Maxemo EMREE 26-27
A 40 y/o woman has a seizure 2 days after severe postpartum hemorrhage. She cannot lactate. BP 101/61 mmHg, glucose 2.0 mmol/L. What is the most likely underlying mechanism?
💡 EXPLANATION:
Sheehan syndrome occurs due to severe postpartum hemorrhage causing hypoperfusion and ischemic necrosis of the pituitary gland. This panhypopituitarism presents with failure to lactate and secondary adrenal insufficiency (hypoglycemia, hypotension).
A 57 y/o F with a history of IV drug use presents with a DVT. Labs show elevated creatinine (150 µmol/L) and low total calcium (1.4 mmol/L). What is the most likely underlying mechanism for her hypercoagulable state?
Anonymous Quiz
13%
Factor V Leiden mutation
7%
Antiphospholipid antibodies
20%
Decreased hepatic synthesis of Protein C
60%
Urinary loss of antithrombin III
Maxemo EMREE 26-27
A 57 y/o F with a history of IV drug use presents with a DVT. Labs show elevated creatinine (150 µmol/L) and low total calcium (1.4 mmol/L). What is the most likely underlying mechanism for her hypercoagulable state?
💡 EXPLANATION:
IV drug use can cause nephropathy. The low total calcium reflects severe hypoalbuminemia seen in nephrotic syndrome. The hypercoagulable state is driven by excessive urinary loss of anticoagulant proteins, specifically antithrombin III.
A 17 y/o F weightlifter presents with primary amenorrhea. She has new unilateral pulsating headaches and nausea. Exam shows normal breast/pubic hair and normal pelvis. BP 137/90 mmHg, HR 98/min. Urine hCG is negative. Most likely diagnosis?
Anonymous Quiz
6%
Prolactinoma
6%
Mullerian agenesis
0%
Polycystic ovary syndrome
89%
Functional hypothalamic amenorrhea
Maxemo EMREE 26-27
A 17 y/o F weightlifter presents with primary amenorrhea. She has new unilateral pulsating headaches and nausea. Exam shows normal breast/pubic hair and normal pelvis. BP 137/90 mmHg, HR 98/min. Urine hCG is negative. Most likely diagnosis?
💡 EXPLANATION:
Functional hypothalamic amenorrhea results from excessive physical stress (intense exercise) suppressing the HPO axis. This causes anovulation and presents as primary or secondary amenorrhea in competitive female athletes.
28 y/o F with Crohn's and BMI 33 presents with tender, discharging nodules and fistulas in the right inframammary fold for 2 months. She has a history of axillary lesions that healed with scarring. What is the most likely diagnosis?
Anonymous Quiz
12%
Furunculosis
0%
Acne conglobata
65%
Hidradenitis suppurativa
24%
Cutaneous Crohn's disease
Maxemo EMREE 26-27
28 y/o F with Crohn's and BMI 33 presents with tender, discharging nodules and fistulas in the right inframammary fold for 2 months. She has a history of axillary lesions that healed with scarring. What is the most likely diagnosis?
💡 EXPLANATION:
Hidradenitis suppurativa is a chronic inflammatory disease causing recurrent nodules, abscesses, and fistulas in intertriginous zones. It heals with scarring and is strongly associated with obesity, insulin resistance, and Crohn's disease.
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🔬 Today's Test: EMERGENCY MEDICINE
👉 https://app.maxemo.app/s/dft-emree
Yesterday's Ranks🏆
CARDIOLOGY
1. Mohammed Aramin
2. UNBOTHERED SOUL
3. Samyak99
4. Aisha
5. Shruti p
6. Silverlin
7. Cipher_
8. Reyansh Malhotra
9. Samer
10. Aysha
⏳ Test Ends at 07:00 PM
Join channel 👇
https://t.me/studywithmaxemoemree
A 37 y/o M with HIV on ART presents with progressive gynecomastia, a buffalo hump, hollowed cheeks, and dyslipidemia. The medication class responsible for this syndrome is most known to induce which metabolic abnormality?
