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.
A 56 y/o F with a history of rheumatic fever presents with dyspnea. Auscultation at the apex reveals a mid-diastolic rumbling murmur preceded by a sharp, high-pitched sound shortly after S2. What is the mechanism of this early diastolic sound?
Anonymous Quiz
22%
Rapid passive ventricular filling
17%
Atrial contraction against resistance
44%
Abrupt arrest of mitral leaflet opening
17%
Prolapse of mitral valve leaflets
Maxemo EMREE 26-27
A 56 y/o F with a history of rheumatic fever presents with dyspnea. Auscultation at the apex reveals a mid-diastolic rumbling murmur preceded by a sharp, high-pitched sound shortly after S2. What is the mechanism of this early diastolic sound?
💡 EXPLANATION:
The sound is an Opening Snap (OS), characteristic of Mitral Stenosis. It occurs in early diastole when high atrial pressure forces the stenotic leaflets open, causing them to snap as they abruptly reach their limit. Rapid filling causes S3.
A 65 y/o male with HTN and smoking history presents with progressive SOB. Exam: displaced apex beat, S3 gallop, and apical holosystolic murmur radiating to the axilla. Echo shows dilated LV, reduced EF, and normal MV leaflets. What is the mechanism?
Anonymous Quiz
21%
Ruptured chordae tendineae
16%
Rheumatic leaflet fusion
16%
Myxomatous degeneration
47%
Mitral annulus dilation
Maxemo EMREE 26-27
A 65 y/o male with HTN and smoking history presents with progressive SOB. Exam: displaced apex beat, S3 gallop, and apical holosystolic murmur radiating to the axilla. Echo shows dilated LV, reduced EF, and normal MV leaflets. What is the mechanism?
💡 EXPLANATION:
This describes functional (secondary) mitral regurgitation. Left ventricular dilation stretches the mitral annulus and displaces papillary muscles (tethering), preventing proper leaflet coaptation despite the leaflets being structurally normal.
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Yesterday's Ranks🏆
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1. Reyansh Malhotra
2. Rizwan H
3. Sam
4. Dr. Shukla
5. Samyak99
6. Shruti p
7. Siddharth Sharma
8. Zaffar
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DERMATOLOGY
1. Mohammed Aramin
2. Reyansh Malhotra
3. Rizwan H
4. Piyush Patel
5. Wafaa
6. Dr.shymaa
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A 55 y/o M presents to ED with severe chest pain radiating to the left arm. ECG reveals ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
Anonymous Quiz
9%
Left anterior descending
5%
Left circumflex
86%
Right coronary artery
0%
Left main