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.

Incase of preterm baby when to give hepatitis B vaccine?
A. Immediately after delivery
B. Wait till baby weight is 1.5kg

Full recall: 1500 gram neonate with negative HBV mother, when to vaccine:
A- At birth
B- 1 month based on chronological age
C- 2 months based on corrected age
D- Within 1 week of hospital discharge
Ans: B

Abdulrahman: The correct answer is B ( or at discharge). Here’s a table from the CDC:

Mva with splenic tear Done splenectomy What is goona decrease in his blood after surger ?
A.Insulin
B.Glucagon
C.Tg
D.Glucose

Abdulrahman: The answer is insulin because it is an anabolic hormone. The hormonal response of physiologic stress includes elevation in the serum levels of glucagon, glucocorticoids, and catecholamines and reduction in insulin.

Husband has gonorrhea, his wife presented with UTI symptoms how to confirm diagnosis?
A-Ano genital swap
B- endo cervix swap
C- superior vaginal swap
D- urine culture

Another recall: Woman her husband has gonorrhea what’s the most diagnostic for her?
A. Anogenital swap
B. High vaginal swap
C. Endocervical swap
D. Urine culture

Abdulrahman: The answer is endocervical swab. A low vaginal swab would be correct (not upper/high) UTD:
- Men: Nucleic acid amplification tests (NAAT) of the first-catch urine is the diagnostic test of choice. A urethral swab is also an acceptable specimen for NAAT.
- Women: NAAT of a self- or clinician-collected vaginal swab is the preferred diagnostic test. An endocervical swab is an equally appropriate alternative specimen for NAAT if a speculum exam is already being performed.