©EVERLY 2024/2025 ALL RIGHTS RESERVED.
ROSH Medical Exam Questions And
Answers. Verified And Updated.
A patient presents to the clinic complaining of a tearing pain with bowel movements and
reports small streaks of blood on the toilet paper. A physical examination of the patient's anus
reveals a lesion most likely in which of the following anatomic locations? - Answer✔post
midline
A 32-year-old man is admitted to the intensive care unit with a high fever, severe headache,
vomiting, and rash for three days. Physical exam reveals a petechial rash involving the palms
and soles that began on his wrists and ankles. Labs reveal dehydration and acute renal failure.
Which of the following diagnostic tests would be most useful in securing a diagnosis? -
Answer✔skin biopsy - RMSF
42-year-old woman presents to the emergency department after a suicide attempt. The patient
was depressed two days ago and took an entire bottle of acetaminophen. She initially felt
slightly nauseous and generally unwell but was otherwise asymptomatic. A family member
convinced her to come to the emergency department for further evaluation. Which of the
following history or physical exam findings is most consistent with toxic acetaminophen
ingestion - Answer✔
33-year-old woman presents to the clinic for obstetric care. She reports a history of two
consecutive, painless second-trimester miscarriages. Her past medical history is remarkable for
previous conization for cervical intraepithelial neoplasia. She is currently twelve weeks
pregnant. Which of the following is the most appropriate next step in management in this
patient? - Answer✔
32-year-old woman with history of migraine headaches presents for evaluation of increased
frequency of headaches. She takes abortive medication for migraines 2-4 times weekly and
misses several days of work a month. You decide to start topiramate daily for migraine
prophylaxis. Of the following, which one is the most common side effect of this medication? -
Answer✔paresthesia
1|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
Topiramate is an anticonvulsant used for migraine prevention and treatment of epilepsy.
Central nervous system side effects are the most common and include paresthesias,
nervousness, fatigue, ataxia, drowsiness, lack of concentration, dizziness and confusion.
Topiramate should be initiated at a low dose and gradually titrated to the recommended dose
to reduce the risk of these side effects. Also, topiramate should not be discontinued abruptly,
but instead decreased gradually over weeks, as sudden cessation may increase the risk for
seizure.
In addition to anticonvulsants, antihypertensive agents and antidepressants are sometimes
used for migraine prophylaxis. Beta-blockers and tricyclic antidepressants are commonly used.
Patients with a history of bronchospastic disease should avoid nonselective beta-blockers, such
as propranolol, due to the possible side effect of bronchospasm (B). Tricyclic antidepressants
antagonize muscarinic receptors leading to dry mouth (A), constipation, urinary retention, and
sometimes blurred vision. Topiramate is used in the prevention of seizures (D) as well as
migraines, and seizure is also a potential side effect of abrupt discontinuation of topiramate
A 65-year-old man presents to his physician for a gradual decline in exertional fortitude and
dyspnea on exertion that has been getting worse over the past two months. Physical exam
demonstrates a mid-systolic murmur heard best at the second intercostal space near the right
sternal border. The murmur decreases with isometric handgrip and Valsalva maneuvers. What
is the most likely diagnosis? - Answer✔
24-year-old woman presents with dysuria, urgency, and urinary frequency for the last three
days. Today, she developed nausea, flank pain, and a fever. What is the most likely diagnosis? -
Answer✔
19-month-old boy is brought into the emergency department by his parents with concern for
intermittent cough and fever for the past 3 days. On exam, he has a mild inspiratory stridor and
a barking cough. Exam of the posterior oropharynx is unremarkable and his oxygen saturation is
98% on room air. An anteroposterior soft tissue neck X-ray and chest X-ray are obtained. Which
of the following findings on imaging is most consistent with the diagnosis? - Answer✔
75-year-old man with a past medical history of lung cancer presents to the Emergency
Department complaining of three days of low back pain, bilateral lower extremity weakness,
and urinary retention. Digital rectal exam demonstrates decreased rectal tone. What is the
most likely diagnosis? - Answer✔
27-year-old tall, thin male presents to the emergency room with moderate right-sided chest
pain and dyspnea. He says it started quickly while he was watching television 30 minutes ago.
He is tachypneic and tachycardic, however his heart rate and blood pressure are stable at this
2|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
point. Lung exam reveals decreased breath sounds at his right lung field. Which of the following
other physical exam findings would be expected in this patient? - Answer✔decr right sided
tactile frem
45-year-old man with a history of obesity and diabetes mellitus presents to the emergency
department complaining of abdominal pain that radiates to his back, and nausea and vomiting.
