Male patient complains of episode of hematemesis. normal past medical history Labs show mild anemia ,All over labs are normal except elevated urea level in blood?
A-Mallory Weiss syndrome
B-erosive gastritis
C-PUD

Better recall: 40 years old adult male medically free presented to ER C/O several episodes of hematemesis for the first time, takes no medication, no family history of similar attacks, normal abdominal examination no guarding no tenderness.
Hgb: 9
Plt: 250
Alk: slightly decrease
All other tests were normal
What is the diagnosis:
A-Erosive gastritis
B-eptic ulcer disease
C-Mallory Weiss syndrome
D-Esophageal varices

Another recall: 30 year old male, presented to ER with several episodes of hematemesis.
No similar previous episodes, not on any medications, no alcohol intake, no smoking, no liver disease/jaundice.
Labs:
Normal ALT
Low ALP
BUN 14 (high)
(Nothing else of significance based on my memory)

Abdulrahman: Even though we have a lot of info in this question, it is still vague. I will go with Erosive gastritis, but you need to check for other clues when you get the full question:

- Varices: No history of liver disease/jaundice (normal labs) or alcohol intake
- Erosive gastritis and PUD: Clinical signs and symptoms may be similar. High urea could be a sign of H-pylori. if the anemia is a B12 anemia, then consider erosive gastritis.
- Mallory-Wiss syndrome: will present with multiple episodes of vomiting then the hematemesis will occur.

39 y / o Patient with symptoms of SLE, arthritis and malar rash, what medication should be started ?
A- Hydroxychloroquine and Mycophenolate mofetil
B- Hydroxychloroquine and Methotrexate and Steroid
C- Hydroxychloroquine
D- Methotrexate

Abdulrahman: The answer is Hydroxychloroquine and steroids. Arthritis in patients with SLE usually responds to NSAIDs or hydroxychloroquine. Patients with arthralgia may benefit from acetaminophen. Glucocorticoids may be added to control arthritis in patients whose symptoms have not resolved while on antimalarials and/or NSAIDs.
- Mild-moderate disease (skin and joints involvement): NSAIDs + HCQ (if failed low dose steroids + MTX)
- Moderate - severe (CNS, cardiac, renal): High dose steroids + cyclosporine

Here is a different but similar question from Umm Al-Qura:

35 years old female known case of SLE came with left and right ankle severe pain a diagnosis of SLE arthritis is made she is already on lupus medications what drug to add ?
A. methotrexate
B. hydroxyurea
C. sulfasalazine
D. prednisolone
Abdulrahman: I will go with D since she has an active disease right now. They did not mention what medications she is taking right now. The patient should be on Methotrexate & Prednisolone. Methotrexate takes time to work. B and C are excluded as they are not used.

Another similar question: male with RA and the disease was active.. they asked what what would you give him?
A. MTX + prednisolone + hydroxychloroquine
B. MTX + sulfasalazine
all the other options didn’t have prednisolone

Abdulrahman: The answer here is A

Another two similar questions: RA case on Ibuprofen and Methotrexate for 6 months, came with exacerbations. What to add?
A. Adalimumab
B. Azathioprine
C. Cyclophosphamide
D. Hydroxychloroquine

Abdulrahman: A

RA patient with severe symptoms not responding to methotrexate, hydroxychloroquine, what to add?
A. NSAID
B. Adalimumab
C. Sulfasalazine

Abdulrahman: B

Patient P4 came for contraceptive method. Patient had regular cycle but increase in bleeding recently. Hx of CS, and endometritis after the second CS which has been treated. Which of the following is contraindication for IUD?
A. Hx of endometritis
B. Abnormal bleeding
C. Other things not relevant I couldn't remember

Better recall: This patient was using IUD before, but she got pregnant nonetheless. Delivered with C-Section. Then she developed endometritis. Which of the following represent contraindication:
A- previous CS
B- history of Pelvic infection
C- history of contraceptive failure
D- genital bleeding

Abdulrahman: The answer is abnormal bleeding / Genital bleeding. UTD: Here are the absolute, evidence-based contraindications to IUDs:
- Severe distortion of the uterine cavity
- Active pelvic infection (the patient is currently not active)
- Known or suspected pregnancy
- Wilson's disease or copper allergy
- Unexplained abnormal uterine bleeding
= Breast cancer

child presenting with croup and received the usual treatment with no improvement. What is the important investigation to be done?
A- Lateral neck X-ray
B- Chest inspiration and expiration X-ray
C- Visualization by laryngoscopy
D- Chest CT

Abdulrahman: This question is quite difficult and there are a lot of different points of view. I am between A (next step) and C (best test to confirm) since I think that this is bacterial tracheitis (ddx of unresolved croup) and not epiglottitis (no drooling and there was no mentioning of the patient being very sick or history of missing vaccines).

- UTD: Atypical course: Children admitted for croup typically remain in the hospital for <36 hours. The child who does not show improvement as expected (over the course of one to two days) may have an underlying airway abnormality or may be developing a complication of croup. A biphasic illness with poor response to nebulized epinephrine in conjunction with high fever and toxic appearance should prompt consideration of bacterial tracheitis. Bronchoscopic diagnosis: Definitive diagnosis of bacterial tracheitis requires direct visualization of the airway via laryngoscopy and tracheobronchoscopy.

- Nelson: radiographs may be helpful in distinguishing between severe laryngotracheobronchitis and epiglottitis.

To summarize:
- If the patient was treated with only one dose of epinephrine, give another dose (treatment of croup)
- If no improvement after 2 doses and the scenario suggests that the patient is still deteriorating, go for direct visualization by laryngoscope (to diagnose bacterial tracheitis and therefor start antibiotics)
- If the scenario suggest that he was treated as croup, got better, then came back with drooling, go for lateral neck x-ray (to diagnose epiglottis)

A healthy 40 year old man presents for a tuberculosis screen. He is asymptomatic with a normal Chest XR, and his last PPD 5 years ago was negative. Today, his PPD is positive. What is the treatment?
A- Isoniazid for 6 months
B- Isoniazid, Rifampin, Ethambutol and Pyrazinamide
C- Reassurance
D- Rifampicin and isoniazid for 3 months

Another similar question: Nurse during checkup for contract renewal was asymptomatic and normal except PPD of 12mm. What's the management?
A. No need
B. isoniazid 300 mg for 3 months
C. Isoniazid 300 mg for 6 monthes
D. rifampin, isonizid, another drug for 9 months or 6 months

Abdulrahman: The correct answer is isoniazid for 6 months (answered by Umm Al-Qura). Here are 3 ways of managing latent TB:
1. Isoniazid+B6 for 9 months
2. Rifampin for 4 months
3. Isoniazid + Rifampin 3 months

In the first question, Both A and D are correct. I think there was some mistake when writing the recalled choices (mistaken the period or did not write the frequency). If not, I would go for D since INH is not recommended to be given without vitamin B6.

Man test positive to HIV on routine screening and begs you not to tell anyone
A. Infor his boss
B. Report the case
C. Inform wife
D. Can't remember the last

Abdulrahman: This is an old ethical question. The answer is B with 100% certainty. HIV is a reportable disease, so you have to report it. You have to tell the husband to tell his wife, and arrange a meeting with both of them afterwards, but you have to report the case nonetheless.

Long scenario female pregnant of baby with down syndrome, how to diagnose?
A- high inhibin, high HCG, low estriol, low AFP
B- Low inhibin, high HCG, High estriol, low AFP
C- high inhibin, low HCG, low estriol, high AFP

Abdulrahman: The correct answer is A.

Patient fall from hight next step ?
A- Check pulse

Better recall: Patient fall down from 3m GCS normal vitally normal
only complaining of sever bilateral heel pain. What is of the following is most appropriate next :
A- Check pulse
B- Bilateral x ray
C- Pain management
D- Stint

Abdulrahman: The correct answer is A. You have to check the pulses as part of the ACLS protocol (Circulation).

Pt post some cholangio intervention few hours later he devolps chills and rigor only no fever mentioned
TWBs was 9 normal till 10
RR 18
HR 90
Bp 115/88
Temp :38 degree exactly
What is the most likely diagnosis:
A) sepsis
B) SIRS
C) bactermia
D) septic shock

Abdulrahman: The answer is SIRS since it almost fulfills the criteria and it can occur after procedures. It is the only plausible answer between these choices.
- No mentioning of suspected or confirmed infection (WBCs are normal and the question does not mention that the procedure was contaminated, dirty, or any complications that happened afterwards)
- No evidence of bacteremia (requires cultural diagnosis)
- Septic shock (patient is hemodynamically stable).

Lady, with bruises and fracture bc her husband beat her, what to do?
A- educate about violence
B- inform authorities
C- talk to the husband

Abdulrahman: The answer is B. It’s not the time to educate her about violence and you can’t talk to the husband before informing the authorities.

Case about COPD what is the long term TX?
A- ICS + LABA
B- SABA + LABA + chest therapy
C- Phsophodiesterase inhibitor + LABA

Better recall: Management for COPD mMRC 2 (Modified Medical Research Council)?
A. Combined Salmetrol + fluticasone
B. Phosphodiesterase-4 (PDE₄) inhibitors + Salmetrol + fluticasone
C. Albutarol as needed + Salmetrol+ pulmonary rehabilitation
D. Albutarol as needed + fluticasone

Abdulrahman: The answer is C in the second recall (SABA + LABA + pulmonary rehabilitation)

31 year-old female was following up for the last 5 year with women health, last year negative and this year, negative Pap smear and negative HPV Test, next time to do Pap smear:
A- 6 months
B- 1 year
C- 2 years
D- 3years

Abdulrahman: The correct answer between these choices is D. But remember:
- Every 3 years: pap smear alone.
- Every 5 years: Pap smear + HPV testing.