Scenario chid with bloody diarrhea doctor prescribed ( i remember say consultant) acetaminophen and probiotic Child not improved , now present ill with convulsion and petechic rash on extremities Labrotary ( low HB , low plateat, decrease potassium )
A- heamolytic ureamic syndrome
B- idiopathic thrombothytopenic purpura
C-thrombotic thrombocytopenia purpura
D- not remember
Abdulrahman: The answer is A.
- HUS is more common in children
- Bloody diarrhea is more common with HUS.
- Thrombocytopenia and seizures are present in both TTP and HUS.
Neurological involvement in the acute phase of HUS occurs in 17–52% of children; the most common acute problem is generalised or partial seizure activity in more than half of those with neurological signs.
A- heamolytic ureamic syndrome
B- idiopathic thrombothytopenic purpura
C-thrombotic thrombocytopenia purpura
D- not remember
Abdulrahman: The answer is A.
- HUS is more common in children
- Bloody diarrhea is more common with HUS.
- Thrombocytopenia and seizures are present in both TTP and HUS.
Neurological involvement in the acute phase of HUS occurs in 17–52% of children; the most common acute problem is generalised or partial seizure activity in more than half of those with neurological signs.
Patient with 2x2 peri rectal abscess / collection not sure. She is asymptomatic what is Tx?
A- Conservative
B- I&D
C- Open drainage
Abdulrahman: The answer is B. The primary treatment of anorectal abscess is surgical drainage. Once diagnosed, all perianal and perirectal abscesses should be drained promptly; lack of fluctuance should not be a reason to delay treatment. Any undrained anorectal abscess can continue to expand into adjacent spaces as well as progress to generalized systemic infection.
A- Conservative
B- I&D
C- Open drainage
Abdulrahman: The answer is B. The primary treatment of anorectal abscess is surgical drainage. Once diagnosed, all perianal and perirectal abscesses should be drained promptly; lack of fluctuance should not be a reason to delay treatment. Any undrained anorectal abscess can continue to expand into adjacent spaces as well as progress to generalized systemic infection.
Female patient presented with signs and symptoms of SBO and mass irreducible medial to pupic tubercle. What is your provisional diagnosis?
A-inguinal hernia
B -femoral hernia
C-obturator hernia
D-incisional hernia
Abdulrahman: The answer is A. The location is above and medial to the pubic tubercle. Femoral hernias are inferior to the inguinal ligament, lateral to the pubic tubercle , and medial to the femoral vein.
A-inguinal hernia
B -femoral hernia
C-obturator hernia
D-incisional hernia
Abdulrahman: The answer is A. The location is above and medial to the pubic tubercle. Femoral hernias are inferior to the inguinal ligament, lateral to the pubic tubercle , and medial to the femoral vein.
Scenario about Perforated duodenal ulcer ( not mention diagnose ) and ask about how to manage?
A- Graham ometal patch
Abdulrahman: Answer A is correct. Schwartz: The options for surgical treatment of perforated duodenal ulcer are simple patch closure (graham omental patch), patch closure and HSV, or patch closure and V + D. Simple patch closure, currently the most commonly performed operation for perforated peptic ulcer, should be done in patients with hemodynamic instability and/ or exudative peritonitis signifying a perforation >24 hours old. I don’t think they will make you choose between the types of patches or the addition of HSV and V + D. Here is a table from Schwartz:
A- Graham ometal patch
Abdulrahman: Answer A is correct. Schwartz: The options for surgical treatment of perforated duodenal ulcer are simple patch closure (graham omental patch), patch closure and HSV, or patch closure and V + D. Simple patch closure, currently the most commonly performed operation for perforated peptic ulcer, should be done in patients with hemodynamic instability and/ or exudative peritonitis signifying a perforation >24 hours old. I don’t think they will make you choose between the types of patches or the addition of HSV and V + D. Here is a table from Schwartz:
The dose of insulin & NS to give for patient with dka?
A- 2l normal saline and insulin 0.1unit
Abdulrahman: Answer A is correct. The patient should receive 2 liters of NS with 0.1 units/kg/hr to reach glucose level 150-200. Here is the management of DKA in detail:
A- 2l normal saline and insulin 0.1unit
Abdulrahman: Answer A is correct. The patient should receive 2 liters of NS with 0.1 units/kg/hr to reach glucose level 150-200. Here is the management of DKA in detail:
Pt recently diagnosed as type 1 DM ON insulin before meal 3 Cmes and long acCng at night Pt has fasting hypoglycemia and hypoglycemia after meals What should you do ?
A- Increase does of long acting insulin and decrease short acting befor meal
B- Decrease long acting and increase short acting
C- Decrease long acting and short acting
D- Don’t change doeses
Abdulrahman: The answer is C. This patient experiences hypoglycemia attack before meals (effect of long-acting) and after meals (effect of short-acting).
A- Increase does of long acting insulin and decrease short acting befor meal
B- Decrease long acting and increase short acting
C- Decrease long acting and short acting
D- Don’t change doeses
Abdulrahman: The answer is C. This patient experiences hypoglycemia attack before meals (effect of long-acting) and after meals (effect of short-acting).
