ROSH REVIEW EMERGENCY
MEDICINE QUESTIONS AND
CORRECT DETAILED ANSWERS
GRADED A+
A 14-year-old boy presents complaining of intense pruritus in his groin,
axillae, and between his fingers after returning home from summer camp
1 week ago. He reports several other campers had similar symptoms. On
exam, you note excoriations in the inguinal region and axillae
surrounding scattered, erythematous papules. Which of the following is
the most appropriate treatment?
Ketoconazole
Lindane
Permethrin
Prednisone - ANSWER- Correct Answer ( C )
Explanation:
This patient has scabies; a pruritic dermatitis caused by cutaneous
infection with the mite Sarcoptes scabei, var hominis. Scabies is
spread by skin-to-skin contact and should be considered in patients
with generalized pruritus, especially when exposure to others with
similar symptoms is reported. The rash of scabies involves papules,
which are often excoriated. Burrows are pathognomonic but not
uniformly present. Unless previously infected, pruritus generally
,takes 3-6 weeks to develop because symptoms are due to delayed
(Type IV) sensitivity reaction. The pruritus is classically worse at
night and affects the web spaces of the fingers, flexor aspect of the
wrists, axillae, groin, nipples, and the periumbilical region. Except
in cases involving an immunocompromised host, the scalp and face
are generally spared. Diagnosis is clinical but can be confirmed by
placing scrapings collected with a #15 blade scalpel in mineral oil for
microscopic examination. The treatment of choice for primary
scabies infection is the application of topical scabicidal agents, with
repeat application in 7 days. The treatment of choice is permethrin
5% lotion. Individuals affected by scabies should avoid skin-to-skin
contact with others. Patients with typical scabies may return to
school or work 24 hours after the first treatment.
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
MEDICINE QUESTIONS AND
CORRECT DETAILED ANSWERS
GRADED A+
A 14-year-old boy presents complaining of intense pruritus in his groin,
axillae, and between his fingers after returning home from summer camp
1 week ago. He reports several other campers had similar symptoms. On
exam, you note excoriations in the inguinal region and axillae
surrounding scattered, erythematous papules. Which of the following is
the most appropriate treatment?
Ketoconazole
Lindane
Permethrin
Prednisone - ANSWER- Correct Answer ( C )
Explanation:
This patient has scabies; a pruritic dermatitis caused by cutaneous
infection with the mite Sarcoptes scabei, var hominis. Scabies is
spread by skin-to-skin contact and should be considered in patients
with generalized pruritus, especially when exposure to others with
similar symptoms is reported. The rash of scabies involves papules,
which are often excoriated. Burrows are pathognomonic but not
uniformly present. Unless previously infected, pruritus generally
,takes 3-6 weeks to develop because symptoms are due to delayed
(Type IV) sensitivity reaction. The pruritus is classically worse at
night and affects the web spaces of the fingers, flexor aspect of the
wrists, axillae, groin, nipples, and the periumbilical region. Except
in cases involving an immunocompromised host, the scalp and face
are generally spared. Diagnosis is clinical but can be confirmed by
placing scrapings collected with a #15 blade scalpel in mineral oil for
microscopic examination. The treatment of choice for primary
scabies infection is the application of topical scabicidal agents, with
repeat application in 7 days. The treatment of choice is permethrin
5% lotion. Individuals affected by scabies should avoid skin-to-skin
contact with others. Patients with typical scabies may return to
school or work 24 hours after the first treatment.
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
