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.
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.
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.
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.
Quick Recall
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…
السؤال هذا ترا جاني في إختبار الهيئة بالملّي وجاوبت عليه FAST والحمدالله هذه درجتي بالسيرجري بعد الإختبار:
Quick Recall
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…
تم تعديل إجابة السؤال هذا لC وعدلت الشرح 👍🏼
A female patient presented complaining of a sudden urge to void, frequent voidings during the day and getting up to void more than once per night. She diagnosed as urge urinary incontinence. Which of the following considers the most appropriate management?
A- Kegel exercises
B- Vaginalcones
C- Oxybutynin
D- Oxybutynin and Kegel exercises
Abdulrahman: The answer is A. UTD: Behavioral therapies (e.g., bladder training, bladder-control strategies, pelvic floor muscle training, fluid management) should be offered as first-line therapy to all patients with overactive bladder.
A- Kegel exercises
B- Vaginalcones
C- Oxybutynin
D- Oxybutynin and Kegel exercises
Abdulrahman: The answer is A. UTD: Behavioral therapies (e.g., bladder training, bladder-control strategies, pelvic floor muscle training, fluid management) should be offered as first-line therapy to all patients with overactive bladder.
2 yr boy, diarrhoea , some times with blood , refuse to eat meat at all , has two elder sisters with same pattern. What's next :
A- chromosomal essay
B- Anti immunoglobulin ( written exactly like this)
C- Antidiarrheal
Abdulrahman: This is a very bad recall. Please send me a better one if you find it. Anyway, You can’t start ant-immunoglobulins right away and you can’t give antidiarrheal in this case because the bleeding is worrisome.
A- chromosomal essay
B- Anti immunoglobulin ( written exactly like this)
C- Antidiarrheal
Abdulrahman: This is a very bad recall. Please send me a better one if you find it. Anyway, You can’t start ant-immunoglobulins right away and you can’t give antidiarrheal in this case because the bleeding is worrisome.
A patient after gastric sleeve gastrectomy complains from abdominal pain and low mood. What to do?
A- Reassure the family
B- Give antidepressant
C- Admit to hospital for re-evaluation
Abdulrahman: The answer is A. This is normal in post-op patients.
A- Reassure the family
B- Give antidepressant
C- Admit to hospital for re-evaluation
Abdulrahman: The answer is A. This is normal in post-op patients.
45 years old male or female, has a mass 5 cm in right upper limb, (MRI shows a mass from triceps) what to do next?
A- Incisional biopsy
B- Excisional biopsy
C- Core needle biopsy
D- PET scan
Abdulrahman: The answer is C. In another recall, it was suggested that the mass was a sarcoma in the triceps. Core needle biopsy is the standard now to diagnose sarcoma , previously it was incisional bx. Accuracy of core needle (trucut bx) is up to 85%.
A- Incisional biopsy
B- Excisional biopsy
C- Core needle biopsy
D- PET scan
Abdulrahman: The answer is C. In another recall, it was suggested that the mass was a sarcoma in the triceps. Core needle biopsy is the standard now to diagnose sarcoma , previously it was incisional bx. Accuracy of core needle (trucut bx) is up to 85%.
24 year old man presented with 2-months of bloody diarrhea .He passed 3-4 loose months/ day associated with blood ,and mucus.He gave history of left lower quadrant pain .No fever or weight loos . He underwent sigmoidoscopy.which showed loss of normal vascular pattern with erosions up to splenic flexure (see lab results). Which is the following is
Test Result
RBS 5 1012/L)
HB. 10.9
Platelets count 488
WBC. 6
ESR 32
Consistency LIQUID
Color. Yellow.
Mucus and blood. ++.
Leukocytes. +++.
the best treatment option ?
A. Mesalamine enema.
B. Mesalamine suppository.
C. Mesalamine oral and enema.
D. Mesalamine oral and suppository
Abdulrahman: Based on the full recall, the answer is C. We have to give both systemic (oral) and enema (to reach the splenic flexure). Suppositories (تحميلة) Will not reach that area. This answer was also approved by Dr. Thawaba.
Test Result
RBS 5 1012/L)
HB. 10.9
Platelets count 488
WBC. 6
ESR 32
Consistency LIQUID
Color. Yellow.
Mucus and blood. ++.
Leukocytes. +++.
the best treatment option ?
A. Mesalamine enema.
B. Mesalamine suppository.
C. Mesalamine oral and enema.
D. Mesalamine oral and suppository
Abdulrahman: Based on the full recall, the answer is C. We have to give both systemic (oral) and enema (to reach the splenic flexure). Suppositories (تحميلة) Will not reach that area. This answer was also approved by Dr. Thawaba.
39 yo female with irregular, heavy menstrual periods X6m. Menstrual period every 6 - 8 w, periods now heavier & last 9 d, has 2 kids. PAP 3y ago normal, HPV -ve. Exam: normal.BMI 36.
CBC normal, pregnancy test -ve. What’s the most appropriate management?
A- Oral contraceptive pills
B- Endometrial biopsy
C- Pap smear
D- FSH level
Abdulrahman: The answer is B. This patient is having chronic menorrhagia with increasing frequency, which is worrisome. Hacker and moore: Endometrial hyperplasia should be suspected when women develop intermenstrual bleeding, or when high-risk women develop unexplained heavy or prolonged menstruation bleeding. In premenopausal women, endometrial sampling is necessary to obtain a histologic diagnosis, especially for women at high risk of hyperplasia (chronic anovulation, obesity, diabetes mellitus). Although, you should do US first to check the thickening of the endometrium before going for the biopsy.
CBC normal, pregnancy test -ve. What’s the most appropriate management?
