EMERGENCY MEDICINE ROSH MOCK EXAM 2026 UPDATE |QUESTIONS AND
VERIFIED ANSWERS|FREQUENTLY MOST TESTED QUESTIONS| GET IT RIGHT!!
Question 1
A 32-year-old woman at 10 weeks gestation presents with persistent nausea and decreased food
intake for two weeks. She is able to tolerate small sips of water and denies abdominal pain. What
is the first-line medication for this patient?
A) Ondansetron
B) Metoclopramide
C) Pyridoxine
D) Prochlorperazine
E) Methylprednisolone
Correct Answer: C) Pyridoxine
Rationale: Pyridoxine (Vitamin B6) is the first-line recommended treatment for nausea in
pregnancy. It is a water-soluble B complex vitamin involved in the metabolism of lipids,
amino acids, and carbohydrates. While it is effective for nausea, it typically does not assist
with active vomiting. If nausea persists, an antihistamine or a 5-HT3 antagonist like
Ondansetron may be added as second-line therapy.
Question 2
What is the mechanism of action for Pyridoxine in the context of pregnancy-related nausea?
A) Dopamine D2 receptor antagonist
B) Serotonin 5-HT3 receptor antagonist
C) H1 receptor antagonist
D) Metabolism of lipids, amino acids, and carbohydrates
E) Prostaglandin synthesis inhibition
Correct Answer: D) Metabolism of lipids, amino acids, and carbohydrates
Rationale: Pyridoxine (Vitamin B6) serves as a coenzyme in various metabolic processes,
including the metabolism of amino acids and lipids. While the exact mechanism for its anti-
nausea effect in pregnancy isn't fully elucidated, its role in these metabolic pathways is its
primary biochemical function.
Question 3
A patient with Hyperemesis Gravidarum is found to have a significant electrolyte abnormality.
Which of the following is most characteristic of this condition?
A) Hyperkalemic metabolic acidosis
B) Hypokalemic, hypochloremic metabolic alkalosis
C) Hyponatremic metabolic acidosis
D) Hypercalcemic metabolic alkalosis
E) Hypomagnesemic respiratory acidosis
Correct Answer: B) Hypokalemic, hypochloremic metabolic alkalosis
Rationale: Significant vomiting leads to the loss of gastric hydrochloric acid (HCL) and
, 2
potassium. This results in a hypochloremic metabolic alkalosis. As the body attempts to
conserve sodium at the expense of potassium in the kidneys, hypokalemia develops.
Question 4
A 39-year-old man with diabetes presents with severe left hand pain. On exam, the distal pulp of
the index finger is tense, erythematous, and exquisitely tender. He denies trauma. What is the
most appropriate initial therapy?
A) Intravenous antibiotics only
B) Warm soaks and elevation
C) Incision and drainage
D) Tetanus toxoid and outpatient follow-up
E) Digital nerve block and observation
Correct Answer: C) I&D
Rationale: The patient has a felon, which is a pyogenic abscess of the digital subcutaneous
tissue and pulp. Because the pulp is divided into septa, the pressure can increase rapidly,
leading to ischemia or osteomyelitis. The definitive treatment for an abscess is incision and
drainage. Staph aureus is the most common pathogen.
Question 5
Which of the following is a potential complication of an untreated felon?
A) Flexor tenosynovitis
B) Osteomyelitis of the distal phalanx
C) Septic arthritis of the DIP joint
D) All of the above
E) None of the above
Correct Answer: D) All of the above
Rationale: Because of the anatomical proximity of the pulp to the bone and the flexor
tendon sheath, an untreated felon can spread proximally to cause flexor tenosynovitis, or
deep to cause osteomyelitis or septic arthritis.
Question 6
A nurse presents to the ED with painful vesicles on the tip of her finger. She mentions she was
recently treating a patient with an oral infection. What is the most important contraindication in
this patient’s management?
A) Topical acyclovir
B) Warm compresses
C) Incision and drainage
D) Splinting the finger
E) Oral valacyclovir
Correct Answer: C) Incision and drainage
Rationale: This patient has herpetic whitlow. Unlike a felon, which is bacterial, herpetic
, 3
whitlow is viral (HSV). Performing an I&D on herpetic whitlow is contraindicated as it
does not help resolve the infection and significantly increases the risk of a secondary
bacterial infection.
Question 7
An 18-year-old man is involved in a high-speed MVC. On exam, he has periorbital ecchymosis
with tarsal plate sparing. What does the "tarsal plate sparing" specifically suggest?
A) Orbital floor fracture
B) Globe rupture
C) Basilar skull fracture
D) Zygomatic arch fracture
E) Nasal bone fracture
Correct Answer: C) Basilar skull fracture
Rationale: Periorbital ecchymosis ("raccoon eyes") with tarsal plate sparing is a classic sign
of a basilar skull fracture. The sparing occurs because the ecchymosis is caused by blood
tracking from a distance (the skull base) rather than local trauma to the eyelid, which
would involve the tarsal plate.
Question 8
Which of the following findings is most commonly associated with a basilar skull fracture
involving the temporal bone?
A) Proptosis
B) Hemotympanum
C) Teardrop pupil
D) Positive Seidel test
E) Afferent pupillary defect
Correct Answer: B) Hemotympanum
Rationale: Hemotympanum (blood behind the tympanic membrane) is a common clinical
sign of a basilar skull fracture, particularly those involving the petrous portion of the
temporal bone. Other signs include Battle sign (mastoid ecchymosis) and CSF
otorrhea/rhinorrhea.
Question 9
What is the most appropriate initial imaging study for a patient with suspected raccoon eyes and
suspected intracranial injury?
