ROSH Medical All Exam Questions/Answer Graded A+
2025/2026
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
42-year-old man presents via emergency medical services after an injury that occurred
while he was working. There was an explosion at the chemical plant where he was
employed. An initial survey of the patient shows deep-partial thickness burns of his neck
and face along with burns of varying degrees on his torso and hands. There is soot in
his nose and mouth. Which of the following is the most appropriate next step in
managing this patient? - prepare for emergent intubation
24-year-old previously healthy woman presents to the ED complaining that she cannot
move her legs. The symptoms occurred suddenly after she was told that her fiancé died
in a motorcycle accident. She denies any associated symptoms, including pain. The
sensation and deep tendon reflexes in her lower extremities are normal. She has
normal muscle tone. What is the most likely diagnosis? - conversion d/o
32-year-old man presents with severe bilateral eye pain that started in the late evening
while watching television. He works as a welder during the day. He has associated
tearing, photophobia, and foreign body sensation. He does not use contact lenses.
Visual acuity in 20/40 OD and 20/40 OS. His eye examination after fluorescein staining
is seen above. What is the most likely diagnosis? - UV keratitis
72-year-old man presents with worsening low back pain for the past one month. The
pain is worse with extension of his back and after walking for several minutes. The pain
is relieved with sitting. Physical exam shows that extension of the spine produces pain
radiating down his bilateral legs. Which of the following is the most likely diagnosis? -
spinal stenosis
47-year-old man presents as a trauma activation after a head-on motor vehicle crash at
20 mph. He was a restrained driver and the airbags did deploy. There were no drugs or
alcohol involved. He is uncertain if he lost consciousness. EMS extricated him, put him
in spinal immobilization, and splinted an obviously fractured femur. On primary survey,
his airway is protected, he is breathing easily, and is normotensive. Vital signs are
within normal limits. Secondary survey is notable for a GCS score of 15, a mildly tender
right trapezius muscle, and an ecchymotic and deformed left femur with normal distal
neurovascular function. The presence of which historical or physical finding
necessitates cervical spinal imaging? - mech of injury
5-year-old girl presents with a blistering rash surrounding her mouth and extending into
her nares after a recent head cold. A close examination of the area reveals multiple
pus-filled blisters that erupt with minimal pressure, and diffuse honey-colored crusting
lesions. Which of the following tests would best reveal the cause of this eruption and
guide treatment? -
Which of the following signs is a normal finding during early pregnancy? - chadwick
2025/2026
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
42-year-old man presents via emergency medical services after an injury that occurred
while he was working. There was an explosion at the chemical plant where he was
employed. An initial survey of the patient shows deep-partial thickness burns of his neck
and face along with burns of varying degrees on his torso and hands. There is soot in
his nose and mouth. Which of the following is the most appropriate next step in
managing this patient? - prepare for emergent intubation
24-year-old previously healthy woman presents to the ED complaining that she cannot
move her legs. The symptoms occurred suddenly after she was told that her fiancé died
in a motorcycle accident. She denies any associated symptoms, including pain. The
sensation and deep tendon reflexes in her lower extremities are normal. She has
normal muscle tone. What is the most likely diagnosis? - conversion d/o
32-year-old man presents with severe bilateral eye pain that started in the late evening
while watching television. He works as a welder during the day. He has associated
tearing, photophobia, and foreign body sensation. He does not use contact lenses.
Visual acuity in 20/40 OD and 20/40 OS. His eye examination after fluorescein staining
is seen above. What is the most likely diagnosis? - UV keratitis
72-year-old man presents with worsening low back pain for the past one month. The
pain is worse with extension of his back and after walking for several minutes. The pain
is relieved with sitting. Physical exam shows that extension of the spine produces pain
radiating down his bilateral legs. Which of the following is the most likely diagnosis? -
spinal stenosis
47-year-old man presents as a trauma activation after a head-on motor vehicle crash at
20 mph. He was a restrained driver and the airbags did deploy. There were no drugs or
alcohol involved. He is uncertain if he lost consciousness. EMS extricated him, put him
in spinal immobilization, and splinted an obviously fractured femur. On primary survey,
his airway is protected, he is breathing easily, and is normotensive. Vital signs are
within normal limits. Secondary survey is notable for a GCS score of 15, a mildly tender
right trapezius muscle, and an ecchymotic and deformed left femur with normal distal
neurovascular function. The presence of which historical or physical finding
necessitates cervical spinal imaging? - mech of injury
5-year-old girl presents with a blistering rash surrounding her mouth and extending into
her nares after a recent head cold. A close examination of the area reveals multiple
pus-filled blisters that erupt with minimal pressure, and diffuse honey-colored crusting
lesions. Which of the following tests would best reveal the cause of this eruption and
guide treatment? -
Which of the following signs is a normal finding during early pregnancy? - chadwick
