Rosh Review UPDATED ACTUAL Questions and CORRECT Answers
1. A patient is diagnosed with ventila- B Cefepime
tor-associated pneumonia in the med-
ical intensive care unit and the deci- Pseudomonas is susceptible to 4th Generation
sion is made to initiate broad-spec- Cephalosporins - Cefepime, Cefquinome.
trum antibiotics with antipseudomon-
al coverage. Which of the following is
Pseudomonas aeruginosa susceptible
to?
A Cefazolin
B Cefepime
C Cefpodoxime
D Ceftriaxone
2. 29F has a 10-year history of migraine C Propranolol
headaches. She had been using ergo-
tamine to abort her headaches, but is Prophylaxis for migraine headaches: Beta Block-
now having one or two headaches per er (Propranolol), Antiepileptics (Topiramate, Val-
week that are interfering with work. proic Acid), Calcium Channel Blockers (Vera-
Which of the following is the most ap- pamil), & TCAs (Amitriptyline) and recently ap-
propriate preventive therapy? proved Botulinum Toxin A injections.
A Ketorolac X A - Ketorolac is an NSAID, not used for preven-
B Promethazine tion.
C Propranolol X B - Promethazine is an antiemetic if a patient
D Sumatriptan has N/V with migraines, but is not preventive.
X D - Sumatriptan is an abortive when given
subcutaneously, but is not preventive.
3. 34F presents with concerns about B Copper-containing intrauterine device
contraception. She is in a monoga-
mous relationship & wishes to main- Copper IUD has a 10-year lifespan, is highly
effective, and has minor side effects that does
, tain long-term fertility. She has regu- not include weight gain. It is easily reversible,
lar menstrual cycles that are typically and non-hormonal. An IUD is a good choice for
28 days and consist of light bleeding patients with a history of VTE, migraine with aura,
for 4-5 days. She experienced menar- or uncontrolled HTN (which this patient has!).
che at 11 y.o. Medical history significant
for essential HTN and hypothyroidism, X A - OCP is contraindicated in patients with
currently taking lisinopril & levothyrox- increased risk of CV sequelae, including uncon-
ine. Vitals are BP 145/96 mmHg, HR trolled DM or HTN or smokers.
88 bpm, SpO2 98% on room air, and T X C - contains estrogen and has similar side
98.4F. PE shows no abnormalities. She effect and risk profile as OCP.
is concerned about taking a prescrip- X D - can cause weight gain or irregular vaginal
tion that may cause weight gain or nau- bleeding.
sea. Which of the following is the most X E - contains estrogen.
appropriate contraceptive method for
this patient?
A Combined estrogen-progestin oral
contraceptives
B Copper-containing intrauterine de-
vice
C Estrogen-progestin vaginal ring
D Implantable etonogestrel
E Transdermal contraceptive patch
4. 18M agricultural laborer presents with C Myocarditis
an intensely sore throat and fever. He
reports he has never been sick before. Diphtheria has been fairly well eliminated in
The patient's vaccination history is not the US due to Tdap vaccination. Patient with
available. Vitals are BP of 110/65 mm unknown vaccination history + presentation
Hg, HR of 70 bpm, RR of 12 bpm, T of suspicious for Diphtheria (pseudomembrane
100.8°F, and BMI of 20 kg/m2. The sub- oral lesions that bleed when scraped, sore
mandibular area shows significant ede- throat, barking cough, hoarse, cervical LNs, sub-
, ma, and laryngoscopic exam reveals a mandibular swelling). Major complications in-
dull-colored, leathery plaque adhering clude Myocarditis, Nephritis, Polyneuropathy,
to the right tonsil, which bleeds upon and Thrombocytopenia. Treat with Penicillin or
scraping. What is one of the potential Erythromycin, and treat toxin separately with
complications of this patient's disease? neutralizing antitoxin. Notify the CDC
A Esophagitis
B Hemolytic uremic syndrome
C Myocarditis
D Reactive arthritis
E Splenic rupture
5. A 56-year-old man with a 10-year histo- D White blood cell count 18,000
ry of alcohol use disorder presents to
the emergency room with nausea and Acute Pancreatitis Ranson's Criteria at admission:
dull, epigastric pain that radiates to the age > 55 y.o., WBCs > 16k, Glucose > 200, LDH
back for the past 2 hours. Which of the > 350, AST > 250
following lab values is associated with
At 48 hours: Hct decrease by > 10%, BUN in-
a poor prognosis for the suspected di-
crease by > 5, Calcium < 8, PaO2 < 60, base
agnosis?
deficit > 4, fluid sequestration > 6 L.
