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.
A 45y M with prior syphilis presents with ataxia, shooting leg pains, and incontinence. O/E: Argyll Robertson pupils. CSF VDRL is positive. What is the most appropriate treatment?
Anonymous Quiz
35%
IM Benzathine Penicillin G 2.4 MU
15%
PO Doxycycline 100 mg BID
42%
IV Aqueous Crystalline Penicillin G
8%
IV Ceftriaxone 2 g daily
Maxemo EMREE 26-27
A 45y M with prior syphilis presents with ataxia, shooting leg pains, and incontinence. O/E: Argyll Robertson pupils. CSF VDRL is positive. What is the most appropriate treatment?
💡 EXPLANATION:
Neurosyphilis (e.g., Tabes Dorsalis) requires IV Aqueous Crystalline Penicillin G (18-24 million units/day) for 10-14 days to ensure adequate CSF penetration. IM Benzathine Penicillin does not achieve therapeutic levels in the CNS.
A 26-year-old G1P0 woman at 14 weeks gestation has asymptomatic bacteriuria (>100,000 CFU/mL E. coli). She denies dysuria. She has no known drug allergies. What is the most appropriate pharmacotherapy?
Anonymous Quiz
28%
Reassurance and observation
55%
Nitrofurantoin
7%
Ciprofloxacin
10%
Doxycycline
Maxemo EMREE 26-27
A 26-year-old G1P0 woman at 14 weeks gestation has asymptomatic bacteriuria (>100,000 CFU/mL E. coli). She denies dysuria. She has no known drug allergies. What is the most appropriate pharmacotherapy?
💡 EXPLANATION:
Asymptomatic bacteriuria in pregnancy requires treatment to prevent pyelonephritis and preterm delivery. Nitrofurantoin is safe in the 2nd trimester. Fluoroquinolones (ciprofloxacin) and tetracyclines (doxycycline) are contraindicated in pregnancy.
A 35 y/o M has these labs: HBsAg (+), HBeAg (-), Anti-HBe (+), Anti-HBc IgG (+). HBV DNA is <2,000 IU/mL with persistently normal ALT. Which phase of chronic Hepatitis B infection does this represent?
Anonymous Quiz
12%
Immune tolerant phase
23%
Immune reactive phase
35%
Inactive carrier phase
31%
HBeAg-negative chronic hepatitis
Maxemo EMREE 26-27
A 35 y/o M has these labs: HBsAg (+), HBeAg (-), Anti-HBe (+), Anti-HBc IgG (+). HBV DNA is <2,000 IU/mL with persistently normal ALT. Which phase of chronic Hepatitis B infection does this represent?
💡 EXPLANATION:
This profile (HBsAg+, HBeAg-, Anti-HBe+, low viral load <2,000 IU/mL, normal ALT) defines the Inactive Carrier state (HBeAg-negative chronic infection). It indicates seroconversion has occurred with low viral replication and minimal liver inflammation.
A 35 y/o asplenic male presents with high fever, confusion, and hypotension 12 hours after sustaining a dog bite. BP 80/50 mmHg, HR 125/min. Which organism is the most likely cause of this fulminant presentation?
Anonymous Quiz
14%
Pasteurella multocida
17%
Staphylococcus aureus
55%
Capnocytophaga canimorsus
14%
Eikenella corrodens
Maxemo EMREE 26-27
A 35 y/o asplenic male presents with high fever, confusion, and hypotension 12 hours after sustaining a dog bite. BP 80/50 mmHg, HR 125/min. Which organism is the most likely cause of this fulminant presentation?
💡 EXPLANATION:
C. canimorsus is a commensal in dog saliva that causes overwhelming post-splenectomy infection (OPSI) and fulminant sepsis in asplenic patients. While P. multocida is common in bites, it typically causes local cellulitis rather than rapid septic shock.
A 9y/o child presents with facial edema and cola-colored urine. History reveals pharyngitis 3 weeks prior. O/E: BP 145/95 mmHg. Urinalysis shows RBC casts. What is the most likely diagnosis?
Anonymous Quiz
6%
Minimal change disease
0%
IgA nephropathy
3%
Alport syndrome
90%
Post-streptococcal glomerulonephritis
Maxemo EMREE 26-27
A 9y/o child presents with facial edema and cola-colored urine. History reveals pharyngitis 3 weeks prior. O/E: BP 145/95 mmHg. Urinalysis shows RBC casts. What is the most likely diagnosis?
💡 EXPLANATION:
This is a classic presentation of Post-streptococcal Glomerulonephritis (PSGN). Key features are nephritic syndrome (HTN, edema, hematuria) occurring 1-3 weeks after a Group A Strep infection. IgA nephropathy is synpharyngitic (occurs within days of infection).
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A term neonate is delivered to an HBsAg-positive mother. The physical examination is unremarkable. Which intervention is indicated for the infant within 12 hours of birth?
Anonymous Quiz
4%
Hepatitis B vaccine only
21%
Hepatitis B immunoglobulin (HBIG) only
71%
Hepatitis B vaccine and HBIG
4%
Oral antiviral prophylaxis
Maxemo EMREE 26-27
A term neonate is delivered to an HBsAg-positive mother. The physical examination is unremarkable. Which intervention is indicated for the infant within 12 hours of birth?
💡 EXPLANATION:
Infants born to HBsAg-positive mothers require dual immunoprophylaxis to prevent vertical transmission. Both the Hepatitis B vaccine (active immunity) and Hepatitis B Immunoglobulin (passive immunity) must be administered within 12 hours.
A patient presents with acute high fever, toxicity, and an exquisitely painful inguinal lymph node (bubo) after camping near prairie dogs. What is the most likely causative organism?
Anonymous Quiz
22%
Francisella tularensis
48%
Yersinia pestis
22%
Bartonella henselae
7%
Brucella melitensis