ROSH REVIEW EMERGENCY MEDICINE
FINAL TEST 2026 QUESTIONS WITH
CORRECT ANSWERS GRADED A+
◍ True or false: Maternal use of nonsteroidal anti-inflammatory medications
can cause fetal closure of the ductus arteriosus?.
Answer: True.
◍ Which of the following causes acute painful loss of vision? Central retinal
artery occlusionCentral retinal vein occlusionOptic neuritisRetinal
detachment.
Answer: Correct Answer ( C )Explanation:Optic neuritis, an inflammatory,
demyelinating disease of the optic nerve, presents as an acute monocular
loss of vision. It is more frequently seen in young women. Although often
idiopathic, approximately 30% of patients will develop multiple sclerosis
(MS) within five years. Vision loss, most commonly a loss of central vision,
and loss of color perception, develops over a period of hours and peaks in
about one week. Eye pain, typically worse with eye movements, occurs in
about 90% of patient. On examination, an afferent pupillary defect is usually
present as is a swollen disk. Diagnosis is made based on history and
physical exam findings. Magnetic resonance imaging of the brain and orbits
with gadolinium will confirm the diagnosis and is helpful in determining
those patients at risk for developing multiple sclerosis. After peak vision
loss at one to two weeks, symptoms will gradually improve. Intravenous
corticosteroids have been shown to increase the rate of recovery, as well as
delay the onset of multiple sclerosis, although long-term visual outcome and
rate of developing MS at five years are not affected by this treatment.
Central retinal artery occlusion (A) presents with acute, painless loss of
vision. On examination, the retina is edematous and the fovea is seen as a
, cherry-red spot. Central retinal vein occlusion (B) also presents with acute,
painless loss of vision. Funduscopic examination reveals hemorrhage
described as "blood and thunder". A retinal detachment (D) is typically
painless. Patients describe flashing lights and floaters, with vision loss
curtain-like in appearance.
◍ One Step FurtherQuestion: What syndrome is most commonly seen in Asian
men and associated with sudden cardiac death secondary to ventricular
fibrillation?.
Answer: Answer: Brugada syndrome.
◍ Correct Answer ( C )Explanation:Acute coronary syndrome occurs when
there is imbalance between myocardial oxygen demand and delivery. This
most commonly occurs when an atherosclerotic plaque in a coronary artery
is disrupted, resulting in platelet aggregation and thrombus formation, which
occludes the affected vessel, blocking blood flow. Acute coronary syndrome
can also occur from coronary vasospasm, or as a result of forces extrinsic to
the coronary arteries, such as decreased blood flow (hypotension), increased
myocardial oxygen demand (fever, tachycardia, thyrotoxicosis), or
decreased oxygen delivery (anemia, hypoxemia). The electrocardiogram
(ECG) is the most helpful initial test for acute coronary syndrome.
ST-elevation in consecutive leads is used to diagnose ST elevation
myocardial ischemia, and the pattern of elevation can predict which vessel is
involved. In this case, the patient has ST elevation in lea.
Answer: A 62-year-old woman was walking her dog when she began to
experience intense substernal chest pressure. She became very diaphoretic
and felt nauseated. She called 911 and was brought to the ED. Her
electrocardiogram is shown above. Which of the following best describes
the location of the patient's myocardial infarction?
AnterolateralAnteroseptalInferiorPosterior
◍ Question: What environmental disorder is acetazolamide used to treat?.
Answer: Acute mountain sickness.
◍ Question: What is the classic finding of hypertrophic cardiomyopathy on
, echocardiogram?.
Answer: Disproportionate septal hypertrophy.
◍ A 58-year-old man presents with chest pain. His electrocardiogram is shown
above. A right-sided electrocardiogram is also performed and shows
elevated ST segments in V4R and V5
R. Which of the following medications is contraindicated?
AspirinBivalirudinHeparinNitroglycerin.
Answer: Correct Answer ( D )Explanation:The patient has evidence of a
right ventricular infarction. In the majority of people, the right ventricle
receives its blood supply from the right coronary artery. Inferior myocardial
infarctions typically result from blockage in blood flow to the right coronary
artery, and approximately 30 percent of inferior myocardial infarctions
involve the right ventricle. It is critical to recognize the presence of right
ventricular involvement because it is associated with increased mortality and
cardiovascular complications, and treatment differs from other types of
myocardial infarction. Right ventricular involvement can be diagnosed by
obtaining a right-sided ECG. ST elevation in precordial lead V4R in the
presence of an inferior myocardial infarction is diagnostic of right
ventricular infarction. Patients with right ventricular involvement are
dependent upon preload to maintain cardiac output and are at risk for
hypotension if preload is reduced. Treatment of right ventricular infarction,
in addition to early reperfusion, includes using fluids to maintain adequate
preload, reducing right ventricular afterload, and using inotropes like
dobutamine, if needed, to support the failing right ventricle. Nitroglycerin,
which is commonly used in acute myocardial for its preload and afterload
reducing effects, should not be used in right ventricular infarction because it
can precipitate critical hypotension and cardiovascular collapse.
