Questions
Just like the actual exam
Aligned with the National Board of Medical Examiners format. Authored & peer-reviewed by faculty, clinicians, and clerkship 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 58-year-old man presents to the clinic with bilateral hand and wrist pain that has been progressively worsening for 6 months. He says the pain is accompanied by morning stiffness that now lasts up to 45 minutes, which slows him down when getting up for work. On physical exam, you note the proximal joints of both hands are swollen and tender. Which of the following is the most likely diagnosis?
A Fibromyalgia
B Osteoarthritis
C Reactive arthritis
D Rheumatoid arthritis
Rheumatoid arthritis is considered an autoimmune disease that presents with symmetrical, inflammatory polyarthritis, often associated with morning stiffness lasting over 30 minutes. Rheumatoid arthritis commonly affects the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. The joints are described as swollen and boggy, secondary to synovial hypertrophy or effusion. X-rays consistent with rheumatoid arthritis show bony erosions or subchondral cysts or both. The diagnosis can be confirmed with anti-cyclic citrullinated protein antibodies, with or without a positive rheumatoid factor. ESR and CRP are both nonspecific to rheumatoid arthritis but are likely to be elevated secondary to inflammation. Arthritis presenting for less than a few weeks should prompt further workup for alternate causes, as rheumatoid arthritis is a chronic condition and considered appropriate when symptoms have been present for 6 weeks or more.
Fibromyalgia (A) is a diagnosis of exclusion in a patient who presents with widespread pain as well as somatic or psychiatric symptoms. Although tenderness on exam is common in fibromyalgia, the presence of swelling, warmth, and decreased joint range of motion points more toward rheumatoid arthritis as the likely diagnosis. It is possible for fibromyalgia to develop concurrently with other conditions such as arthritis. Osteoarthritis (B) in the hands usually affects the distal interphalangeal (DIP) joints and reveals narrowed joint spacing on imaging. It may present with morning pain or stiffness, but it is transient, not lasting more than 30 minutes. Osteoarthritis is also classically associated with Heberden and Bouchard nodes, which are hard, bony swellings on the DIP and PIP joints, respectively, unlike the soft, boggy, swelling seen in the joints of rheumatoid arthritis. Reactive arthritis (C) is an inflammatory and asymmetric arthritis associated with infections. It affects the larger joints, as opposed to the smaller peripheral joints. The classic triad of reactive arthritis includes joint pain, conjunctivitis or uveitis, and urethritis or cervicitis. A patient who presents with recent urethritis or enteric infection along with monoarticular joint pain should lead to concern for reactive arthritis.
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.
Powerful Analytics
Track progress, performance, & predictions
Your personal analytics allow you to see your progress at all times, so you can create an efficient and effective learning strategy and stay on pace with your plan.
Focus your learning
Deep insights to determine your strengths and weaknesses so you can spend your time on the subjects that matter.
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 first line in the treatment of early-onset rheumatoid arthritis?
Reveal AnswerA: Methotrexate.
Rheumatoid Arthritis
- More common in women and those aged 40–50 years
- Morning stiffness lasting > 30 minutes
- PE will show symmetrical soft, red, tender swelling in joints (MCP, PIP)
- Bilateral ulnar deviation at MCP, boutonnière deformity, and swan-neck deformity
- Labs will show positive RF, anti-cyclic citrullinated peptide antibodies
- Most commonly caused by autoimmune destruction of synovial joints
- Treatment is DMARDs
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 needed to score well on my shelf exam, so I looked for a resource with high-yield content. Rosh Review was it. I ended up scoring the highest shelf score for the rotation.
Monique Smith
Medical Student
FAQs
Get a little more clarification
Where can I find free shelf exam practice questions?
You can access free practice questions with a free trial for a Shelf Exam Qbank—no billing information required. The free trial includes practice questions that align with topics found on the shelf exam and include comprehensive answer explanations and beautiful teaching images.
After practicing with these questions, if you decide you're ready for hundreds of additional questions to help you confidently prep for the shelf exam, you can easily upgrade to a full Qbank subscription.
After practicing with these questions, if you decide you're ready for hundreds of additional questions to help you confidently prep for the shelf exam, you can easily upgrade to a full Qbank subscription.
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Whether you have a trial account or you purchased a subscription, access Rosh Review by logging in at app.roshreview.com.
To access the Qbank, go to the Create Exam tab to begin making and taking exams made up of questions from the Qbank.
You can find any boost exams under the My Exams → Boost Exam tab.
Once you've completed and submitted a few exams, you can see your statistics under the Performance Analysis tab.
To access the Qbank, go to the Create Exam tab to begin making and taking exams made up of questions from the Qbank.
You can find any boost exams under the My Exams → Boost Exam tab.
Once you've completed and submitted a few exams, you can see your statistics under the Performance Analysis tab. Who writes the questions and explanations for the medical student Qbanks?
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.
Do you offer a free trial?
Absolutely! You can try out a number of sample questions in the actual app by creating a free account (no billing information required—we promise).
You will get a fully functional account, forever, with a limited number of questions. If you love it, you can easily purchase a full content subscription. You won't be charged at any point during your trial until you make a purchase.