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.

Post appendectomy day 5 (presents on day 8) with right iliac fossa pain. Purulent
discharge was noted. BP stable, temp high. What is the most appropriate next step?
A- IV antibiotic
B- Percutaneous drainage
C- Exploratory laparotomy

Better recall: 25 year old male Pt 8th day post surgery with wound site redness & tenderness with purulent discharge.. most appropriate?
A. IV antibiotics
B. CT abdominal
C. Open drainage
D. Exploratory laparoscopy

Abdulrahman: The answer is C. You have to open the wound and drain it. This question was answered by Dr. Thawaba:

14 y.o female with epigastric abdominal pain since a month Patient was complaining that it is affecting her life, On exam patient had multiple bruises in abdomen when asked about it she said it appeared after she fell over her cycle 18 days back, next inv?
A- CT abdominal
B- Abdominal US
D- laparotomy

Abdulrahman: If he presented in the first two days, I would go with B. Since he presented after 2 weeks, I will choose A. Dr. Abeidi’s answer to this question “Traumatic pancreatitis. Although US can be done as an initial investigation, it is rarely useful when it comes to imaging the pancreas. CT is more sensitive and would always be ordered in such a clinical scenario”

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A woman was bathing her child and noticed a mass in his flank, which of the following invx is most appropriate?
A- Abdominal radiography (XRAY)
B- Abdominal CT
C- Abdominal MRI
D- Abdominal radiography and ultrasonography

Abdulrahman: The most common intra-abdominal tumors found in children are neuroblastoma, followed by nephroblastoma or Wilms' tumor. Most appropriate is a vague way of asking a question. I would go for an ultrasound US as a next step then a CT to confirm. Here is a picture that can help you differentiate between the two.

Nelson: An abdominal ultrasound or computed tomography (CT) scan can usually distinguish an intrarenal mass from a mass in the adrenal gland or other surrounding structures.

Patient developed severe pain and swelling and altered mental status after femural artery repair. What is the management?
A- Traction
B- Nerve repair
C- Embolization

Abdulrahman: This question is confusing and all over the place. If you can send me a better recall, I would really appreciate it. This is most likely a case of compartment syndrome and requires immediate fasciotomy.

patient comes with joint pain in her hands and fingers. Labs show an elevated ESR and CRP. X-Ray of the hands show multiple erosions. What treatment will you give for this patient?
A- Hydroxychloroquine
B- Hydroxychloroquine with weekly methotrexate
C- Intravenous steroids
D- Indomethacin

Abdulrahman: The answer is B. Although the best option would be to add steroids to the regiment.

Another similar question: Patient with joint swelling and redness diagnosed as RA
A. MTX
B. MTX+ sulfa
C. MTX+ Hydroxychloroquine
D. MTX+ Hydroxychloroquine + prednisone
Abdulrahman: D

Cholelithiasis with 12 mm CD what to do?
A- ERCP
B- MRCP
C- Cholecystectomy

Abdulrahman: Since the findings already suggest choledocolithiasis (>6 or 7 is considered a dilated common bile duct), we go directly for ERCP. Schwartz: P atients with choledocholithiasis are best approached endoscopically, with sphincterotomy and stone removal, or by placement of an endoscopic biliary stent.

Patient came with new onset of LBBB ( given dx ) was given aspirin, heparin
what to the most appropriate next step ?
A- Give carvidolol
B- Give warfarin
C- Do pci
D- Do echo

Abdulrahman: I am between C and D. It depends if the patient is symptomatic or not. Since he was given some of the treatment for MI (ASA and heparin), I would go for PCI, since a new LBBB is considered an MI equivalent. I am sure that it will be much clearer for you in the exam.