ROSH REVIEW COMPREHENSIVE
EXAMINATION TEST 2026 EXAM STUDY
SHEET ALREADY PASSED
◍ PDA. Answer: Patent Ductus Arteriosus
Patient will be complaining of failure to thrive, poor feeding,
tachycardia, and tachypnea
PE will show continuous, rough, "machinery-like" murmur, heard best
in the first interspaces of the LSB
Diagnosis is made by echo
Treatment is indomethacin
◍ True or false: Maternal use of nonsteroidal anti-inflammatory
medications can cause fetal closure of the ductus arteriosus?. Answer:
True.
◍ A 49 year-old woman presents with chest pain and shortness of
breath. Her pain is constant, non-exertional and does not radiate into
the back. She denies hemoptysis, history of previous venous
thromboembolism, trauma or surgery within the last 4 weeks or
unilateral leg swelling. She takes no medications. She smokes a half
pack of cigarettes per day. Her vital signs at triage are temperature
98.6°F, blood pressure 120/80 mm Hg, heart rate 108 bpm. Her heart
rate improves to 97 bpm upon reevaluation. Her physician decides to
evaluate her for a pulmonary embolism. In addition to an ECG and a
,chest X-ray, which of the following is the most appropriate next step
in diagnosis of pulmonary embolism?
CT pulmonary angiogram
D-dimer followed by a CT pulmonary angiogram if positive
Use the pulmonary embolism rule out criteria to exclude pulmonary
embolism
V/Q scan. Answer: Correct Answer ( B )
Explanation:
Patients who present with signs and symptoms concerning for a
pulmonary embolism should be evaluated by a stepwise approach.
The first step is to determine the likelihood of pulmonary embolism.
Physician gestalt has been shown to have similar sensitivity and
specificity as the Wells' criteria. If the patient is deemed to be low
risk, either by the Wells' criteria or clinician gestalt, the Pulmonary
Embolism Rule-out Criteria (PERC) rule should be evaluated. If the
patient has any one of the following, D-dimer testing should be
performed: age ≥ 50 years, HR ≥ 100 bpm at any time in the
emergency department, room air oxygen saturation < 95%, prior
history of venous thromboembolism, trauma or surgery within 4
weeks, hemoptysis, exogenous estrogen use, or unilateral leg
swelling. This patient is low risk for pulmonary embolism but had a
heart rate greater than 100 bpm at triage, and therefore, should be
evaluated by a D-dimer followed by a CT pulmonary angiogram if
positive.
◍ PE Rule Out Criteria. Answer:
,◍ What is a Hampton's hump?. Answer: It is a wedge shaped
infiltrate seen on chest X-ray indicative of a pulmonary infarct.
◍ Correct Answer ( C )
Explanation:
The patient has a felon, which is a pyogenic infection of the digital
subcutaneous tissue and pulp. Staphylococcus aureus is the most
common causative organism. The finger pads contain septae that
confine the infection leading to increased pressure at the distal finger.
The infection can cause intense pain, swelling and redness. Minor
trauma of the overlying skin is often the primary cause. Incision and
drainage is the recommended initial treatment if the finger is swollen
and tense with palpable fluctuance. If left untreated, the infection may
spread to the flexor tendon sheath leading to flexor tenosynovitis, or
to the bone leading to osteomyelitis. A unilateral longitudinal incision
is made to spare the sensate portion of the finger pad. This approach
usually achieves adequate drainage of infection. Dissection with a
hemostat to break up septations may be required to sufficiently.
Answer: A 39-year-old man presents to the Emergency Department
with left hand pain. He denies recent trauma, genital or oral lesions, or
fever. His medical history is significant for diabetes mellitus and
tobacco abuse. His examination is shown above. Which of the
following is the most appropriate initial therapy for this patient?
◍ Felon. Answer:
, ◍ True or false: Incision and drainage should be avoided in cases of
herpetic whitlow.. Answer: True, as this can lead to secondary
bacterial infection.
◍ Herpetic Whitlow. Answer:
◍ A 23-year-old man with a history of insulin-dependent diabetes
presents to the ED with vomiting and shortness of breath. He recently
became homeless and has not been using his insulin. On physical
exam, he has a fruity odor to his breath. After two hours of treatment
in the ED, his serum labs include: glucose 220 mg/dL, sodium 133
mEq/L, chloride 101 mEq/L, and bicarbonate 12 mmol/L. Which of
the following is the most appropriate next step in management?
Allow the patient to eat a turkey sandwich
Change to dextrose-containing intravenous fluid
Discharge home with endocrinology follow-up
Transition to subcutaneous insulin therapy. Answer: Correct Answer (
B)
Explanation:
This patient is exhibiting signs and symptoms consistent with diabetic
ketoacidosis (DKA). DKA is more common in insulin-dependent
diabetics. Management of DKA includes cardiac monitoring,
aggressive intravenous fluid hydration, and insulin administration
most often in the form of an insulin drip. Therapy should be continued
until the anion gap is closed; however, this may take longer to achieve
than the normalization of the serum glucose level. Once the glucose
EXAMINATION TEST 2026 EXAM STUDY
SHEET ALREADY PASSED
◍ PDA. Answer: Patent Ductus Arteriosus
Patient will be complaining of failure to thrive, poor feeding,
tachycardia, and tachypnea
PE will show continuous, rough, "machinery-like" murmur, heard best
in the first interspaces of the LSB
Diagnosis is made by echo
Treatment is indomethacin
◍ True or false: Maternal use of nonsteroidal anti-inflammatory
medications can cause fetal closure of the ductus arteriosus?. Answer:
True.
