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
Maxemo EMREE 26-27
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?
💡 EXPLANATION:
Left hemispatial neglect is a hallmark sign of a lesion in the non-dominant parietal lobe (usually the right). The right parietal lobe processes spatial awareness. Left-sided parietal lesions typically result in aphasia, apraxia, or Gerstmann syndrome.
A 60 y/o M with HTN presents with sudden left hemiplegia. MRI reveals a lacunar infarct in the right internal capsule. Which vessels are most likely occluded?
Anonymous Quiz
13%
Anterior cerebral artery
75%
Lenticulostriate arteries
13%
Posterior cerebral artery
0%
Vertebral arteries
Maxemo EMREE 26-27
A 60 y/o M with HTN presents with sudden left hemiplegia. MRI reveals a lacunar infarct in the right internal capsule. Which vessels are most likely occluded?
💡 EXPLANATION:
Internal capsule lacunar infarcts result from occlusion of lenticulostriate arteries (MCA branches). These small perforating vessels are prone to lipohyalinosis due to chronic HTN, causing pure motor hemiparesis.
A 17 y/o M presents with episodes of sudden bilateral leg weakness triggered by intense laughter. He reports preserved consciousness during these events. Physical exam is normal. What is the most likely diagnosis?
Anonymous Quiz
14%
Atonic seizure
18%
Vasovagal syncope
29%
Narcolepsy
39%
Hypokalemic periodic paralysis
Maxemo EMREE 26-27
A 17 y/o M presents with episodes of sudden bilateral leg weakness triggered by intense laughter. He reports preserved consciousness during these events. Physical exam is normal. What is the most likely diagnosis?
💡 EXPLANATION:
The patient exhibits cataplexy (sudden loss of muscle tone triggered by strong emotion like laughter) with preserved consciousness. This is pathognomonic for Narcolepsy. Seizures and syncope typically involve loss of consciousness.
A 25 y/o patient spends hours checking a perceived nose defect in the mirror. During intense anxiety, they report feeling detached from their body. Reality testing remains intact. What is the most likely diagnosis?
Anonymous Quiz
64%
Body dysmorphic disorder
4%
Delusional disorder
7%
Obsessive-compulsive disorder
25%
Depersonalization disorder
Maxemo EMREE 26-27
A 25 y/o patient spends hours checking a perceived nose defect in the mirror. During intense anxiety, they report feeling detached from their body. Reality testing remains intact. What is the most likely diagnosis?
💡 EXPLANATION:
Body Dysmorphic Disorder is characterized by preoccupation with perceived physical defects and compulsive behaviors (mirror checking). Dissociative symptoms may occur secondarily to anxiety. Reality testing distinguishes it from somatic delusions.
A 29 y/o F, 2 weeks postpartum, presents with 4 days of severe insomnia, agitation, and delusions that her baby is evil. She exhibits manic behavior and confusion. What is the most likely diagnosis?
Anonymous Quiz
10%
Postpartum blues
17%
Postpartum depression
73%
Postpartum psychosis
0%
Obsessive-compulsive disorder