ROSH REVIEW EMERGENCY MEDICINE
COMPREHENSIVE STUDY GUIDE 2026 FULL
QUESTIONS AND SOLUTIONS GRADED A+
◍ Contraindications to succinylcholine administration.
Answer: malignant hyperpyrexiamotor neuron diseasemuscular
dystrophiesguillian barre syndromesevere burns >5daysspinal cord damage
1 wk-3months
◍ Which type of bowel obstruction is generally associated with elderly or
psychiatric patients who are bedridden and taking chronic anticholinergic
medications?.
Answer: sigmoid volvulus
◍ What medication commonly used by young women has been associated
with the development of erythema nodosum?.
Answer: OCPs
◍ Papilledema.
Answer: Patient presents with acute onset of intermittent headaches and
blurred visionPE will show optic disk swellingFocus on finding intracranial
pathologyMost commonly caused secondary to increased intracranial
pressureTreatment is the treatment of the underlying disorder
◍ What two traumatic mechanisms in pediatric patients frequently cause a
duodenal hematoma?.
Answer: Lap belt injuries and handlebar injuries
◍ A 22-year-old woman presents with dyspnea. She has a history of asthma
and noted increased difficulty breathing starting yesterday. She says she has
been using her albuterol inhaler every 15 minutes for the last four hours
without relief. What laboratory abnormality is likely to be found in this
, patient?.
Answer: HYPOkalemiaAlbuterol most common side effects include tremor
and tachycardia.
◍ What is the name of the eye pairs of a brown recluse spider?.
Answer: Dyad
◍ What is the treatment for normal pressure hydrocephalus?.
Answer: ventricular shunting
◍ What maneuvers will INCREASE the intensity of the murmur associated
with hypertrophic cardiomyopathy?.
Answer: valsalva maneuver and standing
◍ What is HELLP syndrome?.
Answer: It is a group of symptoms that occur in pregnant women who have
hemolysis, elevated liver enzymes, and low platelet count.
◍ Primary Immune Thrombocytopenia.
Answer: Patient will be a child 2–6 years oldHistory of recent viral
infectionRed spots on skin or easy bleedingPE will show petechiae, purpura,
and gingival bleedingLabs will show platelets < 100,000/µLMost commonly
caused by antiplatelet antibodiesTreatment is observation, steroids, IVIG
◍ A 30-year-old woman who is 32 weeks pregnant presents to the emergency
department with painful vaginal bleeding and uterine contractions that began
abruptly about 30 minutes ago. The contractions are persistent, getting
stronger, and do not have a consistent pattern. Physical exam shows marked
abdominal tenderness and decreased fetal movement. Which of the
following is a strong risk factor for this condition?
A. Current tobacco use
B. Gestational diabetes
C. Obesity
D. PCOS.
Answer: Correct Answer: (A) Current tobacco useExplanation:Abruptio
placentae, also known as placental abruption, is the premature separation of
,the placenta from the uterus. It should be considered in all patients who
present with painful bleeding in the second half of their pregnancy, as it has
a high fetal and maternal morbidity and mortality rate. Uterine hemorrhage
leads to hematoma formation, causing compression of the uterus and
compromising the blood supply to the fetus. The muscle wall in this area of
the uterus can be weakened and can increase the risk of uterine rupture,
which is a life-threatening emergency. Patients most commonly present with
painful vaginal bleeding, but bleeding may not always be present. Other
symptoms include contractions, abdominal tenderness, and decreased fetal
movement indicating fetal distress. Patients who have a history of previous
placental abruption are at the highest risk. Possible causes including trauma,
such as assault, abuse, or motor vehicle collisions, should also be
considered. Correctable risk factors include smoking and cocaine abuse, and
cessation of these two activities may help to prevent future abruptions.
Ultrasound of the uterus should be performed to exclude placenta previa
before performing a pelvic examination, which can increase the risk of
hemorrhage. Patients should be admitted to the hospital with possible
delivery if abruptio placentae is suspected. Cesarean delivery is necessary to
save the mother and fetus, with hysterectomy being required if hemorrhage
cannot be controlled after delivery.Gestational diabetes (B) is not a risk
factor for placental abruption but can cause complications like premature
birth, stillbirth, and macrosomia. Obesity (C) is a risk factor for gestational
diabetes, premature birth, stillbirth, and preeclampsia, but not placental
abruption. Polycystic ovarian syndrome (D) can lead to increased risk of
miscarriage, preeclampsia, gestational diabetes, and premature and stillbirth
but is not a risk factor for placental abruption.Gestational diabetes (B) is not
a risk factor for placental abruption but can cause complications like
premature birth, stillbirth, and macrosomia. Obesity (C) is a risk factor for
gestational diabetes, premature birth, stillbirth, and preeclampsia, but not
placental abruption. Polycystic ovarian syndrome (D) can lead to increased
risk of miscarriage, preeclampsia, gestational diabetes, and premature and
stillbirth but is not a risk factor for placental abruption.