Physical examination reveals tenderness in his epigastrium and yellow deposits are noted on
the extensor surfaces of his forearms. Which of the following will most likely be seen on his
lipid panel? - Answer✔markedly elevated TG
54-year-old woman presents with intermittent numbness and tingling in the first three digits of
her right hand for the last week. The symptoms are exacerbated by knitting or typing. Physical
exam reveals positive Phalen and Tinel signs. What is the most likely diagnosis? -
Answer✔carpal tunnel
16-year-old female competitive runner complains of pain and tenderness over her shins when
she runs. On physical exam you notice point tenderness over her left tibia. X-rays are normal
but MRI reveals a hairline fracture in the tibia. She has suffered multiple stress fractures of this
bone before. A prompt workup should be initiated for which of the following disorders? -
Answer✔hypopara
55-year-old man presents to his pulmonologist with progressive shortness of breath over the
past year. He was previously healthy and now can barely make it up the stairs in his home. A
chest radiograph shows enlargement of the pulmonary arteries with a normal sized cardiac
shadow and normal-appearing lung fields. An echocardiogram is performed showing a normal-
shaped left ventricle and thickened myocardium in the right ventricle. Which diagnosis is most
likely in this patient? - Answer✔pulm arterial HTN
42-year-old man presents via emergency medical services after an injury that occurred while he
was working. There was an explosion at the chemical plant where he was employed. An initial
survey of the patient shows deep-partial thickness burns of his neck and face along with burns
of varying degrees on his torso and hands. There is soot in his nose and mouth. Which of the
following is the most appropriate next step in managing this patient? - Answer✔prepare for
emergent intubation
24-year-old previously healthy woman presents to the ED complaining that she cannot move
her legs. The symptoms occurred suddenly after she was told that her fiancé died in a
motorcycle accident. She denies any associated symptoms, including pain. The sensation and
deep tendon reflexes in her lower extremities are normal. She has normal muscle tone. What is
the most likely diagnosis? - Answer✔conversion d/o
32-year-old man presents with severe bilateral eye pain that started in the late evening while
watching television. He works as a welder during the day. He has associated tearing,
3|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
photophobia, and foreign body sensation. He does not use contact lenses. Visual acuity in
20/40 OD and 20/40 OS. His eye examination after fluorescein staining is seen above. What is
the most likely diagnosis? - Answer✔UV keratitis
72-year-old man presents with worsening low back pain for the past one month. The pain is
worse with extension of his back and after walking for several minutes. The pain is relieved with
sitting. Physical exam shows that extension of the spine produces pain radiating down his
bilateral legs. Which of the following is the most likely diagnosis? - Answer✔spinal stenosis
47-year-old man presents as a trauma activation after a head-on motor vehicle crash at 20
mph. He was a restrained driver and the airbags did deploy. There were no drugs or alcohol
involved. He is uncertain if he lost consciousness. EMS extricated him, put him in spinal
immobilization, and splinted an obviously fractured femur. On primary survey, his airway is
protected, he is breathing easily, and is normotensive. Vital signs are within normal limits.
Secondary survey is notable for a GCS score of 15, a mildly tender right trapezius muscle, and
an ecchymotic and deformed left femur with normal distal neurovascular function. The
presence of which historical or physical finding necessitates cervical spinal imaging? -
Answer✔mech of injury
5-year-old girl presents with a blistering rash surrounding her mouth and extending into her
nares after a recent head cold. A close examination of the area reveals multiple pus-filled
blisters that erupt with minimal pressure, and diffuse honey-colored crusting lesions. Which of
the following tests would best reveal the cause of this eruption and guide treatment? -
Answer✔
Which of the following signs is a normal finding during early pregnancy? - Answer✔chadwick
21-year-old woman presents with pelvic pain that has been worsening over the last two days.
She reports vaginal discharge, nausea, and chills for the last week. Physical exam reveals thin,
copious vaginal discharge, cervical motion tenderness, and a mass in the left adnexa. Pregnancy
test is negative. A pelvic ultrasound reveals a complex multiloculated left adnexal mass. Which
of the following intravenous antibiotic regimens represents the most appropriate
pharmacotherapy? - Answer✔cefoxitan and doxy (TOA)
When evaluating for stress urinary incontinence, which of the following tests should be
performed to confirm the diagnosis? - Answer✔bladder stress test
Examination of a 75-year-old woman reveals a tender, dilated, right temporal artery. She also
complains of right-sided jaw pain when chewing. Her temperature is 38.1°C (100.5°F). Which of
the following is the most appropriate initial treatment for this patient? - Answer✔prednisone
Which of the following class of medications is used as first-line therapy for post-traumatic stress
disorder? - Answer✔SSRI
4|Page
ROSH Medical Exam Questions And
Answers. Verified And Updated.
