ROSH REVIEW CERTIFICATION EVALUATION
EXAM Q&A: 2026 STUDY GUIDE 100% CORRECT
◍ Question: What is a Holter monitor? Answer: Answer: It is an
ambulatory ECG worn for 24-48 hours and it is the most frequent
non-invasive test used to evaluate cardiac rhythm abnormalities.
◍ A 12-year-old girl presents to the office with anal itching that
seems to be worse at night. She has no issues with constipation or any
other changes in her bowel habits. On physical exam you see some
excoriations around the anus but no tear or palpable hemorrhoid. This
first occurred a few days after returning home from a summer camp in
northern Michigan, where she was in a cabin with 15 other girls for
one month. Which of the following is the most likely diagnosis?
Internal hemorrhoid
Lyme disease
Pinworms
Scabies Answer: Correct Answer ( C )
Explanation:
Pinworm is the most common helminthic parasite encountered by
primary care providers in developed nations. It is acquired by
ingesting parasite eggs, and most people remain asymptomatic after
being colonized. Pinworm (E. vermicularis) is a quintessential
intestinal parasite with no geographic constraints. It is transmissible
,by close contact with colonized persons. People have had pinworm
for thousands of years, and before modern sanitation, colonization by
pinworm probably was universal. E. vermicularis has a simple life
cycle with a "hand to mouth" existence. The worm is acquired by
ingesting parasite eggs. Most often these eggs are on the hands of the
host; however, the small eggs also may become airborne, inhaled, and
then swallowed. During the night, egg-laden females migrate out of
the anal canal and onto the perianal skin. Each female deposits up to
17,000 eggs which mature rapidly, becoming infective within six
hours causing extreme pruritus. Infestation typically causes perianal
itching and scratching gathers eggs onto the hands, promoting
reinfection and transmission to others. Diagnosis is made by the
cellophane tape test and all members of the household should be
treated. Pinworm infection is readily treated with a single 100-mg
dose of mebendazole or a 400-mg dose of albendazole.
Internal hemorrhoids (A) can cause anal itching, but are usually
palpable on physical exam and are associated with blood in the stool
and would not be restricted to night time itching. Lyme disease (B) is
uncommon in Michigan and transmitted by a tick. The characteristic
bulls-eye (erythema migrans) rash is usually present. Scabies (D) can
cause itching in the rectal area but is associated with linear
,excoriations in regions other than the anus, such as along the
waistline, the interdigi
◍ Question: What is the cellophane tape test for pinworms? Answer:
Answer: A two- to three-inch piece of clear tape is applied serially to
several perianal areas in the morning before washing. The tape is then
applied to a glass slide.
Rapid Review
Pinworms
Transmission via ingestion of Enterobius vermicularis eggs
Nocturnal pruritus ani
Dx: tape test
◍ An 83-year-old woman with a history of constipation presents to
the ED complaining of a rectal mass. On exam, you note the mass
seen in the image above. What is the most appropriate next step in
management?
Attempt manual reduction
Consultation to a colorectal surgeon
Immediately begin broad-spectrum antibiotics
, Inject local anesthesia and perform an excisional thrombectomy
Answer: Correct Answer ( A )
Explanation:
Rectal prolapse is a disease of the very young and the very old. In
adults, it is most commonly seen in older women and is most often
associated with excessive straining while defecating, coughing, or
sneezing. This is due to laxity of attachment structures and is often
accompanied by prolapse of the bladder (cystocele) and uterus. Often,
bloody mucous discharge will be seen along with fecal incontinence
and dull pain. Manual reduction is usually sufficient for most cases
and should be attempted in the ED.
In some cases, the rectal tissue becomes edematous and at risk for
vascular compromise. These cases require urgent surgical consultation
(B). Antibiotics (C) are not necessary in adult rectal prolapse.
Pediatric rectal prolapse is more worrisome and is associated with
malnutrition, parasitic infection, and cystic fibrosis. An excisional
thrombectomy (D) is reserved for thrombosed external hemorrhoids,
not rectal prolapse.