, ◍ True or false: Anterior wall duodenal ulcers are more likely to penetrate
than perforate..
Answer: False
◍ Which of the following structures is most likely to be injured in a knee
(tibiofemoral) dislocation?
A. Biceps femoris tendon
B. Femoral vein
C. Popliteal artery
D. Tibial nerve.
Answer: Correct Answer: (C) Popliteal arteryExplanation:Tibiofemoral
dislocations are serious injuries with a high rate of complications. They are
usually due to high-energy trauma, such as a fall from a height or motor
vehicle trauma, but can occur in obese patients who fall from a standing
height. Approximately 50% of knee dislocations will reduce spontaneously
prior to presentation to the emergency department, so it is important to
obtain a history of the mechanism of injury and the position of the leg
during and immediately after the injury. Dislocations are most commonly
anterior or posterior but can also occur in medial, lateral, or rotatory
directions. Physical examination findings include a joint effusion due to
hemarthrosis, ecchymoses, recurvatum (hyperextension) of more than 30°,
and laxity to testing of at least three out of the four major ligaments (anterior
cruciate, posterior cruciate, medial collateral, and lateral collateral). X-rays
are indicated to determine the direction of the dislocation. They may be
normal if it has been reduced or may show subtle asymmetry of the joint
spaces. Immediate closed reduction is indicated for dislocations that have
not reduced spontaneously. Damage to the popliteal artery is the most
common injury associated with knee dislocations and occurs in 40% of
patients. The popliteal artery is anchored distally by the soleus muscle and
tethered across the popliteal space, so it is vulnerable to injury. The presence
or absence of pulses is not reliable for evaluating injury to the popliteal
artery, so the ankle-brachial index should be measured in all patients with
knee dislocations. If it is below 0.9, further studies, such as an arterial
COMPREHENSIVE STUDY GUIDE 2026 FULL
QUESTIONS AND SOLUTIONS GRADED A+
◍ Contraindications to succinylcholine administration.
Answer: malignant hyperpyrexiamotor neuron diseasemuscular
dystrophiesguillian barre syndromesevere burns >5daysspinal cord damage
1 wk-3months
◍ Which type of bowel obstruction is generally associated with elderly or
psychiatric patients who are bedridden and taking chronic anticholinergic
medications?.
Answer: sigmoid volvulus
◍ What medication commonly used by young women has been associated
with the development of erythema nodosum?.
Answer: OCPs
◍ Papilledema.
Answer: Patient presents with acute onset of intermittent headaches and
blurred visionPE will show optic disk swellingFocus on finding intracranial
pathologyMost commonly caused secondary to increased intracranial
pressureTreatment is the treatment of the underlying disorder
◍ What two traumatic mechanisms in pediatric patients frequently cause a
duodenal hematoma?.
Answer: Lap belt injuries and handlebar injuries
◍ A 22-year-old woman presents with dyspnea. She has a history of asthma
and noted increased difficulty breathing starting yesterday. She says she has
been using her albuterol inhaler every 15 minutes for the last four hours
without relief. What laboratory abnormality is likely to be found in this
, patient?.
Answer: HYPOkalemiaAlbuterol most common side effects include tremor
and tachycardia.
◍ What is the name of the eye pairs of a brown recluse spider?.
Answer: Dyad
◍ What is the treatment for normal pressure hydrocephalus?.
Answer: ventricular shunting
◍ What maneuvers will INCREASE the intensity of the murmur associated
with hypertrophic cardiomyopathy?.
Answer: valsalva maneuver and standing
◍ What is HELLP syndrome?.
Answer: It is a group of symptoms that occur in pregnant women who have
hemolysis, elevated liver enzymes, and low platelet count.
◍ Primary Immune Thrombocytopenia.
