ROSH REVIEW EXAMINATION TEST Q&A:
2026 STUDY GUIDE QUESTIONS AND
SOLUTIONS 100% CORRECT
◍ A 26-year-old woman presents for her annual exam and is inquiring
about birth control. She is current on her immunizations and her last
pap smear was 2 years ago. She is in a monogamous relationship with
her boyfriend and does not have any immediate plans for pregnancy.
She has a history of migraines with aura but does not require any
prescription medication.
Which of the following birth control methods is the best option for
her?
A. Behavioral methods such as the withdrawal method and periodic
abstinence
B. Etonogestrel/ethinyl estradiol vaginal
C. Medroxyprogesterone acetate
D. Norelgestromin/ethinyl estradiol transdermal. Answer: Correct
Answer ( C )
Explanation:
Contraception counseling should be routinely performed in all women
of child-bearing age at every annual visit. There are many options
such as behavioral, barrier and pharmacological methods. However,
pharmacological therapy has the highest rate of pregnancy prevention
and should be recommended in all women, unless there are
,contraindications. This patient has a history of migraines with aura
which is considered a contraindication to estrogen use. Other
contraindications to estrogen are history of deep vein thrombosis,
breast cancer within the past 5 years, cigarette smoking in women
more than 35 years of age who smoke more than 15 cigarettes per day,
ischemic heart disease, stroke, active liver disease, major surgery with
prolonged immobilization and poorly controlled hypertension. In
these cases, progesterone only therapy (medroxyprogesterone) should
be used in the form of the intrauterine device, the injection or the
subcutaneous implantation in the arm.
◍ A 24-year-old woman with no past medical history presents with
left wrist pain after a fall. The left extremity is grossly deformed and
the patient complains of severe pain. The patient has a blood pressure
of 183/100 mm Hg.
While awaiting X-rays, what management is indicated for the patients
elevated blood pressure?
A. Arrange admission for blood pressure control
B. Start an oral beta-blocker and monitor for response
C. Start intravenous beta-blocker and admit to the intensive care unit
D. Treat the patient's pain and reassess the blood pressure. Answer:
Correct Answer ( D )
Explanation:
The patient presents with a markedly elevated blood pressure in the
setting of pain from a trauma and should have pain control initiated
and her blood pressure rechecked. Hypertension is defined as a
,persistent SBP >140 mm Hg or DBP >90 mm Hg. Pain and anxiety
are common causes of elevated blood pressure and heart rate in the
outpatient setting. Historically, patients with elevated blood pressure
and nonspecific symptoms were referred to as hypertensive urgency
but this term has fallen out of use. In a patient presenting with
elevated blood pressure who does not have signs or symptoms of end-
organ damage, the clinician's focus should be on identifying external
reasons for the elevated pressure and treating or addressing these. In
this case, the reduction or relief of pain will likely lead to decreased
blood pressure.
(A) Patients with elevated blood pressure and an absence of end-organ
damage (e.g. acute coronary syndrome, aortic dissection,
encephalopathy, change in renal function) do not require admission
for management. A primary care physician in the outpatient setting
best manages these patients.
(B) Starting a beta-blocker will not be beneficial in a patient with
acute pain as the cause of elevated blood pressure.
(C) Similarly, administration of an intravenous beta-blocker and
admission to the intensive care unit is not indicated as the patient
exhibits no end-organ damage.
◍ Which of the following disorders causes a normal anion gap
metabolic acidosis?
A. Cyanide exposure
, B. Diabetic ketoacidosis
C. Diarrhea
D. Salicylate ingestion. Answer: Correct Answer ( C )
Diarrhea is a common cause of normal anion gap metabolic acidosis.
Metabolic acidosis is defined as a reduced serum bicarbonate
concentration. Normal anion gap metabolic acidosis is thought to be
less immediately dangerous than anion gap metabolic acidosis.
Normal anion gap metabolic acidosis can be caused by a variety of
conditions including rapid infusion of 0.9% saline, renal tubular
acidosis, ingestion of acetazolamide and calcium chloride and
hypoaldosteronism.
Cyanide (A), diabetic ketoacidosis (B) and salicylate ingestion (D) are
all causes of increased anion gap metabolic acidosis.
◍ A 58-year-old man presents with 3 months of headache and
diplopia. He also reports that chewing tough foods has been
progressively painful. Laboratory testing reveals a normocytic anemia
and ESR of 88 mm/hour. A brain CT is normal. Which of the
following is the most appropriate initial intervention?
