A 38y/o F presents with difficulty looking upward, lid lag, and palpitations. Examination reveals tachycardia but is otherwise unremarkable. What is the most appropriate initial diagnostic investigation?
Anonymous Quiz
3%
MRI Brain with contrast
35%
Acetylcholine receptor antibodies
62%
Thyroid function tests
0%
Electrocardiogram
Maxemo EMREE 26-27
A 38y/o F presents with difficulty looking upward, lid lag, and palpitations. Examination reveals tachycardia but is otherwise unremarkable. What is the most appropriate initial diagnostic investigation?
💡 EXPLANATION:
Lid lag and restrictive ophthalmoplegia (upgaze deficit) combined with palpitations suggests thyroid eye disease/thyrotoxicosis. Thyroid function tests (TFTs) are the gold standard for diagnosis. Myasthenia gravis typically presents with ptosis, not lid lag.
A 60-year-old male heavy smoker presents with significant weight loss and dyspnea. Chest X-ray reveals a large unilateral pleural effusion. What is the most likely etiology?
Anonymous Quiz
67%
Bronchogenic carcinoma
8%
Tuberculosis
11%
Congestive heart failure
14%
Parapneumonic effusion
Maxemo EMREE 26-27
A 60-year-old male heavy smoker presents with significant weight loss and dyspnea. Chest X-ray reveals a large unilateral pleural effusion. What is the most likely etiology?
💡 EXPLANATION:
In an older smoker with weight loss and unilateral effusion, malignancy (lung cancer) is the most probable cause. While TB is possible, the smoking history and age favor neoplasm. CHF typically causes bilateral transudates.
A 45-year-old female is scheduled for elective cholecystectomy. When discussing the benefits of the laparoscopic approach compared to open surgery, which outcome is considered a primary advantage?
Anonymous Quiz
9%
Prolonged postoperative ileus
84%
Shorter hospital stay
3%
Increased postoperative pain
3%
Delayed mobilization
Maxemo EMREE 26-27
A 45-year-old female is scheduled for elective cholecystectomy. When discussing the benefits of the laparoscopic approach compared to open surgery, which outcome is considered a primary advantage?
💡 EXPLANATION:
Laparoscopic cholecystectomy is minimally invasive, resulting in reduced tissue trauma. Key advantages over open surgery include decreased postoperative pain, earlier mobilization, shorter hospital stays, and faster return to daily activities.
An 18-month-old M presents with a 6% TBSA partial thickness scald on the chest. Vitals are stable, and the child is alert and tolerating fluids. What is the most appropriate initial fluid management?
Anonymous Quiz
42%
Oral rehydration
52%
IV Ringer's lactate
0%
IV Normal saline
6%
IV Dextrose 5%
Maxemo EMREE 26-27
An 18-month-old M presents with a 6% TBSA partial thickness scald on the chest. Vitals are stable, and the child is alert and tolerating fluids. What is the most appropriate initial fluid management?
💡 EXPLANATION:
In children with burns <10% TBSA who are hemodynamically stable and tolerating oral intake, oral rehydration is the standard of care. IV fluid resuscitation (Parkland formula) is generally indicated for burns >10% TBSA in pediatrics.
A 60 y/o F presents with chronic fatigue, generalized hyperpigmentation, and postural dizziness. BP is 100/60 mmHg sitting and 85/50 mmHg standing. Which electrolyte profile is most likely associated with her condition?
Anonymous Quiz
61%
Hyponatremia and Hyperkalemia
26%
Hyponatremia and Hypokalemia
10%
Hypernatremia and Hypokalemia
3%
Hypernatremia and Hyperkalemia
Maxemo EMREE 26-27
A 60 y/o F presents with chronic fatigue, generalized hyperpigmentation, and postural dizziness. BP is 100/60 mmHg sitting and 85/50 mmHg standing. Which electrolyte profile is most likely associated with her condition?
💡 EXPLANATION:
The clinical triad of hyperpigmentation, fatigue, and orthostatic hypotension indicates Primary Adrenal Insufficiency (Addison's disease). Aldosterone deficiency leads to renal sodium loss (hyponatremia) and potassium retention (hyperkalemia).
A 68 y/o F presents with weight gain, chronic constipation, and dry, rough skin. Family reports she has become socially withdrawn and lethargic. What is the most likely diagnosis?
Anonymous Quiz
11%
Major depression
81%
Hypothyroidism
3%
Cushing syndrome
6%
Alzheimer dementia
Maxemo EMREE 26-27
A 68 y/o F presents with weight gain, chronic constipation, and dry, rough skin. Family reports she has become socially withdrawn and lethargic. What is the most likely diagnosis?
💡 EXPLANATION:
Hypothyroidism in the elderly often presents with 'pseudodementia' (social withdrawal), accompanied by somatic signs like weight gain, constipation, and dry skin (myxedema). These physical findings distinguish it from primary depression.
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A patient presents with a painless, translucent bluish swelling on the floor of the mouth. Which salivary gland is the primary origin of this mucus extravasation cyst (ranula)?
Anonymous Quiz
0%
Parotid gland
21%
Submandibular gland
64%
Sublingual gland
15%
Minor salivary gland
Maxemo EMREE 26-27
A patient presents with a painless, translucent bluish swelling on the floor of the mouth. Which salivary gland is the primary origin of this mucus extravasation cyst (ranula)?
💡 EXPLANATION:
A ranula is a mucus extravasation cyst arising primarily from the sublingual gland. It typically presents as a frog belly-like, translucent blue swelling on the floor of the mouth due to trauma or obstruction causing mucin leakage into tissue.
A pregnant woman presents with gum bleeding. Physical examination reveals a spleen palpable 4 cm below the costal margin. Laboratory investigations show a platelet count of 50,000/μL. Which diagnosis is most consistent with these clinical findings?
Anonymous Quiz
18%
Malaria
50%
Immune thrombocytopenia (ITP)
12%
Gestational thrombocytopenia
21%
HELLP syndrome
Maxemo EMREE 26-27
A pregnant woman presents with gum bleeding. Physical examination reveals a spleen palpable 4 cm below the costal margin. Laboratory investigations show a platelet count of 50,000/μL. Which diagnosis is most consistent with these clinical findings?
💡 EXPLANATION:
Significant splenomegaly (4 cm) combined with thrombocytopenia suggests a secondary cause like Malaria or malignancy. Splenomegaly is atypical for ITP (diagnosis of exclusion) and HELLP syndrome. Gestational thrombocytopenia is mild (>70k) and asymptomatic.
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A female patient presents with amenorrhea and galactorrhea. Labs reveal TSH 7 mIU/L, low Free T4, and Prolactin 90 ng/mL. What is the most appropriate next step?
Anonymous Quiz
23%
Start cabergoline
31%
Initiate levothyroxine
43%
MRI of pituitary gland
3%
Repeat prolactin level
Maxemo EMREE 26-27
A female patient presents with amenorrhea and galactorrhea. Labs reveal TSH 7 mIU/L, low Free T4, and Prolactin 90 ng/mL. What is the most appropriate next step?
💡 EXPLANATION:
While primary hypothyroidism causes hyperprolactinemia, a level of 90 ng/mL is disproportionately high for a TSH of 7 mIU/L. MRI is warranted to exclude a pituitary adenoma or stalk compression.