate oral
CCiprofloxacin intravenous
DNeomycin-polymyxin B-hydrocortisone otic drops
Multifocal atrial tachycardia
A 74-year-old man presents to the clinic with a cough, shortness
of breath, and a low-grade fever for the past 3 days. The patient
,reports no chest pain or leg swelling. He has a medical history of
chronic obstructive pulmonary disease for which he takes
albuterol and glycopyrrolate. Vital signs include an HR of 132
bpm, BP of 135/80 mm Hg, RR of 22/min, oxygen saturation of
93% on room air, and T of 100.1°F. Physical examination reveals
bilateral expiratory wheezing and no pretibial edema or erythema.
The patient has no rales on auscultation. The patient’s
electrocardiogram is shown above. What rhythm is seen on the
above electrocardiogram?
AAtrial fibrillation
BMultifocal atrial tachycardia
CSinus tachycardia with premature ventricular beats
DWandering atrial pacemaker
Adenosine 6 mg IV
A 45-year-old woman presents to the emergency department with
reports of sudden-onset racing heart, lightheadedness, and
fatigue. The symptoms began spontaneously while she was
sitting at her desk at work and have continued intermittently for
the past 45 minutes. She has had two similar episodes in the past
month that lasted only a few minutes each. Her medical history is
significant for GERD and generalized anxiety disorder. On exam,
she is mildly anxious and short of breath. Her blood pressure is
124/80 mm Hg, heart rate is 150 beats/minute, respiratory rate is
22 breaths/minute, oxygen saturation is 96%, and temperature is
98.0°F. An ECG is shown above. The patient was instructed on
how to perform the Valsalva maneuver and made three attempts
without any change in her heart rate. The emergency department
clinician also attempted initiating a gag with mild improvement in
the patient’s heart rate, but after approximately 60 seconds, her
heart rate accelerated to 170 beats per minute. Which of the
following is the most appropriate treatment for this patient?
AAdenosine 6 mg IV
BAmiodarone 150 mg IV
CMetoprolol 5 mg IV
, DSynchronized cardioversion
Neuroimaging with MRI
A 46-year-old man with a medical history of hypertension and
hyperlipidemia presents to the emergency department for
evaluation of back and left leg pain, tingling in his left foot, and an
episode of urinary incontinence. He states the symptoms were
noticeable when he woke up this morning but have gotten
progressively worse over the course of the day, and he is unable
to walk. He has tried taking ibuprofen and acetaminophen without
relief. He reports no injury or trauma but notes he cleaned out his
garage all day yesterday. He reports no history of back issues or
surgical history. He takes lisinopril and atorvastatin as prescribed
and does not use tobacco, daily alcohol, or other substances.
Vital signs are a temperature of 99.0°F, heart rate of 96 bpm,
blood pressure of 144/88 mm Hg, respiratory rate of 18
breaths/min, and oxygen saturation of 98% on room air. On
physical examination, the patient is unable to point his toes
downward. He has 2/5 strength of his extensor hallucis longus
and anterior tibialis muscles. No other muscle strength deficits are
noted in his left leg, right leg, or bilateral upper extremities. He
has an absent Achilles reflex and intact patellar reflex on the left
side. Decreased rectal tone is noted on digital rectal examination,
and the patient has decreased sensation to light touch in the
perineum and perianal regions. Bladder scan demonstrates < 100
cc of urine in the bladder. What is the most appropriate next step
for the management of this condition?
ACatheterization of the bladder
BEpidural steroid injection
CNeuroimaging with MRI
DNSAIDs and mobilization
Colorectal cancer screening
A 38-year-old woman presents to the emergency department with
“aching” left lower quadrant pain, nausea, vomiting, and diarrhea
that began last week. Her vital signs are a temperature of
Exam Questions and Correct Answers
(Verified Answers) Latest Version
Inability to extend the wrist
A 59-year-old woman with a history of hyperlipidemia presents to
the emergency department via EMS for evaluation of right arm
pain. She was walking her dog when the dog pulled on the leash
quickly, causing the patient to fall on an outstretched arm. She
states she felt her arm “snap.” She reports some tingling on her
dorsal palm, located near her thumb. She has no shoulder, elbow,
or wrist pain. On physical examination, she is cradling her right
arm. There is a mild deformity noted in her upper arm and
associated moderate swelling. Vital signs are heart rate of 96
bpm, blood pressure of 142/86 mm Hg, respiratory rate of 16/min,
and oxygen saturation of 99% on room air. Radiographs are
shown above. Which physical exam finding should make you
suspicious for the most likely associated nerve injury?
AInability to abduct fingers
BInability to extend the wrist
CInability to flex the wrist
DInability to make an OK sign
Short-acting beta-agonist and supplemental oxygen to SpO2
88-92%
A 64-year-old man presents to the emergency department with
reports of worsening productive cough for the past 3 days. He
states he has had a persistent wet cough on a regular basis for
the last 2 years, but it has been aggravated over the last few
days. He also notes an increase in sputum production. He reports
no alleviating or aggravating factors. His medical history is
significant for hypertension controlled with metoprolol. He has a
,20 pack-year history of smoking. Vital signs include an HR of 89
bpm, BP of 130/82 mm Hg, RR of 24/min, SpO2 of 87% on room
air, and T of 98.6°F. On physical examination, rhonchi and
prolonged expiration are noted. What is the initial management for
this patient’s current condition?
