Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let’s get started. Episode 18 is limited to audio only, but video returns for episode 19. A 21-year-old woman presents with pain, tearing, photophobia, and left eye redness. She has been wearing her contact lenses continuously for the last two weeks. A slit lamp examination reveals a white, hazy opacity on the cornea at the 3 o’clock position of the cornea with associated limbal flush. Which of the following is the most appropriate pharmacotherapy? A. Topical acyclovir B. Topical amphotericin B C. Topical ciprofloxacin D. Topical cyclopentolate You can find other episodes of The Rosh Reveal podcast here. Remember to subscribe to the podcast and leave us feedback! Apple podcasts Android Google podcasts For more great Rosh Review content, including thousands of more questions, explanations, and custom teaching images, visit any of the pages below: PA: Didactics, Rotation Exams, PANCE, PANRE Nurse Practitioner: FNP Certification Exam, ENP Certification Exam, AGACNP Certification Exam, AGPCNP Certification Exam, CPNP-PC Certification Exam, PMHNP Certification Exam Nursing: <a href="https://www.roshreview.
Nov 5, 2019
Welcome back to RoshCast for Episode 52! For those of you taking the upcoming in-training exam, an early congratulations! All of your hard work will surely pay off soon. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team! Begin to be now what you will be hereafter.–William James Question 1 A 64-year-old woman presents to the emergency department with a right-sided headache. Past medical history includes hypertension, migraines, and polymyalgia rheumatica. Her symptoms started three days ago and have progressively worsened. She states that this headache is different from her previous migraines. It is frontal and she describes it as an ache without radiation of symptoms. She does describe worsening of symptoms with eating as well as when she brushes her hair. She admits to feeling more tired the last couple of days as well as having partial vision loss in the right eye. She denies any nausea or vomiting. Vital signs demonstrate a temperature of 38°C but otherwise are within normal limits. Physical examination is remarkable for tenderness to palpation over the right temple and visual acuities of 20/40 OS and 20/80 OD. What is the most appropriate next step in this patient’s management? A. Intravenous methylprednisolone B. Obtain erythrocyte sedimentation rate and C-reactive protein to confirm the diagnosis C. Obtain temporal artery biopsy D. Oral prednisone Teaching Image Question 2 A 42-year-old man presents to the emergency department with lower back pain that started acutely while lifting a couch. He complains of pain radiating to the right posterolateral calf. He denies any bowel or bladder incontinence. On examination, he has decreased plantar flexion at the right ankle and numbness of the right lateral foot. Disk herniation at which level is most likely responsible for his findings? A. L2–L3 B. L3–L4 C. L4–L5 D. L5–S1 Teaching Image Question 3 Which of the following is most likely to be seen in hepatorenal syndrome? A. Arteriolar congestion B. Histologically normal kidneys C. Necrosis of the renal tubules D. Segmental sclerosis of the renal glomeruli Teaching Image Question 4 A 27-year-old man presents to the ED with left-hand pain. He was at work as an auto mechanic when he accidentally injected his left index finger with a grease gun. On physical exam, the digit is swollen with a central pinhole wound. The remainder of the hand exam is unremarkable. Which of the following will best determine the amount of tissue damage a substance will cause? A. Chemical properties of the substance B. The pressure of the injection C. The temperature of the substance injected D. The volume of the substance injected <a href="https://www.roshreview.
Feb 24, 2019
A champion is defined not by their wins but by how they can recover when they fall.–Serena Williams Welcome back to RoshCast for Episode 51! For those of you taking the initial certification exam, you’re at the home stretch. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team! We have a great episode for you to get you prepped in your final studies! Question 1 A 46-year-old man presents with a progressive dull headache over the past 3 weeks. It is worse in the morning and with bending over or coughing. He denies any fever or congestion. For the last two days, he has had associated nausea and three episodes of vomiting. Which of the following characteristics seen on neuroimaging would be most consistent with a glioblastoma? A. Heterogenous mass with central necrosis B. Lack of enhancement with administration of contrast C. Presence of calcifications D. Well circumscribed margins Teaching Image Question 2 A 16-year-old African American boy presents with a scalp rash. On examination, it is a 5 x 5 cm boggy and thickened area of the right parietal cap with an overlying scaly and crusty plaque and hair loss. The lesion appears yellowish-green under a Wood’s lamp. What is the treatment of choice for this lesion? A. Clotrimazole ointment B. Ketoconazole shampoo C. Oral amphotericin B D. Oral griseofulvin Teaching Image Question 3 A 22-year-old man recently diagnosed with schizophrenia presents to the ED with altered mental status. His blood pressure is 160/80 mm Hg, pulse 130 beats per minute, and temperature is 39.5°C. He is noted to be confused and diaphoretic. He has muscle rigidity and a tremor in his hands. What is the most likely diagnosis? A. Malignant hyperthermia B. Neuroleptic malignant syndrome C. Serotonin syndrome D. Tyramine reaction Teaching Image Question 4 A 21-year-old woman presents with painful urination. She has no vaginal discharge and is not sexually active. Which of the following is most sensitive for a urinary tract infection on urine dipstick testing? A. Bacteria B. Blood C. Leukocyte esterase D. Nitrites Teaching Image Question 5 Which of the following findings would be consistent with a diagnosis of tetralogy of Fallot? A. Bounding pulses and a continuous machine-like murmur B. Decreased pulses in lower extremities C. Increased pulmonary vascular markings on chest radiography D. Loud, single second heart sound with a harsh systolic murmur <a href="https://www.
