Questions

Just like the actual exam

Aligned with the American Board of Emergency Medicine format. Authored & peer-reviewed by faculty, clinicians, and program directors.

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

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.

CT of the abdomen and pelvis (A) is an imaging modality that can be helpful in diagnosing intussusception, but it is rarely needed and typically would not be the first diagnostic test in the evaluation. Upper GI series (C) can be helpful in diagnosing volvulus in infants and newborns. Midgut volvulus presents in infants with bilious vomiting and abdominal distension. An X-ray of the abdomen (D) is generally nondiagnostic for intussusception. In severe cases, when bowel perforation complicates intussusception, it may identify abdominal free air.


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

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.

intussusception

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Compare with your peers (chart)

Compare with your peers

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

Find out your probability of passing

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 common cause of intestinal obstruction in children under 2 years of age?

REVEAL ANSWER

A: Intussusception.

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
As a practicing physician and mom, I had very little time to prepare for my ConCert exam. Rosh Review allowed me to study whenever I could find a free moment, and I easily passed the exam.

FAQs

Get a little more clarification

How many questions are on the ABEM ConCert exam?
It has 190 multiple-choice questions, which you have 4.75 hours to complete. The exam is online and open book, so you can take it at home.
How do I earn CME with Rosh Review?
If you sign up for an account that is linked to CME, here’s what you need to do:
  • Complete either all the questions or 1,000 questions in your Qbank (depending on your package)
Once that’s complete, here’s how to claim and download your certificate:
  • Go to the Account Settings tab (only on desktop/laptop)
  • Select Claim next to the subscription package name (see an example)
  • Complete the survey
  • Download your certificate
You’ll earn up to 100 AMA PRA Cat 1 CME credits.
How do I get started?
Whether you have a trial account or you purchased a subscription, access Rosh Review by logging in at app.roshreview.com.



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Who writes the questions and explanations?
The finest people around! Question writers are board-certified clinicians who have all performed well on their certification exams. Answer explanations are derived from the specialty’s authoritative resources with some personal input to simplify the material and synthesize it for greatest comprehension and recall.

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