◍ One Step FurtherQuestion: What is the treatment for ethylene glycol
poisoning?.
Answer: Answer: Fomepizole.
◍ What kind of incontinence do patients with spinal cord compression
, syndromes develop?.
Answer: Overflow incontinence.
◍ Endometriosis.
Answer: Patient will be a womanComplaining of pre or midcycle
dysmenorrhea, dyspareunia, dyschezia (painful bowel movement)PE will
show uterosacral nodularity or a fixed or retroverted uterusDiagnosis is
made by laparoscopyMost common site is ovariesMittelschmerz (B) is
unilateral midcycle pelvic pain related to ovulation. Pelvic inflammatory
disease (C) is characterized by fever, pelvic pain, bilateral adnexal pain,
cervical motion tenderness, and vaginal discharge. Patients with a ruptured
ovarian cyst (D) often present with acute onset of unilateral pelvic pain
which may be accompanied by nausea and vomiting.
◍ PDA.
Answer: Patent Ductus ArteriosusPatient will be complaining of failure to
thrive, poor feeding, tachycardia, and tachypneaPE will show continuous,
rough, "machinery-like" murmur, heard best in the first interspaces of the
LSBDiagnosis is made by echoTreatment is indomethacin
◍ A 65-year-old man with a past medical history of hypertension presents to
the Emergency Department with "tearing" chest and abdominal pain
radiating towards his back. His blood pressure is 185/98 mm Hg. Which of
the following medications should be administered first?
AspirinEsmololHeparinNitroprusside.
Answer: Correct Answer ( B )Explanation:Esmolol is the first line treatment
for a hypertensive patient with an aortic dissection. Rate-controlling
medication (e.g. esmolol) should be given before vasodilators to prevent
reflex tachycardia and subsequent increase in aortic shearing forces. An
aortic dissection occurs when the intima tears allowing blood to cause a
false channel and intramural hematoma. If this extends to the heart it can
precipitate myocardial infarction, severe aortic regurgitation, or pericardial
tamponade leading to death. Risk factors include a history of hypertension,
collagen vascular disease or aortic aneurysm, as well as current pregnancy
FINAL TEST 2026 QUESTIONS WITH
CORRECT ANSWERS GRADED A+
◍ True or false: Maternal use of nonsteroidal anti-inflammatory medications
can cause fetal closure of the ductus arteriosus?.
Answer: True.
◍ Which of the following causes acute painful loss of vision? Central retinal
artery occlusionCentral retinal vein occlusionOptic neuritisRetinal
detachment.
Answer: Correct Answer ( C )Explanation:Optic neuritis, an inflammatory,
demyelinating disease of the optic nerve, presents as an acute monocular
loss of vision. It is more frequently seen in young women. Although often
idiopathic, approximately 30% of patients will develop multiple sclerosis
(MS) within five years. Vision loss, most commonly a loss of central vision,
and loss of color perception, develops over a period of hours and peaks in
about one week. Eye pain, typically worse with eye movements, occurs in
about 90% of patient. On examination, an afferent pupillary defect is usually
present as is a swollen disk. Diagnosis is made based on history and
physical exam findings. Magnetic resonance imaging of the brain and orbits
with gadolinium will confirm the diagnosis and is helpful in determining
those patients at risk for developing multiple sclerosis. After peak vision
loss at one to two weeks, symptoms will gradually improve. Intravenous
corticosteroids have been shown to increase the rate of recovery, as well as
delay the onset of multiple sclerosis, although long-term visual outcome and
rate of developing MS at five years are not affected by this treatment.
Central retinal artery occlusion (A) presents with acute, painless loss of
vision. On examination, the retina is edematous and the fovea is seen as a
, cherry-red spot. Central retinal vein occlusion (B) also presents with acute,
painless loss of vision. Funduscopic examination reveals hemorrhage
described as "blood and thunder". A retinal detachment (D) is typically
painless. Patients describe flashing lights and floaters, with vision loss
curtain-like in appearance.
◍ One Step FurtherQuestion: What syndrome is most commonly seen in Asian
men and associated with sudden cardiac death secondary to ventricular
fibrillation?.
Answer: Answer: Brugada syndrome.