Answer: Patient will be a child 2–6 years oldHistory of recent viral
infectionRed spots on skin or easy bleedingPE will show petechiae, purpura,
and gingival bleedingLabs will show platelets < 100,000/µLMost commonly
caused by antiplatelet antibodiesTreatment is observation, steroids, IVIG
◍ A 30-year-old woman who is 32 weeks pregnant presents to the emergency
department with painful vaginal bleeding and uterine contractions that began
abruptly about 30 minutes ago. The contractions are persistent, getting
stronger, and do not have a consistent pattern. Physical exam shows marked
abdominal tenderness and decreased fetal movement. Which of the
following is a strong risk factor for this condition?
A. Current tobacco use
B. Gestational diabetes
C. Obesity
D. PCOS.
Answer: Correct Answer: (A) Current tobacco useExplanation:Abruptio
placentae, also known as placental abruption, is the premature separation of
,the placenta from the uterus. It should be considered in all patients who
present with painful bleeding in the second half of their pregnancy, as it has
a high fetal and maternal morbidity and mortality rate. Uterine hemorrhage
leads to hematoma formation, causing compression of the uterus and
compromising the blood supply to the fetus. The muscle wall in this area of
the uterus can be weakened and can increase the risk of uterine rupture,
which is a life-threatening emergency. Patients most commonly present with
painful vaginal bleeding, but bleeding may not always be present. Other
symptoms include contractions, abdominal tenderness, and decreased fetal
movement indicating fetal distress. Patients who have a history of previous
placental abruption are at the highest risk. Possible causes including trauma,
such as assault, abuse, or motor vehicle collisions, should also be
considered. Correctable risk factors include smoking and cocaine abuse, and
cessation of these two activities may help to prevent future abruptions.
Ultrasound of the uterus should be performed to exclude placenta previa
before performing a pelvic examination, which can increase the risk of
hemorrhage. Patients should be admitted to the hospital with possible
delivery if abruptio placentae is suspected. Cesarean delivery is necessary to
save the mother and fetus, with hysterectomy being required if hemorrhage
cannot be controlled after delivery.Gestational diabetes (B) is not a risk
factor for placental abruption but can cause complications like premature
birth, stillbirth, and macrosomia. Obesity (C) is a risk factor for gestational
diabetes, premature birth, stillbirth, and preeclampsia, but not placental
abruption. Polycystic ovarian syndrome (D) can lead to increased risk of
miscarriage, preeclampsia, gestational diabetes, and premature and stillbirth
but is not a risk factor for placental abruption.Gestational diabetes (B) is not
a risk factor for placental abruption but can cause complications like
premature birth, stillbirth, and macrosomia. Obesity (C) is a risk factor for
gestational diabetes, premature birth, stillbirth, and preeclampsia, but not
placental abruption. Polycystic ovarian syndrome (D) can lead to increased
risk of miscarriage, preeclampsia, gestational diabetes, and premature and
stillbirth but is not a risk factor for placental abruption.
, ◍ True or false: Anterior wall duodenal ulcers are more likely to penetrate
than perforate..
Answer: False
◍ Which of the following structures is most likely to be injured in a knee
(tibiofemoral) dislocation?
A. Biceps femoris tendon
B. Femoral vein
C. Popliteal artery
D. Tibial nerve.
Answer: Correct Answer: (C) Popliteal arteryExplanation:Tibiofemoral
dislocations are serious injuries with a high rate of complications. They are
usually due to high-energy trauma, such as a fall from a height or motor
vehicle trauma, but can occur in obese patients who fall from a standing
height. Approximately 50% of knee dislocations will reduce spontaneously
prior to presentation to the emergency department, so it is important to
obtain a history of the mechanism of injury and the position of the leg
during and immediately after the injury. Dislocations are most commonly
anterior or posterior but can also occur in medial, lateral, or rotatory
directions. Physical examination findings include a joint effusion due to
hemarthrosis, ecchymoses, recurvatum (hyperextension) of more than 30°,
and laxity to testing of at least three out of the four major ligaments (anterior
cruciate, posterior cruciate, medial collateral, and lateral collateral). X-rays
are indicated to determine the direction of the dislocation. They may be
normal if it has been reduced or may show subtle asymmetry of the joint
spaces. Immediate closed reduction is indicated for dislocations that have
not reduced spontaneously. Damage to the popliteal artery is the most
common injury associated with knee dislocations and occurs in 40% of
patients. The popliteal artery is anchored distally by the soleus muscle and
tethered across the popliteal space, so it is vulnerable to injury. The presence
or absence of pulses is not reliable for evaluating injury to the popliteal
artery, so the ankle-brachial index should be measured in all patients with
knee dislocations. If it is below 0.9, further studies, such as an arterial
