Launched in 2016, Roshcast Emergency Medicine Board Review is the first question and answer style emergency medicine podcast. Utilizing the time tested questions of Rosh Review, Nachi Gupta, MD and Jeff Nusbaum, MD, both Emergency Physicians in New York City, review core emergency medicine concepts to improve listeners’ performance on the boards and in the wards. Going through questions from the question bank, one by one, they dissect not only the question, but also each of the other answer choices, taking advantage of all possible learning opportunities in addition to reviewing key test-taking strategies. At the beginning of each episode, they open with a rapid review of material covered in previous episodes or on the Rosh Review blog. Then, at the end of the episode, they close out with another rapid review of topics covered during the episode. Spaced repetition at its finest. This podcast is ideal for the emergency physician, physician assistant, nurse practitioner, EMT, and medical student who works in the Emergency Department or has an interest in emergency medicine. Give it a listen….you won’t be disappointed.
What Is the First-Line Treatment for This Patient’s Eye Pain?
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
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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
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Ep 52 Roshcast Emergency Board Review
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
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
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?
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
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
Ep 51 Roshcast Emergency Board Review
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!
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
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
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
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?
C. Leukocyte esterase
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
Ep 50 Roshcast Emergency Board Review
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!
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
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
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
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.
Ep 49 Roshcast Emergency Board Review
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.
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
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
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
D. Poppy seeds
Which of the following is due to the intense thermal radiation seen in lightning strikes?
A. Cataract formation
B. Hypertension and tachycardia
D. Tympanic membrane rupture
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 ...
Ep 48 Roshcast Emergency Board Review
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 email@example.com.
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
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
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
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?
B. Miliary tuberculosis