Vulvar lesion at 5 o'clock, inflammatory changes up to cervix, red , edematus :
A- Carbuncle
B- Bartholin
C- SCC
D- furuncle
Could be this question: 38-year-old women is seen for the evaluation of a swelling in her right vulva. She has also noted pain in this area when walking and during coitus. On examination a
mildly tender fluctuant mass was noticed just outside the introits in the right
vulva. What is the most likely diagnosis?
Abdulrahman: The answer is Bartholin’s abscess. Bartholin’s glands are normally located located at the 5-o’clock and 7-o’clock position. When infected (abscess), they are usually unilateral, tender, and are surrounded by edema and erythema.
A- Carbuncle
B- Bartholin
C- SCC
D- furuncle
Could be this question: 38-year-old women is seen for the evaluation of a swelling in her right vulva. She has also noted pain in this area when walking and during coitus. On examination a
mildly tender fluctuant mass was noticed just outside the introits in the right
vulva. What is the most likely diagnosis?
Abdulrahman: The answer is Bartholin’s abscess. Bartholin’s glands are normally located located at the 5-o’clock and 7-o’clock position. When infected (abscess), they are usually unilateral, tender, and are surrounded by edema and erythema.
30 weeks gestamon , she has lower abdominal pain with no bleeding or leaking if we suspect preterm labor , which of the following will confirm preterm labor ?
A- History will be enough to confirm preterm labor
B- Presence of contracaons in the CTG
C- Pelvic examinaaon
D- cervix length
Better recall or another similar question: A mother presented to the clinic at 30 weeks gestation with +ve uterine contractions 4 in 10mins With no bleeding and Leakage. CTG is normal and reactive. Which of the following will confirm preterm labor?
A- Cervical dilatation exam
B- History alone is enough for diagnosis
C- CTG is diagnostic
D- No leakage means no preterm labor
Abdulrahman: The answer is cervical dilation through pelvic examination. All the other options are clearly incorrect. UTD: labor is defined as regular and painful uterine contractions that cause progressive dilation & effacement of the cervix. No contractions = not in labor, thus it’s essential to identify the presence of contraction on CTG (missing in the first question). Presence of contractions only could indicate false labor (Braxton Hicks). Braxton Hicks are irregular in frequency, less intense and usually go away if you change positions. They are the body's way of getting ready for labor, but it doesn't mean labor is coming.
A- History will be enough to confirm preterm labor
B- Presence of contracaons in the CTG
C- Pelvic examinaaon
D- cervix length
Better recall or another similar question: A mother presented to the clinic at 30 weeks gestation with +ve uterine contractions 4 in 10mins With no bleeding and Leakage. CTG is normal and reactive. Which of the following will confirm preterm labor?
A- Cervical dilatation exam
B- History alone is enough for diagnosis
C- CTG is diagnostic
D- No leakage means no preterm labor
Abdulrahman: The answer is cervical dilation through pelvic examination. All the other options are clearly incorrect. UTD: labor is defined as regular and painful uterine contractions that cause progressive dilation & effacement of the cervix. No contractions = not in labor, thus it’s essential to identify the presence of contraction on CTG (missing in the first question). Presence of contractions only could indicate false labor (Braxton Hicks). Braxton Hicks are irregular in frequency, less intense and usually go away if you change positions. They are the body's way of getting ready for labor, but it doesn't mean labor is coming.
Smoker and obese female pament on combined OCP, at imagining there is 4x4 cm hepamc hemangioma. What is the most important thing to advise the pt.?
A- Decrease high carbohydrate and faJy meals
B- Stop smoking
C- Eat diet rich in fiber
D- Stop OCP
Another recall or similar question: 28 y/o male, obese and smoker diagnosed with right hepatic hemangioma 4*4 cm. What will you tell the patient ?
A- Stop smoking
B- Avoid high carb and fat meal
C- Avoid high physical exercise
D- Weight loss
Abdulrahman: For the first question, stopping OCP is very beneficial in cases of adenoma only. Although according to UTD: While there is no definitive strategy for prevention, living a healthy lifestyle, smoking cessation, a nutritious diet, and in particular limiting alcohol intake can all contribute to overall health and increased quality of life. Sex hormone-mimicking medications (e.g., OCPs) can cause the hemangioma to grow. I would go with stopping OCP, because estrogen can influence the lesion to grow (although the risk of rupture is similar for pregnant and nonpregnant women). As for the second question, patients with hepatic hemangioma should avoid high physical exercise to avoid the risk of rupture.
