ROSH Medical Exam Questions and Answers latest Test

ROSH MEDICAL EXAM QUESTIONS AND ANSWERS 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? 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? 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 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? 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? paresthesia 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? 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? 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? 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? 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 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? 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? 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? 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? 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? pulm arterial HTN