ROSH COMPREHENSIVE EXAM STUDY
GUIDE WITH COMPLETE SOLUTIONS
●● Should family members of an infected individual also be treated for
scabies?
Answer: Yes, family members and sexual contacts.
●● Scabies
Answer: Sarcoptes scabiei
Pruritic rash worse at night
Linear burrows
Interdigital spaces of hands/feet, penis, breasts
Permethrin (first line)
Ivermectin
**head and back are sparred
(head involved in children)
●● An 18-month-old boy presents to the emergency department with
worsening shortness of breath. The parents report he has had a cough,
runny nose, and fussiness for the past five days. On exam, the patient
demonstrates subcostal retractions, tachypnea, and diffuse wheezing.
The patient is given an albuterol nebulizer treatment without any
,improvement of his wheezing. Chest X-ray does not show any
abnormality. Which of the following organisms is the most likely cause
of his symptoms?
Bordetella pertussis
Haemophilus influenzae
Parainfluenza virus
Respiratory syncytial virus
Answer: Correct Answer ( D )
Explanation:
The patient has bronchiolitis, which is the most common lower
respiratory tract infection in patients less than two years of age. It
remains the leading cause for hospitalization in infants under one year of
age. Bronchiolitis is most commonly caused by respiratory syncytial
virus (RSV), but may be caused by other viral agents. Bronchiolitis is
inflammation of the lower respiratory tract, which involves edema,
epithelial cell necrosis, bronchospasm, and increased mucus production.
The resultant lower airway obstruction causes increased work of
breathing and wheezing. Bronchiolitis is a clinical diagnosis based on
age under two years old, rhinorrhea, tachypnea, and wheezing. Unlike
asthma or reactive airway disease, there is often no significant
improvement with albuterol. There is often a history of several days of
upper respiratory symptoms, such as rhinorrhea, mild cough, and mild
fever. Rapid antigen tests, blood work, and radiographs are not usually
needed. Radiographs may demonstrate hyperinflation and atelectasis, but
do not show any focal infiltrates like with pneumonia. Bronchiolitis is
,usually self-limited, with respiratory status typically improving over 2-5
days. Management involves supportive care.
●● Bronchiolitis
Answer:
●● What months of the year contain the peak incidence of RSV in North
America?
Answer: November to March.
●● A 76-year-old man presents to the emergency department with
shortness of breath and lightheadedness. Vital signs include blood
pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate 22
breaths/minute, and temperature 37.6°C. He has distended neck veins
and occasional dropped radial beats. His lungs are clear to auscultation,
but his heart sounds are distant. He has some fullness to palpation of the
right upper quadrant of his abdomen. Which of the following is the most
appropriate diagnostic test?
Bedside echocardiography
Chest radiograph
Computed tomography angiogram of the chest
Electrocardiogram
Answer: Correct Answer ( A )
Explanation:
, This patient presents with a clinical picture consistent with obstructive
shock. His distended neck veins, full right upper quadrant, muffled heart
sounds, and hypotension are all consistent with pericardial tamponade. A
pericardial sac slowly accumulating fluid can stretch without obstructing
cardiac function. Tamponade occurs when rapid fluid accumulation
results in elevated pressures that inhibit venous return. This is a dynamic
process over the course of the cardiac cycle, therefore bedside
echocardiography is the diagnostic test of choice. Fluid around the heart
with evidence of right atrial compression and right ventricular diastolic
collapse are diagnostic of pericardial tamponade.
●● Pericardial Effusion
Answer:
●● What is the emergent treatment of pericardial tamponade?
Answer: Pericardiocentesis.
●● An 8-year-old African-American girl with a history of sickle cell
anemia presents with diffuse pain consistent with an acute sickle cell
pain crisis. While in the emergency department, she develops acute onset
headache, right sided facial droop and right arm weakness. A CT scan
confirms the diagnosis. Which of the following is the next best step in
management?