Oct 30, 2018
A hero is someone who has given his or her life to something bigger than oneself.–Joseph Campbell Welcome back to RoshCast for Episode 50! Wow!! We can’t believe we’re already at Episode 50. It’s been a real journey building this podcast from the original concept two years ago. And in the last year, we have seen some pretty big changes, including Megha joining the team. We are excited to see how RoshCast continues to evolve over the next fifty episodes and two years. None of this would be possible without you, our listeners. Your listenership and feedback is what drives us to keep delivering high-quality content! We value every moment you give your attention to us, and we try our best to design the episode to maximize your learning. We have a pretty involved process for choosing questions to present to you and for how we manipulate and deliver the content before we get it to your ears. With that, let’s kick off a great episode! Question 1 A 70-year-old woman with history of coronary artery disease, hypertension, and diabetes presents to the emergency department with chest pressure and shortness of breath. Her exam is notable for a new holosystolic murmur best heard over the midaxillary line as well as diffuse bilateral rales. Which of the following is most likely to be seen on this patient’s ECG? A. Biventricular tachycardia B. S1Q3T3 pattern C. ST-depressions in I, V6, and aVL without ST-elevations D. ST elevations in II, III, aVF Teaching Image Question 2 A 26-year-old woman with no medical history presents with bleeding gums after brushing her teeth for the last three days. Her complaint was preceded two weeks ago by a URI. Her examination is unremarkable except for oozing from the gums. Labs show a platelet count of 23,000. Which of the following is the most appropriate next step in management? A. IV immunoglobulin B. Platelet transfusion C. Steroids, IV immunoglobulin D. Steroids, IV immunoglobulin, and platelet transfusion Teaching Image Question 3 Which of the following is most suggestive of measles infection? A. A prodrome of fever, lymphadenopathy, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads to the trunk and limbs B. Diffuse maculopapular rash with white spots on the buccal mucosa C. High fever for three days followed by the appearance of a pink maculopapular rash after defervescence D. Presence of shallow ulcers on oral mucosa and vesicular lesions on the palms and soles Teaching Image Question 4 A 23-year-old man who has unprotected, receptive anal intercourse presents to the ED with two weeks of worsening rectal pain and dyschezia. On exam, he has numerous ulcers in the anorectal area and a crop of grouped vesicles containing clear fluid on an erythematous base. The surrounding skin shows no sign of cellulitis or abscess.
