EMERGENCY MEDICINE ROSH Mock Exam
Question and Answers Latest Versions 2025
What bone is most commonly involved in basilar skull fractures?
temporal bone
What basic metabolic panel abnormality is associated with upper GI
bleeding?
Elevated BUN/Creatinine ratio
A 77-year-old woman presents with an acute change in mental status.
She has a history of diabetes mellitus, hypertension, and prior
ischemic stroke. Home medications include aspirin, clopidogrel,
lisinopril, and glyburide. She was found by family to be confused and
diaphoretic. Her blood sugar was 32 mg/dL. She was given 50 grams
of intravenous dextrose by emergency personnel with a return to her
baseline mental status. On arrival to the emergency department, her
blood sugar is 185 mg/dL. When asked, she thinks she may have
accidentally taken an extra dose of her glyburide this morning. She is
currently asymptomatic and asking when she can go home. Which of
the following is the most appropriate management of this patient?
Admission for 24-hour observation
-b/c the hypoglycemic effect of sulfonylureas lasts up to 24 hours allowing
for once-daily dosing
-work by promoting endogenous insulin secretion by the pancreas
What is trench foot?
Prolonged wet and cold (but nonfreezing) exposure causing reversible
neurovascular injury
What medication is indicated in cases of recurrent hypoglycemia
associated with sulfonylurea overdose?
Octreotide, a somatostatin analogue that inhibits release of insulin from the
pancreatic beta-islet cells
A 27-month-old girl presents to the ED with parents after one episode
of generalized convulsions. Parents note she has was initially
lethargic but then cleared to baseline. Temperature in the ED is
102.9°F. As you move to examine her, she has another generalized
tonic clonic seizure. It rapidly terminates without intervention and she
,returns to baseline. Which of the following is the next most important
step in this child's workup?
Observation & Reassurance if patient remains at mental baseline and
don't continually have seizures requiring intervention
DX: COMPLEX Febrile seizure
-any event not meeting the criteria for a simple febrile seizure
-should raise suspicion for serious disease such as meningitis, intracranial
hemorrhage, or intracranial mass
- should prompt providers to consider further workup with laboratory
testing, lumbar puncture, EEG, and neuroimaging; however, if the patient
returns to baseline despite repeat seizures (2-3), then this testing is
not required
What would you expect to find on the cerebrospinal fluid analysis of a
patient with bacterial meningitis?
Elevated white blood cell count, elevated protein, low glucose, organisms
on gram stain
simple febrile seizure
(1) generalized tonic-clonic seizure
(2) occurring in the appropriate age group of age 6 months to 5 years
(3) seizure is less than 15 minutes in duration
(4) the child has a nonfocal neurologic exam
(5) there is no recurrence of seizures within 24 hours
A 39-year-old woman presents to the ED with fever and altered mental
status after an intentional overdose. On physical exam, you note
lower extremity hyperreflexia and myoclonus. Vital signs are BP
170/110 mm Hg, HR 126 beats per minute, RR 24 breaths per minute,
and T 101.2°F. Which of the following is the classic antidote to this
toxicologic process?
cyproheptadineor benzodiazepines, hydration/cooling
DX: serotonin syndrome
Bromocriptine is for neuroleptic malignant syndrome like dantrolene
What is the youngest age someone may receive tPA for acute stroke?
18 yo
A 64 year-old woman presents to the emergency department
complaining of facial pain. She was at a major league baseball game
and was struck in the face with a foul ball. She is awake and alert and
able to provide you with the history. On physical exam she has
, extensive swelling and ecchymosis to the nasal bridge and upper lip
region. Upon grasping her upper teeth, the nasal complex and maxilla
move together as a unit. A CT of the facial bones reveals a fracture
extending from the maxilla superiorly to the nasal bridge in a
pyramidal shape. What is the most likely diagnosis?
Le Fort II fracture
-fracture extends from the maxilla superiorly to the nasal bridge, including
the lacrimal bones, orbital floor and rim.
-physical exam: nasal complex moves with the maxilla when the upper
teeth are grasped and rocked
-CT of the facial bones will confirm the diagnosis
-Management: pain control and facial trauma consultation for operative
repair
Evaluation of extraocular movement on physical exam in patients with
facial trauma is utilized to rule out what complication of orbital
trauma?
Orbital fracture with associated muscle entrapment
A 42-year-old man presents with pain in his foot after falling while
descending the stairs. He is unable to bear weight on the foot. Pulses
and sensation are intact. He has pain with palpation of the midfoot
and a small area of ecchymosis on the plantar surface of the foot. His
X-ray is shown above. What is the likely diagnosis?
Lisfranc injury (tarsometatarsal joint complex)
-comprised of the articulations of the bases of the first three metatarsals
with the cuneiforms and the fourth and fifth metatarsals with the cuboid,
joined together with multiple ligaments
-Ecchymosis on the plantar surface of the foot is pathognomonic
-The medial border of the second metatarsal should align with the medial
aspect of the middle cuneiform and the medial border of the fourth
metatarsal should align with the medial border of the cuboid:Any widening
or malalignment > 1 mm in these areas is pathological
-Initial treatment: immobilization with a short-leg cast, elevation, and pain
control. The patient should be non-weight bearing. Orthopedic consultation
is necessary.
What technique may improve the chance of diagnosing a Lisfranc
injury on plain radiograph?
