25y F presents with sudden severe LLQ pain and vomiting after exertion. UPT negative. TVUS shows left ovarian edema, free fluid, and a mass with preserved Doppler flow. Pain persists despite analgesia. What is the most appropriate next step?
Anonymous Quiz
24%
CT abdomen and pelvis
68%
Urgent laparoscopy
4%
MRI pelvis
4%
Observation and serial US
Maxemo EMREE 26-27
25y F presents with sudden severe LLQ pain and vomiting after exertion. UPT negative. TVUS shows left ovarian edema, free fluid, and a mass with preserved Doppler flow. Pain persists despite analgesia. What is the most appropriate next step?
💡 EXPLANATION:
Suspect ovarian torsion given sudden pain, mass, and edema. Preserved Doppler flow does not rule out torsion (venous outflow obstruction occurs before arterial). Urgent laparoscopy is required for definitive diagnosis and ovarian salvage.
A 52y F presents with green nipple discharge. Exam reveals a firm subareolar mass and nipple inversion. Mammography shows tubular calcifications. What is the most likely diagnosis?
Anonymous Quiz
19%
Intraductal papilloma
0%
Periductal mastitis
58%
Mammary duct ectasia
23%
Invasive ductal carcinoma
Maxemo EMREE 26-27
A 52y F presents with green nipple discharge. Exam reveals a firm subareolar mass and nipple inversion. Mammography shows tubular calcifications. What is the most likely diagnosis?
💡 EXPLANATION:
Mammary duct ectasia is a benign inflammatory condition in perimenopausal women. Classic signs include green/gray discharge, nipple inversion, and tubular calcifications. Papilloma causes bloody discharge; carcinoma typically shows microcalcifications.
74y/o M smoker presents with chronic cough and weight loss. Exam reveals oral mucosal hyperpigmentation and BP 155/95. Labs: K 2.9 mmol/L, Glucose 10.5 mmol/L. CXR shows a right hilar mass. What is the most likely diagnosis?
Anonymous Quiz
15%
Squamous cell carcinoma
26%
Adenocarcinoma
0%
Large cell carcinoma
59%
Small cell carcinoma
Maxemo EMREE 26-27
74y/o M smoker presents with chronic cough and weight loss. Exam reveals oral mucosal hyperpigmentation and BP 155/95. Labs: K 2.9 mmol/L, Glucose 10.5 mmol/L. CXR shows a right hilar mass. What is the most likely diagnosis?
💡 EXPLANATION:
Small cell lung cancer (SCLC) is a neuroendocrine tumor often producing ectopic ACTH. This leads to Cushing's syndrome (HTN, hyperglycemia) and mineralocorticoid excess causing severe hypokalemia. Hyperpigmentation is due to concomitant MSH secretion.
A 26y/o male smoker presents with sudden left chest pain and dyspnea. Vitals: HR 110, RR 24. Exam shows left hyperresonance and diminished breath sounds. CXR confirms a large primary spontaneous pneumothorax. What is the underlying pathophysiology?
Anonymous Quiz
50%
Rupture of subpleural apical blebs
38%
Rupture of emphysematous bullae
0%
Bronchopleural fistula formation
13%
Alpha-1 antitrypsin deficiency
Maxemo EMREE 26-27
A 26y/o male smoker presents with sudden left chest pain and dyspnea. Vitals: HR 110, RR 24. Exam shows left hyperresonance and diminished breath sounds. CXR confirms a large primary spontaneous pneumothorax. What is the underlying pathophysiology?
💡 EXPLANATION:
Primary spontaneous pneumothorax (PSP) typically affects young male smokers without underlying lung disease. The mechanism is the rupture of small subpleural apical blebs. Emphysematous bullae rupture is associated with secondary pneumothorax (e.g., COPD).
A 35y/o M presents with dry cough, ankle pain, and tender shin nodules. CXR reveals bilateral hilar lymphadenopathy. What is the most likely diagnosis?
Anonymous Quiz
16%
Tuberculosis
24%
Hodgkin lymphoma
60%
Sarcoidosis
0%
Histoplasmosis
Maxemo EMREE 26-27
A 35y/o M presents with dry cough, ankle pain, and tender shin nodules. CXR reveals bilateral hilar lymphadenopathy. What is the most likely diagnosis?