Oct 16, 2018
Life is like riding a bicycle. To keep your balance, you must keep moving.–Albert Einstein Welcome back to RoshCast for Episode 49! We have a lot of exciting material in this episode. Definitely don’t skip this one! For those taking the initial certification exam, it’s just around the corner. Go back and listen to old episodes and review. Question 1 A 14-year-old boy developed an itchy, painful, erythematous rash on his hands, forearms, and face about a day after hiking in nearby woods with some friends. Your exam shows linear erythematous papules over his forearms with similar swelling and erythema around his eyes (including eyelids), cheeks, and forehead. You suspect poison ivy that he reports he has had in the past. Which of the following is most likely to improve the course of his illness? A. Oral diphenhydramine every six hours B. Three-week prednisone taper C. Topical 1% hydrocortisone three times daily D. Topical calamine lotion twice daily Teaching Image Question 2 Which of the following patients will benefit most from receiving tissue plasminogen activator for acute pulmonary embolism detected in the emergency department? A. 55-year-old man with a history of hypertension with vital signs showing HR 100/min, BP 80/40 mm Hg, R 24/min, and oxygen saturation 92% B. 55-year-old man with a history of hypertension with vital signs showing HR 145 bpm, BP 136/86 mm Hg, R 24/min, and oxygen saturation 92% C. 55-year-old woman with a history of hypertension and systemic lupus erythematosus with vital signs showing HR 100 bpm, BP 116/86 mm Hg, R 24/min, and oxygen saturation 85% D. 55-year-old woman with a history of hypertension with vital signs showing HR 110 bpm, BP 122/80 mm Hg, R 24/min, and oxygen saturation 92% with evidence of right ventricular dysfunction on echocardiogram Teaching Image Question 3 A 55-year-old woman presents to the emergency department unresponsive. She and her friend had finished eating 60 minutes earlier when the patient collapsed to the floor while talking. Which of the following foods is most likely the cause? A. Apricot kernels B. Fava beans C. Peanuts D. Poppy seeds Teaching Image Question 4 Which of the following is due to the intense thermal radiation seen in lightning strikes? A. Cataract formation B. Hypertension and tachycardia C. Mydriasis D. Tympanic membrane rupture Teaching Image Question 5 A 32-year-old woman with no past medical history presents to the emergency department with a four-day history of bloody diarrhea and abdominal cramping. She states that her boyfriend is having similar symptoms but did not want to ...
Oct 2, 2018
Success is not final, failure is not fatal: it is the courage to continue that counts.–Winston Churchill Welcome back to RoshCast for Episode 48! We’re going to jump right into questions this week. Remember to send us feedback for any changes you would like to see at firstname.lastname@example.org. Question 1 An 8-year-old previously healthy boy presents with back pain and fever for 4 days. He complains of pain in the low back, which is increased with bending or twisting. The pain radiates down into his left leg. He denies trauma. Physical exam is remarkable only for tenderness to palpation over the lumbar spine. What management is indicated A. Ibuprofen and follow up with his pediatrician B. MRI of the lumbar spine C. Plain radiographs of the lumbar spine D. Urinalysis Teaching Image Question 2 A 40-year-old man is brought to the emergency department after being assaulted during a bar fight. He has proptosis of the right eye with a measured intraocular pressure of 50 mm Hg. A lateral canthotomy is started. Once the Kelly clamp is released from the lateral canthus, what is the appropriate next step? A. Clamp the medial canthus B. Cut the inferior crus of the lateral canthal tendon C. Cut the superior crus of the lateral canthal tendon D. Recheck intraocular pressure Teaching Image Question 3 A 25-year-old man presents to the emergency department after sustaining burns to the hands, legs, and chest after falling into a bonfire. On physical examination, there are partial-thickness burns on the upper half of the anterior torso along with the bilateral palms of the hands and bilateral anterior legs. He weighs 70 kg. You begin to initiate fluid resuscitation using the Parkland formula. How much fluid should this patient receive in the first eight hours? A. 10,640 mL B. 4,060 mL C. 5,320 mL D. 8,120 mL Teaching Image Question 4 A 64-year-old man presents to the emergency department with cough and shortness of breath that has progressively been worsening over the last several weeks. He has also been more fatigued and is unable to get around the house anymore. He denies fever and night sweats. He has a past medical history of hypertension and takes lisinopril daily. He is an immigrant from Argentina where he used to work as a miner. He denies tobacco use. What is the most likely diagnosis based on this chest radiograph? A. Histoplasmosis B. Miliary tuberculosis C. Pneumoconiosis D. Sarcoidosis Teaching Image Teaching Image
Sep 18, 2018