EXAM Q&A: 2026 STUDY GUIDE 100% CORRECT
◍ Question: What is a Holter monitor? Answer: Answer: It is an
ambulatory ECG worn for 24-48 hours and it is the most frequent
non-invasive test used to evaluate cardiac rhythm abnormalities.
◍ A 12-year-old girl presents to the office with anal itching that
seems to be worse at night. She has no issues with constipation or any
other changes in her bowel habits. On physical exam you see some
excoriations around the anus but no tear or palpable hemorrhoid. This
first occurred a few days after returning home from a summer camp in
northern Michigan, where she was in a cabin with 15 other girls for
one month. Which of the following is the most likely diagnosis?
Internal hemorrhoid
Lyme disease
Pinworms
Scabies Answer: Correct Answer ( C )
Explanation:
Pinworm is the most common helminthic parasite encountered by
primary care providers in developed nations. It is acquired by
ingesting parasite eggs, and most people remain asymptomatic after
being colonized. Pinworm (E. vermicularis) is a quintessential
intestinal parasite with no geographic constraints. It is transmissible
,by close contact with colonized persons. People have had pinworm
for thousands of years, and before modern sanitation, colonization by
pinworm probably was universal. E. vermicularis has a simple life
cycle with a "hand to mouth" existence. The worm is acquired by
ingesting parasite eggs. Most often these eggs are on the hands of the
host; however, the small eggs also may become airborne, inhaled, and
then swallowed. During the night, egg-laden females migrate out of
the anal canal and onto the perianal skin. Each female deposits up to
17,000 eggs which mature rapidly, becoming infective within six
hours causing extreme pruritus. Infestation typically causes perianal
itching and scratching gathers eggs onto the hands, promoting
reinfection and transmission to others. Diagnosis is made by the
cellophane tape test and all members of the household should be
treated. Pinworm infection is readily treated with a single 100-mg
dose of mebendazole or a 400-mg dose of albendazole.
Internal hemorrhoids (A) can cause anal itching, but are usually
palpable on physical exam and are associated with blood in the stool
and would not be restricted to night time itching. Lyme disease (B) is
uncommon in Michigan and transmitted by a tick. The characteristic
bulls-eye (erythema migrans) rash is usually present. Scabies (D) can
cause itching in the rectal area but is associated with linear
,excoriations in regions other than the anus, such as along the
waistline, the interdigi
◍ Question: What is the cellophane tape test for pinworms? Answer:
Answer: A two- to three-inch piece of clear tape is applied serially to
several perianal areas in the morning before washing. The tape is then
applied to a glass slide.
Rapid Review
Pinworms
Transmission via ingestion of Enterobius vermicularis eggs
Nocturnal pruritus ani
Dx: tape test
◍ An 83-year-old woman with a history of constipation presents to
the ED complaining of a rectal mass. On exam, you note the mass
seen in the image above. What is the most appropriate next step in
management?
Attempt manual reduction
Consultation to a colorectal surgeon
Immediately begin broad-spectrum antibiotics
, Inject local anesthesia and perform an excisional thrombectomy
Answer: Correct Answer ( A )
Explanation:
Rectal prolapse is a disease of the very young and the very old. In
adults, it is most commonly seen in older women and is most often
associated with excessive straining while defecating, coughing, or
sneezing. This is due to laxity of attachment structures and is often
accompanied by prolapse of the bladder (cystocele) and uterus. Often,
bloody mucous discharge will be seen along with fecal incontinence
and dull pain. Manual reduction is usually sufficient for most cases
and should be attempted in the ED.
In some cases, the rectal tissue becomes edematous and at risk for
vascular compromise. These cases require urgent surgical consultation
(B). Antibiotics (C) are not necessary in adult rectal prolapse.
Pediatric rectal prolapse is more worrisome and is associated with
malnutrition, parasitic infection, and cystic fibrosis. An excisional
thrombectomy (D) is reserved for thrombosed external hemorrhoids,
not rectal prolapse.
