ROSH REVIEW EXAM STUDY GUIDE TEST
BANK 2026 ACTUAL EXAM FULL SOLUTION
◍ Should family members of an infected individual also be treated for
scabies?. Answer: Yes, family members and sexual contacts.
◍ Scabies. Answer: 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)
◍ An 18-month-old boy presents to the emergency department with
worsening shortness of breath. The parents report he has had a cough,
runny nose, and fussiness for the past five days. On exam, the patient
demonstrates subcostal retractions, tachypnea, and diffuse wheezing.
The patient is given an albuterol nebulizer treatment without any
improvement of his wheezing. Chest X-ray does not show any
abnormality. Which of the following organisms is the most likely
cause of his symptoms?
,Bordetella pertussis
Haemophilus influenzae
Parainfluenza virus
Respiratory syncytial virus. Answer: Correct Answer ( D )
Explanation:
The patient has bronchiolitis, which is the most common lower
respiratory tract infection in patients less than two years of age. It
remains the leading cause for hospitalization in infants under one year
of age. Bronchiolitis is most commonly caused by respiratory
syncytial virus (RSV), but may be caused by other viral agents.
Bronchiolitis is inflammation of the lower respiratory tract, which
involves edema, epithelial cell necrosis, bronchospasm, and increased
mucus production. The resultant lower airway obstruction causes
increased work of breathing and wheezing. Bronchiolitis is a clinical
diagnosis based on age under two years old, rhinorrhea, tachypnea,
and wheezing. Unlike asthma or reactive airway disease, there is often
no significant improvement with albuterol. There is often a history of
several days of upper respiratory symptoms, such as rhinorrhea, mild
cough, and mild fever. Rapid antigen tests, blood work, and
radiographs are not usually needed. Radiographs may demonstrate
hyperinflation and atelectasis, but do not show any focal infiltrates
like with pneumonia. Bronchiolitis is usually self-limited, with
respiratory status typically improving over 2-5 days. Management
involves supportive care.
◍ Bronchiolitis. Answer:
,◍ What months of the year contain the peak incidence of RSV in
North America?. Answer: November to March.
◍ A 76-year-old man presents to the emergency department with
shortness of breath and lightheadedness. Vital signs include blood
pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate
22 breaths/minute, and temperature 37.6°C. He has distended neck
veins and occasional dropped radial beats. His lungs are clear to
auscultation, but his heart sounds are distant. He has some fullness to
palpation of the right upper quadrant of his abdomen. Which of the
following is the most appropriate diagnostic test?
Bedside echocardiography
Chest radiograph
Computed tomography angiogram of the chest
Electrocardiogram. Answer: Correct Answer ( A )
Explanation:
This patient presents with a clinical picture consistent with obstructive
shock. His distended neck veins, full right upper quadrant, muffled
heart sounds, and hypotension are all consistent with pericardial
tamponade. A pericardial sac slowly accumulating fluid can stretch
without obstructing cardiac function. Tamponade occurs when rapid
fluid accumulation results in elevated pressures that inhibit venous
return. This is a dynamic process over the course of the cardiac cycle,
therefore bedside echocardiography is the diagnostic test of choice.
Fluid around the heart with evidence of right atrial compression and
right ventricular diastolic collapse are diagnostic of pericardial
tamponade.
, ◍ Pericardial Effusion. Answer:
◍ What is the emergent treatment of pericardial tamponade?. Answer:
Pericardiocentesis.
◍ An 8-year-old African-American girl with a history of sickle cell
anemia presents with diffuse pain consistent with an acute sickle cell
pain crisis. While in the emergency department, she develops acute
onset headache, right sided facial droop and right arm weakness. A
CT scan confirms the diagnosis. Which of the following is the next
best step in management?
Alteplase
Exchange transfusion
MRI brain
Tranexamic acid. Answer: Correct Answer ( B )
Explanation:
Cerebrovascular events are a potential complication of sickle cell
disease. This patient developed symptoms concerning for acute
ischemic stroke. For pediatric patients with acute ischemic stroke in
the setting of sickle cell disease, exchange transfusion is the treatment
of choice. Transfusion goals include decreasing hemoglobin S levels
to less than 30% and obtaining a total hemoglobin level of 10 g/dL.