If you fell down yesterday, stand up today. –H. G. Wells Welcome back to RoshCast for Episode 47! Let’s kick off this episode with a review of Neisseria meningitides, an important topic for clinical practice and personal safety. * Neisseria meningitides is highly contagious and antibiotic prophylaxis is indicated for close contacts of an infected patient, including those in contact with secretions as well as members of the same household or daycare center.* Healthcare workers with close contact with the patient’s secretions should also receive prophylaxis.* There are three options for prophylaxis: * Rifampin is administered at a dose of 10 mg/kg with a max dose of 600 mg every 12 hours for 4 doses, and this is 100% effective as far as we know.* Ceftriaxone 250 mg IM can be given for 1 dose, which is 97–100% effective.* The least effective option is Ciprofloxacin 500 mg PO for 1 dose, and that’s 90–95% effective. * Even though rifampin is the most effective, be wary of its side effects, which include turning secretions like tears and urine orange. Contact lens wearers should be warned of permanent staining. Teaching Image Now onto this week’s podcast Question 1 A 33-year-old woman presents to the ED with agitation and severe respiratory distress. She has been taking a significant amount of “pain medication” for low back pain, according to her son. The patient is screaming about her “ears ringing.” Vital signs are BP 100/60 mm Hg, HR 140 beats per minute, RR 35 breaths per minute, and T 100.1°F. Which of the following complications is she at risk of developing? A. Hemodynamically significant lower gastrointestinal bleeding B. Increased intracranial pressure C. Noncardiogenic pulmonary edema D. Urinary retention requiring catheterization Teaching Image Question 2 Which of the following is associated with carbon monoxide poisoning? A. Bilateral basal ganglia hypodensities B. Elevated pH C. Low PO2 D. Odor of bitter almonds Teaching Image Question 3 A 62-year-old woman presents to the emergency department with dizziness. She describes the events as a spinning sensation that is worse with position changes. The dizziness is associated with hearing loss as well as tinnitus and vomiting. She notes it started three days ago and that she has had multiple episodes all lasting less than a day since that time. On physical examination, horizontal nystagmus is present as is decreased hearing on the left. The remainder of the ear and neurologic examination is within normal limits. A head CT and brain MRI are performed and are negative. Which of the following is the most likely diagnosis? A. Acoustic neuroma B. Labyrinthitis C. Meniere disease D. Vestibular neuritis Teaching Image <a href="https://www.
Sep 4, 2018
Only those who dare to fail greatly can ever achieve greatly.–Robert F. Kennedy Welcome back to RoshCast for Episode 46! Let’s kick off this episode with a rapid review of molluscum contagiosum. * Molloscum contagiosum is caused by poxvirus. It is seen in children, sexually active adults, and immunocompromised patients like those with HIV.* The rash presents as painless, pearly, umbilicate papules, and it is spread by direct skin-to-skin contact.* Children present with lesions on the face, trunk, and extremities, whereas sexually active adults can present with lesions in the genital regions, lower abdomen, and thighs. The rash tends to spare the palms and soles.* Most patient will not require therapy with spontaneous resolution occurring in months. Those with extensive lesions may benefit from cryotherapy.* HIV positive patients with a CD4 count less than 100 are at greater risk for developing molluscum contagiosum. Teaching Image Now onto this week’s podcast Question 1 Which of the following organisms is one of the most commonly implicated in the development of a lung abscess? A. Klebsiella pneumoniae B. Peptostreptococcus C. Staphylococcus aureus D. Streptococcus pneumoniae Teaching Image Question 2 A 26-year-old man presents to the ED after being hit in the head by a foul baseball. The patient was initially alert and talking to you. He is now becoming progressively more somnolent. Which of the following would you expect to see on a non-contrast computed tomography scan of the head? A. A collection of blood layering in the basilar cisterns B. A crescent-shaped frontal hematoma crossing suture lines C. A lenticular-shaped hematoma in the temporal region D. An intraparenchymal hemorrhage within the frontal lobe Teaching Image Question 3 A 55-year-old man who is taking several antihypertensive medications presents to the ED with nausea, vomiting, shortness of breath, and a rash after eating a home-cooked Thai meal at a friend’s house about one hour ago. The symptoms began within seconds of the first bite of his meal. Despite the patient being administered 2 doses of intramuscular epinephrine, diphenhydramine, dexamethasone, and crystalloid fluids, his blood pressure remains at 75/38 mm Hg. Which other medication should be considered in this patient? A. Cimetidine B. Glucagon C. Norepinephrine D. Octreotide Question 4 A 36-year-old man presents to the ED after having a seizure. He has a folder full of medical records dating back 15 years. Several of the records are from other cities and states. It is now 11:00 pm on a Friday night. His primary care physician, neurologist, and psychiatrist are “out of town,” and he believes that he needs to be admitted for the duration of the weekend. He has another episode in the ED and immediately following this he returns to his baseli...
