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
Maxemo EMREE 26-27
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?
💡 EXPLANATION:
The clinical picture of acute fever, toxicity, and a painful bubo following rodent exposure indicates Bubonic Plague caused by *Yersinia pestis*. *F. tularensis* causes Tularemia (ulceroglandular); *B. henselae* causes Cat Scratch Disease.
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A 28 y/o veterinary technician, fully vaccinated against rabies 5 years ago, sustains a bite from a stray cat. The wound is cleaned. What is the most appropriate post-exposure prophylaxis?
Anonymous Quiz
43%
Rabies vaccine on days 0 and 3
30%
Rabies vaccine on days 0, 3, 7, 14
17%
Rabies vaccine + Rabies IG (RIG)
10%
Rabies IG (RIG) only