Maxemo EMREE 26-27
A 47 y/o M post-RTA presents with respiratory distress. A chest X-ray demonstrates the nasogastric tube coiled within the left hemithorax. What is the definitive management?
💡 EXPLANATION:
An NG tube in the chest is pathognomonic for traumatic diaphragmatic rupture with gastric herniation. Urgent laparotomy is required to reduce the viscera and repair the defect. Chest tubes are contraindicated due to the high risk of gastric perforation.
A 76y M with HTN presents with acute pain, erythema, and swelling of the right 1st MTP joint. He started a new antihypertensive medication 1 month ago. Which agent is the most likely cause?
Anonymous Quiz
13%
Amlodipine
4%
Lisinopril
79%
Hydrochlorothiazide
4%
Losartan
Maxemo EMREE 26-27
A 76y M with HTN presents with acute pain, erythema, and swelling of the right 1st MTP joint. He started a new antihypertensive medication 1 month ago. Which agent is the most likely cause?
💡 EXPLANATION:
The patient has podagra (acute gout). Thiazide diuretics (Hydrochlorothiazide) cause hyperuricemia by decreasing uric acid excretion in the proximal tubule, precipitating gout flares. Losartan is uricosuric; other agents have neutral effects.
A 45 y/o F presents with Raynaud's phenomenon, dysphagia, sclerodactyly, and exertional dyspnea. Suspecting diffuse systemic sclerosis, which autoantibody is most specific for this condition?
Anonymous Quiz
10%
Anti-centromere
19%
Anti-dsDNA
71%
Anti-Scl-70
0%
Anti-Ro/SSA
Maxemo EMREE 26-27
A 45 y/o F presents with Raynaud's phenomenon, dysphagia, sclerodactyly, and exertional dyspnea. Suspecting diffuse systemic sclerosis, which autoantibody is most specific for this condition?
💡 EXPLANATION:
Anti-Scl-70 (anti-topoisomerase I) is highly specific for diffuse cutaneous systemic sclerosis and correlates with pulmonary fibrosis. Anti-centromere is specific for limited SSc (CREST syndrome). Anti-dsDNA is specific for SLE.
A 62y/o F presents with right-sided headache, jaw claudication, and scalp tenderness. O/E: Reduced visual acuity in the right eye. ESR is 95 mm/hr. What is the most appropriate immediate management?
Anonymous Quiz
29%
Perform temporal artery biopsy
71%
Administer IV methylprednisolone
0%
Order MRI brain with contrast
0%
Prescribe oral carbamazepine
Maxemo EMREE 26-27
A 62y/o F presents with right-sided headache, jaw claudication, and scalp tenderness. O/E: Reduced visual acuity in the right eye. ESR is 95 mm/hr. What is the most appropriate immediate management?
💡 EXPLANATION:
This is Giant Cell Arteritis (GCA) with visual involvement. Immediate high-dose corticosteroids (IV methylprednisolone) are mandated to prevent permanent blindness. Temporal artery biopsy is the gold standard for diagnosis but must not delay treatment.
A 78 y/o F with Giant Cell Arteritis is started on prednisolone 60 mg/day. Which medication is indicated to prevent the most significant long-term adverse effect of this therapy?
Anonymous Quiz
8%
Omeprazole
63%
Alendronate
17%
Aspirin
13%
Methotrexate
Maxemo EMREE 26-27
A 78 y/o F with Giant Cell Arteritis is started on prednisolone 60 mg/day. Which medication is indicated to prevent the most significant long-term adverse effect of this therapy?
💡 EXPLANATION:
High-dose corticosteroids are a major cause of secondary osteoporosis (GIOP). Elderly women are at high risk for fragility fractures. Bisphosphonates (Alendronate) with Calcium/Vit D are the standard of care for bone protection in this population.
A 28 y/o M presents with a 6-month hx of alternating buttock pain and morning stiffness >1 hr, improving with exercise. O/E: positive Schober's test. What is the most sensitive imaging modality to detect early sacroiliitis in this patient?
Anonymous Quiz
13%
Plain radiograph of SI joints
61%
MRI of sacroiliac joints
22%
CT scan of sacroiliac joints
4%
Radionuclide bone scan
Maxemo EMREE 26-27
A 28 y/o M presents with a 6-month hx of alternating buttock pain and morning stiffness >1 hr, improving with exercise. O/E: positive Schober's test. What is the most sensitive imaging modality to detect early sacroiliitis in this patient?