Including weight-bearing (stress) views
Question and Answers Latest Versions 2025
What bone is most commonly involved in basilar skull fractures?
temporal bone
What basic metabolic panel abnormality is associated with upper GI
bleeding?
Elevated BUN/Creatinine ratio
A 77-year-old woman presents with an acute change in mental status.
She has a history of diabetes mellitus, hypertension, and prior
ischemic stroke. Home medications include aspirin, clopidogrel,
lisinopril, and glyburide. She was found by family to be confused and
diaphoretic. Her blood sugar was 32 mg/dL. She was given 50 grams
of intravenous dextrose by emergency personnel with a return to her
baseline mental status. On arrival to the emergency department, her
blood sugar is 185 mg/dL. When asked, she thinks she may have
accidentally taken an extra dose of her glyburide this morning. She is
currently asymptomatic and asking when she can go home. Which of
the following is the most appropriate management of this patient?
Admission for 24-hour observation
-b/c the hypoglycemic effect of sulfonylureas lasts up to 24 hours allowing
for once-daily dosing
-work by promoting endogenous insulin secretion by the pancreas
What is trench foot?
Prolonged wet and cold (but nonfreezing) exposure causing reversible
neurovascular injury
What medication is indicated in cases of recurrent hypoglycemia
associated with sulfonylurea overdose?
Octreotide, a somatostatin analogue that inhibits release of insulin from the
pancreatic beta-islet cells
A 27-month-old girl presents to the ED with parents after one episode
of generalized convulsions. Parents note she has was initially
lethargic but then cleared to baseline. Temperature in the ED is
102.9°F. As you move to examine her, she has another generalized
tonic clonic seizure. It rapidly terminates without intervention and she
,returns to baseline. Which of the following is the next most important
step in this child's workup?
Observation & Reassurance if patient remains at mental baseline and
don't continually have seizures requiring intervention
DX: COMPLEX Febrile seizure
-any event not meeting the criteria for a simple febrile seizure
-should raise suspicion for serious disease such as meningitis, intracranial
hemorrhage, or intracranial mass
- should prompt providers to consider further workup with laboratory
testing, lumbar puncture, EEG, and neuroimaging; however, if the patient
returns to baseline despite repeat seizures (2-3), then this testing is
not required
What would you expect to find on the cerebrospinal fluid analysis of a
patient with bacterial meningitis?
Elevated white blood cell count, elevated protein, low glucose, organisms
on gram stain
simple febrile seizure
(1) generalized tonic-clonic seizure
(2) occurring in the appropriate age group of age 6 months to 5 years
(3) seizure is less than 15 minutes in duration
(4) the child has a nonfocal neurologic exam
(5) there is no recurrence of seizures within 24 hours
A 39-year-old woman presents to the ED with fever and altered mental
status after an intentional overdose. On physical exam, you note
lower extremity hyperreflexia and myoclonus. Vital signs are BP
170/110 mm Hg, HR 126 beats per minute, RR 24 breaths per minute,
and T 101.2°F. Which of the following is the classic antidote to this
toxicologic process?
cyproheptadineor benzodiazepines, hydration/cooling
DX: serotonin syndrome
Bromocriptine is for neuroleptic malignant syndrome like dantrolene
What is the youngest age someone may receive tPA for acute stroke?
18 yo
A 64 year-old woman presents to the emergency department
complaining of facial pain. She was at a major league baseball game
and was struck in the face with a foul ball. She is awake and alert and
able to provide you with the history. On physical exam she has
, extensive swelling and ecchymosis to the nasal bridge and upper lip
region. Upon grasping her upper teeth, the nasal complex and maxilla
move together as a unit. A CT of the facial bones reveals a fracture
extending from the maxilla superiorly to the nasal bridge in a
pyramidal shape. What is the most likely diagnosis?
Le Fort II fracture
-fracture extends from the maxilla superiorly to the nasal bridge, including
the lacrimal bones, orbital floor and rim.
-physical exam: nasal complex moves with the maxilla when the upper
teeth are grasped and rocked
-CT of the facial bones will confirm the diagnosis
-Management: pain control and facial trauma consultation for operative
repair
Evaluation of extraocular movement on physical exam in patients with
facial trauma is utilized to rule out what complication of orbital
trauma?
Orbital fracture with associated muscle entrapment
A 42-year-old man presents with pain in his foot after falling while
descending the stairs. He is unable to bear weight on the foot. Pulses
and sensation are intact. He has pain with palpation of the midfoot
and a small area of ecchymosis on the plantar surface of the foot. His
X-ray is shown above. What is the likely diagnosis?
Lisfranc injury (tarsometatarsal joint complex)
-comprised of the articulations of the bases of the first three metatarsals
with the cuneiforms and the fourth and fifth metatarsals with the cuboid,
joined together with multiple ligaments
-Ecchymosis on the plantar surface of the foot is pathognomonic
-The medial border of the second metatarsal should align with the medial
aspect of the middle cuneiform and the medial border of the fourth
metatarsal should align with the medial border of the cuboid:Any widening
or malalignment > 1 mm in these areas is pathological
-Initial treatment: immobilization with a short-leg cast, elevation, and pain
control. The patient should be non-weight bearing. Orthopedic consultation
is necessary.
What technique may improve the chance of diagnosing a Lisfranc
injury on plain radiograph?
Including weight-bearing (stress) views