A Aspartate aminotransferase 200
units/L
B Glucose 172 mg/dL
C Serum lactate dehydrogenase 300
units/L
D White blood cell count 18,000
6. 45M presents complaining of a "racing D Plasma fractionated metanephrines
heart", palpitations, increased sweat-
ing, and headaches for the past three Initial biochemical test performed on a patient
months. He denies any new life stres- considered high-risk for Pheochromocytoma.
, sors and history of anxiety or panic at- X A - 24-hour urine fractionated metanephrines
tacks. He is not currently on any med- & catecholamines is the initial biochemical test in
ications. The patient reports his father patients considered low-risk for Pheochromocy-
experienced similar symptoms when toma.
he was around the same age and was X B - should be done, but NOT the initial test.
ultimately diagnosed with a tumor on X C - indicated in this patient who has a positive
his adrenal gland. Patient's BP in the family history, but NOT the initial test.
office is 164/98 mm Hg and his HR
is 88 beats per minute with a regular
rhythm. PE reveals a diaphoretic, well
developed man without focal neurolog-
ical deficits. TSH and T3/T4 levels were
all reported WNL. Which of the follow-
ing diagnostic tests would be the most
appropriate next step for this patient?
A 24-hour urine fractionated
metanephrines and catecholamines
B CT scan
C Genetic testing
D Plasma fractionated metanephrines
7. 23M with a history of ulcerative coli- C Plain radiography
tis presents with abdominal pain and
vomiting. On exam, he is febrile with Evidence of Toxic Megacolon on plain radiogra-
a HR of 125 beats per minutes and phys = colonic dilation 6+ cm.
BP of 92/63 mm Hg. He has diffuse
X A - Colonoscopy risky due to risk of perforation.
abdominal tenderness and distention.
Which of the following imaging studies X B - CT may help with management, identifying
etiology or complications, but is not first line
is most appropriate to diagnose toxic
diagnostic study.
megacolon?
1. A patient is diagnosed with ventila- B Cefepime
tor-associated pneumonia in the med-
ical intensive care unit and the deci- Pseudomonas is susceptible to 4th Generation
sion is made to initiate broad-spec- Cephalosporins - Cefepime, Cefquinome.
trum antibiotics with antipseudomon-
al coverage. Which of the following is
Pseudomonas aeruginosa susceptible
to?
A Cefazolin
B Cefepime
C Cefpodoxime
D Ceftriaxone
2. 29F has a 10-year history of migraine C Propranolol
headaches. She had been using ergo-
tamine to abort her headaches, but is Prophylaxis for migraine headaches: Beta Block-
now having one or two headaches per er (Propranolol), Antiepileptics (Topiramate, Val-
week that are interfering with work. proic Acid), Calcium Channel Blockers (Vera-
Which of the following is the most ap- pamil), & TCAs (Amitriptyline) and recently ap-
propriate preventive therapy? proved Botulinum Toxin A injections.
A Ketorolac X A - Ketorolac is an NSAID, not used for preven-
B Promethazine tion.
C Propranolol X B - Promethazine is an antiemetic if a patient
D Sumatriptan has N/V with migraines, but is not preventive.
X D - Sumatriptan is an abortive when given
subcutaneously, but is not preventive.
3. 34F presents with concerns about B Copper-containing intrauterine device
contraception. She is in a monoga-
mous relationship & wishes to main- Copper IUD has a 10-year lifespan, is highly
effective, and has minor side effects that does
, tain long-term fertility. She has regu- not include weight gain. It is easily reversible,
lar menstrual cycles that are typically and non-hormonal. An IUD is a good choice for
28 days and consist of light bleeding patients with a history of VTE, migraine with aura,
for 4-5 days. She experienced menar- or uncontrolled HTN (which this patient has!).
che at 11 y.o. Medical history significant
for essential HTN and hypothyroidism, X A - OCP is contraindicated in patients with
currently taking lisinopril & levothyrox- increased risk of CV sequelae, including uncon-
ine. Vitals are BP 145/96 mmHg, HR trolled DM or HTN or smokers.