Anonymous Quiz
6%
Hypocalcemia
81%
Insulin resistance
6%
Hyperuricemia
6%
Hypothyroidism
Maxemo EMREE 26-27
A 37 y/o M with HIV on ART presents with progressive gynecomastia, a buffalo hump, hollowed cheeks, and dyslipidemia. The medication class responsible for this syndrome is most known to induce which metabolic abnormality?
💡 EXPLANATION:
Protease inhibitors can cause lipodystrophy syndrome, altering adipocyte function and glucose transporters. This leads to peripheral insulin resistance, hyperglycemia, dyslipidemia, and characteristic fat redistribution.
A 68 y/o M presents with worsening confusion, polyuria, and 7 kg weight loss over 3 weeks. Labs show severe hypercalcemia (Ca2+ 3.05 mmol/L) and a suppressed PTH level (8 pg/mL). What is the most likely cause of his presentation?
Anonymous Quiz
18%
Primary hyperparathyroidism
76%
Occult malignancy
6%
Vitamin D toxicity
0%
Thiazide-induced hypercalcemia
Maxemo EMREE 26-27
A 68 y/o M presents with worsening confusion, polyuria, and 7 kg weight loss over 3 weeks. Labs show severe hypercalcemia (Ca2+ 3.05 mmol/L) and a suppressed PTH level (8 pg/mL). What is the most likely cause of his presentation?
💡 EXPLANATION:
Severe hypercalcemia with suppressed PTH and significant weight loss in an elderly patient strongly indicates a PTH-independent cause, most commonly an occult malignancy producing PTH-related peptide (PTHrP).
A 65M with diaphoresis presents with 2 hours of substernal chest pain. His ECG shows ST elevation in leads II, III, and aVF. What is the most likely diagnosis?
Anonymous Quiz
10%
Anterior wall myocardial infarction
90%
Inferior wall myocardial infarction
0%
Lateral wall myocardial infarction
0%
Acute pericarditis
Maxemo EMREE 26-27
A 65M with diaphoresis presents with 2 hours of substernal chest pain. His ECG shows ST elevation in leads II, III, and aVF. What is the most likely diagnosis?
💡 EXPLANATION:
ST elevation in leads II, III, and aVF localizes the infarct to the inferior wall of the heart. Anterior MI involves V1 to V4, lateral MI involves leads I, aVL, V5, and V6, and acute pericarditis typically causes diffuse ST elevation.
A child presents with a bright red rash on both cheeks giving a classic slapped cheek appearance. What is the most likely diagnosis?
Anonymous Quiz
64%
Erythema infectiosum
32%
Scarlet fever
5%
Measles
0%
Rubella
Maxemo EMREE 26-27
A child presents with a bright red rash on both cheeks giving a classic slapped cheek appearance. What is the most likely diagnosis?
💡 EXPLANATION:
Erythema infectiosum, also called fifth disease, is caused by parvovirus B19. The characteristic slapped cheek rash is pathognomonic.
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show TSH 14 mIU per L and free T4 0.5 ng per dL. No goiter is palpated. What is the most appropriate next step?
Anonymous Quiz
50%
Start levothyroxine therapy
15%
Repeat TSH and free T4 in 4 weeks
10%
Order a thyroid ultrasound
25%
Check for anti TPO antibodies
Maxemo EMREE 26-27
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show TSH 14 mIU per L and free T4 0.5 ng per dL. No goiter is palpated. What is the most appropriate next step?
💡 EXPLANATION:
The patient has overt primary hypothyroidism with both clinical features and biochemical confirmation. Immediate treatment with levothyroxine is indicated. Further testing can be done later but should not delay therapy.
Postoperative fever and confusion in an elderly patient with an indwelling urinary catheter is most indicative of which condition?
Anonymous Quiz
10%
Atelectasis
85%
Urosepsis
5%
Surgical site infection
0%
Anastomotic leak
Maxemo EMREE 26-27
Postoperative fever and confusion in an elderly patient with an indwelling urinary catheter is most indicative of which condition?
💡 EXPLANATION:
In an elderly catheterized patient, fever with delirium strongly suggests urinary tract infection progressing to urosepsis. This corresponds to the water category in postoperative fever causes.