A six year old girl presenting to the pediatric emergency department with unstable gait and progressive difficulty climbing the stairs over the last 10 days the parents reported that the child has been “choking on her own saliva” the symptoms began was prickly sensation in the fingers and toes that developed to ascending and symmetrical there is a history of viral gastroenteritis three weeks before

physical examination confirms the absence of the knee-jerk reflex CSF analysis of weighted protein concentration with normal cell count
nerve conduction test reduced velocity which off the following is most appropriate treatment:
1-plasma exchange
2-IVIG ✅
3-MTX
4-steroids

جاني مرتين بالاختبار.

Child with 3 degree burn and 1% of genitalia surface affected:
A- Refer to burn unit ✅
B- sterile wound ointment
C- antibiotic ointment
D- dressing and discharge


Answer is A
Burns involving the face, hands, feet, genitalia, perineum, or major joints are an indication of referral to burn unit.
Ref: Schwartz.

Patient is suspected to have posriasis in the valva , highest diagnostic tool?
A-Biopsy ✅
B-scrach with hydroxyde
C-something iodine
D- Clinical diagnosis


Paoriasis is a Clinical diagnosis but when vulvar lesions are present biopsy becomes the diagnostic tool in this situation.
Ref: UTD.
جاني فالاختبار.

Pt with vesicles and maculopapular rash in the right chest, how to diagnose?
A- Blood culture
B- Skin biopsy
C- Skin swab for culture
D- No further tests required ✅

جاني في نوڤمبر
الكيس كانت واضحة انها shingles

No further tests required unless there’s a neurological symptoms in which we use PCR to diagnose it.

ماكان فيه Neurological Symptoms.
الاجابة D.

Pediatric with decreased appetite and fatigue , she had pallor and splenomegaly, and systolic murmur. Labs showed showed only IDA (low MCV, low hg) borderline reticulocytes (1.3), RBC (4)
I am not sure it they said iron was normal or not but I think it wasn’t mentioned
Provided this same exact picture ,what should be replaced?
A- Iron
B- Folate
C- VitB12
D- Erythrocytes

Another recalls:
Child has fatigue and splenomegally
Hb low
RBC low
MCV low
Retic normal
Iron normal
What to replace in this case?
A Iron
B.B12
C.Folate
D. Erythrocytes ✅

Child has fatigue and splenomegaly , Hb low,RBC low ,MCV low ,Retic normal ,Iron normal , What to replace in this case ?
A.Iron
B.B12
C.Folate
D.Erythrocytes ✅


Bdran: Answer is Erythrocytes. According to the other recalls the Iron profile was provided and it’s normal.
Since the Diagnostic test of IDA is iron profile this patient doesn’t have IDA.
So, replacing iron will have no rule in this case. A is excluded.

Exclude Vit B12 and folate since the lab shows Low MCV.

The only microcytic anemia that fits with this case is Thalassemia and to say wether major or minor we Need Hb electrophoresis.

Note: if the scenario didn’t mention Iron profile and gives you hints like:
- Drinking milk for a period of time
- high RDW
- Kolionychia and other signs of IDA
Answer will be Iron ✅


بحسب خبرتي المتواضعه في الـ SMLE اذا جاتك الصوره غير والسيناريو غير اعتمادك على السيناريو هو افضل خيار.
الصورة كأنّ فيها Hypersigmented neutrophil وتتعارض بشكل مباشر مع السيناريو.

15 month boy came to ER complaining of abdominal discomfort, emesis, stool with blood and mucus on phisycal examination he has increase abdominal sound
X-ray report shows obstractive bowel ( written like this )
A- give antibiotic
B- Go to OR and do surgery
C- Barium enema ✅
D- bowel rest, IV hydration and wait until symptoms gone


Answer is C.
15 months with these Sx?
Could be wither IBD, amebiasis, or intussusception.
I will go for Barium enema to confirm the diagnosis of intussuception.
Currant jelly stool is a mixture of blood and mucous and sloghed mucosa. ( Amboss )

In intussusception X ray will show a intestinal obstruction which is non specific finding.

next step would be US
Conformatory is Enema.

Management will be:
Fluid, electrolyte correction and Non- operative procedure by enema either with fluid or with air.
But Not to wait for the Sx to be gone you must act because it’s a mechanical problem, waiting for Sx to be gone will not be helpful.

When to go for OR?
- Failed enema 3 times.
- signs of peritonitis
- Unstable patients.