A patient presents to the clinic complaining of a tearing pain with bowel movements and
reports small streaks of blood on the toilet paper. A physical examination of the patient's anus
reveals a lesion most likely in which of the following anatomic locations? - Answer✔post
midline
A 32-year-old man is admitted to the intensive care unit with a high fever, severe headache,
vomiting, and rash for three days. Physical exam reveals a petechial rash involving the palms
and soles that began on his wrists and ankles. Labs reveal dehydration and acute renal failure.
Which of the following diagnostic tests would be most useful in securing a diagnosis? -
Answer✔skin biopsy - RMSF
42-year-old woman presents to the emergency department after a suicide attempt. The patient
was depressed two days ago and took an entire bottle of acetaminophen. She initially felt
slightly nauseous and generally unwell but was otherwise asymptomatic. A family member
convinced her to come to the emergency department for further evaluation. Which of the
following history or physical exam findings is most consistent with toxic acetaminophen
ingestion - Answer✔
33-year-old woman presents to the clinic for obstetric care. She reports a history of two
consecutive, painless second-trimester miscarriages. Her past medical history is remarkable for
previous conization for cervical intraepithelial neoplasia. She is currently twelve weeks
pregnant. Which of the following is the most appropriate next step in management in this
patient? - Answer✔
32-year-old woman with history of migraine headaches presents for evaluation of increased
frequency of headaches. She takes abortive medication for migraines 2-4 times weekly and
misses several days of work a month. You decide to start topiramate daily for migraine
prophylaxis. Of the following, which one is the most common side effect of this medication? -
Answer✔paresthesia
1|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
Topiramate is an anticonvulsant used for migraine prevention and treatment of epilepsy.
Central nervous system side effects are the most common and include paresthesias,
nervousness, fatigue, ataxia, drowsiness, lack of concentration, dizziness and confusion.
Topiramate should be initiated at a low dose and gradually titrated to the recommended dose
to reduce the risk of these side effects. Also, topiramate should not be discontinued abruptly,
but instead decreased gradually over weeks, as sudden cessation may increase the risk for
seizure.
In addition to anticonvulsants, antihypertensive agents and antidepressants are sometimes
used for migraine prophylaxis. Beta-blockers and tricyclic antidepressants are commonly used.
Patients with a history of bronchospastic disease should avoid nonselective beta-blockers, such
as propranolol, due to the possible side effect of bronchospasm (B). Tricyclic antidepressants
antagonize muscarinic receptors leading to dry mouth (A), constipation, urinary retention, and
sometimes blurred vision. Topiramate is used in the prevention of seizures (D) as well as
migraines, and seizure is also a potential side effect of abrupt discontinuation of topiramate
A 65-year-old man presents to his physician for a gradual decline in exertional fortitude and
dyspnea on exertion that has been getting worse over the past two months. Physical exam
demonstrates a mid-systolic murmur heard best at the second intercostal space near the right
sternal border. The murmur decreases with isometric handgrip and Valsalva maneuvers. What
is the most likely diagnosis? - Answer✔
24-year-old woman presents with dysuria, urgency, and urinary frequency for the last three
days. Today, she developed nausea, flank pain, and a fever. What is the most likely diagnosis? -
Answer✔
19-month-old boy is brought into the emergency department by his parents with concern for
intermittent cough and fever for the past 3 days. On exam, he has a mild inspiratory stridor and
a barking cough. Exam of the posterior oropharynx is unremarkable and his oxygen saturation is
98% on room air. An anteroposterior soft tissue neck X-ray and chest X-ray are obtained. Which
of the following findings on imaging is most consistent with the diagnosis? - Answer✔
75-year-old man with a past medical history of lung cancer presents to the Emergency
Department complaining of three days of low back pain, bilateral lower extremity weakness,
and urinary retention. Digital rectal exam demonstrates decreased rectal tone. What is the
most likely diagnosis? - Answer✔
27-year-old tall, thin male presents to the emergency room with moderate right-sided chest
pain and dyspnea. He says it started quickly while he was watching television 30 minutes ago.
He is tachypneic and tachycardic, however his heart rate and blood pressure are stable at this
2|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
point. Lung exam reveals decreased breath sounds at his right lung field. Which of the following
other physical exam findings would be expected in this patient? - Answer✔decr right sided
tactile frem
45-year-old man with a history of obesity and diabetes mellitus presents to the emergency
department complaining of abdominal pain that radiates to his back, and nausea and vomiting.
