50 episodes

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.

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    • Medicine

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.

    Ep 52 Roshcast Emergency Board Review

    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







    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







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    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







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    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







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    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







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    • 14 min
    Ep 51 Roshcast Emergency Board Review

    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!















    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







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    • 13 min
    Ep 50 Roshcast Emergency Board Review

    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!















    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 a**l 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.

    • 17 min
    Ep 49 Roshcast Emergency Board Review

    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.















    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 come ...

    • 15 min
    Ep 48 Roshcast Emergency Board Review

    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 roshcast@roshreview.com.















    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







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    • 15 min
    Ep 47 Roshcast Emergency Board Review

    Ep 47 Roshcast Emergency Board Review

    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







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    • 14 min

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