آخر ساعه من يوم الجمعه.
لاتنسوني وجميع المسلمين من طيب
دعواتكم.

رزقنا الله وإياكم فرحه تمحو كل حزن وفرج لكل صابر وشفاء لكل مريض ومعافاه لكل مُبتلى وغُفراناً لكل ذنب..

13 Dec

ER. Abdominal pain generlized tenderness hx of open laparotomy 10 years ago abdomen distended imaging multiple air levels distended small intestine fever no vitals what is the best?
A. Exp lap
B. Diagnostic laparoscope
C. Abx

Answer is CT scan ✅

This is a classic Question about adhesions.
They usually paints the scenario with Hx of surgical abdomen ( Laparotomy, sleeve, appendectomy ) and then presents with intestinal obstruction symptoms and multiple air levels on x ray.

CT scan is the preferred step in the approach to diagnose the adhesions.

This exact Question came to one of my colleagues and CT scan is present among choices ✅

Copd patient presented with exacerbation he was fully conscious. He was started on high flow oxygen then he started to deteriorate with decreased level of consciousness. PH 7.18 PaO2 15 kpa . What is the initial thing you would do?
A- intubation and ventilation
B- decrease oxygen flow ✅
C- give salbutamol?
D- give ipratropium?

COPD patients should never receive High flow oxygen.

Pt had RTA in er, only has a bruises in lower abdomen and abdominal pain, what is the most appropriate nest step ?
Bp : 110/80
Temperature : 37.2
HR : 88
RR : 19

A. CT
B. Fast
C. Initial assessment and resuscitation ✅
D. Exploratory laboratory

Primary survey should be the first step.

Pediatric, known case of congestive heart failure and hypertension presented with dyspnea on exertion And decreased exercise tolerance X ray showed cardiomyopathy:
A- stat iv frusemide ✅
B- digoxin
C- reassure as this is expected of disease

Another recall: a child known to have congestive heart failure and dilated cardiomyopathy, present with cough and shortness of breath A chest X-ray was given "" not the exact one but similar"" What consultation you will give?
A- give digoxin
B- give inhaled. can't remember exactly the one, but was one of the asthma drugs
C- tell them it's a normal progression of his disease

69- 6 YO known case of congestive heart failure, present in ER with SOB after playing, HR : 200 other examination normal, ask about apportiate mangment.

A- iv fursamide ✅
B- observation as symptom expected of his diagnosis.


جاني في نوڤمبر.
كان معاه صورة Xray فيها Cardiomegaly.

Answer is IV furosemide

65 years old man admitted for elective ventral hernia repair, K/C of hypertension and BA, upon examination bilateral crepitation, ascites and bilateral edema, what to do?
A- Proceed with hernia repair.
B- Don’t repair unless obstruction has occurred ✅
C- Delay until situation is controlled.

هذا جاني فالاختبار..
طيب عشان تفهمون ليش حطيت B
ركزوا معي

Smoking
Obesity
Diabetes
COPD
Asthma
Congestive heart failure

All of these are relative contraindications to elective ventral hernia repair.

Relative contraindications means:
You don’t repair the hernia unless incarcerated or strangulated.

As elaborated in this case patient has asthma and signs of congestive heart failure.

DrThawabah also agrees with this answer ✅.

UTD

Dr Thawabah

الابروتش اللي انا ماشي عليه في الـ Hemorrhoids:

Note: You should know the grades first.

Grade 1 and 2:
- start by conservative management ( High fiber diet, increase fluid intake, Avoid fatty meals, Regular exercise, sitz bath )

- If failed?
Rubber band ligation.

Grade 3:
- Start by conservative as above.
- if failed?
Does the patient have bleeding?
Yes? rubber band
No? hemorrhoidectomy

Grade 4 or thrombosed?
- Hemorrhoidectomy.

If the patient is 40 or above?
COLONOSCOPY!

Grades of internal hemorrhoids.

55 years old male, presented with exertional dyspnea and syncope, on examination he was found to have systolic ejection murmur that radiates to the carotids, on ECG there is left ventricular hypertophy. How would you manage this patient?

A- antihypertensives with tight BP control
B- refer for surgical correction ✅
C- give vasodilator
D- give diuretic

جاني فالاختبار..
Answer is B.
The murmur described in the question is a murmur of Aortic stenosis ( AS ).
Surgery is indicated for AS if:
- Symptomatic ( SAD )
Syncope, Angina, Dyspnea
- EF < 50%
- Going for cardiac surgery for other reason.