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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2. Reyansh Malhotra
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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
Maxemo EMREE 26-27
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?
💡 EXPLANATION:
Prerenal AKI is characterized by a disproportionately elevated urea, oliguria, and urine Na+ <20 mmol/L due to intact tubular sodium reabsorption in response to hypoperfusion from low cardiac output or diuretics.
A 30 y/o man is brought to the ED after prolonged heat exposure in the desert. Urine is dark brown; dipstick is positive for blood but microscopy shows no RBCs. Serum creatinine is elevated. Which mechanism best explains his renal failure?
Anonymous Quiz
60%
Tubular obstruction and oxidative damage by myoglobin
15%
Autoimmune destruction of the glomerular basement membrane
20%
Direct ischemic injury to the renal papillae
5%
Interstitial inflammation secondary to an allergic reaction
Maxemo EMREE 26-27
A 30 y/o man is brought to the ED after prolonged heat exposure in the desert. Urine is dark brown; dipstick is positive for blood but microscopy shows no RBCs. Serum creatinine is elevated. Which mechanism best explains his renal failure?
💡 EXPLANATION:
Heat stroke caused rhabdomyolysis, releasing myoglobin. Myoglobin is filtered by the kidneys, causing direct oxidative toxicity and tubular obstruction, leading to acute tubular necrosis. The dipstick detects myoglobin as false-positive blood.
A 50 y/o diabetic man presents with a BP of 140/90 mmHg and microalbuminuria (45 mg/day). Which medication is the most appropriate next step to slow the progression of his renal disease?
Anonymous Quiz
29%
Start amlodipine
57%
Start lisinopril
14%
Start furosemide
0%
Start metoprolol
Maxemo EMREE 26-27
A 50 y/o diabetic man presents with a BP of 140/90 mmHg and microalbuminuria (45 mg/day). Which medication is the most appropriate next step to slow the progression of his renal disease?
💡 EXPLANATION:
Lisinopril (an ACE inhibitor) is the drug of choice for diabetic patients with microalbuminuria. It slows nephropathy progression by dilating the efferent arteriole, thereby reducing intraglomerular pressure.
A 62 y/o man presents with acute onset right-sided facial droop, right arm weakness, and expressive aphasia. Which of the following is the most likely occluded vessel?
Anonymous Quiz
67%
Left middle cerebral artery
19%
Right middle cerebral artery
5%
Left anterior cerebral artery
10%
Left posterior cerebral artery
Maxemo EMREE 26-27
A 62 y/o man presents with acute onset right-sided facial droop, right arm weakness, and expressive aphasia. Which of the following is the most likely occluded vessel?
💡 EXPLANATION:
Left MCA occlusion classically presents with contralateral (right-sided) facial and upper extremity weakness, along with expressive (Broca's) aphasia due to involvement of the dominant cerebral hemisphere.