A 48y/o F presents with a rapidly enlarging, painful shin ulcer following minor trauma. O/E: 5cm ulcer with a necrotic base and irregular, violaceous, undermined borders. Which condition is most strongly associated with this diagnosis?
Anonymous Quiz
30%
Ulcerative colitis
30%
Diabetes mellitus
40%
Venous insufficiency
0%
Systemic lupus erythematosus
Maxemo EMREE 26-27
A 48y/o F presents with a rapidly enlarging, painful shin ulcer following minor trauma. O/E: 5cm ulcer with a necrotic base and irregular, violaceous, undermined borders. Which condition is most strongly associated with this diagnosis?
💡 EXPLANATION:
Diagnosis: Pyoderma Gangrenosum (PG). Features include rapid progression, severe pain, and undermined violaceous borders triggered by trauma (pathergy). Up to 50% of cases are associated with systemic disease, most commonly Inflammatory Bowel Disease (IBD).
62M COPD patient presents with dyspnea. O/E: Drowsy, diffuse wheezes. Vitals: RR 10/min, SpO2 90% (4L O2). ABG: pH 7.25, PaCO2 70 mmHg, PaO2 60 mmHg. What is the primary cause of his altered mental status?
Anonymous Quiz
16%
Severe hypoxemia
53%
CO2 narcosis
26%
Metabolic acidosis
5%
Cerebral ischemia
Maxemo EMREE 26-27
62M COPD patient presents with dyspnea. O/E: Drowsy, diffuse wheezes. Vitals: RR 10/min, SpO2 90% (4L O2). ABG: pH 7.25, PaCO2 70 mmHg, PaO2 60 mmHg. What is the primary cause of his altered mental status?
💡 EXPLANATION:
Drowsiness in a COPD patient with bradypnea and severe hypercapnia (PaCO2 70 mmHg) indicates CO2 narcosis. High CO2 causes direct CNS depression and respiratory acidosis. Hypoxemia is present but CO2 retention is the primary driver of the altered mental status.
A 45y F presents with fever, RUQ pain, jaundice, confusion, and BP 90/60 mmHg. Labs show WBC 19×10⁹/L, elevated bilirubin, and ALP. Ultrasound reveals cholelithiasis and a dilated CBD. What is the diagnosis?
Anonymous Quiz
25%
Acute cholecystitis
38%
Choledocholithiasis
8%
Acute hepatitis
29%
Acute ascending cholangitis
Maxemo EMREE 26-27
A 45y F presents with fever, RUQ pain, jaundice, confusion, and BP 90/60 mmHg. Labs show WBC 19×10⁹/L, elevated bilirubin, and ALP. Ultrasound reveals cholelithiasis and a dilated CBD. What is the diagnosis?
💡 EXPLANATION:
The patient exhibits Reynolds' pentad (Charcot's triad + hypotension + confusion), diagnostic for acute ascending cholangitis. This indicates a septic biliary emergency requiring broad-spectrum antibiotics and urgent biliary decompression.
A 55 y/o M with HTN and DM presents with chest pain. ECG reveals ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
Anonymous Quiz
14%
Left anterior descending artery
77%
Right coronary artery
5%
Left circumflex artery
5%
Left main coronary artery
Maxemo EMREE 26-27
A 55 y/o M with HTN and DM presents with chest pain. ECG reveals ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
💡 EXPLANATION:
ST elevation in leads II, III, and aVF indicates an inferior wall MI. The Right Coronary Artery (RCA) supplies the inferior wall in approximately 90% of patients (right-dominant circulation). LAD occlusion affects anterior leads (V1-V4).
A 25y/o F with T1DM presents with DKA. Labs: Glucose 23.3 mmol/L, pH 7.15, K 5.5 mmol/L. Despite likely total body depletion, what is the primary mechanism for the initial serum hyperkalemia?
Anonymous Quiz
43%
Impaired renal excretion
48%
Transcellular shift
9%
Excessive dietary intake
0%
Pseudohyperkalemia
Maxemo EMREE 26-27
A 25y/o F with T1DM presents with DKA. Labs: Glucose 23.3 mmol/L, pH 7.15, K 5.5 mmol/L. Despite likely total body depletion, what is the primary mechanism for the initial serum hyperkalemia?
