Just like the actual exam

Aligned with the Board of Certification for Emergency Nursing format. Authored & peer-reviewed by Certified Emergency Nurses.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
  • Must be well structured


A 42-year-old man presents with low back pain. Which of the following history or exam findings should raise concern for a serious cause of his pain?

A Pain that is exacerbated by twisting
B Pain that is worse after a long workday
C Paraspinal tenderness on exam
D Postvoid residual > 200 mL

Red flags of back pain should immediately alert the emergency team to a serious cause of a patient’s back pain. Back pain that is unremitting, associated with fevers or chills, in an immunocompromised patient (such as a patient with HIV or diabetes), or associated with an elevation in inflammatory markers (such as an elevated ESR or CRP) all raise concern for infection such as an epidural abscess, vertebral osteomyelitis, or discitis. Concerning findings for back pain that may require a surgical intervention such as cauda equina syndrome include midline back pain (suggesting a fracture), lower extremity weakness or paresthesias, loss of rectal tone, and urinary or fecal retention or incontinence. An elevated postvoid residual volume (with 200 mL as a common cutoff) is highly concerning for cauda equina syndrome and, in the appropriate clinical setting, warrants an MRI and spine surgery consultation.

Pain that is exacerbated by twisting (A), pain that is worse after a long workday (B), and paraspinal tenderness on exam (C), in addition to pain worse with stretching, are all suggestive of a muscle strain, which requires only analgesia, hot or cold packs, and recommendation to engage in activity as tolerated and outpatient physical therapy.


Written with a purpose

Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

  • Created for optimal learning and recall
  • Help reinforce your knowledge
  • Focus on the essential information


Created to enhance learning

Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.

red flags of back pain

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Discover how your answer choices align with those selected by learners across the country.

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Using data generated by previous users, your Qbank gives a prediction of how likely you are to pass your exam.

One Step Further

Taking your learning to the next level

After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Q: What is the most appropriate diagnostic test for supporting a diagnosis of infectious back pain (epidural abscess, vertebral osteomyelitis, or discitis)?


A: An MRI of the spine.

Back Pain

  • Night pain, weight loss: malignancy
  • Back pain + fever + neurological deficits: epidural abscess
  • Acute bony tenderness: fracture
  • Young, morning stiffness: seronegative spondyloarthropathy
  • Urinary retention: cauda equina syndrome
  • Pain with extension, relief with flexion: spinal stenosis
  • Image if red flags present

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information
I love Rosh Review! I learn from every question!


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How do you decide which topics to cover?
Every question in your Qbank is based on topics found in the most recent version of your specialty’s practice model. As you review each question, the category that correlates with the material being tested will appear on the screen. If it’s not in the model, it won’t be on the exam.

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