32y F p/w bloody diarrhea and fever (39.5°C) x2 days after eating undercooked eggs. She is immunocompetent with mild dehydration. Vitals are stable. What is the most appropriate management?
Anonymous Quiz
17%
Oral ciprofloxacin
52%
Oral rehydration therapy
0%
Loperamide
30%
Intravenous ceftriaxone
Maxemo EMREE 26-27
32y F p/w bloody diarrhea and fever (39.5°C) x2 days after eating undercooked eggs. She is immunocompetent with mild dehydration. Vitals are stable. What is the most appropriate management?
💡 EXPLANATION:
Non-typhoidal Salmonella is usually self-limited in immunocompetent adults. Treatment is supportive (fluids/electrolytes). Antibiotics are not indicated as they prolong the carrier state. Antimotility agents are contraindicated in bloody diarrhea.
A 4 y/o M presents with pallor and dark urine 2 weeks after an episode of bloody diarrhea. Labs: Hb 7.5 g/dL, Plt 95×10^9/L, Cr 168 µmol/L, and schistocytes on smear. Which triad defines this clinical syndrome?
Anonymous Quiz
9%
Fever, hemolytic anemia, neurological signs
91%
Microangiopathic hemolytic anemia, thrombocytopenia, AKI
0%
Anemia, neutropenia, thrombocytopenia
0%
Hematuria, hypertension, edema
Maxemo EMREE 26-27
A 4 y/o M presents with pallor and dark urine 2 weeks after an episode of bloody diarrhea. Labs: Hb 7.5 g/dL, Plt 95×10^9/L, Cr 168 µmol/L, and schistocytes on smear. Which triad defines this clinical syndrome?
💡 EXPLANATION:
Diagnosis is Hemolytic Uremic Syndrome (HUS), often post-diarrheal (STEC). The classic triad is Microangiopathic Hemolytic Anemia (MAHA), Thrombocytopenia, and Acute Kidney Injury (AKI). TTP adds fever and neuro signs.
A 37y/o M smoker, BMI 33 kg/m², reports 1-month retrosternal burning worsening after meals and when supine. No dysphagia or weight loss. Vitals are stable. What is the most appropriate initial management?
Anonymous Quiz
17%
Refer for upper endoscopy
26%
H. pylori urea breath test
35%
Initiate empiric omeprazole
22%
Ambulatory 24-hour pH monitoring
Maxemo EMREE 26-27
A 37y/o M smoker, BMI 33 kg/m², reports 1-month retrosternal burning worsening after meals and when supine. No dysphagia or weight loss. Vitals are stable. What is the most appropriate initial management?
💡 EXPLANATION:
Classic GERD symptoms without alarm features (dysphagia, GI bleeding, weight loss) warrant an empiric trial of proton pump inhibitors (PPI) for 8 weeks. Endoscopy is indicated for alarm symptoms or treatment failure. Testing for H. pylori is not first-line for typical GERD.
A 40y/o F with obesity and DM2 presents with persistent RUQ pain, fever (38.6°C), and nausea for 12 hours. Exam reveals a positive Murphy sign. What is the most likely diagnosis?
Anonymous Quiz
0%
Biliary colic
91%
Acute cholecystitis
0%
Choledocholithiasis
9%
Ascending cholangitis
Maxemo EMREE 26-27
A 40y/o F with obesity and DM2 presents with persistent RUQ pain, fever (38.6°C), and nausea for 12 hours. Exam reveals a positive Murphy sign. What is the most likely diagnosis?
💡 EXPLANATION:
Persistent RUQ pain (>6h), fever, and positive Murphy sign indicate acute cholecystitis due to cystic duct obstruction. Biliary colic typically resolves <6h without systemic signs. Cholangitis presents with Charcot triad (fever, RUQ pain, jaundice).
A 62 y/o M presents with sudden onset of large-volume, painless bright red blood per rectum. Vitals are stable. Abdomen is soft and non-tender. The bleeding stops spontaneously after 4 hours. What is the most likely diagnosis?
Anonymous Quiz
35%
Angiodysplasia
39%
Diverticulosis
9%
Ischemic colitis
17%
Colorectal carcinoma
Maxemo EMREE 26-27
A 62 y/o M presents with sudden onset of large-volume, painless bright red blood per rectum. Vitals are stable. Abdomen is soft and non-tender. The bleeding stops spontaneously after 4 hours. What is the most likely diagnosis?