Aug 21, 2018
There is only one corner of the universe you can be certain of improving, and that’s your own self.–Aldous Huxley Welcome back to RoshCast for Episode 45! Let’s start out with a review of rabies before getting to core content Q&A. * The most common wild reservoirs of rabies are raccoons, skunks, bats, foxes, and coyotes. Domestic animals like cats, dogs, and cattle can also get rabies. Rodents, reptiles, and birds on the other hand are not carriers and cannot transmit rabies.* One important factor in deciding if you get rabies postexposure prophylaxis is whether the animal can be found and held for observation.* The rabies postexposure prophylaxis has two parts: the immunoglobulin and the vaccine.* When giving rabies postexposure prophylaxis, inject the immunoglobulin into the wound and start the rabies vaccine series which the patient will receive on days 1, 3, 7, 14, and 28. Now onto this week’s podcast Question 1 Which of the following is true regarding acute respiratory distress syndrome? A. Define as PaO2:FiO2 > 300 B. Empiric corticosteroids should be given C. Positive end-expiratory pressure should be increased with increases in FiO2 D. Tidal volume should be started at 10 mL/kg in intubated patients Teaching Image Question 2 A 35-year-old man presents to the ED after being assaulted in a bar fight. He has signs of significant facial trauma. On physical exam, you note a tooth fracture through the enamel and dentin but does not involve the pulp. Which of the following is the most appropriate next step in management of his dental injury? A. Calcium hydroxide paste B. Extract the tooth C. Immediate dental consult D. Pencillin VK Teaching Image Question 3 A 62-year-old man presents with acute onset of chest pain with radiation to the shoulders and nausea while walking his dog. On examination, he is diaphoretic with heart rate 94 bpm, respiratory rate 20 bpm, blood pressure 92/59 mm Hg, and oxygen saturation 96% on room air. His ECG reveals 2 mm elevation in aVR. Occlusion of which coronary artery is most likely responsible for this patient’s presentation? A. Left anterior descending artery B. Left circumflex artery C. Left main coronary artery D. Right coronary artery Teaching Image Question 4 A 62-year-old man presents for evaluation of chest pain. Approximately three weeks ago the patient had a myocardial infarction with stent placement. Last evening he developed pleuritic chest pain and fever. He has no cough and does not feel short of breath. His ECG is shown above. Which of the following is the most likely diagnosis? A. Dressler syndrome B. Infarct pericarditis C. Left ventricular aneurysm D.
Aug 7, 2018
By failing to prepare, you are preparing to fail.–Benjamin Franklin Welcome back to RoshCast for Episode 44! We are back to an every other week schedule covering core content. Let’s start out with a rapid review of neonatal conjunctivitis. * The three dangerous causes of neonatal conjunctivitis that you need to consider in the ED are gonorrhea, chlamydia, and herpes.* Gonorrhea is the most aggressive bacteria associated with neonatal conjunctivitis. It presents in the first week of life with purulent drainage and ulcerations, and it can disseminate to cause gonococcal sepsis. Culture the drainage for confirmation, and treat the baby with cefotaxime.* Chlamydia neonatal conjunctivitis, which presents in the first month of life, can disseminate into the lungs. Treat with oral erythromycin.* The third and least dangerous cause of neonatal conjunctivitis is herpetic. In this case you may see vesicles in the eye. Treat this with IV acyclovir. Now onto this week’s podcast Question 1 A 21-year-old man presents after he was bitten by a spider. He has a picture of the spider on his phone (shown above). Which of the following is a potential complication of a bite by this spider? A. Abdominal rigidity B. Autonomic instability C. Coagulation abnormalities D. Pancreatitis Teaching Image Question 2 A 66-year-old man with hypertension and hyperlipidemia presents after an episode of severe chest pain while walking to work. He is currently asymptomatic. His vitals are T 36.27°C, HR 76/min, BP 143/85 mm Hg, RR 18/min, and oxygen saturation 99%. A 12-lead ECG is performed as seen above. Which of the following is the most appropriate next step in management? A. Give 325 mg of aspirin, and activate the cardiac catheterization lab B. Give 325 mg of aspirin, and admit for serial troponin testing and stress test C. Give 325 mg of aspirin, and discharge home with cardiology follow-up in 24–48 hours D. Send d-dimer, and consider CT pulmonary angiogram if elevated Teaching Image Question 3 A 17-year-old boy from New Jersey presents with a 3-day history of rash and a 1-day history of facial droop. He also complains of a headache. The images above represent the physical examination findings. In addition you note mild nuchal rigidity. A noncontrast head CT is performed and is normal. Which of the following is the next best step for this patient? A. Acyclovir and corticosteroids B. Lumbar puncture C. MRI brain D. Serologic testing for Lyme disease Teaching Image Question 4 A 52-year-old man presents with decreased sensation in the upper extremities and chronic neck pain. He states that the loss of sensation has been progressive for months. On physical examination,
Jul 24, 2018