Physical examination reveals tenderness in his epigastrium and yellow deposits are noted on
the extensor surfaces of his forearms. Which of the following will most likely be seen on his
lipid panel? - Answer✔markedly elevated TG
54-year-old woman presents with intermittent numbness and tingling in the first three digits of
her right hand for the last week. The symptoms are exacerbated by knitting or typing. Physical
exam reveals positive Phalen and Tinel signs. What is the most likely diagnosis? -
Answer✔carpal tunnel
16-year-old female competitive runner complains of pain and tenderness over her shins when
she runs. On physical exam you notice point tenderness over her left tibia. X-rays are normal
but MRI reveals a hairline fracture in the tibia. She has suffered multiple stress fractures of this
bone before. A prompt workup should be initiated for which of the following disorders? -
Answer✔hypopara
55-year-old man presents to his pulmonologist with progressive shortness of breath over the
past year. He was previously healthy and now can barely make it up the stairs in his home. A
chest radiograph shows enlargement of the pulmonary arteries with a normal sized cardiac
shadow and normal-appearing lung fields. An echocardiogram is performed showing a normal-
shaped left ventricle and thickened myocardium in the right ventricle. Which diagnosis is most
likely in this patient? - Answer✔pulm arterial HTN
42-year-old man presents via emergency medical services after an injury that occurred while he
was working. There was an explosion at the chemical plant where he was employed. An initial
survey of the patient shows deep-partial thickness burns of his neck and face along with burns
of varying degrees on his torso and hands. There is soot in his nose and mouth. Which of the
following is the most appropriate next step in managing this patient? - Answer✔prepare for
emergent intubation
24-year-old previously healthy woman presents to the ED complaining that she cannot move
her legs. The symptoms occurred suddenly after she was told that her fiancé died in a
motorcycle accident. She denies any associated symptoms, including pain. The sensation and
deep tendon reflexes in her lower extremities are normal. She has normal muscle tone. What is
the most likely diagnosis? - Answer✔conversion d/o
32-year-old man presents with severe bilateral eye pain that started in the late evening while
watching television. He works as a welder during the day. He has associated tearing,
3|Page
, ©EVERLY 2024/2025 ALL RIGHTS RESERVED.
photophobia, and foreign body sensation. He does not use contact lenses. Visual acuity in
20/40 OD and 20/40 OS. His eye examination after fluorescein staining is seen above. What is
the most likely diagnosis? - Answer✔UV keratitis
72-year-old man presents with worsening low back pain for the past one month. The pain is
worse with extension of his back and after walking for several minutes. The pain is relieved with
sitting. Physical exam shows that extension of the spine produces pain radiating down his
bilateral legs. Which of the following is the most likely diagnosis? - Answer✔spinal stenosis
47-year-old man presents as a trauma activation after a head-on motor vehicle crash at 20
mph. He was a restrained driver and the airbags did deploy. There were no drugs or alcohol
involved. He is uncertain if he lost consciousness. EMS extricated him, put him in spinal
immobilization, and splinted an obviously fractured femur. On primary survey, his airway is
protected, he is breathing easily, and is normotensive. Vital signs are within normal limits.
Secondary survey is notable for a GCS score of 15, a mildly tender right trapezius muscle, and
an ecchymotic and deformed left femur with normal distal neurovascular function. The
presence of which historical or physical finding necessitates cervical spinal imaging? -
Answer✔mech of injury
5-year-old girl presents with a blistering rash surrounding her mouth and extending into her
nares after a recent head cold. A close examination of the area reveals multiple pus-filled
blisters that erupt with minimal pressure, and diffuse honey-colored crusting lesions. Which of
the following tests would best reveal the cause of this eruption and guide treatment? -
Answer✔
Which of the following signs is a normal finding during early pregnancy? - Answer✔chadwick
21-year-old woman presents with pelvic pain that has been worsening over the last two days.
She reports vaginal discharge, nausea, and chills for the last week. Physical exam reveals thin,
copious vaginal discharge, cervical motion tenderness, and a mass in the left adnexa. Pregnancy
test is negative. A pelvic ultrasound reveals a complex multiloculated left adnexal mass. Which
of the following intravenous antibiotic regimens represents the most appropriate
pharmacotherapy? - Answer✔cefoxitan and doxy (TOA)
When evaluating for stress urinary incontinence, which of the following tests should be
performed to confirm the diagnosis? - Answer✔bladder stress test
Examination of a 75-year-old woman reveals a tender, dilated, right temporal artery. She also
complains of right-sided jaw pain when chewing. Her temperature is 38.1°C (100.5°F). Which of
the following is the most appropriate initial treatment for this patient? - Answer✔prednisone
Which of the following class of medications is used as first-line therapy for post-traumatic stress
disorder? - Answer✔SSRI
4|Page
