Maxemo EMREE 26-27
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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
25%
Acute exacerbation of COPD
54%
Spontaneous pneumothorax
4%
Lung cancer
17%
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
47%
Hypoglossal Nucleus
7%
Facial Nucleus
33%
Nucleus Ambiguus
13%
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.
Postoperative fever and confusion in an elderly patient with an indwelling urinary catheter is most indicative of which condition?
Anonymous Quiz
12%
Atelectasis
76%
Urosepsis
12%
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.
Maxemo EMREE 26-27
What is the primary mechanism of action of spironolactone?
💡 EXPLANATION:
Spironolactone is a potassium sparing diuretic that competitively antagonizes aldosterone receptors in the distal nephron, reducing sodium reabsorption and potassium excretion.
A 55M with resistant hypertension, carotid bruits, and peripheral artery disease has hypokalemia and elevated plasma renin activity. These findings are most consistent with which condition?
Anonymous Quiz
17%
Primary aldosteronism
50%
Renovascular hypertension
8%
Cushing syndrome
25%
Pheochromocytoma
Maxemo EMREE 26-27
A 55M with resistant hypertension, carotid bruits, and peripheral artery disease has hypokalemia and elevated plasma renin activity. These findings are most consistent with which condition?
💡 EXPLANATION:
Widespread atherosclerosis with resistant hypertension and high renin levels suggests renal artery stenosis causing renovascular hypertension. Primary aldosteronism typically suppresses renin.
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Maxemo EMREE 26-27
The underlying pathophysiology of iron deficiency anemia involves:
💡 EXPLANATION:
Iron is essential for heme synthesis. Deficiency leads to reduced hemoglobin production and microcytic hypochromic red blood cells.
A stable 30-year-old woman with pain and bleeding at 8 weeks amenorrhea has ultrasound evidence of a right adnexal mass and no intrauterine pregnancy. Beta hCG is 1200. What is the most appropriate management?
Anonymous Quiz
29%
Administer methotrexate
71%
Repeat beta hCG in 48 hours
0%
Laparoscopic salpingectomy
0%
Expectant management
Maxemo EMREE 26-27
A stable 30-year-old woman with pain and bleeding at 8 weeks amenorrhea has ultrasound evidence of a right adnexal mass and no intrauterine pregnancy. Beta hCG is 1200. What is the most appropriate management?
💡 EXPLANATION:
This is a confirmed ectopic pregnancy meeting criteria for medical management with methotrexate due to hemodynamic stability, low beta hCG level, and small adnexal mass.
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A patient with Graves disease develops a subtle high frequency tremor of the outstretched hands. This finding represents which complication?
Anonymous Quiz
29%
Coarse tremor
14%
Pretibial myxedema
14%
Exophthalmos
43%
Fine tremor
Maxemo EMREE 26-27
A patient with Graves disease develops a subtle high frequency tremor of the outstretched hands. This finding represents which complication?
💡 EXPLANATION:
Hyperthyroidism produces an adrenergic state leading to a high frequency low amplitude fine tremor, best seen with hands outstretched.
A patient with an inferior STEMI develops hypotension after nitrates with clear lung fields. What is the most likely cause?
Anonymous Quiz
0%
Papillary muscle rupture
40%
Right ventricular infarction
0%
Ventricular free wall rupture
60%
Cardiogenic shock from left ventricular failure
Maxemo EMREE 26-27
A patient with an inferior STEMI develops hypotension after nitrates with clear lung fields. What is the most likely cause?
💡 EXPLANATION:
Inferior STEMI may involve the right ventricle. Nitrates reduce preload and can precipitate hypotension in right ventricular infarction. Clear lungs argue against left ventricular failure.