Alteplase
Exchange transfusion
GUIDE WITH COMPLETE SOLUTIONS
●● Should family members of an infected individual also be treated for
scabies?
Answer: Yes, family members and sexual contacts.
●● Scabies
Answer: Sarcoptes scabiei
Pruritic rash worse at night
Linear burrows
Interdigital spaces of hands/feet, penis, breasts
Permethrin (first line)
Ivermectin
**head and back are sparred
(head involved in children)
●● An 18-month-old boy presents to the emergency department with
worsening shortness of breath. The parents report he has had a cough,
runny nose, and fussiness for the past five days. On exam, the patient
demonstrates subcostal retractions, tachypnea, and diffuse wheezing.
The patient is given an albuterol nebulizer treatment without any
,improvement of his wheezing. Chest X-ray does not show any
abnormality. Which of the following organisms is the most likely cause
of his symptoms?
Bordetella pertussis
Haemophilus influenzae
Parainfluenza virus
Respiratory syncytial virus
Answer: Correct Answer ( D )
Explanation:
The patient has bronchiolitis, which is the most common lower
respiratory tract infection in patients less than two years of age. It
remains the leading cause for hospitalization in infants under one year of
age. Bronchiolitis is most commonly caused by respiratory syncytial
virus (RSV), but may be caused by other viral agents. Bronchiolitis is
inflammation of the lower respiratory tract, which involves edema,
epithelial cell necrosis, bronchospasm, and increased mucus production.
The resultant lower airway obstruction causes increased work of
breathing and wheezing. Bronchiolitis is a clinical diagnosis based on
age under two years old, rhinorrhea, tachypnea, and wheezing. Unlike
asthma or reactive airway disease, there is often no significant
improvement with albuterol. There is often a history of several days of
upper respiratory symptoms, such as rhinorrhea, mild cough, and mild
fever. Rapid antigen tests, blood work, and radiographs are not usually
needed. Radiographs may demonstrate hyperinflation and atelectasis, but
do not show any focal infiltrates like with pneumonia. Bronchiolitis is
,usually self-limited, with respiratory status typically improving over 2-5
days. Management involves supportive care.
●● Bronchiolitis
Answer:
●● What months of the year contain the peak incidence of RSV in North
America?
Answer: November to March.
●● A 76-year-old man presents to the emergency department with
shortness of breath and lightheadedness. Vital signs include blood
pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate 22
breaths/minute, and temperature 37.6°C. He has distended neck veins
and occasional dropped radial beats. His lungs are clear to auscultation,
but his heart sounds are distant. He has some fullness to palpation of the
right upper quadrant of his abdomen. Which of the following is the most
appropriate diagnostic test?
Bedside echocardiography
Chest radiograph
Computed tomography angiogram of the chest
Electrocardiogram
Answer: Correct Answer ( A )
Explanation:
, This patient presents with a clinical picture consistent with obstructive
shock. His distended neck veins, full right upper quadrant, muffled heart
sounds, and hypotension are all consistent with pericardial tamponade. A
pericardial sac slowly accumulating fluid can stretch without obstructing
cardiac function. Tamponade occurs when rapid fluid accumulation
results in elevated pressures that inhibit venous return. This is a dynamic
process over the course of the cardiac cycle, therefore bedside
echocardiography is the diagnostic test of choice. Fluid around the heart
with evidence of right atrial compression and right ventricular diastolic
collapse are diagnostic of pericardial tamponade.
●● Pericardial Effusion
Answer:
●● What is the emergent treatment of pericardial tamponade?
Answer: Pericardiocentesis.
●● An 8-year-old African-American girl with a history of sickle cell
anemia presents with diffuse pain consistent with an acute sickle cell
pain crisis. While in the emergency department, she develops acute onset
headache, right sided facial droop and right arm weakness. A CT scan
confirms the diagnosis. Which of the following is the next best step in
management?
Alteplase
Exchange transfusion