💡 EXPLANATION:
Diagnosis: Axial Spondyloarthritis. MRI of the SI joints is the most sensitive investigation for detecting early active inflammation (bone marrow edema), which occurs before structural damage becomes visible on plain X-rays or CT.
A 35 y/o M with severe adult-onset asthma presents with painful shin nodules, migratory arthralgia, and acute left foot drop. Which laboratory finding is most characteristic of the suspected systemic diagnosis?
Anonymous Quiz
24%
Peripheral blood eosinophilia
48%
Positive c-ANCA titer
19%
Depressed C3/C4 levels
10%
Positive Anti-GBM antibodies
Maxemo EMREE 26-27
A 35 y/o M with severe adult-onset asthma presents with painful shin nodules, migratory arthralgia, and acute left foot drop. Which laboratory finding is most characteristic of the suspected systemic diagnosis?
💡 EXPLANATION:
Dx: Eosinophilic Granulomatosis with Polyangiitis (EGPA/Churg-Strauss). Classic triad: adult asthma, eosinophilia, and vasculitis (mononeuritis multiplex). Marked peripheral eosinophilia (>1500/µL) is the hallmark. ANCA is often absent (~60%).
A male with chronic rhinosinusitis and peripheral eosinophilia has positive MPO-ANCA. Which clinical history most specifically distinguishes this condition from Microscopic Polyangiitis?
Anonymous Quiz
17%
Cavitary lung nodules
22%
Hepatitis B infection
48%
Adult-onset asthma
13%
Saddle nose deformity
Maxemo EMREE 26-27
A male with chronic rhinosinusitis and peripheral eosinophilia has positive MPO-ANCA. Which clinical history most specifically distinguishes this condition from Microscopic Polyangiitis?
💡 EXPLANATION:
Diagnosis: Eosinophilic Granulomatosis with Polyangiitis (EGPA). While Microscopic Polyangiitis is also p-ANCA+, EGPA is uniquely distinguished by a prodrome of atopy, allergic rhinitis, and adult-onset asthma alongside eosinophilia.
❤1
A 45 y/o M on bendroflumethiazide presents with acute onset pain, redness, and swelling of the right 1st MTP joint. Examination reveals localized erythema and warmth. No contraindications exist. What is the most appropriate initial medication?
Anonymous Quiz
30%
Allopurinol
39%
Naproxen
30%
Febuxostat
0%
Probenecid
Maxemo EMREE 26-27
A 45 y/o M on bendroflumethiazide presents with acute onset pain, redness, and swelling of the right 1st MTP joint. Examination reveals localized erythema and warmth. No contraindications exist. What is the most appropriate initial medication?
💡 EXPLANATION:
Diagnosis is acute gouty arthritis (podagra), likely thiazide-induced. First-line management for acute attacks involves NSAIDs (Naproxen), Colchicine, or Steroids. Urate-lowering agents (Allopurinol, Febuxostat) are for chronic prophylaxis.
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2. Rizwan H
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🔬 Today's Test: OBSTETRICS AND GYNAECOLOGY
👉 https://app.maxemo.app/s/dft-emree
Yesterday's Ranks🏆
ENDOCRINOLOGY
1. zayed
2. Shruti p
3. Rizwan H
4. Nigarish
5. Samyak99
6. Amna
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8. Aisha
9. Silverlin
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A 27 y/o F reports painful triphasic color changes (white-blue-red) in fingers triggered by cold. Physical exam is normal. Which initial investigation is indicated to differentiate primary from secondary causes?
Anonymous Quiz
14%
Upper limb arterial Doppler
14%
Nerve conduction studies
48%
ANA and inflammatory markers
24%
Digital subtraction angiography
❤1
Maxemo EMREE 26-27
A 27 y/o F reports painful triphasic color changes (white-blue-red) in fingers triggered by cold. Physical exam is normal. Which initial investigation is indicated to differentiate primary from secondary causes?
💡 EXPLANATION:
The patient exhibits Raynaud's phenomenon. While often primary in young women, it is crucial to rule out secondary causes (Connective Tissue Diseases like Scleroderma or SLE). ANA and ESR/CRP are the standard initial screening tests for underlying autoimmunity.