40 years old male presented with shortness of breath for two weeks relieved by rest and worsens with exertion. No Chest Pain and No Palpitations and No Sweating. What is like likely type of chest pain?
Troponin: 0.09 (Normal < 0.04)
A- Typical Anginal Chest Pain
B- Atypical Angina
C- Pulmonary Embolism
D- Myocardial Infraction
Dayel: The answer is B. Atypical Angina may express other signs and symptoms like SOB without chest pain.
Abdulrahman: To add to Dayel, let’s exclude:
Troponin: 0.09 (Normal < 0.04)
A- Typical Anginal Chest Pain
B- Atypical Angina
C- Pulmonary Embolism
D- Myocardial Infraction
Dayel: The answer is B. Atypical Angina may express other signs and symptoms like SOB without chest pain.
Abdulrahman: To add to Dayel, let’s exclude:
Patient with sudden severe epigastric pain for 8h associated with vomiting and nausea, on examination epigastric tenderness,,,labs only given elevated amylase.
What is most helpful to determine the disease severity or something like thing:?
A- Procalcitonin
B- ESR
C- CRP
D- Alt
Abdulrahman: Both A and C are correct. However, I will go with C as it is used as an early indicator of severity and to monitor progression of inflammation. CRP will determine severity during the first 48hrs of symptoms onset. Also, procalcitonin is not used as frequently as CRP. Also, procalcitonin is not used as frequently as CRP.
What is most helpful to determine the disease severity or something like thing:?
A- Procalcitonin
B- ESR
C- CRP
D- Alt
Abdulrahman: Both A and C are correct. However, I will go with C as it is used as an early indicator of severity and to monitor progression of inflammation. CRP will determine severity during the first 48hrs of symptoms onset. Also, procalcitonin is not used as frequently as CRP. Also, procalcitonin is not used as frequently as CRP.
57 yo woman has 3rd-degree hemorrhoids (with NO bleeding). Which of the following is the appropriate management?
A- fiber supplementation
B- rubber band ligation
C- surgical hemorrhoidectomy
Abdulrahman: There are multiple approaches to follow this question. Dr. J: The answer is A. If B and C are together in the choices, they’re both wrong. Colonoscopy is a better choice.
I will explain the approach that I found and helped me in my exam:
- 1st & 2nd degrees: start with conservative. If it fails, go with rubber band ligation.
- 3rd degree: start with conservative. If it fails, go with hemorrhoidectomy. *Exception*: if there’s bleeding go with rubber band ligation.
- 4th degree: hemorrhoidectomy.
A- fiber supplementation
B- rubber band ligation
C- surgical hemorrhoidectomy
Abdulrahman: There are multiple approaches to follow this question. Dr. J: The answer is A. If B and C are together in the choices, they’re both wrong. Colonoscopy is a better choice.
I will explain the approach that I found and helped me in my exam:
- 1st & 2nd degrees: start with conservative. If it fails, go with rubber band ligation.
- 3rd degree: start with conservative. If it fails, go with hemorrhoidectomy. *Exception*: if there’s bleeding go with rubber band ligation.
- 4th degree: hemorrhoidectomy.
Another recall: 48 y/o with grade 3 hemorrhoids at 3 and 11 o’clock What is the best next step?
A-Colonoscopy
B-Hemorrhoidectomy
C-Band ligation
Abdulrahman: The answer here is A, since the patient is above 40
A-Colonoscopy
B-Hemorrhoidectomy
C-Band ligation
Abdulrahman: The answer here is A, since the patient is above 40
Pt painless defication Blood in th stool. Biles reduced spontanius in 3 areas 3.7....Hb very low
Dx hemmorriid was given which of the following is Definitive management ?
A- conservative manag
B- fiber diet
C- rubbber band ligation
D- hemorroidectomy
Another recall: 24-year-old woman with recurrent on-off PR bleeding after defecation. She has spontaneously reduced hemorrhoids. Hb was low. On examination: 3 hemorrhoids at 2,7,10 O’clock How would u manage?
A - Observation
B - Band ligation
C - Hemorrhoidectomy
D - Conservative
Abdulrahman: The answer is B, because she’s symptomatic. Low Hgb is not from the hemorrhoids, since hemorrhoids do not cause this much bleeding.
Dx hemmorriid was given which of the following is Definitive management ?
A- conservative manag
B- fiber diet
C- rubbber band ligation
D- hemorroidectomy
Another recall: 24-year-old woman with recurrent on-off PR bleeding after defecation. She has spontaneously reduced hemorrhoids. Hb was low. On examination: 3 hemorrhoids at 2,7,10 O’clock How would u manage?
A - Observation
B - Band ligation
C - Hemorrhoidectomy
D - Conservative
Abdulrahman: The answer is B, because she’s symptomatic. Low Hgb is not from the hemorrhoids, since hemorrhoids do not cause this much bleeding.
Pt came 3 days after roux-Y surgery complaining of fever chills and left shoulder pain. Best diagnostic investigation?
A- Ct with contrast
B- Laparoscopic
C- Endoscopy
D- Exploratory laparotomy
Abdulrahman: This patient most likely has a leak after the surgery. The management depends if the patient is stable or not (you will know in the exam if he is stable or not). The best investigation if stable is CT with contrast. If unstable, exploratory laparotomy.