A- Decrease high carbohydrate and faJy meals
B- Stop smoking
C- Eat diet rich in fiber
D- Stop OCP
Another recall or similar question: 28 y/o male, obese and smoker diagnosed with right hepatic hemangioma 4*4 cm. What will you tell the patient ?
A- Stop smoking
B- Avoid high carb and fat meal
C- Avoid high physical exercise
D- Weight loss
Abdulrahman: For the first question, stopping OCP is very beneficial in cases of adenoma only. Although according to UTD: While there is no definitive strategy for prevention, living a healthy lifestyle, smoking cessation, a nutritious diet, and in particular limiting alcohol intake can all contribute to overall health and increased quality of life. Sex hormone-mimicking medications (e.g., OCPs) can cause the hemangioma to grow. I would go with stopping OCP, because estrogen can influence the lesion to grow (although the risk of rupture is similar for pregnant and nonpregnant women). As for the second question, patients with hepatic hemangioma should avoid high physical exercise to avoid the risk of rupture.
Patient known hypertensive on lisinopril and amlodipine, recently diagnosed as TB What you will do
A- decrease lisinopril dose
B- stop amlodipine
C- increase lisinopril
D- stop rifampicin
Better recall: 45 YO male known hypertensive (on lisinopril 20 mg and amlodipine 5 mg) and recent Hx of thromboembolism (on warfarin 2mg) presented with productive cough and hemoptysis for 2 months. MTB-PCR is +ve. He was started on first line anti TB medications. Which of the following adjustment should be made to his medications?
A- Decrease lisinopril dose
B- Increase warfarin dose
C- Increase amlodipine dose
D- Stop rifampicin.
Abdulrahman: The answer is increase the warfarin the doss and increase lisinopril in the first question (approved by Om-Alqurra). Rifampicin will decrease the serum concentration of amlodipine, lisinopril, and warfarin due to the induction of cytochrome P450 (increase metabolism), which will cause worsening of the patient’s hypertension.
A- decrease lisinopril dose
B- stop amlodipine
C- increase lisinopril
D- stop rifampicin
Better recall: 45 YO male known hypertensive (on lisinopril 20 mg and amlodipine 5 mg) and recent Hx of thromboembolism (on warfarin 2mg) presented with productive cough and hemoptysis for 2 months. MTB-PCR is +ve. He was started on first line anti TB medications. Which of the following adjustment should be made to his medications?
A- Decrease lisinopril dose
B- Increase warfarin dose
C- Increase amlodipine dose
D- Stop rifampicin.
Abdulrahman: The answer is increase the warfarin the doss and increase lisinopril in the first question (approved by Om-Alqurra). Rifampicin will decrease the serum concentration of amlodipine, lisinopril, and warfarin due to the induction of cytochrome P450 (increase metabolism), which will cause worsening of the patient’s hypertension.
A case with hypokalemia and hypocalcemia with flat T wave , other labs show very high urea and creatinine. What is the next management?
A- Dextrose
B- Ca gluconate
C- Ca resonium
D-Renal replacement
Abdulrahman: This patient most likely has an acute kidney injury (AKI) or chronic kidney injury (CKD) that worsened. Acute hypocalcemia can be life-threatening, so we need to stabilize the cardiac membrane as fast as possible with calcium gluconate. Choice D is incorrect because the patient doesn’t have absolute indications for renal replacement therapy (Dialysis):-
1- Refractory hypervolemia
2- Refractory acidosis
3- Refractory hyperkalemia
4- Uremic manifestations (uremic encephalopathy or uremic pericarditis)
5- Intoxication (patient received medicine overdose)
A- Dextrose
B- Ca gluconate
C- Ca resonium
D-Renal replacement
Abdulrahman: This patient most likely has an acute kidney injury (AKI) or chronic kidney injury (CKD) that worsened. Acute hypocalcemia can be life-threatening, so we need to stabilize the cardiac membrane as fast as possible with calcium gluconate. Choice D is incorrect because the patient doesn’t have absolute indications for renal replacement therapy (Dialysis):-
1- Refractory hypervolemia
2- Refractory acidosis
3- Refractory hyperkalemia
4- Uremic manifestations (uremic encephalopathy or uremic pericarditis)
5- Intoxication (patient received medicine overdose)
Quick Recall pinned «✨ First question 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…»
4 months baby born preterm 33 weeks due to emergency cescrian section regarding his vaccines what is the most appropriate protocol to follow?