◍ Correct Answer ( C )Explanation:Acute coronary syndrome occurs when
there is imbalance between myocardial oxygen demand and delivery. This
most commonly occurs when an atherosclerotic plaque in a coronary artery
is disrupted, resulting in platelet aggregation and thrombus formation, which
occludes the affected vessel, blocking blood flow. Acute coronary syndrome
can also occur from coronary vasospasm, or as a result of forces extrinsic to
the coronary arteries, such as decreased blood flow (hypotension), increased
myocardial oxygen demand (fever, tachycardia, thyrotoxicosis), or
decreased oxygen delivery (anemia, hypoxemia). The electrocardiogram
(ECG) is the most helpful initial test for acute coronary syndrome.
ST-elevation in consecutive leads is used to diagnose ST elevation
myocardial ischemia, and the pattern of elevation can predict which vessel is
involved. In this case, the patient has ST elevation in lea.
Answer: A 62-year-old woman was walking her dog when she began to
experience intense substernal chest pressure. She became very diaphoretic
and felt nauseated. She called 911 and was brought to the ED. Her
electrocardiogram is shown above. Which of the following best describes
the location of the patient's myocardial infarction?
AnterolateralAnteroseptalInferiorPosterior
◍ Question: What environmental disorder is acetazolamide used to treat?.
Answer: Acute mountain sickness.
◍ Question: What is the classic finding of hypertrophic cardiomyopathy on
, echocardiogram?.
Answer: Disproportionate septal hypertrophy.
◍ A 58-year-old man presents with chest pain. His electrocardiogram is shown
above. A right-sided electrocardiogram is also performed and shows
elevated ST segments in V4R and V5
R. Which of the following medications is contraindicated?
AspirinBivalirudinHeparinNitroglycerin.
Answer: Correct Answer ( D )Explanation:The patient has evidence of a
right ventricular infarction. In the majority of people, the right ventricle
receives its blood supply from the right coronary artery. Inferior myocardial
infarctions typically result from blockage in blood flow to the right coronary
artery, and approximately 30 percent of inferior myocardial infarctions
involve the right ventricle. It is critical to recognize the presence of right
ventricular involvement because it is associated with increased mortality and
cardiovascular complications, and treatment differs from other types of
myocardial infarction. Right ventricular involvement can be diagnosed by
obtaining a right-sided ECG. ST elevation in precordial lead V4R in the
presence of an inferior myocardial infarction is diagnostic of right
ventricular infarction. Patients with right ventricular involvement are
dependent upon preload to maintain cardiac output and are at risk for
hypotension if preload is reduced. Treatment of right ventricular infarction,
in addition to early reperfusion, includes using fluids to maintain adequate
preload, reducing right ventricular afterload, and using inotropes like
dobutamine, if needed, to support the failing right ventricle. Nitroglycerin,
which is commonly used in acute myocardial for its preload and afterload
reducing effects, should not be used in right ventricular infarction because it
can precipitate critical hypotension and cardiovascular collapse.
◍ One Step FurtherQuestion: What is the treatment for ethylene glycol
poisoning?.
Answer: Answer: Fomepizole.
◍ What kind of incontinence do patients with spinal cord compression
, syndromes develop?.
Answer: Overflow incontinence.
◍ Endometriosis.
Answer: Patient will be a womanComplaining of pre or midcycle
dysmenorrhea, dyspareunia, dyschezia (painful bowel movement)PE will
show uterosacral nodularity or a fixed or retroverted uterusDiagnosis is
made by laparoscopyMost common site is ovariesMittelschmerz (B) is
unilateral midcycle pelvic pain related to ovulation. Pelvic inflammatory
disease (C) is characterized by fever, pelvic pain, bilateral adnexal pain,
cervical motion tenderness, and vaginal discharge. Patients with a ruptured
ovarian cyst (D) often present with acute onset of unilateral pelvic pain
which may be accompanied by nausea and vomiting.
◍ PDA.
Answer: Patent Ductus ArteriosusPatient will be complaining of failure to
thrive, poor feeding, tachycardia, and tachypneaPE will show continuous,
rough, "machinery-like" murmur, heard best in the first interspaces of the
LSBDiagnosis is made by echoTreatment is indomethacin
◍ A 65-year-old man with a past medical history of hypertension presents to
the Emergency Department with "tearing" chest and abdominal pain
radiating towards his back. His blood pressure is 185/98 mm Hg. Which of
the following medications should be administered first?
AspirinEsmololHeparinNitroprusside.
Answer: Correct Answer ( B )Explanation:Esmolol is the first line treatment
for a hypertensive patient with an aortic dissection. Rate-controlling
medication (e.g. esmolol) should be given before vasodilators to prevent
reflex tachycardia and subsequent increase in aortic shearing forces. An
aortic dissection occurs when the intima tears allowing blood to cause a
false channel and intramural hematoma. If this extends to the heart it can
precipitate myocardial infarction, severe aortic regurgitation, or pericardial
tamponade leading to death. Risk factors include a history of hypertension,
collagen vascular disease or aortic aneurysm, as well as current pregnancy
