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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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
Maxemo EMREE 26-27
A 45-year-old male presents with chronic sinusitis, recurrent hemoptysis, and elevated creatinine. Urinalysis reveals microscopic hematuria. What is the most likely diagnosis?
💡 EXPLANATION:
Granulomatosis with polyangiitis (formerly Wegener's) presents with a clinical triad: upper airway disease (sinusitis/saddle nose), lower airway involvement (hemoptysis/cavitation), and glomerulonephritis. c-ANCA is typically positive.
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A patient presents with fever and cough. CXR reveals an opacity in the right lung field obscuring the right heart border. What is the primary radiographic abnormality?
Anonymous Quiz
12%
Pleural effusion
77%
Consolidation
8%
Pneumothorax
4%
Atelectasis
Maxemo EMREE 26-27
A patient presents with fever and cough. CXR reveals an opacity in the right lung field obscuring the right heart border. What is the primary radiographic abnormality?
💡 EXPLANATION:
Airspace opacification that obscures adjacent soft tissue borders (positive silhouette sign) is characteristic of consolidation. This finding is the hallmark of pneumonia, where air in the alveoli is replaced by exudate.
A 32-year-old female non-smoker presents with recurrent spontaneous pneumothorax. Chest HRCT reveals diffuse, round, thin-walled cysts uniformly distributed throughout both lungs. What is the most likely diagnosis?
Anonymous Quiz
29%
Pulmonary Langerhans cell histiocytosis
42%
Lymphangioleiomyomatosis
25%
Birt-Hogg-Dubé syndrome
4%
Lymphocytic interstitial pneumonia
Maxemo EMREE 26-27
A 32-year-old female non-smoker presents with recurrent spontaneous pneumothorax. Chest HRCT reveals diffuse, round, thin-walled cysts uniformly distributed throughout both lungs. What is the most likely diagnosis?
💡 EXPLANATION:
Lymphangioleiomyomatosis (LAM) affects women of childbearing age. It is characterized by recurrent pneumothorax and diffuse, uniform thin-walled cysts on HRCT. PLCH is typically associated with smoking and irregular cysts.
A 6y M presents with fever and headache x3d. O/E: T 38.9°C, +Kernig sign. CSF: WBC 200 (90% lymphs), Glu 3.1 mmol/L (Serum 5.3), Protein 0.6 g/L, Gram stain negative. What is the most likely diagnosis?
Anonymous Quiz
7%
Bacterial meningitis
44%
Viral meningitis
41%
Tuberculous meningitis
7%
Fungal meningitis
Maxemo EMREE 26-27
A 6y M presents with fever and headache x3d. O/E: T 38.9°C, +Kernig sign. CSF: WBC 200 (90% lymphs), Glu 3.1 mmol/L (Serum 5.3), Protein 0.6 g/L, Gram stain negative. What is the most likely diagnosis?
💡 EXPLANATION:
CSF findings of lymphocytic pleocytosis, normal glucose (ratio >0.5), and mild protein elevation are classic for aseptic (viral) meningitis. Bacterial meningitis typically presents with neutrophilic pleocytosis and hypoglycemia.