ROSH REVIEW EMERGENCY MEDICINE
PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ Administer IV pentobarbita.
Answer: You are caring for a 60 kg patient who has been seizing for 30
minutes. You have already administered 6 mg of IV lorazepam and 1,200
mg of phenytoin without termination of seizure activity. Which of the
following should most likely be your next step?AAdminister another bolus
of IV phenytoinBAdminister IV fosphenytoinCAdminister IV
pentobarbitalDAdminister IV sodium bicarbonate
◍ Avascular necrosis.
Answer: Which of the following is the most concerning complication of this
injury?AAvascular necrosisBInfectionCMalunionDOsteoarthritis
◍ Fresh frozen plasma infusion.
Answer: A 25-year-old man with a history of hereditary angioedema
presents with swelling of the tongue and lips for 30 minutes. The patient
appears to have difficulty breathing if he lies flat but is comfortable when
sitting up. Visualization of the mouth and posterior pharynx is completely
obstructed by the tongue. What management should be
initiated?ADiphenhydramineBEpinephrine 1 mg/mL intramuscularCFresh
frozen plasma infusionDMethylprednisolone
◍ Cough.
Answer: What is the most common complaint seen in acute
bronchitis?AChest painBCoughCFeverDSputum production
◍ Administer intravenous naloxone.
Answer: A 17-year-old boy is brought to the emergency department by his
, friends. They were at a house party and found their friend unconscious after
he ingested an unknown substance. On physical exam, vital signs are temp
96F, heart rate 50, respiratory rate of 4, and oxygen saturation 92% on room
air. The boys pupils are miotic. On lung auscultation, there are crackles
bilaterally. You administer supplemental oxygen. Which of the following is
the most appropriate clinical intervention?AAdminister intravenous
naloxoneBBegin intravenous fluids with sodium bicarbonateCInitiate
therapy with benzodiazepinesDPerform gastric lavage
◍ Cervical spine magnetic resonance imaging.
Answer: A 1-year-old boy presents unconscious to the emergency
department with multisystem trauma after he was a passenger in a motor
vehicle accident. He is placed in a cervical collar. Which of the following,
can definitively clear the cervical spine?ACervical spine computed
tomography scanBCervical spine magnetic resonance imagingCCervical
spine radiographsDClinical clearance
◍ Ischemic colitis.
Answer: An 82-year-old nursing-home resident is sent to the emergency
department with lower abdominal pain and bloody diarrhea. He has a history
of vascular dementia, hypertension, and hyperlipidemia. The facility nurse
notes that he seems to have the most abdominal pain and blood in his stools
after eating. On examination, he is afebrile and a nasogastric aspirate is
negative for evidence of bleeding. Which of the following is the most likely
cause of this patient’s bleeding?AAngiodysplasiaBDiverticular
bleedingCIschemic colitisDPeptic ulcer disease
◍ Pacemaker **sick sinus syndrome.
Answer: A 67-year-old woman with sick sinus syndrome reports significant
lightheadedness. If she is driving and a “dizzy spell” begins, she has to pull
off the road and wait for it to pass. You capture an ECG during one of her
spells in the office and note a bradycardia in the 50s. Which of the following
is the best treatment
recommendation?AAtenololBDefibrillatorCDigitalisDPacemaker
,◍ Spinal epidural abscess.
Answer: A 32-year-old woman reports back pain and difficulty urinating for
5 days. The pain is located in her lumbar spine and is constant and dull. She
says she feels the urge to urinate every 5 minutes, but only a small amount
of urine is expressed. On physical exam, her vital signs are a T of 101.1°F
(38.4°C), BP of 110/72 mm Hg, and HR of 115 bpm. Cardiac exam reveals
a 2/6 systolic murmur. Lung exam is normal. Abdominal exam reveals a
large, tender suprapubic mass. Musculoskeletal exam reveals tenderness
over her lumbar spine and track marks consistent with IV drug use in her
left antecubital fossa. Neurological exam reveals 4/5 strength in her bilateral
lower extremities. What is the most likely cause of her symptoms?ABladder
cancerBNecrotic uterine leiomyomaCSpinal epidural abscessDTubo-ovarian
abscess
◍ Sinus node dysfunction.
Answer: A 71-year-old woman presents with 2 days of dizziness and
“almost passing out.” Her ECG shows episodes of alternating bradycardia
and tachycardia with narrow QRS complexes. Which of the following is the
most likely diagnosis?AAtrial flutterBDigitalis toxicityCSinus node
dysfunctionDVentricular tachycardia
◍ bilateral fracture of the C2 vertebra.
