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).

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.

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

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 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.

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.

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.

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.

Which of the following drugs increase the survival in a patient with heart failure :
A- Beta blocker.
B- ACE inhibitors
C- Digoxin
D- Nitrites.

Abdulrahman: Both A and B are correct choices. I would go with ACE-I because they are mainly the first drugs to be used in patients with heart failure, so they have the priority.

Pt RTA with multiple facial laceration O2 sat 80%, best airway
A- Orotracheal tube
B- Nasotracheal tube
C- Surgical tracheostomy
D- Cricothyrotomy

Abdulrahman: The answer is D. The best way to support the airway is always Orotracheal. After that, cricothyrotomy. Nasotracheal is not ideal in an emergency setting. In our case, there is facial or C-spine injury, so don’t do orotracheal, go for cricothyrotomy.

32 years old female with right cervical lump. Upon examination she has enlarged cervical lymph node with normal thyroid gland. Percutaneous biopsy taken from the lump. Histopathology report: follicular thyroid cells, which of the following is the most likely diagnosis?
A- Ectopic thyroid
B- Follicular thyroid carcinoma
C- Papillary thyroid carcinoma
D- Cyst

Abdulrahman: The answer is C.

للتذكير, ترا الأسئلة كلها مكتوبة بملف جاهز وراح أرسله لكم بإذن الله بعد ما أجاوب على كل الأسئلة وتنتهي فترة تصحيحنا (15-20 أوقست) 💙

Female with bloating and GI symptoms. Started gluten free diet by herself and now she is better and visiting the GP. What to do?
A- Dietician referral
B- GI referral
C- No need to continue on gluten free diet
D- Stop gluten free diet and then do celiac serology

Better recall: Female convinced she is allergic to gluten she said (wheat) and did gluten free diet by her own and there was relief of symptoms:
A- Refer to gastroenterologist
B- Introduce gluten and then investigate for celiac
C- then no need to eat gluten if feel good

Abdulrahman: The answer is to continue the gluten diet and investigate celiac disease. Celiac is a lifelong disease, it should be diagnosed properly. No need to refer to a gastroenterologist to do the tests (Anti-tissue transglutaminase (tTG) and/or Anti-endomysium (EMA)) and interpret them.

4 years old came with his mother she complains he is irritable easily and picky in his food. He drinks 3 glass of *raw* cow milk daily and heats red meat. His mother says that his brother has the same issue. What is the dx
A- iron def
B- thalassemia a trait

Abdulrahman: No labs are shown at all to make a proper diagnosis. I would go with A most likely since ingesting a large amount of cow milk can cause IDA.

Old patient came for elective cholecystectomy you find out he was admitted 2 weeks ago in icu for management of MI, what will you do?
A- do it in this admission
B- delay it 6 weeks
C- delay it 6 months
D - no need to do it anymore

Another similar question (or different recall?): 55 year old diabetic female patient has to do elective cholecystectomy but she had an episode of myocardial infarction 6 weeks ago. What is the most proper course of action in this case?
A- Open Cholecystectomy In Same Admission
B- Laparoscopic Cholecystectomy
C- Laparoscopic Cholecystectomy In 6 Months
D- Observation

Abdulrahman: The correct answer is to do laparoscopic cholecystectomy after 6 weeks. I think choice B is the same as in the first question (6 weeks) which is correct.

السؤال هذا ترا جاني في إختبار الهيئة بالملّي وجاوبت عليه FAST والحمدالله هذه درجتي بالسيرجري بعد الإختبار: