A 45 y/o M presents with chronic sinusitis, nasal crusting, hemoptysis, and hematuria. Urinalysis shows RBC casts. Serum creatinine is elevated. Which diagnosis is most likely?
Anonymous Quiz
47%
Goodpasture syndrome
6%
Microscopic polyangiitis
29%
Granulomatosis with polyangiitis
18%
Churg-Strauss syndrome
Maxemo EMREE 26-27
A 45 y/o M presents with chronic sinusitis, nasal crusting, hemoptysis, and hematuria. Urinalysis shows RBC casts. Serum creatinine is elevated. Which diagnosis is most likely?
💡 EXPLANATION:
Granulomatosis with Polyangiitis (GPA/Wegener's) is defined by the triad of upper airway (sinusitis), lower airway (hemoptysis), and renal disease (glomerulonephritis). c-ANCA is typically positive. Goodpasture syndrome spares the upper airway.
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A patient presents with fever and cough. CXR demonstrates a dense opacity in the right lower zone that obscures the right heart border. What is the primary radiographic abnormality?
Anonymous Quiz
0%
Pleural effusion
87%
Lobar consolidation
13%
Pneumothorax
0%
Pulmonary edema
Maxemo EMREE 26-27
A patient presents with fever and cough. CXR demonstrates a dense opacity in the right lower zone that obscures the right heart border. What is the primary radiographic abnormality?
💡 EXPLANATION:
The finding of an opacity obscuring the heart border (positive Silhouette sign) is characteristic of lobar consolidation (pneumonia). This represents alveolar filling with fluid/pus. Pleural effusions typically show a meniscus, while pneumothorax appears hyperlucent.
A 32y F non-smoker presents with recurrent spontaneous pneumothorax. HRCT chest reveals diffuse, uniformly distributed thin-walled cysts. What is the most likely diagnosis?
Anonymous Quiz
28%
Pulmonary Langerhans cell histiocytosis
50%
Lymphangioleiomyomatosis
11%
Birt-Hogg-Dubé syndrome
11%
Lymphoid interstitial pneumonia
Maxemo EMREE 26-27
A 32y F non-smoker presents with recurrent spontaneous pneumothorax. HRCT chest reveals diffuse, uniformly distributed thin-walled cysts. What is the most likely diagnosis?
💡 EXPLANATION:
Lymphangioleiomyomatosis (LAM) affects women of childbearing age, presenting with recurrent pneumothorax and diffuse thin-walled cysts on HRCT. PLCH is associated with smoking and irregular cysts. Birt-Hogg-Dubé cysts are typically basal/subpleural.
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A patient presents with fever and cough. CXR demonstrates a dense opacity in the right lower zone that obscures the right heart border. What is the primary radiographic abnormality?
Anonymous Quiz
6%
Pleural effusion
69%
Lobar consolidation
19%
Pneumothorax
6%
Pulmonary edema
❤1
Maxemo EMREE 26-27
A patient presents with fever and cough. CXR demonstrates a dense opacity in the right lower zone that obscures the right heart border. What is the primary radiographic abnormality?
💡 EXPLANATION:
The finding of an opacity obscuring the heart border (positive Silhouette sign) is characteristic of lobar consolidation (pneumonia). This represents alveolar filling with fluid/pus. Pleural effusions typically show a meniscus, while pneumothorax appears hyperlucent.
A 32y F non-smoker presents with recurrent spontaneous pneumothorax. HRCT chest reveals diffuse, uniformly distributed thin-walled cysts. What is the most likely diagnosis?
Anonymous Quiz
32%
Pulmonary Langerhans cell histiocytosis
47%
Lymphangioleiomyomatosis
16%
Birt-Hogg-Dubé syndrome
5%
Lymphoid interstitial pneumonia
Maxemo EMREE 26-27
A 32y F non-smoker presents with recurrent spontaneous pneumothorax. HRCT chest reveals diffuse, uniformly distributed thin-walled cysts. What is the most likely diagnosis?
💡 EXPLANATION:
Lymphangioleiomyomatosis (LAM) affects women of childbearing age, presenting with recurrent pneumothorax and diffuse thin-walled cysts on HRCT. PLCH is associated with smoking and irregular cysts. Birt-Hogg-Dubé cysts are typically basal/subpleural.
A 45M with a devastating anoxic brain injury is evaluated for brain death. He has no cranial nerve reflexes and is apneic. His leg flexes slightly when his foot is stimulated. What is the most likely explanation for his leg movement?
Anonymous Quiz
14%
Incomplete Brainstem Death
14%
Malingering
64%
Spinal Reflex
7%
Locked-in Syndrome
Maxemo EMREE 26-27
A 45M with a devastating anoxic brain injury is evaluated for brain death. He has no cranial nerve reflexes and is apneic. His leg flexes slightly when his foot is stimulated. What is the most likely explanation for his leg movement?
💡 EXPLANATION:
Spinal reflexes (like the triple flexion reflex) are mediated by the spinal cord and can persist even with complete and irreversible loss of all brain and brainstem function. Their presence does not preclude the diagnosis of brain death.
❤1
What is the classic clinical triad for Susac syndrome?
Anonymous Quiz
20%
Encephalopathy, branch retinal artery occlusion, sensorineural hearing loss
40%
Nystagmus, intention tremor, scanning speech
0%
Hypertension, bradycardia, irregular respirations
40%
Hypotension, muffled heart sounds, jugular venous distention
Maxemo EMREE 26-27
What is the classic clinical triad for Susac syndrome?
💡 EXPLANATION:
Susac syndrome is a rare autoimmune endotheliopathy affecting the microvasculature of the brain, retina, and cochlea. Think of it as a triad of tiny vessel trouble hitting the head, eyes, and ears.
❤1
A 38-year-old female, one week post-thyroidectomy, presents with perioral tingling, carpopedal spasm, and respiratory stridor. Vitals are stable. What is the most appropriate initial step in management?
Anonymous Quiz
17%
Administer oral calcium and calcitriol
50%
Administer IV calcium gluconate
33%
Measure parathyroid hormone (PTH) level
0%
Administer IV magnesium sulfate