Answer: Hangman's Fracture
◍ alkali burn tx.
Answer: Water lavage 60mins+, avoid hypothermia
◍ Tx of hypertrophic cardiomyopathy.
Answer: beta blockers
◍ A fall on an outstretched hand leads to a dinner fork deformity of the wrist.
What is the suspected diagnosis?.
Answer: Colles fracture
◍ Symptom control may be achieved with clonidine.
Answer: A 23-year-old man with a history of opiate use presents to the
, emergency department with tachycardia, hypertension, and mydriasis.
Which of the following is true regarding management?AAntiemetics should
be withheld as they may cause serious side effectsBConsider ICU admission
for the potential for symptoms to worsenCNaloxone should be
givenDSymptom control may be achieved with clonidine
◍ thyroid storm tx.
Answer: propranolol, b-blocker, iodine
◍ Loss of pain, temperature, and of motor function.
Answer: A 17-year-old boy presents after being thrown a far distance off of
a horse. Which of the following is consistent with an anterior cord
syndrome?AIsolated motor function lossBLoss of all motor and sensory
functionCLoss of pain, temperature, and of motor functionDUpper greater
than lower motor weakness
◍ Airway management, intravenous antibiotics, and admission.
Answer: A 19-year-old man presents with a sore throat and difficulty
swallowing. He has had 4 days of worsening sore throat and fever, but today
he was unable to swallow any liquids. Physical examination reveals a
muffled voice, difficulty tolerating saliva, and minimal pharyngeal erythema
with a midline uvula. He also has tenderness over the hyoid bone. Which of
the following is the best management?AAirway management, intravenous
antibiotics, and admissionBInhaled racemic epinephrine and discharge
homeCIntravenous corticosteroids and discharge homeDNeedle aspiration
of peritonsilar area
◍ CT angiogram of the left upper extremity.
Answer: A 27-year-old woman with no reported medical history presents to
the emergency department after falling onto her left shoulder while playing
soccer. Vital signs today include a heart rate of 70 bpm, blood pressure of
120/80 mm Hg, respiratory rate of 22 breaths per minute, pulse oxygenation
of 99% on room air, and temperature of 98.6°F. Physical examination
reveals a regular heart rate and rhythm. She has tenderness, edema, and
bruising at the mid-aspect of her left clavicle. Her sensation is intact in her
PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ Administer IV pentobarbita.
Answer: You are caring for a 60 kg patient who has been seizing for 30
minutes. You have already administered 6 mg of IV lorazepam and 1,200
mg of phenytoin without termination of seizure activity. Which of the
following should most likely be your next step?AAdminister another bolus
of IV phenytoinBAdminister IV fosphenytoinCAdminister IV
pentobarbitalDAdminister IV sodium bicarbonate
◍ Avascular necrosis.
Answer: Which of the following is the most concerning complication of this
injury?AAvascular necrosisBInfectionCMalunionDOsteoarthritis
◍ Fresh frozen plasma infusion.
Answer: A 25-year-old man with a history of hereditary angioedema
presents with swelling of the tongue and lips for 30 minutes. The patient
appears to have difficulty breathing if he lies flat but is comfortable when
sitting up. Visualization of the mouth and posterior pharynx is completely
obstructed by the tongue. What management should be
initiated?ADiphenhydramineBEpinephrine 1 mg/mL intramuscularCFresh
frozen plasma infusionDMethylprednisolone
◍ Cough.
Answer: What is the most common complaint seen in acute
bronchitis?AChest painBCoughCFeverDSputum production
◍ Administer intravenous naloxone.
Answer: A 17-year-old boy is brought to the emergency department by his
, friends. They were at a house party and found their friend unconscious after
he ingested an unknown substance. On physical exam, vital signs are temp
96F, heart rate 50, respiratory rate of 4, and oxygen saturation 92% on room
air. The boys pupils are miotic. On lung auscultation, there are crackles
bilaterally. You administer supplemental oxygen. Which of the following is
the most appropriate clinical intervention?AAdminister intravenous
naloxoneBBegin intravenous fluids with sodium bicarbonateCInitiate
therapy with benzodiazepinesDPerform gastric lavage
◍ Cervical spine magnetic resonance imaging.
Answer: A 1-year-old boy presents unconscious to the emergency
department with multisystem trauma after he was a passenger in a motor
vehicle accident. He is placed in a cervical collar. Which of the following,
can definitively clear the cervical spine?ACervical spine computed
tomography scanBCervical spine magnetic resonance imagingCCervical
spine radiographsDClinical clearance
◍ Ischemic colitis.