Elderly pt. admiaed to ICU with acute MI, and developed pneumonia on tazocin, he also has RUQ pain and tenderness. Management?
A- ERCP drainage
B- emergency cholecystectomy
C- convert from tazocin to meropenem
D- us guided cholecystostomy drainage
Abdulrahman: The answer is D. This patient most likely has acalculous cholecystitis. This typically occurs in critically ill patients due to a combination of factors (e.g., bile stasis and hypoperfusion). ERCP drainage and emergency cholecystectomy are not indicated in this case due to the patient's inability to undergo surgery (elderly, ICU, and has pneumonia). Switching antibiotics will not do anything in this case.
A- ERCP drainage
B- emergency cholecystectomy
C- convert from tazocin to meropenem
D- us guided cholecystostomy drainage
Abdulrahman: The answer is D. This patient most likely has acalculous cholecystitis. This typically occurs in critically ill patients due to a combination of factors (e.g., bile stasis and hypoperfusion). ERCP drainage and emergency cholecystectomy are not indicated in this case due to the patient's inability to undergo surgery (elderly, ICU, and has pneumonia). Switching antibiotics will not do anything in this case.
29 yo female presented with sever epigastric pain radiating to the back she’s had sleeve gastrectomy 3 months ago. Physical examination revealed epigastric tenderness. Lab. Amylase high Stable vitals USG was negative for biliary stones but positive sluggish and normal biliary ducts. Most appropriate next step:
A- Ultrasound endoscopy
B- Something and pyloromyotomy
C- Lap Cholecystectomy
D- Percutaneous Cholecystostomy
Another recall: 30 y/o complaining of abdominal pain radiating to the back associated with vomiting; he did gastric sleeve 3 months back. US: gallbladder sludge with no stone; normal cystic duct EBC normal Amylase 700 What is the most appropriate investigation?
A. Endoscopic US
B. Endoscopic sphincterotomy
C. Laparoscopic cholecystectomy
D. Open cholecystectomy
Abdulrahman: I will copy Doctor Abeidi’s answer since it is very well explained. This is a very common clinical scenario. Rapid weight loss is associated with an increased risk of gallstone formation. In fact, there is a 30 percent risk of gallstone formation after Bariatric surgery. Most of those stones will form during the first 18 postoperative months. This is quite understandable because this is the period where most weight loss occurs. This question describes a patient with central abdominal pain and elevated pancreatic enzymes. US confirms presence of stones or sludge (for all practical reasons, stones and sludge behave similarly) Most episodes of acute biliary pancreatitis are self-limiting, they respond to conservative management in the form of hydration and pain medications. This should be followed by laparoscopic cholecystectomy once pancreatic inflammation settles down. This typically takes place a day or two after hospitalization. Since there is no biliary obstruction, endoscopic US and ERCP are both not indicated. Open cholecystectomy is always a possible salvage technique in case of difficult laparoscopic procedure, but certainly wouldn’t be the first option that you offer to a patient.
Hence, the answer is C: laparoscopic cholecystectomy
A- Ultrasound endoscopy
B- Something and pyloromyotomy
C- Lap Cholecystectomy
D- Percutaneous Cholecystostomy
Another recall: 30 y/o complaining of abdominal pain radiating to the back associated with vomiting; he did gastric sleeve 3 months back. US: gallbladder sludge with no stone; normal cystic duct EBC normal Amylase 700 What is the most appropriate investigation?
A. Endoscopic US
B. Endoscopic sphincterotomy
C. Laparoscopic cholecystectomy
D. Open cholecystectomy
Abdulrahman: I will copy Doctor Abeidi’s answer since it is very well explained. This is a very common clinical scenario. Rapid weight loss is associated with an increased risk of gallstone formation. In fact, there is a 30 percent risk of gallstone formation after Bariatric surgery. Most of those stones will form during the first 18 postoperative months. This is quite understandable because this is the period where most weight loss occurs. This question describes a patient with central abdominal pain and elevated pancreatic enzymes. US confirms presence of stones or sludge (for all practical reasons, stones and sludge behave similarly) Most episodes of acute biliary pancreatitis are self-limiting, they respond to conservative management in the form of hydration and pain medications. This should be followed by laparoscopic cholecystectomy once pancreatic inflammation settles down. This typically takes place a day or two after hospitalization. Since there is no biliary obstruction, endoscopic US and ERCP are both not indicated. Open cholecystectomy is always a possible salvage technique in case of difficult laparoscopic procedure, but certainly wouldn’t be the first option that you offer to a patient.
Hence, the answer is C: laparoscopic cholecystectomy
30 years old female, pregnant , GA 33 , presented with fever, rigor , and loin pain , she has hx of UTI twice in this pregnancy. What is the most appropriate management?