A) Skull X-ray
B) MRI brain
C) Non-contrast Head CT
D) Facial X-rays
E) Ultrasound of the orbits
Correct Answer: C) Non-contrast Head CT
VERIFIED ANSWERS|FREQUENTLY MOST TESTED QUESTIONS| GET IT RIGHT!!
Question 1
A 32-year-old woman at 10 weeks gestation presents with persistent nausea and decreased food
intake for two weeks. She is able to tolerate small sips of water and denies abdominal pain. What
is the first-line medication for this patient?
A) Ondansetron
B) Metoclopramide
C) Pyridoxine
D) Prochlorperazine
E) Methylprednisolone
Correct Answer: C) Pyridoxine
Rationale: Pyridoxine (Vitamin B6) is the first-line recommended treatment for nausea in
pregnancy. It is a water-soluble B complex vitamin involved in the metabolism of lipids,
amino acids, and carbohydrates. While it is effective for nausea, it typically does not assist
with active vomiting. If nausea persists, an antihistamine or a 5-HT3 antagonist like
Ondansetron may be added as second-line therapy.
Question 2
What is the mechanism of action for Pyridoxine in the context of pregnancy-related nausea?
A) Dopamine D2 receptor antagonist
B) Serotonin 5-HT3 receptor antagonist
C) H1 receptor antagonist
D) Metabolism of lipids, amino acids, and carbohydrates
E) Prostaglandin synthesis inhibition
Correct Answer: D) Metabolism of lipids, amino acids, and carbohydrates
Rationale: Pyridoxine (Vitamin B6) serves as a coenzyme in various metabolic processes,
including the metabolism of amino acids and lipids. While the exact mechanism for its anti-
nausea effect in pregnancy isn't fully elucidated, its role in these metabolic pathways is its
primary biochemical function.
Question 3
A patient with Hyperemesis Gravidarum is found to have a significant electrolyte abnormality.
Which of the following is most characteristic of this condition?
A) Hyperkalemic metabolic acidosis
B) Hypokalemic, hypochloremic metabolic alkalosis
C) Hyponatremic metabolic acidosis
D) Hypercalcemic metabolic alkalosis
E) Hypomagnesemic respiratory acidosis
Correct Answer: B) Hypokalemic, hypochloremic metabolic alkalosis
Rationale: Significant vomiting leads to the loss of gastric hydrochloric acid (HCL) and
, 2
potassium. This results in a hypochloremic metabolic alkalosis. As the body attempts to
conserve sodium at the expense of potassium in the kidneys, hypokalemia develops.
Question 4
A 39-year-old man with diabetes presents with severe left hand pain. On exam, the distal pulp of
the index finger is tense, erythematous, and exquisitely tender. He denies trauma. What is the
most appropriate initial therapy?
A) Intravenous antibiotics only
B) Warm soaks and elevation
C) Incision and drainage
D) Tetanus toxoid and outpatient follow-up
E) Digital nerve block and observation
Correct Answer: C) I&D
Rationale: The patient has a felon, which is a pyogenic abscess of the digital subcutaneous
tissue and pulp. Because the pulp is divided into septa, the pressure can increase rapidly,
leading to ischemia or osteomyelitis. The definitive treatment for an abscess is incision and
drainage. Staph aureus is the most common pathogen.
Question 5
Which of the following is a potential complication of an untreated felon?
A) Flexor tenosynovitis
B) Osteomyelitis of the distal phalanx
C) Septic arthritis of the DIP joint
D) All of the above
E) None of the above
Correct Answer: D) All of the above
Rationale: Because of the anatomical proximity of the pulp to the bone and the flexor
tendon sheath, an untreated felon can spread proximally to cause flexor tenosynovitis, or
deep to cause osteomyelitis or septic arthritis.
Question 6
A nurse presents to the ED with painful vesicles on the tip of her finger. She mentions she was
recently treating a patient with an oral infection. What is the most important contraindication in
this patient’s management?
A) Topical acyclovir
B) Warm compresses
C) Incision and drainage
D) Splinting the finger
E) Oral valacyclovir
Correct Answer: C) Incision and drainage
Rationale: This patient has herpetic whitlow. Unlike a felon, which is bacterial, herpetic
, 3
whitlow is viral (HSV). Performing an I&D on herpetic whitlow is contraindicated as it
does not help resolve the infection and significantly increases the risk of a secondary
bacterial infection.
Question 7
An 18-year-old man is involved in a high-speed MVC. On exam, he has periorbital ecchymosis
with tarsal plate sparing. What does the "tarsal plate sparing" specifically suggest?
A) Orbital floor fracture
B) Globe rupture
C) Basilar skull fracture
D) Zygomatic arch fracture
E) Nasal bone fracture
Correct Answer: C) Basilar skull fracture
Rationale: Periorbital ecchymosis ("raccoon eyes") with tarsal plate sparing is a classic sign
of a basilar skull fracture. The sparing occurs because the ecchymosis is caused by blood
tracking from a distance (the skull base) rather than local trauma to the eyelid, which
would involve the tarsal plate.
Question 8
Which of the following findings is most commonly associated with a basilar skull fracture
involving the temporal bone?
A) Proptosis
B) Hemotympanum
C) Teardrop pupil
D) Positive Seidel test
E) Afferent pupillary defect
Correct Answer: B) Hemotympanum
Rationale: Hemotympanum (blood behind the tympanic membrane) is a common clinical
sign of a basilar skull fracture, particularly those involving the petrous portion of the
temporal bone. Other signs include Battle sign (mastoid ecchymosis) and CSF
otorrhea/rhinorrhea.
Question 9
What is the most appropriate initial imaging study for a patient with suspected raccoon eyes and
suspected intracranial injury?
A) Skull X-ray
B) MRI brain
C) Non-contrast Head CT
D) Facial X-rays
E) Ultrasound of the orbits
Correct Answer: C) Non-contrast Head CT
