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.
Postmenopausal, mammo 2 years back normal. Now mammography reveals a B and micro calcifications, next step?
A- Core biopsy
B- Ultrasound
C- Excision
D- Chemoradiation
Better recall: Postmenopausal, mammo 2 years back normal. Now mammography reveals a speculated mass with irregular margins and micro calcifications, next step?
A- Core biopsy
B- Ultrasound
C- Excision
D- Chemoradiation
Abdulrahman: The answer is A. The patient’s findings are definitely worrisome (speculated mass with irregular margins on top of microcalcifications). We have to go for a core biopsy.
A- Core biopsy
B- Ultrasound
C- Excision
D- Chemoradiation
Better recall: Postmenopausal, mammo 2 years back normal. Now mammography reveals a speculated mass with irregular margins and micro calcifications, next step?
A- Core biopsy
B- Ultrasound
C- Excision
D- Chemoradiation
Abdulrahman: The answer is A. The patient’s findings are definitely worrisome (speculated mass with irregular margins on top of microcalcifications). We have to go for a core biopsy.
32 w pregnant, Premature rupture of membranes 4 ws ago , came today with pain and bleeding spots, next :
A- Tocolytic
B- Steroid
C- Surfactant
D- Antibiotics
Abdulrahman: She is 32 weeks and there is premature rupture of membrane 4 weeks? That is very significant and should not happen. Unfortunately, since she is <34 weeks pregnant, the risk of fetal demise is high due to lung hypoplasia and skeletal deformity. Both B and D are correct. Since she is presenting only now with pain and spots of bleeding, I would prioritize the antibiotics. In full question though, make sure of what the choices are exactly. Is the steroid actually betamethasone and is it the right antibiotic regimen (ampicillin and erythromycin)?
A- Tocolytic
B- Steroid
C- Surfactant
D- Antibiotics
Abdulrahman: She is 32 weeks and there is premature rupture of membrane 4 weeks? That is very significant and should not happen. Unfortunately, since she is <34 weeks pregnant, the risk of fetal demise is high due to lung hypoplasia and skeletal deformity. Both B and D are correct. Since she is presenting only now with pain and spots of bleeding, I would prioritize the antibiotics. In full question though, make sure of what the choices are exactly. Is the steroid actually betamethasone and is it the right antibiotic regimen (ampicillin and erythromycin)?
48 Y/O very obese lady,BMI 41 had plevic organ prolapse many time and then had surgery, what do you expect she’s having now :
A- Entrocele
B- Rectcele
C- Uterine prolapse
D-Cytocele
E-Vesicocele
Abdulrahman: The answer is A (due to hx of POP surgery).
A- Entrocele
B- Rectcele
C- Uterine prolapse
D-Cytocele
E-Vesicocele
Abdulrahman: The answer is A (due to hx of POP surgery).
58 yo female presented with pelvic organ prolapse and Her BMI is 38. She has a family history of surgical repair of POPs. What will you most commonly find ?
A- Cystocele
B- Rectocele
C- Enterocoele
D- Uterine prolapse
Another recall: 48 y.o very obese lady, BMI 41 had hx of pelvic organ prolapse had no surgery, but she had + family history of prolapse repair what do you except she’s having now:
A- Enterocele
B- Rectocele
C- Uterine prolapse
D- Cystocele
Abdulrahman: The answer here is cystocele (no hx of surgery and is the most common type of POP). If the patient is complaining of constipation, think of rectocele.
A- Cystocele
B- Rectocele
C- Enterocoele
D- Uterine prolapse
Another recall: 48 y.o very obese lady, BMI 41 had hx of pelvic organ prolapse had no surgery, but she had + family history of prolapse repair what do you except she’s having now:
A- Enterocele
B- Rectocele
C- Uterine prolapse
D- Cystocele
Abdulrahman: The answer here is cystocele (no hx of surgery and is the most common type of POP). If the patient is complaining of constipation, think of rectocele.
male with lower back pain ,erythmatous and B/L knee joint Labs were of insignificant values ,how to dx?
A- HLB27
B- MRI SPINE
C- CT SPINE
D- JOINT Aspiration
Better recall:A 45-year-old male patient complaining of back pain worsen in the night, not improved by rest, and improved with exercise and in the morning, and the most likely diagnosis is Ankylosing spondylitis, which of the following is the most appropriate test in this case?
A- HLA b27
B- MRI sacroiliac
C- CT sacroiliac
D- Anti CCP
Abdulrahman: The answer is B (MRI of the sacroiliac joint) as it is a case of ankylosing spondylitis. A positive test for HLA-B27 alone is not diagnostic for axSpA, and a negative test for HLA-B27 does not exclude the diagnosis of axSpA. HLA-B27 can be useful to increase the confidence of a diagnosis of axSpA in patients in whom plain radiographs or magnetic resonance imaging (MRI) also exhibit abnormalities consistent with axSpA. Not a lot of patients in Saudi Arabia turn out to be HLA-B27 positive, this is why we usually go for MRI.
A- HLB27
B- MRI SPINE
C- CT SPINE
D- JOINT Aspiration
Better recall:A 45-year-old male patient complaining of back pain worsen in the night, not improved by rest, and improved with exercise and in the morning, and the most likely diagnosis is Ankylosing spondylitis, which of the following is the most appropriate test in this case?
A- HLA b27
B- MRI sacroiliac
C- CT sacroiliac
D- Anti CCP
Abdulrahman: The answer is B (MRI of the sacroiliac joint) as it is a case of ankylosing spondylitis. A positive test for HLA-B27 alone is not diagnostic for axSpA, and a negative test for HLA-B27 does not exclude the diagnosis of axSpA. HLA-B27 can be useful to increase the confidence of a diagnosis of axSpA in patients in whom plain radiographs or magnetic resonance imaging (MRI) also exhibit abnormalities consistent with axSpA. Not a lot of patients in Saudi Arabia turn out to be HLA-B27 positive, this is why we usually go for MRI.
male patient present in the ER after RTA with tibial fracture and he was stable, what is our priority in regard to his management
A- control the pain
B- Control bleeding
C- Limit soft tissue injury
Another recall: A case of a pt with femur fracture after an accident, vitally stable, there is an obvious deformity. What is the most important management:
A- analgesia for pain
B- decrease bleeding
C- decrease soft tissue injury
D- maintaining normal joint function
Abdulrahman: The answer is B. Even if the patient is hemodynamically stable, you have to follow the ABCs in cases of trauma, and controlling the bleeding is a a part of it (C) especially in cases of femur fractures, where there is a high risk of major blood loss.
هذا السؤال غالباً تابع لأسئلة الTrauma بالجراحة وجاني بإختباري اللي جبت فيه 100 بالجراحة الحمدلله
A- control the pain
B- Control bleeding
C- Limit soft tissue injury
Another recall: A case of a pt with femur fracture after an accident, vitally stable, there is an obvious deformity. What is the most important management:
A- analgesia for pain
B- decrease bleeding
C- decrease soft tissue injury
D- maintaining normal joint function
Abdulrahman: The answer is B. Even if the patient is hemodynamically stable, you have to follow the ABCs in cases of trauma, and controlling the bleeding is a a part of it (C) especially in cases of femur fractures, where there is a high risk of major blood loss.
هذا السؤال غالباً تابع لأسئلة الTrauma بالجراحة وجاني بإختباري اللي جبت فيه 100 بالجراحة الحمدلله