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
Maxemo EMREE 26-27
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?
💡 EXPLANATION:
Previously immunized individuals require a 2-dose vaccine booster series (days 0 and 3) to elicit an amnestic response. Rabies Immune Globulin (RIG) is not indicated for previously vaccinated patients.
An 82 y/o nursing home resident presents with fever and AMS. BP 90/60 mmHg. Diagnosis is urosepsis. Hx includes recurrent UTIs treated with multiple antibiotics. Which empiric IV antibiotic is most appropriate?
Anonymous Quiz
29%
Ceftriaxone
35%
Ciprofloxacin
32%
Ertapenem
3%
Amoxicillin
Maxemo EMREE 26-27
An 82 y/o nursing home resident presents with fever and AMS. BP 90/60 mmHg. Diagnosis is urosepsis. Hx includes recurrent UTIs treated with multiple antibiotics. Which empiric IV antibiotic is most appropriate?
💡 EXPLANATION:
Nursing home residence and recent antibiotic use are major risk factors for ESBL-producing organisms. Cephalosporins and fluoroquinolones have high resistance rates. Ertapenem covers ESBLs effectively while sparing anti-pseudomonal carbapenems.
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A 4 y/o child recovers from pneumococcal meningitis but is found to have profound bilateral sensorineural hearing loss. Pathologically, this sequela is most likely caused by inflammatory damage to which structure?
Anonymous Quiz
10%
Tympanic membrane
14%
Ossicular chain
5%
Eustachian tube
71%
Organ of Corti
Maxemo EMREE 26-27
A 4 y/o child recovers from pneumococcal meningitis but is found to have profound bilateral sensorineural hearing loss. Pathologically, this sequela is most likely caused by inflammatory damage to which structure?
💡 EXPLANATION:
Bacterial meningitis spreads from the subarachnoid space to the inner ear via the cochlear aqueduct. This causes suppurative labyrinthitis, resulting in the destruction of the Organ of Corti (hair cells) or neuronal damage to CN VIII, leading to sensorineural hearing loss.
A 50 y/o M presents with severe left otalgia, facial droop, and vertigo. Physical exam reveals vesicular eruptions in the external auditory canal. What is the most likely diagnosis?
Anonymous Quiz
0%
Bell's palsy
96%
Ramsay Hunt syndrome
4%
Bullous myringitis
0%
Malignant otitis externa
Maxemo EMREE 26-27
A 50 y/o M presents with severe left otalgia, facial droop, and vertigo. Physical exam reveals vesicular eruptions in the external auditory canal. What is the most likely diagnosis?
💡 EXPLANATION:
Ramsay Hunt syndrome (Herpes Zoster Oticus) involves VZV reactivation in the geniculate ganglion. It presents with ipsilateral facial paralysis, otalgia, and vesicles in the ear canal. CN VIII involvement causes vertigo and hearing loss.
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A patient is evaluated post-seizure and is found to have left-sided hemispatial neglect, consistently ignoring stimuli on the left side. Which anatomical region is the most likely site of the lesion?
Anonymous Quiz
73%
Right parietal lobe
5%
Left parietal lobe
23%
Right temporal lobe
0%
Left frontal lobe