◍ A 49 year-old woman presents with chest pain and shortness of
breath. Her pain is constant, non-exertional and does not radiate into
the back. She denies hemoptysis, history of previous venous
thromboembolism, trauma or surgery within the last 4 weeks or
unilateral leg swelling. She takes no medications. She smokes a half
pack of cigarettes per day. Her vital signs at triage are temperature
98.6°F, blood pressure 120/80 mm Hg, heart rate 108 bpm. Her heart
rate improves to 97 bpm upon reevaluation. Her physician decides to
evaluate her for a pulmonary embolism. In addition to an ECG and a
,chest X-ray, which of the following is the most appropriate next step
in diagnosis of pulmonary embolism?
CT pulmonary angiogram
D-dimer followed by a CT pulmonary angiogram if positive
Use the pulmonary embolism rule out criteria to exclude pulmonary
embolism
V/Q scan. Answer: Correct Answer ( B )
Explanation:
Patients who present with signs and symptoms concerning for a
pulmonary embolism should be evaluated by a stepwise approach.
The first step is to determine the likelihood of pulmonary embolism.
Physician gestalt has been shown to have similar sensitivity and
specificity as the Wells' criteria. If the patient is deemed to be low
risk, either by the Wells' criteria or clinician gestalt, the Pulmonary
Embolism Rule-out Criteria (PERC) rule should be evaluated. If the
patient has any one of the following, D-dimer testing should be
performed: age ≥ 50 years, HR ≥ 100 bpm at any time in the
emergency department, room air oxygen saturation < 95%, prior
history of venous thromboembolism, trauma or surgery within 4
weeks, hemoptysis, exogenous estrogen use, or unilateral leg
swelling. This patient is low risk for pulmonary embolism but had a
heart rate greater than 100 bpm at triage, and therefore, should be
evaluated by a D-dimer followed by a CT pulmonary angiogram if
positive.
◍ PE Rule Out Criteria. Answer:
,◍ What is a Hampton's hump?. Answer: It is a wedge shaped
infiltrate seen on chest X-ray indicative of a pulmonary infarct.
◍ Correct Answer ( C )
Explanation:
The patient has a felon, which is a pyogenic infection of the digital
subcutaneous tissue and pulp. Staphylococcus aureus is the most
common causative organism. The finger pads contain septae that
confine the infection leading to increased pressure at the distal finger.
The infection can cause intense pain, swelling and redness. Minor
trauma of the overlying skin is often the primary cause. Incision and
drainage is the recommended initial treatment if the finger is swollen
and tense with palpable fluctuance. If left untreated, the infection may
spread to the flexor tendon sheath leading to flexor tenosynovitis, or
to the bone leading to osteomyelitis. A unilateral longitudinal incision
is made to spare the sensate portion of the finger pad. This approach
usually achieves adequate drainage of infection. Dissection with a
hemostat to break up septations may be required to sufficiently.
Answer: A 39-year-old man presents to the Emergency Department
with left hand pain. He denies recent trauma, genital or oral lesions, or
fever. His medical history is significant for diabetes mellitus and
tobacco abuse. His examination is shown above. Which of the
following is the most appropriate initial therapy for this patient?
◍ Felon. Answer:
, ◍ True or false: Incision and drainage should be avoided in cases of
herpetic whitlow.. Answer: True, as this can lead to secondary
bacterial infection.
◍ Herpetic Whitlow. Answer:
◍ A 23-year-old man with a history of insulin-dependent diabetes
presents to the ED with vomiting and shortness of breath. He recently
became homeless and has not been using his insulin. On physical
exam, he has a fruity odor to his breath. After two hours of treatment
in the ED, his serum labs include: glucose 220 mg/dL, sodium 133
mEq/L, chloride 101 mEq/L, and bicarbonate 12 mmol/L. Which of
the following is the most appropriate next step in management?
Allow the patient to eat a turkey sandwich
Change to dextrose-containing intravenous fluid
Discharge home with endocrinology follow-up
Transition to subcutaneous insulin therapy. Answer: Correct Answer (
B)
Explanation:
This patient is exhibiting signs and symptoms consistent with diabetic
ketoacidosis (DKA). DKA is more common in insulin-dependent
diabetics. Management of DKA includes cardiac monitoring,
aggressive intravenous fluid hydration, and insulin administration
most often in the form of an insulin drip. Therapy should be continued
until the anion gap is closed; however, this may take longer to achieve
than the normalization of the serum glucose level. Once the glucose
