A champion is defined not by their wins but by how they can recover when they fall. -Serena Williams Welcome back to RoshCast for Episode 51! For those of you taking the initial certification exam, you’re at the home stretch. Remember to listen to this episode and old episodes as you get closer to the end for more review. Good luck from us at the RoshCast team! We have a great episode for you to get you prepped in your final studies! Question 1 A 46-year-old man presents with a progressive dull headache over the past 3 weeks. It is worse in the morning and with bending over or coughing. He denies any fever or congestion. For the last two days, he has had associated nausea and three episodes of vomiting. Which of the following characteristics seen on neuroimaging would be most consistent with a glioblastoma? A. Heterogenous mass with central necrosis B. Lack of enhancement with administration of contrast C. Presence of calcifications D. Well circumscribed margins Teaching Image Question 2 A 16-year-old African American boy presents with a scalp rash. On examination, it is a 5 x 5 cm boggy and thickened area of the right parietal cap with an overlying scaly and crusty plaque and hair loss. The lesion appears yellowish-green under a Wood’s lamp. What is the treatment of choice for this lesion? A. Clotrimazole ointment B. Ketoconazole shampoo C. Oral amphotericin B D. Oral griseofulvin Teaching Image Question 3 A 22-year old man recently diagnosed with schizophrenia presents to the ED with altered mental status. His blood pressure is 160/80 mm Hg, pulse 130 beats per minute, and temperature is 39.5°C. He is noted to be confused and diaphoretic. He has muscle rigidity and a tremor in his hands. What is the most likely diagnosis? A. Malignant hyperthermia B. Neuroleptic malignant syndrome C. Serotonin syndrome D. Tyramine reaction Teaching Image Question 4 A 21-year-old woman presents with painful urination. She has no vaginal discharge and is not sexually active. Which of the following is most sensitive for a urinary tract infection on urine dipstick testing? A. Bacteria B. Blood C. Leukocyte esterase D. Nitrites Teaching Image Question 5 Which of the following findings would be consistent with a diagnosis of Tetralogy of Fallot? A. Bounding pulses and a continuous machine-like murmur B. Decreased pulses in lower extremities C. Increased pulmonary vascular markings on chest radiography D. Loud, single second heart sound with a harsh systolic murmur Teaching Image Question 6 A 73-year-old man presents with painless vision loss in the right eye. Which of the following on funduscopic examination is most characteristic of central retinal vein occlusion? A. Cherry red fovea B. Pale retina C. Papilledema D. Retinal hemorrhages Teaching Image Teaching Image Teaching Image