ROSH Review ER UPDATED ACTUAL Questions and CORRECT Answers
1. A 14-year-old boy pre- Correct Answer ( C )
sents complaining of Explanation:
intense pruritus in his
groin, axillae, and be- This patient has scabies; a pruritic dermatitis caused by cutaneous infec-
tween his fingers af- tion with the mite Sarcoptes scabei, var hominis. Scabies is spread by
ter returning home skin-to-skin contact and should be considered in patients with general-
from summer camp ized pruritus, especially when exposure to others with similar symptoms
1 week ago. He re- is reported. The rash of scabies involves papules, which are often excori-
ports several other ated. Burrows are pathognomonic but not uniformly present. Unless pre-
campers had similar viously infected, pruritus generally takes 3-6 weeks to develop because
symptoms. On exam, symptoms are due to delayed (Type IV) sensitivity reaction. The pruritus
you note excoriations is classically worse at night and affects the web spaces of the fingers,
in the inguinal region flexor aspect of the wrists, axillae, groin, nipples, and the periumbilical
and axillae surround- region. Except in cases involving an immunocompromised host, the scalp
ing scattered, erythe- and face are generally spared. Diagnosis is clinical but can be confirmed
matous papules. Which by placing scrapings collected with a #15 blade scalpel in mineral oil
of the following is for microscopic examination. The treatment of choice for primary sca-
the most appropriate bies infection is the application of topical scabicidal agents, with repeat
treatment? application in 7 days. The treatment of choice is permethrin 5% lotion.
Ketoconazole Individuals affected by scabies should avoid skin-to-skin contact with
Lindane others. Patients with typical scabies may return to school or work 24
Permethrin hours after the first treatment.
Prednisone
2. Should family mem- Yes, family members and sexual contacts.
bers of an infected in-
dividual also be treated
for scabies?
3. Scabies Sarcoptes scabiei
Pruritic rash worse at night
Linear burrows
, Interdigital spaces of hands/feet, penis, breasts
Permethrin (first line)
Ivermectin
**head and back are sparred
(head involved in children)
4. An 18-month-old boy Correct Answer ( D )
presents to the emer- Explanation:
gency department with
worsening shortness The patient has bronchiolitis, which is the most common lower respira-
of breath. The par- tory tract infection in patients less than two years of age. It remains the
ents report he has leading cause for hospitalization in infants under one year of age. Bron-
had a cough, run- chiolitis is most commonly caused by respiratory syncytial virus (RSV),
ny nose, and fussi- but may be caused by other viral agents. Bronchiolitis is inflammation of
ness for the past the lower respiratory tract, which involves edema, epithelial cell necrosis,
five days. On exam, bronchospasm, and increased mucus production. The resultant lower
the patient demon- airway obstruction causes increased work of breathing and wheezing.
strates subcostal re- Bronchiolitis is a clinical diagnosis based on age under two years old,
tractions, tachypnea, rhinorrhea, tachypnea, and wheezing. Unlike asthma or reactive airway
and diffuse wheezing. disease, there is often no significant improvement with albuterol. There
The patient is given is often a history of several days of upper respiratory symptoms, such as
an albuterol nebulizer rhinorrhea, mild cough, and mild fever. Rapid antigen tests, blood work,
treatment without any and radiographs are not usually needed. Radiographs may demonstrate
improvement of his hyperinflation and atelectasis, but do not show any focal infiltrates like
wheezing. Chest X-ray with pneumonia. Bronchiolitis is usually self-limited, with respiratory sta-
does not show any ab-
, normality. Which of the tus typically improving over 2-5 days. Management involves supportive
following organisms is care.
the most likely cause of
his symptoms?
Bordetella pertussis
Haemophilus influen-
zae
Parainfluenza virus
Respiratory syncytial
virus
5. Bronchiolitis
6. What months of the November to March.
year contain the peak
incidence of RSV in
North America?
7. A 76-year-old man pre- Correct Answer ( A )
sents to the emer- Explanation:
gency department with
shortness of breath This patient presents with a clinical picture consistent with obstructive
and lightheadedness. shock. His distended neck veins, full right upper quadrant, muffled heart
Vital signs include sounds, and hypotension are all consistent with pericardial tamponade.
blood pressure 70/56 A pericardial sac slowly accumulating fluid can stretch without obstruct-
mm Hg, heart rate ing cardiac function. Tamponade occurs when rapid fluid accumulation
124 beats/minute, res- results in elevated pressures that inhibit venous return. This is a dy-
piratory rate 22 namic process over the course of the cardiac cycle, therefore bedside
, breaths/minute, and echocardiography is the diagnostic test of choice. Fluid around the heart
temperature 37.6°C. with evidence of right atrial compression and right ventricular diastolic
He has distended neck collapse are diagnostic of pericardial tamponade.
veins and occasional
dropped radial beats.
His lungs are clear to
auscultation, but his
heart sounds are dis-
tant. He has some full-
ness to palpation of the
right upper quadrant
of his abdomen. Which
of the following is the
most appropriate diag-
nostic test?
Bedside echocardiog-
raphy
Chest radiograph
Computed tomogra-
phy angiogram of the
chest
Electrocardiogram
8. Pericardial Effusion
9. What is the emergent Pericardiocentesis.
treatment of pericar-
dial tamponade?
