Rosh Review UPDATED Actual Exam
Questions and CORRECT Answers
A patient presents with dizziness. Romberg testing with the eyes open is normal, but with the
eyes closed, the patient sways and almost falls over. Given this Romberg test result,
pathology in which of the following systems is most likely?
A Cardiovascular
B Cerebellar
C Vestibular
D Visual - CORRECT ANSWER- ✔✔Vestibular
In the US, what is a common cause of imbalance due to peripheral disease? - CORRECT
ANSWER- ✔✔Diabetic distal peripheral polyneuropathy
An elderly man complains of dizziness upon standing. He denies being dizzy once he has
stood for 5 minutes, and also denies being dizzy when supine or seated. He denies associated
chest pain, palpitations, or dyspnea. Which of the following tests should first be performed
during the evaluation of this positional dizziness?
A Chest radiograph
B Head-up tilt-table testing
C Orthostatic vital signs
D Transesophageal echocardiography - CORRECT ANSWER- ✔✔C orthostatic vital signs
List some medications whose side effects can cause symptoms of orthostasis? - CORRECT
ANSWER- ✔✔Antiparkinsonian drugs, antiadrenergics, anticholinergics, antidepressants,
antiarrhythmics, antipsychotics, diuretics, narcotics and sedatives.
Orthostatic hypotension diagnostic criteria - CORRECT ANSWER- ✔✔Decrease in systolic
blood pressure ≥ 20
Decrease in diastolic blood pressure ≥ 10
Inadequate physiologic response to postural changes
, *rhythm strip showing SVT*
A 1-year-old boy presents with the rhythm seen above. Physical exam is unremarkable except
for tachycardia. Which of the following vagal maneuvers is the most effective to treat this
rhythm?
A Apply external ocular pressure
B Apply ice to the face
C Blow on the patient's face with a straw
D Perform carotid massage - CORRECT ANSWER- ✔✔B apply ice to the face
It is important that when performing this maneuver that you do not occlude the nose or
mouth, and apply the ice only over the patient's forehead, eyes, and bridge of the nose for 10-
15 seconds. Adenosine, an AV-nodal blocking agent, can also be administered in stable
patients.
What is the treatment for a hemodynamically unstable child with supraventricular
tachycardia? - CORRECT ANSWER- ✔✔Cardioversion at 0.5 to 1 J/kg. If unsuccessful,
increase energy dose to 2 J/kg on subsequent attempts.
*US of empty gestational sac*
A 26-year-old woman presents with abdominal cramping after a positive home pregnancy
test. Her vitals are T 98.7°F, HR 94, BP 110/66, RR 18, oxygen saturation 97%. Her exam is
unremarkable. Labs reveal a serum beta HCG of 1000 mIU and she is Rh positive. She states
that the pregnancy is wanted. An ultrasound is performed as seen above. Which of the
following is appropriate management for this patient?
A Administer methotrexate
B Administer Rhogam and discharge home with repeat beta hCG in 48 hours
C Administer Rhogam and methotrexate
D Discharge home with repeat beta hCG in 48 hours - CORRECT ANSWER- ✔✔D
Discharge home with repeat beta hCG in 48 hours
What is the success rate of methotrexate in the management of early ectopic pregnancy? -
CORRECT ANSWER- ✔✔85-93%.
Questions and CORRECT Answers
A patient presents with dizziness. Romberg testing with the eyes open is normal, but with the
eyes closed, the patient sways and almost falls over. Given this Romberg test result,
pathology in which of the following systems is most likely?
A Cardiovascular
B Cerebellar
C Vestibular
D Visual - CORRECT ANSWER- ✔✔Vestibular
In the US, what is a common cause of imbalance due to peripheral disease? - CORRECT
ANSWER- ✔✔Diabetic distal peripheral polyneuropathy
An elderly man complains of dizziness upon standing. He denies being dizzy once he has
stood for 5 minutes, and also denies being dizzy when supine or seated. He denies associated
chest pain, palpitations, or dyspnea. Which of the following tests should first be performed
during the evaluation of this positional dizziness?
A Chest radiograph
B Head-up tilt-table testing
C Orthostatic vital signs
D Transesophageal echocardiography - CORRECT ANSWER- ✔✔C orthostatic vital signs
List some medications whose side effects can cause symptoms of orthostasis? - CORRECT
ANSWER- ✔✔Antiparkinsonian drugs, antiadrenergics, anticholinergics, antidepressants,
antiarrhythmics, antipsychotics, diuretics, narcotics and sedatives.
Orthostatic hypotension diagnostic criteria - CORRECT ANSWER- ✔✔Decrease in systolic
blood pressure ≥ 20
Decrease in diastolic blood pressure ≥ 10
Inadequate physiologic response to postural changes
, *rhythm strip showing SVT*
A 1-year-old boy presents with the rhythm seen above. Physical exam is unremarkable except
for tachycardia. Which of the following vagal maneuvers is the most effective to treat this
rhythm?
A Apply external ocular pressure
B Apply ice to the face
C Blow on the patient's face with a straw
D Perform carotid massage - CORRECT ANSWER- ✔✔B apply ice to the face
It is important that when performing this maneuver that you do not occlude the nose or
mouth, and apply the ice only over the patient's forehead, eyes, and bridge of the nose for 10-
15 seconds. Adenosine, an AV-nodal blocking agent, can also be administered in stable
patients.
What is the treatment for a hemodynamically unstable child with supraventricular
tachycardia? - CORRECT ANSWER- ✔✔Cardioversion at 0.5 to 1 J/kg. If unsuccessful,
increase energy dose to 2 J/kg on subsequent attempts.
*US of empty gestational sac*
A 26-year-old woman presents with abdominal cramping after a positive home pregnancy
test. Her vitals are T 98.7°F, HR 94, BP 110/66, RR 18, oxygen saturation 97%. Her exam is
unremarkable. Labs reveal a serum beta HCG of 1000 mIU and she is Rh positive. She states
that the pregnancy is wanted. An ultrasound is performed as seen above. Which of the
following is appropriate management for this patient?
A Administer methotrexate
B Administer Rhogam and discharge home with repeat beta hCG in 48 hours
C Administer Rhogam and methotrexate
D Discharge home with repeat beta hCG in 48 hours - CORRECT ANSWER- ✔✔D
Discharge home with repeat beta hCG in 48 hours
What is the success rate of methotrexate in the management of early ectopic pregnancy? -
CORRECT ANSWER- ✔✔85-93%.