For adults with acute ischemic stroke in the setting of sickle cell
disease, consider tissue plasminogen activator (tPA). tPA is not
indicated or approved for use in pediatric patients
BANK 2026 ACTUAL EXAM FULL SOLUTION
◍ Should family members of an infected individual also be treated for
scabies?. Answer: Yes, family members and sexual contacts.
◍ Scabies. Answer: 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)
◍ An 18-month-old boy presents to the emergency department with
worsening shortness of breath. The parents report he has had a cough,
runny nose, and fussiness for the past five days. On exam, the patient
demonstrates subcostal retractions, tachypnea, and diffuse wheezing.
The patient is given an albuterol nebulizer treatment without any
improvement of his wheezing. Chest X-ray does not show any
abnormality. Which of the following organisms is the most likely
cause of his symptoms?
,Bordetella pertussis
Haemophilus influenzae
Parainfluenza virus
Respiratory syncytial virus. Answer: Correct Answer ( D )
Explanation:
The patient has bronchiolitis, which is the most common lower
respiratory tract infection in patients less than two years of age. It
remains the leading cause for hospitalization in infants under one year
of age. Bronchiolitis is most commonly caused by respiratory
syncytial virus (RSV), but may be caused by other viral agents.
Bronchiolitis is inflammation of the lower respiratory tract, which
involves edema, epithelial cell necrosis, bronchospasm, and increased
mucus production. The resultant lower airway obstruction causes
increased work of breathing and wheezing. Bronchiolitis is a clinical
diagnosis based on age under two years old, rhinorrhea, tachypnea,
and wheezing. Unlike asthma or reactive airway disease, there is often
no significant improvement with albuterol. There is often a history of
several days of upper respiratory symptoms, such as rhinorrhea, mild
cough, and mild fever. Rapid antigen tests, blood work, and
radiographs are not usually needed. Radiographs may demonstrate
hyperinflation and atelectasis, but do not show any focal infiltrates
like with pneumonia. Bronchiolitis is usually self-limited, with
respiratory status typically improving over 2-5 days. Management
involves supportive care.
◍ Bronchiolitis. Answer:
,◍ What months of the year contain the peak incidence of RSV in
North America?. Answer: November to March.
◍ A 76-year-old man presents to the emergency department with
shortness of breath and lightheadedness. Vital signs include blood
pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate
22 breaths/minute, and temperature 37.6°C. He has distended neck
veins and occasional dropped radial beats. His lungs are clear to
auscultation, but his heart sounds are distant. He has some fullness to
palpation of the right upper quadrant of his abdomen. Which of the
following is the most appropriate diagnostic test?
Bedside echocardiography
Chest radiograph
Computed tomography angiogram of the chest
Electrocardiogram. Answer: Correct Answer ( A )
Explanation:
This patient presents with a clinical picture consistent with obstructive
shock. His distended neck veins, full right upper quadrant, muffled
heart sounds, and hypotension are all consistent with pericardial
tamponade. A pericardial sac slowly accumulating fluid can stretch
without obstructing cardiac function. Tamponade occurs when rapid
fluid accumulation results in elevated pressures that inhibit venous
return. This is a dynamic process over the course of the cardiac cycle,
therefore bedside echocardiography is the diagnostic test of choice.
Fluid around the heart with evidence of right atrial compression and
right ventricular diastolic collapse are diagnostic of pericardial
tamponade.
, ◍ Pericardial Effusion. Answer:
◍ What is the emergent treatment of pericardial tamponade?. Answer:
Pericardiocentesis.
◍ An 8-year-old African-American girl with a history of sickle cell
anemia presents with diffuse pain consistent with an acute sickle cell
pain crisis. While in the emergency department, she develops acute
onset headache, right sided facial droop and right arm weakness. A
CT scan confirms the diagnosis. Which of the following is the next
best step in management?
Alteplase
Exchange transfusion
MRI brain
Tranexamic acid. Answer: Correct Answer ( B )
Explanation:
Cerebrovascular events are a potential complication of sickle cell
disease. This patient developed symptoms concerning for acute
ischemic stroke. For pediatric patients with acute ischemic stroke in
the setting of sickle cell disease, exchange transfusion is the treatment
of choice. Transfusion goals include decreasing hemoglobin S levels
to less than 30% and obtaining a total hemoglobin level of 10 g/dL.
For adults with acute ischemic stroke in the setting of sickle cell
disease, consider tissue plasminogen activator (tPA). tPA is not
indicated or approved for use in pediatric patients
