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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NEPHROLOGY AND UROLOGY
1. Reyansh Malhotra
2. Rizwan H
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4. Dr. Shukla
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7. Siddharth Sharma
8. Zaffar
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10. Avantika Pillai
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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
7. anjali
8. Aisha
9. Silverlin
10. Rahul_md
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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.
A patient presenting with chronic sinusitis, pulmonary infiltrates, and RPGN undergoes a lung biopsy to confirm Granulomatosis with Polyangiitis. Which histopathological finding is diagnostic?
Anonymous Quiz
18%
Non-caseating granulomas
32%
Eosinophilic tissue infiltration
14%
Linear IgG basement membrane deposition
36%
Necrotizing granulomatous vasculitis
Maxemo EMREE 26-27
A patient presenting with chronic sinusitis, pulmonary infiltrates, and RPGN undergoes a lung biopsy to confirm Granulomatosis with Polyangiitis. Which histopathological finding is diagnostic?
💡 EXPLANATION:
GPA is characterized histologically by necrotizing granulomatous inflammation and necrotizing vasculitis of small/medium vessels. It is distinct from EGPA (eosinophilic) and Sarcoidosis (non-caseating). Immunofluorescence is typically pauci-immune.
54y M truck driver c/o constant LBP x3mo, unresponsive to NSAIDs. O/E: T12 tenderness, limited flexion. Neuro intact. What is the most appropriate initial investigation?
Anonymous Quiz
25%
MRI lumbar spine
70%
X-ray thoracolumbar spine
5%
CT lumbar spine
0%
Bone scintigraphy
Maxemo EMREE 26-27
54y M truck driver c/o constant LBP x3mo, unresponsive to NSAIDs. O/E: T12 tenderness, limited flexion. Neuro intact. What is the most appropriate initial investigation?
💡 EXPLANATION:
Red flags (age >50, persistent pain, focal bony tenderness) warrant imaging. Plain X-ray is the standard first-line test to rule out vertebral fractures or lytic lesions. MRI is indicated if neuro signs are present or X-ray is abnormal.
21y M from Cameroon presents with fever, night sweats, and mid-back pain x2 months. Imaging reveals T10 pathologic fracture. Labs: ESR 98 mm/hr. What is the most likely underlying etiology?
Anonymous Quiz
5%
Pyogenic osteomyelitis
95%
Spinal tuberculosis
0%
Multiple myeloma
0%
Metastatic malignancy
Maxemo EMREE 26-27
21y M from Cameroon presents with fever, night sweats, and mid-back pain x2 months. Imaging reveals T10 pathologic fracture. Labs: ESR 98 mm/hr. What is the most likely underlying etiology?
💡 EXPLANATION:
The patient exhibits classic signs of Pott's disease (spinal TB). Key diagnostic clues include origin from a TB-endemic region, chronic constitutional symptoms (night sweats), thoracic involvement, and significantly elevated ESR. Pyogenic infection typically presents acutely.
72y/o M with prostate CA presents with severe back pain and leg weakness (3/5). Exam reveals T12 tenderness, lower limb hypertonia, and L1 sensory level. What is the most appropriate initial management step?
Anonymous Quiz
32%
IV Dexamethasone
53%
Urgent MRI spine
5%
Emergency radiotherapy
11%
Surgical decompression
Maxemo EMREE 26-27
72y/o M with prostate CA presents with severe back pain and leg weakness (3/5). Exam reveals T12 tenderness, lower limb hypertonia, and L1 sensory level. What is the most appropriate initial management step?
💡 EXPLANATION:
Suspect Malignant Spinal Cord Compression (MSCC). Immediate high-dose dexamethasone reduces vasogenic edema and preserves neurological function. This takes precedence over imaging (MRI), though MRI should be performed immediately after.
A 35 y/o M presents 6 months post-MVA involving a right proximal fibula fracture. He exhibits a high-stepping gait where the foot slaps the floor. Sensation is decreased on the right foot dorsum. Which nerve is most likely injured?
Anonymous Quiz
74%
Common peroneal
21%
Tibial
5%
Femoral
0%
Obturator
Maxemo EMREE 26-27
A 35 y/o M presents 6 months post-MVA involving a right proximal fibula fracture. He exhibits a high-stepping gait where the foot slaps the floor. Sensation is decreased on the right foot dorsum. Which nerve is most likely injured?
💡 EXPLANATION:
The patient exhibits steppage gait (foot drop) due to dorsiflexor paralysis. The common peroneal nerve winds around the fibular neck, making it highly vulnerable to proximal fibula fractures. Injury causes foot drop and sensory loss on the foot dorsum.
A 45 y/o M presents with right foot drop and numbness over the foot dorsum. Which physical examination finding indicates L5 radiculopathy rather than common peroneal neuropathy?
Anonymous Quiz
42%
Weakness of ankle inversion
0%
Weakness of ankle eversion
42%
Sensory loss in first web space
16%
Positive Tinel sign at fibular head
Maxemo EMREE 26-27
A 45 y/o M presents with right foot drop and numbness over the foot dorsum. Which physical examination finding indicates L5 radiculopathy rather than common peroneal neuropathy?
💡 EXPLANATION:
L5 radiculopathy affects the tibialis posterior (ankle inversion). The common peroneal nerve supplies dorsiflexors and evertors but spares inversion. Therefore, weak inversion places the lesion at the L5 root level rather than the peripheral nerve.