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Rosh Boost: Emergency Medicine 2025 Practice
Rosh Boost: Emergency Medicine
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Rosh Boost: Emergency MedicineStudy online at https://quizlet.com/_ej14gv
1. Inability to ex- A 59-year-old woman with a history of hyperlipidemia
tend the wrist presents to the emergency department via EMS for eval-
uation of right arm pain. She was walking her dog when
the dog pulled on the leash quickly, causing the patient
to fall on an outstretched arm. She states she felt her
arm "snap." She reports some tingling on her dorsal palm,
located near her thumb. She has no shoulder, elbow, or
wrist pain. On physical examination, she is cradling her
right arm. There is a mild deformity noted in her upper arm
and associated moderate swelling. Vital signs are heart
rate of 96 bpm, blood pressure of 142/86 mm Hg, respi-
ratory rate of 16/min, and oxygen saturation of 99% on
room air. Radiographs are shown above. Which physical
exam finding should make you suspicious for the most
likely associated nerve injury?
AInability to abduct fingers
BInability to extend the wrist
CInability to flex the wrist
DInability to make an OK sign
2. Short-acting A 64-year-old man presents to the emergency depart-
beta-agonist and ment with reports of worsening productive cough for the
supplemental past 3 days. He states he has had a persistent wet cough
oxygen to SpO2 on a regular basis for the last 2 years, but it has been
88-92% aggravated over the last few days. He also notes an
increase in sputum production. He reports no alleviating
or aggravating factors. His medical history is significant
for hypertension controlled with metoprolol. He has a 20
pack-year history of smoking. Vital signs include an HR
of 89 bpm, BP of 130/82 mm Hg, RR of 24/min, SpO2 of
87% on room air, and T of 98.6°F. On physical examina-
, Rosh Boost: Emergency Medicine
Study online at https://quizlet.com/_ej14gv
tion, rhonchi and prolonged expiration are noted. What is
the initial management for this patient's current condition?
AAdministration of ceftriaxone and azithromycin
BEndotracheal intubation
CIV methylprednisolone
DShort-acting beta-agonist and supplemental oxygen to
SpO2 88-92%
3. Neomycin-polymyx-
A 35-year-old woman presents to the emergency de-
in partment reporting right ear pain, yellow discharge, and
B-hydrocorti- difficulty hearing out of the right ear for the last 5 days.
sone otic drops She reports no cold symptoms such as cough, fever, or
sore throat. She believes the pain began about a day after
she used a cotton swab to clean her right ear. The pain
is a 7/10 intensity. She is currently taking ibuprofen 400
mg as needed for the pain, which helps, but the pain
comes back once the medication wears off. Vital signs
include HR of 80 bpm, BP of 120/80 mm Hg, T of 99.2°F,
RR of 16/min, BMI of 22.0 kg/m2, and SpO2 of 99% on
room air. Her physical exam reveals tenderness over the
right tragus and auricle when moved. The right inner ear
canal appears edematous and erythematous. The right
tympanic membrane is intact without erythema and is
mobile upon insufflation. The left ear exam is normal.
Which medication should be administered to the patient?
AAcetic acid-hydrocortisone otic drops
BAmoxicillin-clavulanate oral
CCiprofloxacin intravenous
DNeomycin-polymyxin B-hydrocortisone otic drops
4. Multifocal atrial A 74-year-old man presents to the clinic with a cough,
tachycardia shortness of breath, and a low-grade fever for the past 3
days. The patient reports no chest pain or leg swelling. He
has a medical history of chronic obstructive pulmonary
disease for which he takes albuterol and glycopyrrolate.
Vital signs include an HR of 132 bpm, BP of 135/80 mm
Hg, RR of 22/min, oxygen saturation of 93% on room air,
, Rosh Boost: Emergency Medicine
Study online at https://quizlet.com/_ej14gv
and T of 100.1°F. Physical examination reveals bilateral
expiratory wheezing and no pretibial edema or erythema.
The patient has no rales on auscultation. The patient's
electrocardiogram is shown above. What rhythm is seen
on the above electrocardiogram?
AAtrial fibrillation
BMultifocal atrial tachycardia
CSinus tachycardia with premature ventricular beats
DWandering atrial pacemaker
5. Adenosine 6 mg A 45-year-old woman presents to the emergency depart-
IV ment with reports of sudden-onset racing heart, light-
headedness, and fatigue. The symptoms began sponta-
neously while she was sitting at her desk at work and have
continued intermittently for the past 45 minutes. She has
had two similar episodes in the past month that lasted
only a few minutes each. Her medical history is significant
for GERD and generalized anxiety disorder. On exam, she
is mildly anxious and short of breath. Her blood pressure
is 124/80 mm Hg, heart rate is 150 beats/minute, respira-
tory rate is 22 breaths/minute, oxygen saturation is 96%,
and temperature is 98.0°F. An ECG is shown above. The
patient was instructed on how to perform the Valsalva ma-
neuver and made three attempts without any change in
her heart rate. The emergency department clinician also
attempted initiating a gag with mild improvement in the
patient's heart rate, but after approximately 60 seconds,
her heart rate accelerated to 170 beats per minute. Which
of the following is the most appropriate treatment for this
patient?
AAdenosine 6 mg IV
BAmiodarone 150 mg IV
CMetoprolol 5 mg IV
DSynchronized cardioversion
, Rosh Boost: Emergency Medicine
Study online at https://quizlet.com/_ej14gv
6. Neuroimaging A 46-year-old man with a medical history of hypertension
with MRI and hyperlipidemia presents to the emergency depart-
ment for evaluation of back and left leg pain, tingling in
his left foot, and an episode of urinary incontinence. He
states the symptoms were noticeable when he woke up
this morning but have gotten progressively worse over
the course of the day, and he is unable to walk. He has
tried taking ibuprofen and acetaminophen without relief.
He reports no injury or trauma but notes he cleaned out
his garage all day yesterday. He reports no history of
back issues or surgical history. He takes lisinopril and
atorvastatin as prescribed and does not use tobacco,
daily alcohol, or other substances. Vital signs are a tem-
perature of 99.0°F, heart rate of 96 bpm, blood pressure
of 144/88 mm Hg, respiratory rate of 18 breaths/min,
and oxygen saturation of 98% on room air. On physical
examination, the patient is unable to point his toes down-
ward. He has 2/5 strength of his extensor hallucis longus
and anterior tibialis muscles. No other muscle strength
deficits are noted in his left leg, right leg, or bilateral upper
extremities. He has an absent Achilles reflex and intact
patellar reflex on the left side. Decreased rectal tone is
noted on digital rectal examination, and the patient has
decreased sensation to light touch in the perineum and
perianal regions. Bladder scan demonstrates < 100 cc of
urine in the bladder. What is the most appropriate next
step for the management of this condition?
ACatheterization of the bladder
BEpidural steroid injection
CNeuroimaging with MRI
DNSAIDs and mobilization
7. Colorectal can- A 38-year-old woman presents to the emergency de-
cer screening partment with "aching" left lower quadrant pain, nausea,
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