A- Oral contraceptive pills
B- Endometrial biopsy
C- Pap smear
D- FSH level
Abdulrahman: The answer is B. This patient is having chronic menorrhagia with increasing frequency, which is worrisome. Hacker and moore: Endometrial hyperplasia should be suspected when women develop intermenstrual bleeding, or when high-risk women develop unexplained heavy or prolonged menstruation bleeding. In premenopausal women, endometrial sampling is necessary to obtain a histologic diagnosis, especially for women at high risk of hyperplasia (chronic anovulation, obesity, diabetes mellitus). Although, you should do US first to check the thickening of the endometrium before going for the biopsy.
A patient underwent sigmoidoscopy and found a sigmoid lesion, histology report: sigmoid adenocarcinoma with free margin and no invasion to mucosa. What is the next step?
A- Abdominal CT scan
B- Sigmoidectomy
C- Pelvic MRI
D- PET scan
Another recall: Old male patient admitted as a case of large intestinal obstruction, underwent rigid sigmoidoscopy which showed a mass in sigmoid region, biopsy was taken and resulted as adenocarcinoma, what’s your next step?
A. Colonoscopy
B. CT abdomen
C. MRI pelvis
D. Sigmoidectomy
Abdulrahman: Colonoscopy is the best answer to look at the whole colon since the patient is old and you found an adenocarcinoma in the sigmoid region, so you might find more. If colonoscopy is not there (first question), go for CT abdomen.
A- Abdominal CT scan
B- Sigmoidectomy
C- Pelvic MRI
D- PET scan
Another recall: Old male patient admitted as a case of large intestinal obstruction, underwent rigid sigmoidoscopy which showed a mass in sigmoid region, biopsy was taken and resulted as adenocarcinoma, what’s your next step?
A. Colonoscopy
B. CT abdomen
C. MRI pelvis
D. Sigmoidectomy
Abdulrahman: Colonoscopy is the best answer to look at the whole colon since the patient is old and you found an adenocarcinoma in the sigmoid region, so you might find more. If colonoscopy is not there (first question), go for CT abdomen.
Female did lap chole, 7d later she has abd pain very high total & direct bili. Imaging showed sub hepatic biloma 10cm
A- MRCP
B- CT guided drainage
C- Open drainage
D- Conservative
Abdulrahman: The answer is CT guided drainage. MRCP is diagnostic and not therapeutic. This answer is also approved by Dr. Abeidi and doctor J.
A- MRCP
B- CT guided drainage
C- Open drainage
D- Conservative
Abdulrahman: The answer is CT guided drainage. MRCP is diagnostic and not therapeutic. This answer is also approved by Dr. Abeidi and doctor J.
A female patient underwent laparoscopic cholecystectomy, 2 weeks later she presented with vague abdominal pain, what is the best management?
A. Operative drainage an
B. CT guided drainage
C. Lap drainage
D. ERCP with biliary stent
Abdulrahman: The answer is B. Here is the full question from Dr. Thawaba’s course:
A. Operative drainage an
B. CT guided drainage
C. Lap drainage
D. ERCP with biliary stent
Abdulrahman: The answer is B. Here is the full question from Dr. Thawaba’s course:
Case underwent salpingogram for infertility with occlusion in one tubes
A- IVF
B- ICSI
C- Clomiphene citrate
D- IUI-H
Abdulrahman: This way of management is controversial in this case (between A and C) and the question is missing a lot of important info (e.g., patient’s age). I need a better recall. The best choice based on this information is to do IVF.
A- IVF
B- ICSI
C- Clomiphene citrate
D- IUI-H
Abdulrahman: This way of management is controversial in this case (between A and C) and the question is missing a lot of important info (e.g., patient’s age). I need a better recall. The best choice based on this information is to do IVF.
Elderly female with using LABA, LAMA, SABA, ICS and i think other medications , she did chest physiotherapy Vitals are stable ABG normal O2%90-93% PH normal Co2 normal As much as i remember everything was normal What is the next step?
A- repeat physiotherapy
B- add oral steroids
C- long term O2 therapy
D- Mechanical ventilation
Better recall: Elderly female with Hx of COPD came to you complaining of SOB DYSPNEA She is using LABA, LAMA, SABA, ICS and i think other medications , she did chest physiotherapy Vitals are stable ABG normal O2%90-93% PH normal Co2 normal As much as i remember everything was normal What is the next step?
A- repeat physiotherapy
B- add oral steroids
C- long term O2 therapy
D- Mechanical ventilation
Abdulrahman: The answer is B. She is presenting now with exacerbations (SOB, Dyspnea) and already did physiotherapy but there was no benefit to it. The oxygen saturation is not worrisome in this case because this is normal in COPD patients (88-92%), because we want the respiratory drive. After the exacerbation has resolved, you can start her on long term O2 therapy.
A- repeat physiotherapy
B- add oral steroids
C- long term O2 therapy
D- Mechanical ventilation
Better recall: Elderly female with Hx of COPD came to you complaining of SOB DYSPNEA She is using LABA, LAMA, SABA, ICS and i think other medications , she did chest physiotherapy Vitals are stable ABG normal O2%90-93% PH normal Co2 normal As much as i remember everything was normal What is the next step?
A- repeat physiotherapy
B- add oral steroids
C- long term O2 therapy
D- Mechanical ventilation
Abdulrahman: The answer is B. She is presenting now with exacerbations (SOB, Dyspnea) and already did physiotherapy but there was no benefit to it. The oxygen saturation is not worrisome in this case because this is normal in COPD patients (88-92%), because we want the respiratory drive. After the exacerbation has resolved, you can start her on long term O2 therapy.