Answer: An 82-year-old nursing-home resident is sent to the emergency
department with lower abdominal pain and bloody diarrhea. He has a history
of vascular dementia, hypertension, and hyperlipidemia. The facility nurse
notes that he seems to have the most abdominal pain and blood in his stools
after eating. On examination, he is afebrile and a nasogastric aspirate is
negative for evidence of bleeding. Which of the following is the most likely
cause of this patient’s bleeding?AAngiodysplasiaBDiverticular
bleedingCIschemic colitisDPeptic ulcer disease
◍ Pacemaker **sick sinus syndrome.
Answer: A 67-year-old woman with sick sinus syndrome reports significant
lightheadedness. If she is driving and a “dizzy spell” begins, she has to pull
off the road and wait for it to pass. You capture an ECG during one of her
spells in the office and note a bradycardia in the 50s. Which of the following
is the best treatment
recommendation?AAtenololBDefibrillatorCDigitalisDPacemaker
,◍ Spinal epidural abscess.
Answer: A 32-year-old woman reports back pain and difficulty urinating for
5 days. The pain is located in her lumbar spine and is constant and dull. She
says she feels the urge to urinate every 5 minutes, but only a small amount
of urine is expressed. On physical exam, her vital signs are a T of 101.1°F
(38.4°C), BP of 110/72 mm Hg, and HR of 115 bpm. Cardiac exam reveals
a 2/6 systolic murmur. Lung exam is normal. Abdominal exam reveals a
large, tender suprapubic mass. Musculoskeletal exam reveals tenderness
over her lumbar spine and track marks consistent with IV drug use in her
left antecubital fossa. Neurological exam reveals 4/5 strength in her bilateral
lower extremities. What is the most likely cause of her symptoms?ABladder
cancerBNecrotic uterine leiomyomaCSpinal epidural abscessDTubo-ovarian
abscess
◍ Sinus node dysfunction.
Answer: A 71-year-old woman presents with 2 days of dizziness and
“almost passing out.” Her ECG shows episodes of alternating bradycardia
and tachycardia with narrow QRS complexes. Which of the following is the
most likely diagnosis?AAtrial flutterBDigitalis toxicityCSinus node
dysfunctionDVentricular tachycardia
◍ bilateral fracture of the C2 vertebra.
Answer: Hangman's Fracture
◍ alkali burn tx.
Answer: Water lavage 60mins+, avoid hypothermia
◍ Tx of hypertrophic cardiomyopathy.
Answer: beta blockers
◍ A fall on an outstretched hand leads to a dinner fork deformity of the wrist.
What is the suspected diagnosis?.
Answer: Colles fracture
◍ Symptom control may be achieved with clonidine.
Answer: A 23-year-old man with a history of opiate use presents to the
, emergency department with tachycardia, hypertension, and mydriasis.
Which of the following is true regarding management?AAntiemetics should
be withheld as they may cause serious side effectsBConsider ICU admission
for the potential for symptoms to worsenCNaloxone should be
givenDSymptom control may be achieved with clonidine
◍ thyroid storm tx.
Answer: propranolol, b-blocker, iodine
◍ Loss of pain, temperature, and of motor function.
Answer: A 17-year-old boy presents after being thrown a far distance off of
a horse. Which of the following is consistent with an anterior cord
syndrome?AIsolated motor function lossBLoss of all motor and sensory
functionCLoss of pain, temperature, and of motor functionDUpper greater
than lower motor weakness
◍ Airway management, intravenous antibiotics, and admission.
Answer: A 19-year-old man presents with a sore throat and difficulty
swallowing. He has had 4 days of worsening sore throat and fever, but today
he was unable to swallow any liquids. Physical examination reveals a
muffled voice, difficulty tolerating saliva, and minimal pharyngeal erythema
with a midline uvula. He also has tenderness over the hyoid bone. Which of
the following is the best management?AAirway management, intravenous
antibiotics, and admissionBInhaled racemic epinephrine and discharge
homeCIntravenous corticosteroids and discharge homeDNeedle aspiration
of peritonsilar area
◍ CT angiogram of the left upper extremity.
Answer: A 27-year-old woman with no reported medical history presents to
the emergency department after falling onto her left shoulder while playing
soccer. Vital signs today include a heart rate of 70 bpm, blood pressure of
120/80 mm Hg, respiratory rate of 22 breaths per minute, pulse oxygenation
of 99% on room air, and temperature of 98.6°F. Physical examination
reveals a regular heart rate and rhythm. She has tenderness, edema, and
bruising at the mid-aspect of her left clavicle. Her sensation is intact in her