A- give him vaccine according to his chronological age
B- give him vaccines by his correct gestational age
C- delay all vaccines
D- other
Abdulrahman: The answer is A. Correcting the age (choice B) is done when growth charting and checking developmental milestones (not in vaccinating). Here are the reasons to delay the vaccines:
A- give him vaccine according to his chronological age
B- give him vaccines by his correct gestational age
C- delay all vaccines
D- other
Abdulrahman: The answer is A. Correcting the age (choice B) is done when growth charting and checking developmental milestones (not in vaccinating). Here are the reasons to delay the vaccines:
Heroin addict want to start a program to eliminate the addiction, which drug would you choose ?
A- Naloxone
B- Methadone
Abdulrahman: The answer is B. Pharmacologic therapy for heroin addiction focuses on ameliorating withdrawal symptoms and reducing cravings. Methadone (long-acting) maintenance therapy has been the standard of care for more than 30 years. Naloxone (short-acting) is an antidote that is used in intoxication. Methadone, a long-acting opioid agonist, binds to and occupies mu-opioid receptors, preventing withdrawal symptoms for 24 hours or longer, reduces craving for opioids, and, by maintaining high levels of opioid tolerance, reduces the euphoric effects of subsequent illicit opioid use.
A- Naloxone
B- Methadone
Abdulrahman: The answer is B. Pharmacologic therapy for heroin addiction focuses on ameliorating withdrawal symptoms and reducing cravings. Methadone (long-acting) maintenance therapy has been the standard of care for more than 30 years. Naloxone (short-acting) is an antidote that is used in intoxication. Methadone, a long-acting opioid agonist, binds to and occupies mu-opioid receptors, preventing withdrawal symptoms for 24 hours or longer, reduces craving for opioids, and, by maintaining high levels of opioid tolerance, reduces the euphoric effects of subsequent illicit opioid use.
During the influenza season, the supply of recombinant influenza vaccine (RIV4) is limited. Who gets the priority of receiving the vaccine?
A) School children
B) Pregnant woman
C) Isolated hypertension adults
D) Iron deficiency anemia children
Abdulrahman: The answer is B according to the CDC. Williams + UTD: Vaccinate all women who will be pregnant during flu season. Vaccinate high-risk women prior to flu season. They all should receive the inactivated influenza vaccine as soon as it becomes available and before onset of influenza activity in the community, regardless of their stage of pregnancy. CDC: Emphasis should be placed on targeting vaccines to high-risk groups. Those groups include:
- Healthy children aged 6 to 23 months
- People 65 years and older
- Pregnant women in their second or third trimester during the flu season
- Anyone 2 years or older who has a chronic health condition.
A) School children
B) Pregnant woman
C) Isolated hypertension adults
D) Iron deficiency anemia children
Abdulrahman: The answer is B according to the CDC. Williams + UTD: Vaccinate all women who will be pregnant during flu season. Vaccinate high-risk women prior to flu season. They all should receive the inactivated influenza vaccine as soon as it becomes available and before onset of influenza activity in the community, regardless of their stage of pregnancy. CDC: Emphasis should be placed on targeting vaccines to high-risk groups. Those groups include:
- Healthy children aged 6 to 23 months
- People 65 years and older
- Pregnant women in their second or third trimester during the flu season
- Anyone 2 years or older who has a chronic health condition.
A 47 year old male with 12 hour pain in first metatarsal joint with swelling and tenderness. Temperate 38 C. Cause of Presentation?
A) Disseminated Gonococcus
B) Staphylococcus Aureus
C) Monosodium Urate Crystals
D) Calcium Pyrophosphate Crystals
Abdulrahman: This question is very vague, since both infection and gout can cause fever. We cannot differentiate between septic arthritis and gout without arthrocentesis. Although in this case, the hint is that the location of the pain (first metatarsal joint). I would go with C. Here’s a table that will help you distinguish Gout (Choice C) from pseudogout (D) in the full question.
A) Disseminated Gonococcus
B) Staphylococcus Aureus
C) Monosodium Urate Crystals
D) Calcium Pyrophosphate Crystals
Abdulrahman: This question is very vague, since both infection and gout can cause fever. We cannot differentiate between septic arthritis and gout without arthrocentesis. Although in this case, the hint is that the location of the pain (first metatarsal joint). I would go with C. Here’s a table that will help you distinguish Gout (Choice C) from pseudogout (D) in the full question.
A 25 year old primigravida at 36 weeks gestation presented with feeling fatigue and unwell. She shortly developed shortness of breath and died. What is the likely cause of her presentation?
