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
85%
Acute pericarditis
15%
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
44%
Calcified bicuspid aortic valve
33%
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
18%
Rapid passive ventricular filling
18%
Atrial contraction against resistance
47%
Abrupt arrest of mitral leaflet opening
18%
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
17%
Ruptured chordae tendineae
17%
Rheumatic leaflet fusion
17%
Myxomatous degeneration
50%
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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2. Rizwan H
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2. Reyansh Malhotra
3. Rizwan H
4. Piyush Patel
5. Wafaa
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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
10%
Left anterior descending
5%
Left circumflex
86%
Right coronary artery
0%
Left main
Maxemo EMREE 26-27
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?
💡 EXPLANATION:
ST elevation in leads II, III, and aVF indicates an inferior wall MI. This territory is supplied by the Right Coronary Artery (RCA) in approximately 85-90% of patients (right-dominant circulation).
A 23 y/o F presents with palpitations. Auscultation reveals a mid-systolic click followed by a late systolic murmur at the apex. The murmur intensity increases with the Valsalva maneuver. What is the most likely diagnosis?
Anonymous Quiz
41%
Mitral valve prolapse
18%
Aortic stenosis
14%
Mitral stenosis
27%
Hypertrophic cardiomyopathy
Maxemo EMREE 26-27
A 23 y/o F presents with palpitations. Auscultation reveals a mid-systolic click followed by a late systolic murmur at the apex. The murmur intensity increases with the Valsalva maneuver. What is the most likely diagnosis?
💡 EXPLANATION:
MVP is characterized by a mid-systolic click and late systolic murmur. Decreasing preload (Valsalva) causes earlier leaflet prolapse, accentuating the murmur. This distinguishes it from most murmurs, which decrease with Valsalva.
A 60 y/o M with a 40-pack-year smoking history presents with chronic productive cough and dyspnea. O/E: prolonged expiration. CXR shows hyperinflated lungs. Which investigation is required to confirm the diagnosis and grade severity?
Anonymous Quiz
24%
High-resolution CT chest
10%
Arterial blood gas
48%
Spirometry
19%
Peak expiratory flow rate
Maxemo EMREE 26-27
A 60 y/o M with a 40-pack-year smoking history presents with chronic productive cough and dyspnea. O/E: prolonged expiration. CXR shows hyperinflated lungs. Which investigation is required to confirm the diagnosis and grade severity?
💡 EXPLANATION:
Spirometry is the gold standard for confirming COPD diagnosis (post-bronchodilator FEV1/FVC < 0.70) and grading airflow limitation severity (GOLD guidelines). While CXR suggests hyperinflation, it is not diagnostic for obstruction.
65 y/o M smoker presents with chronic productive cough, dyspnea, and central cyanosis. Chest auscultation reveals bilateral rhonchi. ABG shows hypoxemia and hypercapnia. Which pathological change is the primary cause?
Anonymous Quiz
20%
Alveolar septal destruction
60%
Mucous gland hypertrophy
15%
Reversible bronchoconstriction
5%
Interstitial collagen deposition
Maxemo EMREE 26-27
65 y/o M smoker presents with chronic productive cough, dyspnea, and central cyanosis. Chest auscultation reveals bilateral rhonchi. ABG shows hypoxemia and hypercapnia. Which pathological change is the primary cause?
💡 EXPLANATION:
The patient exhibits signs of Chronic Bronchitis ('Blue Bloater'). The primary pathology is mucous gland hypertrophy and hyperplasia in the bronchi, leading to mucus hypersecretion. Alveolar destruction is seen in emphysema ('Pink Puffer').
A 28y/o F, non-smoker, presents with dry cough, dyspnea, and fatigue. CXR reveals bilateral hilar lymphadenopathy. Labs show elevated serum ACE and calcium. What is the most appropriate next step to establish a definitive diagnosis?
Anonymous Quiz
22%
High-resolution CT chest
78%
Bronchoscopy with transbronchial biopsy
0%
Surgical mediastinoscopy
0%
Initiate oral corticosteroids