88 bpm, SpO2 98% on room air, and T X C - contains estrogen and has similar side
98.4F. PE shows no abnormalities. She effect and risk profile as OCP.
is concerned about taking a prescrip- X D - can cause weight gain or irregular vaginal
tion that may cause weight gain or nau- bleeding.
sea. Which of the following is the most X E - contains estrogen.
appropriate contraceptive method for
this patient?
A Combined estrogen-progestin oral
contraceptives
B Copper-containing intrauterine de-
vice
C Estrogen-progestin vaginal ring
D Implantable etonogestrel
E Transdermal contraceptive patch
4. 18M agricultural laborer presents with C Myocarditis
an intensely sore throat and fever. He
reports he has never been sick before. Diphtheria has been fairly well eliminated in
The patient's vaccination history is not the US due to Tdap vaccination. Patient with
available. Vitals are BP of 110/65 mm unknown vaccination history + presentation
Hg, HR of 70 bpm, RR of 12 bpm, T of suspicious for Diphtheria (pseudomembrane
100.8°F, and BMI of 20 kg/m2. The sub- oral lesions that bleed when scraped, sore
mandibular area shows significant ede- throat, barking cough, hoarse, cervical LNs, sub-
, ma, and laryngoscopic exam reveals a mandibular swelling). Major complications in-
dull-colored, leathery plaque adhering clude Myocarditis, Nephritis, Polyneuropathy,
to the right tonsil, which bleeds upon and Thrombocytopenia. Treat with Penicillin or
scraping. What is one of the potential Erythromycin, and treat toxin separately with
complications of this patient's disease? neutralizing antitoxin. Notify the CDC
A Esophagitis
B Hemolytic uremic syndrome
C Myocarditis
D Reactive arthritis
E Splenic rupture
5. A 56-year-old man with a 10-year histo- D White blood cell count 18,000
ry of alcohol use disorder presents to
the emergency room with nausea and Acute Pancreatitis Ranson's Criteria at admission:
dull, epigastric pain that radiates to the age > 55 y.o., WBCs > 16k, Glucose > 200, LDH
back for the past 2 hours. Which of the > 350, AST > 250
following lab values is associated with
At 48 hours: Hct decrease by > 10%, BUN in-
a poor prognosis for the suspected di-
crease by > 5, Calcium < 8, PaO2 < 60, base
agnosis?
deficit > 4, fluid sequestration > 6 L.
A Aspartate aminotransferase 200
units/L
B Glucose 172 mg/dL
C Serum lactate dehydrogenase 300
units/L
D White blood cell count 18,000
6. 45M presents complaining of a "racing D Plasma fractionated metanephrines
heart", palpitations, increased sweat-
ing, and headaches for the past three Initial biochemical test performed on a patient
months. He denies any new life stres- considered high-risk for Pheochromocytoma.
, sors and history of anxiety or panic at- X A - 24-hour urine fractionated metanephrines
tacks. He is not currently on any med- & catecholamines is the initial biochemical test in
ications. The patient reports his father patients considered low-risk for Pheochromocy-
experienced similar symptoms when toma.
he was around the same age and was X B - should be done, but NOT the initial test.
ultimately diagnosed with a tumor on X C - indicated in this patient who has a positive
his adrenal gland. Patient's BP in the family history, but NOT the initial test.
office is 164/98 mm Hg and his HR
is 88 beats per minute with a regular
rhythm. PE reveals a diaphoretic, well
developed man without focal neurolog-
ical deficits. TSH and T3/T4 levels were
all reported WNL. Which of the follow-
ing diagnostic tests would be the most
appropriate next step for this patient?
A 24-hour urine fractionated
metanephrines and catecholamines
B CT scan
C Genetic testing
D Plasma fractionated metanephrines
7. 23M with a history of ulcerative coli- C Plain radiography
tis presents with abdominal pain and
vomiting. On exam, he is febrile with Evidence of Toxic Megacolon on plain radiogra-
a HR of 125 beats per minutes and phys = colonic dilation 6+ cm.
BP of 92/63 mm Hg. He has diffuse
X A - Colonoscopy risky due to risk of perforation.
abdominal tenderness and distention.
Which of the following imaging studies X B - CT may help with management, identifying
etiology or complications, but is not first line
is most appropriate to diagnose toxic
diagnostic study.
megacolon?
