Maxemo EMREE 26-27
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Maxemo EMREE 26-27
A 67M post-stroke has a droopy left eyelid, a constricted left pupil, and loss of pain/temperature sensation on his left face and right body. What is the most likely diagnosis?
💡 EXPLANATION:
This classic presentation is known as Lateral Medullary (Wallenberg) Syndrome. The combination of ipsilateral Horner's syndrome (ptosis, miosis) and facial sensory loss with contralateral body sensory loss points to a lesion in the lateral medulla. Medial Medullary Syndrome presents with contralateral hemiparesis and ipsilateral tongue deviation. Weber's Syndrome is a midbrain stroke causing an ipsilateral CN III palsy and contralateral weakness. Locked-in Syndrome results from a pontine stroke, causing quadriplegia and mutism.
A boot-shaped heart (coeur en sabot) on chest X-ray is the classic pathognomonic finding for which congenital heart defect?
Anonymous Quiz
13%
Transposition of the Great Arteries
80%
Tetralogy of Fallot
7%
Coarctation of the Aorta
0%
Atrial Septal Defect
Maxemo EMREE 26-27
A boot-shaped heart (coeur en sabot) on chest X-ray is the classic pathognomonic finding for which congenital heart defect?
💡 EXPLANATION:
Remember the boot for PROVe: The shape comes from Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, and a Ventricular septal defect.
A 30-year-old is brought to the ER, found unconscious with bradypnea and pinpoint pupils. What is the most appropriate initial drug to administer?
Anonymous Quiz
6%
50% Dextrose
18%
Flumazenil
41%
Naloxone
35%
Atropine
Maxemo EMREE 26-27
A 30-year-old is brought to the ER, found unconscious with bradypnea and pinpoint pupils. What is the most appropriate initial drug to administer?
💡 EXPLANATION:
The clinical triad of CNS depression (unconsciousness), respiratory depression (bradypnea), and miosis (pinpoint pupils) is the hallmark of an opioid overdose. Naloxone is a competitive opioid antagonist and the immediate, life-saving antidote. While dextrose is considered for any patient with altered mental status, the specific toxidrome makes naloxone the priority. Flumazenil reverses benzodiazepines, and atropine would address bradycardia but not the underlying cause.
The Merseburger triad (goiter, exophthalmos, tachycardia) is indicative of which condition?
Anonymous Quiz
15%
Hashimoto's thyroiditis
85%
Graves' disease
0%
Pheochromocytoma
0%
De Quervain's thyroiditis
Maxemo EMREE 26-27
The Merseburger triad (goiter, exophthalmos, tachycardia) is indicative of which condition?
💡 EXPLANATION:
Graves' disease is an autoimmune disorder causing hyperthyroidism. The Merseburger triad (Goiter, Exophthalmos, Tachycardia) represents the classic signs of the body going into overdrive.
Maxemo EMREE 26-27
What is the primary mechanism of action of Tedizolid?
💡 EXPLANATION:
Tedizolid is an oxazolidinone antibiotic. It exerts its bacteriostatic effect by binding to the 23S rRNA of the 50S ribosomal subunit, which blocks the formation of the 70S initiation complex, thereby inhibiting bacterial protein synthesis at a very early stage.
Hb Electrophoresis: HbA 58%, HbS 35%, HbA2 2%, HbF 5%. These lab values are most consistent with which diagnosis?
Anonymous Quiz
18%
Sickle cell disease (HbSS)
73%
Sickle cell trait (HbAS)
9%
Beta-thalassemia major
0%
Beta-thalassemia minor
Maxemo EMREE 26-27
Hb Electrophoresis: HbA 58%, HbS 35%, HbA2 2%, HbF 5%. These lab values are most consistent with which diagnosis?
💡 EXPLANATION:
The diagnosis is Sickle Cell Trait (HbAS). The key finding is the presence of both normal adult hemoglobin (HbA) and sickle hemoglobin (HbS), with HbA being the larger fraction (>50%). In sickle cell trait, individuals are heterozygous, carrying one normal beta-globin gene and one sickle cell gene. This results in the production of more HbA than HbS. Sickle cell disease has predominant HbS. Beta-thalassemia major has predominant HbF. Beta-thalassemia minor has elevated HbA2.
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What is the recommended first-line empiric treatment for a non-ICU patient who develops hospital-acquired pneumonia (HAP) with a low risk of MRSA?
Anonymous Quiz
10%
Ceftriaxone
20%
Piperacillin-Tazobactam
50%
Vancomycin
20%
Levofloxacin
Maxemo EMREE 26-27
What is the recommended first-line empiric treatment for a non-ICU patient who develops hospital-acquired pneumonia (HAP) with a low risk of MRSA?
💡 EXPLANATION:
Piperacillin-Tazobactam is a broad-spectrum antibiotic with excellent coverage against common HAP pathogens, including Pseudomonas aeruginosa, other gram-negatives, and anaerobes. For empiric treatment of HAP where MRSA risk is low, guidelines recommend an agent like Pip-Tazo that covers Pseudomonas. Ceftriaxone lacks pseudomonal coverage. Vancomycin is for MRSA. Levofloxacin is reserved due to resistance concerns.
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A 26-year-old man with a 4-year history of heavy smoking presents with acute-onset left-sided pleuritic chest pain and shortness of breath. These new findings are most likely due to which complication?
Anonymous Quiz
20%
Acute exacerbation of COPD
60%
Spontaneous pneumothorax
10%
Lung cancer
10%
Pulmonary embolism
Maxemo EMREE 26-27
A 26-year-old man with a 4-year history of heavy smoking presents with acute-onset left-sided pleuritic chest pain and shortness of breath. These new findings are most likely due to which complication?
💡 EXPLANATION:
Smoking is a major risk factor for primary spontaneous pneumothorax in young adults, often due to the rupture of apical blebs. The sudden onset of unilateral chest pain and dyspnea is the classic presentation. COPD is unlikely at this young age, and lung cancer typically has a more gradual onset.
Recall the 67M with Lateral Medullary Syndrome. He now develops hoarseness and difficulty swallowing. Which cranial nerve nucleus is responsible for these new findings?
Anonymous Quiz
33%
Hypoglossal Nucleus
0%
Facial Nucleus
67%
Nucleus Ambiguus
0%
Trigeminal Motor Nucleus
Maxemo EMREE 26-27
Recall the 67M with Lateral Medullary Syndrome. He now develops hoarseness and difficulty swallowing. Which cranial nerve nucleus is responsible for these new findings?
💡 EXPLANATION:
The new onset of dysphonia (hoarseness) and dysphagia (difficulty swallowing) in a patient with Lateral Medullary Syndrome points directly to the involvement of the Nucleus Ambiguus. This nucleus, located in the medulla, provides motor fibers to CN IX and X, which control the muscles of the pharynx and larynx.