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CME for EM

Emergency Medicine Board Review Questions

Questions

Just like the actual exam

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

Question

A 15-month-old girl is brought to the emergency department by her parents with intermittent inconsolability. She has no known medical problems. Her mother states the patient was well and, about 3 hours prior to arrival, suddenly started crying and curled up on the living room floor. The mother reports this lasted for several minutes, after which the patient returned to baseline. She had two additional episodes prior to arrival, with both resolving spontaneously. Vital signs are all unremarkable. Physical examination reveals a well-appearing toddler with a soft, nontender abdomen. Prior to you leaving the room, the patient starts crying inconsolably. You notice she brings her knees to her chest. This lasts for a minute, and the patient subsequently stops crying and returns to baseline. Which of the following is the best next diagnostic test to make the diagnosis?
A CT of the abdomen and pelvis
B Ultrasound of the abdomen
C Upper GI series
D X-ray of the abdomen
Correct Answer Distractors
Intussusception occurs when one segment of the intestine telescopes into another, usually the ileum into the colon. Constriction of the mesentery results in engorgement of the intussusceptum and bowel ischemia, causing the presenting symptoms. Intussusception occurs most commonly before the age of 2 years and is rare before 2 months. It often develops due to a lead point, which drags one portion of the bowel into another. In infants, it typically occurs due to lymphoid hyperplasia from a viral illness and in older children due to Meckel diverticulum, intestinal polyps, lymphoma, and immunoglobulin A vasculitis (formerly Henoch-Schӧnlein purpura). Intussusception is difficult to diagnose due to the variation in the common presentations of intermittent pain and lethargy. Classically, patients will present with a sudden onset of severe abdominal pain with the legs drawn to the chest and then will appear well until the next episode of pain. Another common presentation is an infant with unexplained lethargy. Although the classic teaching is to look for currant jelly stools, these are rarely present, with occult bleeding occurring in the majority of cases and gross bleeding present in half of the cases. Ultrasound is the initial image modality of choice. When there is a high suspicion of intussusception, patients should undergo an immediate air-contrast enema, which is both diagnostic and therapeutic.

Explanations

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

Illustrations

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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.

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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

Question

What is the most common cause of intestinal obstruction in children under 2 years of age?

Reveal Answer

Intussusception (Telescoping Bowel)

  • Patient will be a child 6 months to 3 years
  • Complaining of colicky abdominal pain, vomiting, and bloody stools (currant jelly)
  • Diagnosis is made by ultrasound (target sign)
  • Most common cause is idiopathic
  • Although less common, it is important to be vigilant for pathologic lead points in children of any age
  • Treatment is air or hydrostatic (contrast or saline) enema

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

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