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.
A 68-year-old man with ischemic cardiomyopathy and LVEF 30% is clinically euvolemic following initial diuresis. Which medication provides a proven mortality benefit in this patient?
Anonymous Quiz
22%
Furosemide
9%
Digoxin
70%
Bisoprolol
0%
Diltiazem
Maxemo EMREE 26-27
A 68-year-old man with ischemic cardiomyopathy and LVEF 30% is clinically euvolemic following initial diuresis. Which medication provides a proven mortality benefit in this patient?
💡 EXPLANATION:
Guideline-directed medical therapy (GDMT) for HFrEF includes beta-blockers (e.g., Bisoprolol), which significantly reduce mortality. Diuretics improve symptoms only. Digoxin reduces hospitalizations but not mortality. Diltiazem is generally contraindicated.
A 55 y/o diabetic male presents with 40 min of severe central CP. BP 130/80. ECG shows STE in II, III, aVF. The facility lacks a cath lab; the nearest PCI center is 45 min away. What is the priority management strategy?
Anonymous Quiz
39%
Administer fibrinolysis immediately
57%
Transfer for primary PCI
4%
Await troponin results
0%
Admit to ICU for observation
Maxemo EMREE 26-27
A 55 y/o diabetic male presents with 40 min of severe central CP. BP 130/80. ECG shows STE in II, III, aVF. The facility lacks a cath lab; the nearest PCI center is 45 min away. What is the priority management strategy?
💡 EXPLANATION:
Diagnosis: Inferior STEMI. Guidelines recommend primary PCI over fibrinolysis if the transfer time allows FMC-to-device time <120 mins. With a 45 min transfer, PCI is feasible and superior. Waiting for biomarkers delays critical reperfusion.
A 67y M presents with exertional angina and dizziness. O/E reveals a harsh crescendo-decrescendo systolic murmur at the R 2nd ICS radiating to carotids. Which finding indicates hemodynamically severe aortic stenosis?
Anonymous Quiz
35%
Early systolic ejection click
30%
Single second heart sound
17%
Loud A2 component
17%
Widely split S2
Maxemo EMREE 26-27
A 67y M presents with exertional angina and dizziness. O/E reveals a harsh crescendo-decrescendo systolic murmur at the R 2nd ICS radiating to carotids. Which finding indicates hemodynamically severe aortic stenosis?
💡 EXPLANATION:
Severe AS causes valve immobility, leading to a soft/absent A2 and a single S2. Other signs of severity include a late-peaking murmur and pulsus parvus et tardus. An ejection click suggests a pliable valve (mild AS). Loud A2 indicates HTN.
A 72 y/o M presents with palpitations and mild dyspnea x3h. BP 118/70 mmHg, HR 140 bpm irregular. ECG confirms atrial fibrillation with rapid ventricular response. He is alert and hemodynamically stable. What is the priority initial goal?
Anonymous Quiz
10%
Synchronized cardioversion
67%
Ventricular rate control
10%
Pharmacologic cardioversion
14%
Systemic anticoagulation
Maxemo EMREE 26-27
A 72 y/o M presents with palpitations and mild dyspnea x3h. BP 118/70 mmHg, HR 140 bpm irregular. ECG confirms atrial fibrillation with rapid ventricular response. He is alert and hemodynamically stable. What is the priority initial goal?
💡 EXPLANATION:
In hemodynamically stable patients with acute atrial fibrillation and rapid ventricular response, the initial priority is ventricular rate control (e.g., Beta-blockers or CCBs) to improve symptoms. Cardioversion is reserved for unstable patients.
A 35 y/o M presents with sharp retrosternal pain, worse in supine position and relieved by sitting forward. He reports a recent viral URTI. ECG reveals diffuse concave ST elevations and PR depressions. What is the most likely diagnosis?
Anonymous Quiz
86%
Acute pericarditis
14%
Acute myocardial infarction
0%
Pulmonary embolism
0%
Aortic dissection
Maxemo EMREE 26-27
A 35 y/o M presents with sharp retrosternal pain, worse in supine position and relieved by sitting forward. He reports a recent viral URTI. ECG reveals diffuse concave ST elevations and PR depressions. What is the most likely diagnosis?
💡 EXPLANATION:
Positional chest pain (relieved by leaning forward) post-viral infection, combined with diffuse concave ST elevations and PR depressions on ECG, is pathognomonic for acute pericarditis. STEMI typically shows regional ST elevation.
A 64-year-old man presents with exertional angina and syncope. Exam reveals pulsus parvus et tardus and a harsh systolic murmur at the right upper sternal border. Echo shows an aortic valve area of 0.8 cm². What is the most likely etiology?
Anonymous Quiz
42%
Calcified bicuspid aortic valve
37%
Senile calcific degeneration
11%
Rheumatic heart disease
11%
Infective endocarditis
Maxemo EMREE 26-27
A 64-year-old man presents with exertional angina and syncope. Exam reveals pulsus parvus et tardus and a harsh systolic murmur at the right upper sternal border. Echo shows an aortic valve area of 0.8 cm². What is the most likely etiology?
💡 EXPLANATION:
Severe aortic stenosis (AVA <1.0 cm²) presents with angina, syncope, and dyspnea. In patients <70 years, calcification of a congenital bicuspid valve is the leading cause. Senile degeneration is the primary cause in patients >75 years.