Questions

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Aligned with the NCCPA format and updated blueprint. Authored & peer-reviewed by PA-Cs.

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 55-year-old man with a medical history of hypertension presents to the emergency department with 2 days of left lower quadrant pain and a fever of 38.2°C at home. He has not had nausea or vomiting and has been able to tolerate oral intake. He reports some intermittent painless hematochezia over the last year but states he has never had a colonoscopy. His vitals are HR 89 bpm, RR 16/min, and BP 142/90 mm Hg. His abdominal exam is significant for moderate tenderness to palpation of the left lower quadrant without rebound or rigidity. His CBC shows a white blood cell count of 12,000/µL. A CT scan confirms diverticulitis without perforation or abscess formation. Which of the following is the most appropriate next step in the management of this patient’s diverticulitis?

A Admit for inpatient intravenous antibiotics
B Discharge home with oral antibiotics
C Surgery consult for colon resection
D Urgent colonoscopy to rule out colon cancer

Diverticulosis is one of the most common causes of painless hematochezia in older adults. Approximately 4% of individuals with diverticulosis will go on to develop diverticulitis, an inflammation of the colonic wall that classically presents with left lower quadrant abdominal pain. The majority of diverticulitis involves the sigmoid colon, mimicking the symptoms of appendicitis but on the left side of the abdomen. Diverticulitis is diagnosed by CT scan, preferably with oral and IV contrast, which will show bowel wall thickening. Importantly, colon cancer may have similar findings on CT scan, making diverticulitis difficult to distinguish from colon cancer. CT scan will also reveal the presence of complications such as abscess formation, fistulization, or perforation. Patients with uncomplicated acute diverticulitis may be discharged home on oral antibiotics with coverage for gastrointestinal gram-negative rods and anaerobes. Ciprofloxacin and metronidazole or trimethoprim-sulfamethoxazole and metronidazole are two commonly used regimens. These patients should be given clear return precautions for worsening fever or abdominal pain, as this could indicate treatment failure or the development of complications.

Complicated diverticulitis is indicated by the presence of abscess formation, obstruction, fistulization or perforation. All complicated diverticulitis should be admitted for inpatient intravenous antibiotic treatment (A) and possible surgical intervention. Uncomplicated diverticulitis with the presence of high fever, significant leukocytosis, severe abdominal pain, or inability to tolerate oral intake should also prompt inpatient treatment. Elective colon resection (C) is an option for patients with recurrent diverticulitis or those with high risk of complications from recurrent diverticulitis, such as those with a complicated first episode or with immunosuppression. However, this patient does not have an indication for elective colon resection. Colonoscopy (D) to assess the extent of diverticular disease and exclude colon cancer is indicated in all patients with diverticulitis who have not had a colonoscopy in the last year. This should occur after complete resolution of the diverticulitis. Colonoscopy is not indicated in acute diverticulitis, and colonoscopy before resolution of the diverticulitis increases the risk of bowel perforation and serious complications.


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.

Acute Diverticulitis

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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

Q: What is the most appropriate management of a peridiverticular abscess?

REVEAL ANSWER

A: Percutaneous drainage.

Diverticulitis

  • Patient will be complaining of abdominal pain that is localized to the left lower quadrant, fever, nausea, vomiting, and a change in bowel habits
  • PE will show localized guarding, rigidity, and rebound tenderness
  • Diagnosis is made by CT scan
  • Treatment is ABX

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
Rosh Review was an amazing resource to prepare for the PANRE while I worked a full-time clinical job. The content is high-yield and so easy to access. There's nothing else like it out there.

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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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