💡 EXPLANATION:
In DKA, a total body K+ deficit exists due to osmotic diuresis. However, initial serum hyperkalemia occurs due to an extracellular shift of potassium driven primarily by insulin deficiency and hyperosmolality. Acidosis (H+/K+ exchange) plays a minor role.
A 70y/o M with CHF on furosemide presents with weakness. Labs: K 2.8 mmol/L, HCO3 32 mmol/L. ECG shows prominent U waves. What is the primary mechanism responsible for the observed acid-base disturbance?
Anonymous Quiz
43%
Increased distal tubular hydrogen secretion
19%
Decreased proximal bicarbonate reabsorption
14%
Intracellular shift of bicarbonate
24%
Reduced renal ammonia excretion
Maxemo EMREE 26-27
A 70y/o M with CHF on furosemide presents with weakness. Labs: K 2.8 mmol/L, HCO3 32 mmol/L. ECG shows prominent U waves. What is the primary mechanism responsible for the observed acid-base disturbance?
💡 EXPLANATION:
Loop diuretics increase Na delivery to the distal tubule. Combined with volume contraction (aldosterone activation), this drives distal Na reabsorption in exchange for K and H secretion, resulting in hypokalemic metabolic alkalosis.
A 68 y/o M with COPD presents with fever and dyspnea 2 weeks after an influenza infection. CXR shows RLL consolidation. Sputum Gram stain reveals small Gram-negative coccobacilli. What is the most likely pathogen?
Anonymous Quiz
27%
Streptococcus pneumoniae
8%
Staphylococcus aureus
15%
Klebsiella pneumoniae
50%
Haemophilus influenzae
Maxemo EMREE 26-27
A 68 y/o M with COPD presents with fever and dyspnea 2 weeks after an influenza infection. CXR shows RLL consolidation. Sputum Gram stain reveals small Gram-negative coccobacilli. What is the most likely pathogen?
💡 EXPLANATION:
H. influenzae is a common cause of pneumonia in COPD patients and post-influenza. It presents as small Gram-negative coccobacilli. S. pneumoniae (Gram+ diplococci) and S. aureus (Gram+ clusters) are excluded by Gram stain. Klebsiella appear as Gram-negative rods.
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🔬 Today's Test: DERMATOLOGY
👉 https://app.maxemo.app/s/dft-emree
Yesterday's Ranks🏆
PUBLIC HEALTH
1. Piyush Patel
2. Shruti p
3. Rizwan H
4. Reyansh Malhotra
5. anjali
6. Kabir Reddy
7. Siddharth Sharma
8. Avantika Pillai
9. Zuzu
10. Dr.shymaa
⏳ Test Ends at 07:00 PM
Join channel 👇
https://t.me/studywithmaxemoemree
A G3P2 at 34 weeks gestation presents with sudden, painless bright red vaginal bleeding. She denies trauma or contractions. The uterus is soft and non-tender; FHR is reassuring. What is the most likely diagnosis?
Anonymous Quiz
70%
Placenta previa
22%
Placental abruption
4%
Vasa previa
4%
Uterine rupture
Maxemo EMREE 26-27
A G3P2 at 34 weeks gestation presents with sudden, painless bright red vaginal bleeding. She denies trauma or contractions. The uterus is soft and non-tender; FHR is reassuring. What is the most likely diagnosis?
💡 EXPLANATION:
Painless bright red bleeding in the 3rd trimester is the hallmark of placenta previa. Placental abruption typically presents with abdominal pain and a rigid uterus. Vasa previa presents with fetal distress after ROM. Uterine rupture is painful and catastrophic.
A 72 y/o M presents with acute ischemic stroke symptoms (onset 90 min). BP is 195/110 mmHg. CT head excludes hemorrhage. IV alteplase is planned. What is the mandatory step before initiating therapy?
Anonymous Quiz
5%
Administer aspirin 300 mg rectally
14%
Obtain diffusion-weighted MRI
76%
Lower BP to < 185/110 mmHg
5%
Start IV heparin infusion
Maxemo EMREE 26-27
A 72 y/o M presents with acute ischemic stroke symptoms (onset 90 min). BP is 195/110 mmHg. CT head excludes hemorrhage. IV alteplase is planned. What is the mandatory step before initiating therapy?
💡 EXPLANATION:
Systolic BP must be < 185 mmHg and diastolic < 110 mmHg before IV alteplase administration to reduce the risk of hemorrhagic transformation. If BP cannot be lowered safely, thrombolysis is contraindicated.