A. Intravenous methylprednisolone
B. Oral methotrexate
C. Temporal artery biopsy
D. Ultrasonography. Answer: Correct Answer ( A )
2026 STUDY GUIDE QUESTIONS AND
SOLUTIONS 100% CORRECT
◍ A 26-year-old woman presents for her annual exam and is inquiring
about birth control. She is current on her immunizations and her last
pap smear was 2 years ago. She is in a monogamous relationship with
her boyfriend and does not have any immediate plans for pregnancy.
She has a history of migraines with aura but does not require any
prescription medication.
Which of the following birth control methods is the best option for
her?
A. Behavioral methods such as the withdrawal method and periodic
abstinence
B. Etonogestrel/ethinyl estradiol vaginal
C. Medroxyprogesterone acetate
D. Norelgestromin/ethinyl estradiol transdermal. Answer: Correct
Answer ( C )
Explanation:
Contraception counseling should be routinely performed in all women
of child-bearing age at every annual visit. There are many options
such as behavioral, barrier and pharmacological methods. However,
pharmacological therapy has the highest rate of pregnancy prevention
and should be recommended in all women, unless there are
,contraindications. This patient has a history of migraines with aura
which is considered a contraindication to estrogen use. Other
contraindications to estrogen are history of deep vein thrombosis,
breast cancer within the past 5 years, cigarette smoking in women
more than 35 years of age who smoke more than 15 cigarettes per day,
ischemic heart disease, stroke, active liver disease, major surgery with
prolonged immobilization and poorly controlled hypertension. In
these cases, progesterone only therapy (medroxyprogesterone) should
be used in the form of the intrauterine device, the injection or the
subcutaneous implantation in the arm.
◍ A 24-year-old woman with no past medical history presents with
left wrist pain after a fall. The left extremity is grossly deformed and
the patient complains of severe pain. The patient has a blood pressure
of 183/100 mm Hg.
While awaiting X-rays, what management is indicated for the patients
elevated blood pressure?
A. Arrange admission for blood pressure control
B. Start an oral beta-blocker and monitor for response
C. Start intravenous beta-blocker and admit to the intensive care unit
D. Treat the patient's pain and reassess the blood pressure. Answer:
Correct Answer ( D )
Explanation:
The patient presents with a markedly elevated blood pressure in the
setting of pain from a trauma and should have pain control initiated
and her blood pressure rechecked. Hypertension is defined as a
,persistent SBP >140 mm Hg or DBP >90 mm Hg. Pain and anxiety
are common causes of elevated blood pressure and heart rate in the
outpatient setting. Historically, patients with elevated blood pressure
and nonspecific symptoms were referred to as hypertensive urgency
but this term has fallen out of use. In a patient presenting with
elevated blood pressure who does not have signs or symptoms of end-
organ damage, the clinician's focus should be on identifying external
reasons for the elevated pressure and treating or addressing these. In
this case, the reduction or relief of pain will likely lead to decreased
blood pressure.
(A) Patients with elevated blood pressure and an absence of end-organ
damage (e.g. acute coronary syndrome, aortic dissection,
encephalopathy, change in renal function) do not require admission
for management. A primary care physician in the outpatient setting
best manages these patients.
(B) Starting a beta-blocker will not be beneficial in a patient with
acute pain as the cause of elevated blood pressure.
(C) Similarly, administration of an intravenous beta-blocker and
admission to the intensive care unit is not indicated as the patient
exhibits no end-organ damage.
◍ Which of the following disorders causes a normal anion gap
metabolic acidosis?
A. Cyanide exposure
, B. Diabetic ketoacidosis
C. Diarrhea
D. Salicylate ingestion. Answer: Correct Answer ( C )
Diarrhea is a common cause of normal anion gap metabolic acidosis.
Metabolic acidosis is defined as a reduced serum bicarbonate
concentration. Normal anion gap metabolic acidosis is thought to be
less immediately dangerous than anion gap metabolic acidosis.
Normal anion gap metabolic acidosis can be caused by a variety of
conditions including rapid infusion of 0.9% saline, renal tubular
acidosis, ingestion of acetazolamide and calcium chloride and
hypoaldosteronism.
Cyanide (A), diabetic ketoacidosis (B) and salicylate ingestion (D) are
all causes of increased anion gap metabolic acidosis.
◍ A 58-year-old man presents with 3 months of headache and
diplopia. He also reports that chewing tough foods has been
progressively painful. Laboratory testing reveals a normocytic anemia
and ESR of 88 mm/hour. A brain CT is normal. Which of the
following is the most appropriate initial intervention?
A. Intravenous methylprednisolone
B. Oral methotrexate
C. Temporal artery biopsy
D. Ultrasonography. Answer: Correct Answer ( A )