💡 EXPLANATION:
This presentation is classic for Lofgren's syndrome, an acute form of sarcoidosis consisting of the triad: erythema nodosum, bilateral hilar lymphadenopathy, and polyarthralgia. It is most common in young adults and usually has a good prognosis.
A child with moderate persistent asthma presents with a 2-week history of hoarseness shortly after initiating high-dose inhaled corticosteroids. The oropharyngeal examination is unremarkable. What is the most likely diagnosis?
Anonymous Quiz
15%
Vocal cord nodules
77%
Laryngeal candidiasis
4%
Viral laryngitis
4%
Gastroesophageal reflux
Maxemo EMREE 26-27
A child with moderate persistent asthma presents with a 2-week history of hoarseness shortly after initiating high-dose inhaled corticosteroids. The oropharyngeal examination is unremarkable. What is the most likely diagnosis?
💡 EXPLANATION:
High-dose inhaled corticosteroids cause local immunosuppression, leading to laryngeal candidiasis (thrush) of the vocal cords. This presents as dysphonia even if the oropharynx looks normal. Prevention includes spacer use and mouth rinsing.
A patient with eczema reports asthma symptoms 4–5 days/week, nocturnal awakenings 2x/week, and uses a SABA inhaler daily. Which classification of asthma severity is most accurate for this clinical presentation?
Anonymous Quiz
0%
Intermittent
8%
Mild persistent
81%
Moderate persistent
12%
Severe persistent
Maxemo EMREE 26-27
A patient with eczema reports asthma symptoms 4–5 days/week, nocturnal awakenings 2x/week, and uses a SABA inhaler daily. Which classification of asthma severity is most accurate for this clinical presentation?
💡 EXPLANATION:
This patient has Moderate Persistent asthma based on nocturnal awakenings occurring >1x/week (but not nightly) and daily use of a short-acting beta-agonist (SABA). Mild persistent involves night symptoms 3–4x/month.
A 65 y/o M is admitted with high fever, rust-colored sputum, and RLL consolidation. Vitals are stable. He has no known allergies. What is the most appropriate initial antibiotic regimen?
Anonymous Quiz
9%
Amoxicillin PO
4%
Ciprofloxacin IV
57%
Ceftriaxone + Azithromycin IV
30%
Piperacillin-Tazobactam IV
Maxemo EMREE 26-27
A 65 y/o M is admitted with high fever, rust-colored sputum, and RLL consolidation. Vitals are stable. He has no known allergies. What is the most appropriate initial antibiotic regimen?
💡 EXPLANATION:
Inpatient CAP requires coverage for S. pneumoniae and atypical pathogens. Guidelines recommend a beta-lactam (Ceftriaxone) combined with a macrolide (Azithromycin). Ciprofloxacin is not a respiratory fluoroquinolone.
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DERMATOLOGY
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DERMATOLOGY
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DERMATOLOGY
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DERMATOLOGY
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A 25 y/o M presents with sudden pleuritic chest pain and dyspnea. A chest X-ray is ordered to confirm a pneumothorax. Which specific radiographic line represents the edge of the collapsed lung?
Anonymous Quiz
32%
Parietal pleural line
14%
Scapular border
0%
Skin fold
55%
Visceral pleural line
Maxemo EMREE 26-27
A 25 y/o M presents with sudden pleuritic chest pain and dyspnea. A chest X-ray is ordered to confirm a pneumothorax. Which specific radiographic line represents the edge of the collapsed lung?
💡 EXPLANATION:
A pneumothorax is defined by air in the pleural space separating the lung from the chest wall. The diagnostic hallmark is the visualization of the visceral pleural line (white line) with an absence of lung markings peripheral to it.
A 45-year-old male presents with chronic sinusitis, recurrent hemoptysis, and elevated creatinine. Urinalysis reveals microscopic hematuria. What is the most likely diagnosis?
Anonymous Quiz
15%
Goodpasture syndrome
8%
Microscopic polyangiitis
65%
Granulomatosis with polyangiitis
12%
Eosinophilic granulomatosis with polyangiitis