💡 EXPLANATION:
Diverticulosis is the most common cause of acute, painless, large-volume lower GI bleeding in patients >60 y/o. It results from the rupture of the vasa recta at the diverticular neck. Unlike ischemic colitis, it is painless.
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HIGH YIELD
1. Silverlin
2. Reyansh Malhotra
3. Samira
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A 27-year-old male unrestrained passenger in an MVC presents unresponsive. BP 60/33 mmHg, HR 180/min. FAST scan is positive. Blood samples are drawn immediately prior to fluid resuscitation. Which of the following is the most likely Hemoglobin finding?
Anonymous Quiz
30%
Normal range
35%
Mildly decreased
35%
Severely decreased
0%
Elevated
Maxemo EMREE 26-27
A 27-year-old male unrestrained passenger in an MVC presents unresponsive. BP 60/33 mmHg, HR 180/min. FAST scan is positive. Blood samples are drawn immediately prior to fluid resuscitation. Which of the following is the most likely Hemoglobin finding?
💡 EXPLANATION:
In acute hemorrhage, whole blood (RBCs and plasma) is lost proportionally. Consequently, initial Hb and Hct remain normal. These values decrease only after hemodilution occurs via IV fluid administration or physiological fluid shifts.
32 y/o F presents with recurrent retrosternal chest pain and dysphagia to solids/liquids for 7 months. Symptoms persist despite 8-week PPI. PE and barium swallow are normal. What is the most appropriate next investigation?
Anonymous Quiz
44%
Upper GI endoscopy
16%
Ambulatory pH monitoring
40%
High-resolution manometry
0%
CT chest with contrast
Maxemo EMREE 26-27
32 y/o F presents with recurrent retrosternal chest pain and dysphagia to solids/liquids for 7 months. Symptoms persist despite 8-week PPI. PE and barium swallow are normal. What is the most appropriate next investigation?
💡 EXPLANATION:
Dysphagia to solids and liquids with normal barium swallow suggests a motility disorder (e.g., achalasia, diffuse esophageal spasm). High-resolution manometry is the diagnostic gold standard. Endoscopy evaluates structural lesions, while pH monitoring assesses reflux.
A 5 y/o boy presents with periorbital swelling and frothy urine. BP is normal. Urinalysis shows 3+ protein and no RBCs. Labs show serum albumin 20 g/L and hypercholesterolemia. What is the most likely diagnosis?
Anonymous Quiz
75%
Minimal change disease
17%
Post-streptococcal glomerulonephritis
8%
Focal segmental glomerulosclerosis
0%
Membranous nephropathy
Maxemo EMREE 26-27
A 5 y/o boy presents with periorbital swelling and frothy urine. BP is normal. Urinalysis shows 3+ protein and no RBCs. Labs show serum albumin 20 g/L and hypercholesterolemia. What is the most likely diagnosis?
💡 EXPLANATION:
Minimal change disease is the most common cause of pediatric nephrotic syndrome, presenting with massive proteinuria and edema. It is characterized by podocyte effacement on electron microscopy. It typically responds well to systemic corticosteroids.
A 9 y/o boy presents with cola-colored urine and periorbital edema 2 weeks after an impetigo infection. BP 160/100 mmHg. Urinalysis shows RBC casts and proteinuria. ASO titers are elevated. What is the underlying mechanism of this condition?
Anonymous Quiz
19%
Type II hypersensitivity
57%
Type III hypersensitivity
19%
Type IV hypersensitivity
5%
Type I hypersensitivity
Maxemo EMREE 26-27
A 9 y/o boy presents with cola-colored urine and periorbital edema 2 weeks after an impetigo infection. BP 160/100 mmHg. Urinalysis shows RBC casts and proteinuria. ASO titers are elevated. What is the underlying mechanism of this condition?
💡 EXPLANATION:
Post-streptococcal glomerulonephritis is a Type III hypersensitivity reaction caused by immune complex deposition in the glomeruli. It presents with hematuria, edema, hypertension, low C3 levels, and classic 'lumpy-bumpy' deposits.
A 65 y/o post-MI patient on loop diuretics becomes oliguric. Labs show serum urea 16 mmol/L, creatinine 220 µmol/L, and urine Na+ <20 mmol/L. What is the most likely cause of his acute kidney injury?
Anonymous Quiz
26%
Acute tubular necrosis
63%
Prerenal hypoperfusion
11%
Acute interstitial nephritis
0%
Postrenal obstruction