Special Purpose Exam (SPEX)

SPEX Exam Prep Questions

Pricing

Aligned with the National Board of Medical Examiners 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
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Question

An 18-year-old woman presents to the clinic complaining of a dry cough lasting for 2 weeks. She is afebrile and reports no shortness of breath. The patient, who does not have a remarkable past medical history, is diagnosed with acute bronchitis. Which of the following is the best therapy?

A Azithromycin

B Codeine

C Dextromethorphan with guaifenesin

D Salbutamol

Correct Answer Distractors

Acute bronchitis is a clinical diagnosis and is described as an acute cough, with or without sputum production, due to inflammation of the trachea and large airways of the lungs, without evidence of a lower respiratory infection or a chronic lung disease. The cough associated with acute bronchitis usually lasts for 2–3 weeks. Although fever can occur during the first few days of symptoms, the presence of prolonged fever or a temperature above 100.0°F is not typical and raises the possibility of pneumonia or influenza. The presence of sputum, even if purulent, does not correlate with bacterial infection and is insufficient to warrant antimicrobial treatment. Acute bronchitis is most commonly caused by a virus, such as rhinovirus, enterovirus, or respiratory syncytial virus. Symptomatic treatment and supportive care are recommended, such as by the use of dextromethorphan, guaifenesin, or honey. Dextromethorphan is a nonopioid antitussive shown to be effective at decreasing cough symptoms, and guaifenesin is an expectorant with some benefit in decreasing cough frequency and intensity. The combination of dextromethorphan with guaifenesin is beneficial for the management of acute bronchitis.

Antibiotics such as azithromycin (A) are not recommended in most patients with acute bronchitis. Antibiotics are still commonly prescribed, even though up to 90% of acute bronchitis cases are due to a virus. Antibiotics are only indicated if the patient is suspected of having pertussis (which may be treated with a macrolide) or another contagious illness or if the patient is at increased risk of complications. Codeine (B) is an opioid antitussive given to reduce the cough reflex. However, the American College of Chest Physicians does not recommend the use of codeine in the treatment of upper respiratory infections. Beta-2 agonists such as salbutamol (D) are not recommended for the routine treatment of acute bronchitis due to lack of benefit unless wheezing or airway obstruction is present or there is any underlying lung disease.

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.

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Focus on the essential information

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

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Stands alone from the main explanation so you’re not rereading content

Q: Which illness is chest X-ray imaging primarily used to rule out in a patient with symptoms of acute bronchitis?

Reveal Answer

A: Pneumonia.

Acute Bronchitis

Patient will be complaining of a productive cough for > 5 days
Most commonly caused by viruses
Treatment is symptomatic management
Most common cause of minor hemoptysis
Routine ABX therapy not indicated

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

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Special Purpose Exam (SPEX)

SPEX Exam Prep Questions

Questions

Just like the actual exam

Question

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Compare with your peers

Find out your probability of passing

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Neil Wilson, MD

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