AAdministration of ceftriaxone and azithromycin
BEndotracheal intubation
CIV methylprednisolone
DShort-acting beta-agonist and supplemental oxygen to SpO2
88–92%
Neomycin-polymyxin B-hydrocortisone otic drops
A 35-year-old woman presents to the emergency department
reporting right ear pain, yellow discharge, and difficulty hearing
out of the right ear for the last 5 days. She reports no cold
symptoms such as cough, fever, or sore throat. She believes the
pain began about a day after she used a cotton swab to clean her
right ear. The pain is a 7/10 intensity. She is currently taking
ibuprofen 400 mg as needed for the pain, which helps, but the
pain comes back once the medication wears off. Vital signs
include HR of 80 bpm, BP of 120/80 mm Hg, T of 99.2°F, RR of
16/min, BMI of 22.0 kg/m2, and SpO2 of 99% on room air. Her
physical exam reveals tenderness over the right tragus and
auricle when moved. The right inner ear canal appears
edematous and erythematous. The right tympanic membrane is
intact without erythema and is mobile upon insufflation. The left
ear exam is normal. Which medication should be administered to
the patient?
AAcetic acid-hydrocortisone otic drops
BAmoxicillin-clavulanate oral
CCiprofloxacin intravenous
DNeomycin-polymyxin B-hydrocortisone otic drops
Multifocal atrial tachycardia
A 74-year-old man presents to the clinic with a cough, shortness
of breath, and a low-grade fever for the past 3 days. The patient
,reports no chest pain or leg swelling. He has a medical history of
chronic obstructive pulmonary disease for which he takes
albuterol and glycopyrrolate. Vital signs include an HR of 132
bpm, BP of 135/80 mm Hg, RR of 22/min, oxygen saturation of
93% on room air, and T of 100.1°F. Physical examination reveals
bilateral expiratory wheezing and no pretibial edema or erythema.
The patient has no rales on auscultation. The patient’s
electrocardiogram is shown above. What rhythm is seen on the
above electrocardiogram?
AAtrial fibrillation
BMultifocal atrial tachycardia
CSinus tachycardia with premature ventricular beats
DWandering atrial pacemaker
Adenosine 6 mg IV
A 45-year-old woman presents to the emergency department with
reports of sudden-onset racing heart, lightheadedness, and
fatigue. The symptoms began spontaneously while she was
sitting at her desk at work and have continued intermittently for
the past 45 minutes. She has had two similar episodes in the past
month that lasted only a few minutes each. Her medical history is
significant for GERD and generalized anxiety disorder. On exam,
she is mildly anxious and short of breath. Her blood pressure is
124/80 mm Hg, heart rate is 150 beats/minute, respiratory rate is
22 breaths/minute, oxygen saturation is 96%, and temperature is
98.0°F. An ECG is shown above. The patient was instructed on
how to perform the Valsalva maneuver and made three attempts
without any change in her heart rate. The emergency department
clinician also attempted initiating a gag with mild improvement in
the patient’s heart rate, but after approximately 60 seconds, her
heart rate accelerated to 170 beats per minute. Which of the
following is the most appropriate treatment for this patient?
AAdenosine 6 mg IV
BAmiodarone 150 mg IV
CMetoprolol 5 mg IV
, DSynchronized cardioversion
Neuroimaging with MRI
A 46-year-old man with a medical history of hypertension and
hyperlipidemia presents to the emergency department for
evaluation of back and left leg pain, tingling in his left foot, and an
episode of urinary incontinence. He states the symptoms were
noticeable when he woke up this morning but have gotten
progressively worse over the course of the day, and he is unable
to walk. He has tried taking ibuprofen and acetaminophen without
relief. He reports no injury or trauma but notes he cleaned out his
garage all day yesterday. He reports no history of back issues or
surgical history. He takes lisinopril and atorvastatin as prescribed
and does not use tobacco, daily alcohol, or other substances.
Vital signs are a temperature of 99.0°F, heart rate of 96 bpm,
blood pressure of 144/88 mm Hg, respiratory rate of 18
breaths/min, and oxygen saturation of 98% on room air. On
physical examination, the patient is unable to point his toes
downward. He has 2/5 strength of his extensor hallucis longus
and anterior tibialis muscles. No other muscle strength deficits are
noted in his left leg, right leg, or bilateral upper extremities. He
has an absent Achilles reflex and intact patellar reflex on the left
side. Decreased rectal tone is noted on digital rectal examination,
and the patient has decreased sensation to light touch in the
perineum and perianal regions. Bladder scan demonstrates < 100
cc of urine in the bladder. What is the most appropriate next step
for the management of this condition?
ACatheterization of the bladder
BEpidural steroid injection
CNeuroimaging with MRI
DNSAIDs and mobilization
Colorectal cancer screening
A 38-year-old woman presents to the emergency department with
“aching” left lower quadrant pain, nausea, vomiting, and diarrhea
that began last week. Her vital signs are a temperature of