1. A 14-year-old boy pre- Correct Answer ( C )
sents complaining of Explanation:
intense pruritus in his
groin, axillae, and be- This patient has scabies; a pruritic dermatitis caused by cutaneous infec-
tween his fingers af- tion with the mite Sarcoptes scabei, var hominis. Scabies is spread by
ter returning home skin-to-skin contact and should be considered in patients with general-
from summer camp ized pruritus, especially when exposure to others with similar symptoms
1 week ago. He re- is reported. The rash of scabies involves papules, which are often excori-
ports several other ated. Burrows are pathognomonic but not uniformly present. Unless pre-
campers had similar viously infected, pruritus generally takes 3-6 weeks to develop because
symptoms. On exam, symptoms are due to delayed (Type IV) sensitivity reaction. The pruritus
you note excoriations is classically worse at night and affects the web spaces of the fingers,
in the inguinal region flexor aspect of the wrists, axillae, groin, nipples, and the periumbilical
and axillae surround- region. Except in cases involving an immunocompromised host, the scalp
ing scattered, erythe- and face are generally spared. Diagnosis is clinical but can be confirmed
matous papules. Which by placing scrapings collected with a #15 blade scalpel in mineral oil
of the following is for microscopic examination. The treatment of choice for primary sca-
the most appropriate bies infection is the application of topical scabicidal agents, with repeat
treatment? application in 7 days. The treatment of choice is permethrin 5% lotion.
Ketoconazole Individuals affected by scabies should avoid skin-to-skin contact with
Lindane others. Patients with typical scabies may return to school or work 24
Permethrin hours after the first treatment.
Prednisone
2. Should family mem- Yes, family members and sexual contacts.
bers of an infected in-
dividual also be treated
for scabies?
3. Scabies Sarcoptes scabiei
Pruritic rash worse at night
Linear burrows
, Interdigital spaces of hands/feet, penis, breasts
Permethrin (first line)
Ivermectin
**head and back are sparred
(head involved in children)
4. An 18-month-old boy Correct Answer ( D )
presents to the emer- Explanation:
gency department with
worsening shortness The patient has bronchiolitis, which is the most common lower respira-
of breath. The par- tory tract infection in patients less than two years of age. It remains the
ents report he has leading cause for hospitalization in infants under one year of age. Bron-
had a cough, run- chiolitis is most commonly caused by respiratory syncytial virus (RSV),
ny nose, and fussi- but may be caused by other viral agents. Bronchiolitis is inflammation of
ness for the past the lower respiratory tract, which involves edema, epithelial cell necrosis,
five days. On exam, bronchospasm, and increased mucus production. The resultant lower
the patient demon- airway obstruction causes increased work of breathing and wheezing.
strates subcostal re- Bronchiolitis is a clinical diagnosis based on age under two years old,
tractions, tachypnea, rhinorrhea, tachypnea, and wheezing. Unlike asthma or reactive airway
and diffuse wheezing. disease, there is often no significant improvement with albuterol. There
The patient is given is often a history of several days of upper respiratory symptoms, such as
an albuterol nebulizer rhinorrhea, mild cough, and mild fever. Rapid antigen tests, blood work,
treatment without any and radiographs are not usually needed. Radiographs may demonstrate
improvement of his hyperinflation and atelectasis, but do not show any focal infiltrates like
wheezing. Chest X-ray with pneumonia. Bronchiolitis is usually self-limited, with respiratory sta-
does not show any ab-
, normality. Which of the tus typically improving over 2-5 days. Management involves supportive
following organisms is care.
the most likely cause of
his symptoms?
Bordetella pertussis
Haemophilus influen-
zae
Parainfluenza virus
Respiratory syncytial
virus
5. Bronchiolitis
6. What months of the November to March.
year contain the peak
incidence of RSV in
North America?
7. A 76-year-old man pre- Correct Answer ( A )
sents to the emer- Explanation:
gency department with
shortness of breath This patient presents with a clinical picture consistent with obstructive
and lightheadedness. shock. His distended neck veins, full right upper quadrant, muffled heart
Vital signs include sounds, and hypotension are all consistent with pericardial tamponade.
blood pressure 70/56 A pericardial sac slowly accumulating fluid can stretch without obstruct-
mm Hg, heart rate ing cardiac function. Tamponade occurs when rapid fluid accumulation
124 beats/minute, res- results in elevated pressures that inhibit venous return. This is a dy-
piratory rate 22 namic process over the course of the cardiac cycle, therefore bedside
, breaths/minute, and echocardiography is the diagnostic test of choice. Fluid around the heart
temperature 37.6°C. with evidence of right atrial compression and right ventricular diastolic
He has distended neck collapse are diagnostic of pericardial tamponade.
veins and occasional
dropped radial beats.
His lungs are clear to
auscultation, but his
heart sounds are dis-
tant. He has some full-
ness to palpation of the
right upper quadrant
of his abdomen. Which
of the following is the
most appropriate diag-
nostic test?
Bedside echocardiog-
raphy
Chest radiograph
Computed tomogra-
phy angiogram of the
chest
Electrocardiogram
8. Pericardial Effusion
9. What is the emergent Pericardiocentesis.
treatment of pericar-
dial tamponade?