A) Amniotic Fluid Embolism
B) Peripartum Cardiomyopathy
Abdulrahman: The signs and symptoms here are vague, since both AFE and PPM both can cause shortness of breath and sudden death. You can check the differences between the two entities and decide when the full question comes in the exam:
A) Amniotic Fluid Embolism
B) Peripartum Cardiomyopathy
Abdulrahman: The signs and symptoms here are vague, since both AFE and PPM both can cause shortness of breath and sudden death. You can check the differences between the two entities and decide when the full question comes in the exam:
Another question: 20 pregnant primigravida female 24 week gestation , suddenly developed SOB and CXR shows enlarge heat , she died despite intensive mx Cause?
A⁃ MI
B⁃ IHD
C⁃ VHD
D ⁃ Peripartum cardiomyopathy
Abdulrahman: D
Another recall: 20 years old primigravida 31 week presented to ED with fatigue and tiredness, patient admitted to the hospital and suddenly developed SOB and died .X-ray: show increases cardiac shadow What is the cause?
A. Peripartum cardiomyopathy
B. Amniotic fluid embolism
C. Pulmonary embolism
Abdulrahman: A
A⁃ MI
B⁃ IHD
C⁃ VHD
D ⁃ Peripartum cardiomyopathy
Abdulrahman: D
Another recall: 20 years old primigravida 31 week presented to ED with fatigue and tiredness, patient admitted to the hospital and suddenly developed SOB and died .X-ray: show increases cardiac shadow What is the cause?
A. Peripartum cardiomyopathy
B. Amniotic fluid embolism
C. Pulmonary embolism
Abdulrahman: A
A 13 year old boy medically free presented with neck swelling. One of the relatives recently diagnosed with lymphoma and the family is worried about their child. Which of the following is an indication for lymph node biopsy?
A- Absence of fever
B- Presence of Hepatosplenomegaly
C- Lymph node size > 1cm
D- Tender and hot lymph node
Abdulrahman: I would go with B, since the lymph node size in most textbooks mention that the lymph node size in children should be larger than 2 cm to be considered abnormal and are predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas). Absence of fever and tender/hot lymph nodes are not red flags for malignancy.
Taghreed: UTD: "Early" excisional biopsy refers to biopsy when the child is initially seen at a referral center. Early excisional biopsy is indicated for children with worrisome features:
A- Absence of fever
B- Presence of Hepatosplenomegaly
C- Lymph node size > 1cm
D- Tender and hot lymph node
Abdulrahman: I would go with B, since the lymph node size in most textbooks mention that the lymph node size in children should be larger than 2 cm to be considered abnormal and are predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease or sarcoidosis) or cancer (predominantly lymphomas). Absence of fever and tender/hot lymph nodes are not red flags for malignancy.
Taghreed: UTD: "Early" excisional biopsy refers to biopsy when the child is initially seen at a referral center. Early excisional biopsy is indicated for children with worrisome features:
A 28 year old female presented following radiation of neck with neck swelling. Ultrasound showed swelling in the left lobe of the thyroid of 3x4cm of papillary thyroid cancer. Which of the following is the best management?
A- Left Lobectomy
B- Left Lobectomy with Isthmusectomy
C- Subtotal Thyroidectomy
D- Total Thyroidectomy
Abdulrahman: The answer is D due to the history of radiation.
A- Left Lobectomy
B- Left Lobectomy with Isthmusectomy
C- Subtotal Thyroidectomy
D- Total Thyroidectomy
Abdulrahman: The answer is D due to the history of radiation.
An 8 year old girl with persistent and continuous diarrhea, she drinks 3 pints of goat milk per day and is a fussy eater. Which of the following conditions explain her presentation?
Labs: Hb Low, MCV Low and MCHC High
A- Physiologic Deprivation
B- Giardiasis Parasitic Infection
C- Aplastic Anaemia
D- Hypothyroidism
Abdulrahman: This is a difficult question and is missing important info. I think there is something wrong in the given labs. Dr. Safdar’s answer is A. Consuming too much dairy which can cause diarrhea, even if the patient is not lactose intolerant. Drinking a lot of goat milk can cause folate deficiency (high MCV). Let’s exclude:
Labs: Hb Low, MCV Low and MCHC High
A- Physiologic Deprivation
B- Giardiasis Parasitic Infection
C- Aplastic Anaemia
D- Hypothyroidism
Abdulrahman: This is a difficult question and is missing important info. I think there is something wrong in the given labs. Dr. Safdar’s answer is A. Consuming too much dairy which can cause diarrhea, even if the patient is not lactose intolerant. Drinking a lot of goat milk can cause folate deficiency (high MCV). Let’s exclude: