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.

pediatric pat k/c of Asthma since age 2 years he is now asymptomatic with rare uses of albuterol inhalers, he came for counseling, he had contact sport participation, what is best question to ask to know his response:
A- "Are keeping up with your freinds?"
B- "How frequent do use inhaler?"
C-"presence night symptoms (cough)"

Another recall: 16-year-old male, known case of asthma since 2 years, he uses albuterol inhaler rarely came for counseling. He plays sports. What is the best question to ask to know his response?
A. Are you keeping with your friends?
B. How frequent do you use the inhaler?
C. Are you coughing during the day?
D. Are you coughing while eating?
(There were no night symptoms in the question).

Abdulrahman: Abdulrahman: The answer is A since he rarely uses inhalers and is asymptomatic. You want to see how it affects his daily life.

Another recall (different age): 6 yo child k/c of bronchial asthma He is known player in a school team. Presented with acute exacerbation. Which of the following helps in letting you know recurrence of the exacerbation?
A. Asking how frequent he use the inhaler
B. Are you keeping up with your teammates?
C. Cough during eating
D. Cough during the day

Abdulrahman: The answer here should be the occurrence of asthma symptoms at night. SINA guidelines here differ with children aged 4-12. They are not asked how frequent they use their inhalers during the day.

14 years old Female has severe abdominal pain and mode changes 1 day before the menstrual cycle which prevents her from going to school and daily activities, recently she is on NSAID with some improvement and now she can go to her school and do her daily activities, but she is unsatisfied and requesting more analgesia, what you will give?
A- Diazepam
B- Advice for life style modification
C- Oral estrogen
D- Hysterectomy

Abdulrahman: The answer is B. After giving her NSAIDs, she improved to the point where she can go back to school and do her daily activities. Therefore, there is no need for further medications to be given. I hope no one answers D in the exam…..

هذا السؤال في ملف Doctor J جاوبه بناءً على الMost appropriate لأن السؤال بس قال What to do.

فيه Recall جديد وصلني منكم كان يطلب What is the next step.

بعض الأحيان الريكولات يكون فيها هذا الإختلاف البسيط فقط، فحطوا في بالكم الشيء هذا لما تصححون الأسئلة.

Old pt want to go for hajj he didn't take any Prevention meningococcal vaccine what the best method of prophylaxis antibiotic
A- rifamcine bid for 5 day
B- Cefra for 6 days
C- Azthromycin for 3 days

Abdulrahman: The answer is either ciprofloxacin (one dose) or rifampicin BID for two days (for doses). This is the official MOH Hajj guidelines:

Pregnant in 30g with recurrent UTI :
A- Ct
B- Ultrasound
C- Culture

Another recall: Pregnant with recurrent UTI what to do?
A- X ray
B- US
C- ureteroscopy
D- cystoscopy and RET's

Abdulrahman: There has to be more info to this question. As for the first question, culture is the answer.
- CT and X-rays are not recommended in pregnancy due to risk of radiation
- Renal ultrasound may be indicated to assess for a possible renal abscess.
- Ureteroscopy is not indicated unless there is a suspected stone obstructing the ureter
- Cystoscopy is one of the indications for recurrent UTI, so it might be the answer based on this limited info.

A 40 years old female with chronic kidney disease secondary to diabetes mellitus. Came
for follow-up with no active complaints.
Investigations:
Ca 1.7 mmol/L
Phosphate 1 mmol/L
What would you give for this patient?
A- Sevelamer
B- Cinacalcet
C- Calcitriol
D- Vitamin D Supplements

Abdulrahman: The answer is D. This patient has CKD and DM with no symptoms. She has low calcium (Normal is 4.6-5.2 mg/dL) and low phosphate levels (Normal is 2.8-4.5 mg/dL).
- Sevelamer: used to treat hyperphosphatemia only.
- Cinacalcet: a calcimimetics that mimics calcium to decrease PTH which in turn will lower the calcium levels.
- Calcitriol: the most active form of vitamin D. It raises both calcium and phosphate in the blood by increasing the absorption of calcium in the kidneys, increasing the absorption of calcium and phosphorus from the intestine, and increasing the release of calcium and phosphorus from the bones.
- Vitamin D supplements are the most beneficial in such cases.

post 7 cycle chemotherapy fever with high neutrophils
70% next
A- give him NSIAD and antibiotic
B- wait for culture sensitivity
C- give empiric Abx

Could be this question: Pediatric Pt has leukemia and presented with fever and very low WBC, management?
A-Meropenem
B- not remembered

Abdulrahman: The answer is C in the first question and A in the second question. This is most likely a case of neutropenic fever as a side effect of chemotherapy. Neutropenic fever is treated immediately with meropenem. UTD: In all patients presenting with neutropenic fever, empiric initial broad-spectrum antibacterial therapy should be initiated immediately after blood cultures have been obtained and before any other investigations have been completed. Empiric antibacterial therapy should be started within 60 minutes of presentation in all patients presenting with neutropenic fever.

STEMI , PCI not available , BP 178/99 , Medication:
A- THTH, heparin, ASA, nitroglycerin
B- THTH, ASA, nitroglycerin, BB
C- ASA, BB, nitroglycerin, Heparin

Better recall: Patient presented with symptoms of MI 2 hours ago and it’s anterolateral on ecg and PCI is NOT available management?
A. Aspirin,streptokinase, heparin and beta blockers
B. Aspirin, streptokinase, nitroglycerin and beta blockers

Abdulrahman: initial management is Aspirin, Tpa (streptokinase), heparin, nitroglycerin (don’t give in inferior MI), and beta blockers. There are a couple of choices missing. I am sure you will get the full answer in the exam.

Case acute RUQ pain,jaundice, US and bladder stones what to do
A- Laparoscopic cholecystectomy
B- ERCP
C- I dont remember may be IV Fluid

Abdulrahman: IV fluid always comes first. After that go for ERCP, since the patient has obstructive jaundice.

trauma to axilla and lateral chest wall, fracture 4&5 ribs, while examination, suction sound was sourced from lacerated wound on fractured ribs (no vital data), next:
A- Chest tube
B- Intubation
C- Urgent Thoracotomy

Better recall: Trauma to axilla and lateral chest wall, fracture 4&5 ribs , while examination , suction sound was sourced from lacerated wound on fractured ribs (no vital data) , next:
A. Chest tube
B. Intubation
C. Urgent Thoracotomy
D. Dressing three side

Abdulrahman: The answer is D (also answered by Dr. Thawaba). This is a case of open pneumothorax.
- Intubation is not indicated here since there is no imminent danger to the respiration.
-Thoracotomy has certain indications which can be found in the picture below.
- Chest tube is not the ‘next’ step.

Schwartz: temporary management of this injury includes covering the wound with an occlusive dressing that is taped on three sides. Definitive treatment requires closure of the chest wall defect and tube thoracostomy remote from the wound.

ATLS: initial management includes promptly closing the defect with a sterile dressing large enough to overlap the wound’s edges. Tape it securely on only three sides to provide a flutter-valve effect. As the patient breathes in, the dressing occludes the wound, preventing air from entering. Place a chest tube remote from the wound as soon as possible. Subsequent definitive surgical closure of the wound is frequently required.