A- MRI pelvis
B- Uretroscopy
C- Septic screening
D- Xray of kidney ,ureter and gallbladder
(100% sure no US in choices)
Abdulrahman: This is most likely a case of pyelonephritis and the patient is developing sepsis (fever and rigors) sepsis. I would go with C. It’s not an obstructing stone, so we shouldn’t go with ureteroscopy. MRI pelvis will not show you anything and it is not indicated unless there is no response to treatment and you are suspecting something else. X-ray of the kidney, ureter, and bladder will most likely not show anything and is already contraindicated in pregnancy. In case you suspect an obstructing stone (not this case), UTD: In pregnant patients suspected of having an obstructing stone, kidney/pelvic ultrasonography is the preferred initial imaging modality. If further diagnosis is required following kidney/pelvic ultrasonography, two additional options are available MRI & Low dose CT
A- MRI pelvis
B- Uretroscopy
C- Septic screening
D- Xray of kidney ,ureter and gallbladder
(100% sure no US in choices)
Abdulrahman: This is most likely a case of pyelonephritis and the patient is developing sepsis (fever and rigors) sepsis. I would go with C. It’s not an obstructing stone, so we shouldn’t go with ureteroscopy. MRI pelvis will not show you anything and it is not indicated unless there is no response to treatment and you are suspecting something else. X-ray of the kidney, ureter, and bladder will most likely not show anything and is already contraindicated in pregnancy. In case you suspect an obstructing stone (not this case), UTD: In pregnant patients suspected of having an obstructing stone, kidney/pelvic ultrasonography is the preferred initial imaging modality. If further diagnosis is required following kidney/pelvic ultrasonography, two additional options are available MRI & Low dose CT
A case of swelling ant . Anal after laproscopic surgery , wound is clean ?
A- US drainage
B- Abx
C- Laparotomy
D- Wound exploration
Abdulrahman: Swelling only after laparoscopy surgery is normal due to seroma formation. Since the wound is clean and there is no fever, the answer should be observation. All of the choices don’t make sense.
A- US drainage
B- Abx
C- Laparotomy
D- Wound exploration
Abdulrahman: Swelling only after laparoscopy surgery is normal due to seroma formation. Since the wound is clean and there is no fever, the answer should be observation. All of the choices don’t make sense.
44 year old lady was hit by a vehicle, and brought to the emergency room conscious, on 100% O2 , received 2 liters of normal saline and 2 liters of blood. Blood pressure 60/40 mmHg Examination confirmed abdominal rigidity. 145 beat /Heart rate min CXR and pelvic ×-ray were normal. Which of the following is the most appropriate step?
A- DPL
B- FAST
C- CT scan abdomen
D- surgical exploration
Abdulrahman: The patient is unstable (BP 60/40), go for FAST. If he was stable, go for CT. They will definitely do surgical exploration in real life, but remember, this is an exam and they want you to follow the trauma protocol. Also, they already did CXR and pelvic X-ray for the patient, so why not do FAST to know where the bleeding is and where it is collected exactly? E-FAST takes less than 5 minutes to do.
A- DPL
B- FAST
C- CT scan abdomen
D- surgical exploration
Abdulrahman: The patient is unstable (BP 60/40), go for FAST. If he was stable, go for CT. They will definitely do surgical exploration in real life, but remember, this is an exam and they want you to follow the trauma protocol. Also, they already did CXR and pelvic X-ray for the patient, so why not do FAST to know where the bleeding is and where it is collected exactly? E-FAST takes less than 5 minutes to do.
Patient came to er in shock Peripheral pressure was 15 And mean aerial pressure is 15/16 Vascular resistance was 2000 Cardiac out put was 2.4 l What type of shock
A- cardiogenic shock
B- septic shock
C- hypovolimoc shock
Abdulrahman: The answer is missing the CVP or PCWP. Let’s break it down:
- Mean arterial pressure: Low (70 and 100 mm Hg)
- Systemic vascular resistance: High (excludes septic, anaphylactic, and neurogenic shock)
- Cardiac output: Low (4-8 is normal)
- CVP/CWP (missing): If low, then it’s hypovolemic. If it’s high, the answer is cardiogenic.
They will give you the normal values in the exam, so don’t worry.
A- cardiogenic shock
B- septic shock
C- hypovolimoc shock
Abdulrahman: The answer is missing the CVP or PCWP. Let’s break it down:
- Mean arterial pressure: Low (70 and 100 mm Hg)
- Systemic vascular resistance: High (excludes septic, anaphylactic, and neurogenic shock)
- Cardiac output: Low (4-8 is normal)
- CVP/CWP (missing): If low, then it’s hypovolemic. If it’s high, the answer is cardiogenic.
They will give you the normal values in the exam, so don’t worry.
Pt with hx of IHD with no fever , low CO , low wedge pressure and normal RT ventricular pressure . What's the type of shock ?
A- Septic
B- Cardiogenic
C- Anaphylactic
D- Hypovolemic
Abdulrahman: The answer is D because of the low wedge pressure (important to differentiate between cardiogenic and hypovolemic). Check the table and algorithm more to easily differentiate between the types of shock.
A- Septic
B- Cardiogenic
C- Anaphylactic
D- Hypovolemic
Abdulrahman: The answer is D because of the low wedge pressure (important to differentiate between cardiogenic and hypovolemic). Check the table and algorithm more to easily differentiate between the types of shock.