A- Ct with contrast
B- Laparoscopic
C- Endoscopy
D- Exploratory laparotomy
Abdulrahman: This patient most likely has a leak after the surgery. The management depends if the patient is stable or not (you will know in the exam if he is stable or not). The best investigation if stable is CT with contrast. If unstable, exploratory laparotomy.
Pregnant did not feel her fetus movement what is appropriate next step?
A- US
B- CTG
Abdulrahman: This is a very poor recall. We don’t know what gestational age she is at right now or if she has any other complaints.
A- US
B- CTG
Abdulrahman: This is a very poor recall. We don’t know what gestational age she is at right now or if she has any other complaints.
10 years old boy diagnosed as rheumatic fever for how many years should he receive penicillin
A- 3 years
B- 5 years
C- 10 years
D- 15 years
Abdulrahman: It Depends on the age + the heart condition
Another similar question: A patients with rheumatic carditis without valvular lesion and he is 6 years old How long you will give prophylaxes
A. 5 years
B. 10 years
C. 15 years
D. 20 years
Abdulrahman: C
A- 3 years
B- 5 years
C- 10 years
D- 15 years
Abdulrahman: It Depends on the age + the heart condition
Another similar question: A patients with rheumatic carditis without valvular lesion and he is 6 years old How long you will give prophylaxes
A. 5 years
B. 10 years
C. 15 years
D. 20 years
Abdulrahman: C
patient female elderly with symptoms of Orthopnea SOB PND, JVP, Bilateral basal crackles. S3. what is the diagnosis
A- Pulmonary edema
B- MI
C- Mitral regurgitation
D- Right sided heart failure
Abdulrahman: This is a very bad recall and missing important info. Mitral regurgitation can cause pulmonary edema (Left ventricle heart failure + pulmonary edema + S3 gallop). If he asked about the cause of the symptoms, the answer would be A. But if he asked the diagnosis specifically (what originally caused the symptoms and led to the pulmonary edema), then C is most likely. I know I said this a lot, but I am sure it will be much clearer in the exam.
A- Pulmonary edema
B- MI
C- Mitral regurgitation
D- Right sided heart failure
Abdulrahman: This is a very bad recall and missing important info. Mitral regurgitation can cause pulmonary edema (Left ventricle heart failure + pulmonary edema + S3 gallop). If he asked about the cause of the symptoms, the answer would be A. But if he asked the diagnosis specifically (what originally caused the symptoms and led to the pulmonary edema), then C is most likely. I know I said this a lot, but I am sure it will be much clearer in the exam.
A patient with DVT with ankle-brachial index 0.3 and occlusion size 3 cm. Treatment?
A- Embolectomy
B- Stent
C- tPA
Another recall: Old patient long history of leg claudication *for 2 months* , present with leg pain and ABI <0.3 and , *CTA show artery occlusion more than 3 cm* what to do?
A- amputation
B- thrombolysis
C- embelctomy
Abdulrahman: The answer is amputation (Dr. Abeidi and Dr. J agree with this answer). This is a case of acute limb ischemia on top of chronic limb ischemia. If only acute, give heparin infusion first (faster). I got this question when I got my 100% surgery score. There are two ways to give thrombolysis (catheter directed or systemic). Usually in acute limb ischemia, we give catheter directed thrombolysis. Systemic is given in cases of MI (within the window) or massive PE.
A- Embolectomy
B- Stent
C- tPA
Another recall: Old patient long history of leg claudication *for 2 months* , present with leg pain and ABI <0.3 and , *CTA show artery occlusion more than 3 cm* what to do?
A- amputation
B- thrombolysis
C- embelctomy
Abdulrahman: The answer is amputation (Dr. Abeidi and Dr. J agree with this answer). This is a case of acute limb ischemia on top of chronic limb ischemia. If only acute, give heparin infusion first (faster). I got this question when I got my 100% surgery score. There are two ways to give thrombolysis (catheter directed or systemic). Usually in acute limb ischemia, we give catheter directed thrombolysis. Systemic is given in cases of MI (within the window) or massive PE.
3-month-old baby on check-up presented by his parents to the clinic, he is asymptomatic and the investigations showed: mild microcytic anemia. Which of the following is the most likely diagnosis?
A- Thalassemia.
B- Iron deficiency anemia.
C- Sickle cell disease.
D- Physiological anemia.
Another recall: Asymptomatic baby 4 m come to the clinic by his mother, labs show hemoglobin 9 and low MCH low MCV what is the diagnosis?
A- sickle cell
B- physiological anemia
C- thalassemia trait
Abdulrahman: The answer is thalassemia trait since he’s 3 or 4 months (also answered by Om-Alqura). Let’s discuss the other choices:
- Iron deficiency anemia and physiological anemia: We think about it after 6 months of age. rapid growth and an inadequate intake of dietary iron places children 2 years and under, particularly between 9 and 18 months of age, at the HIGHEST risk of any age group for iron deficiency. It is not the case in our case, since he’s only 3 months old.
- Sickle cell anemia: will have a different presentation and the MCV will be normal (not low)
A- Thalassemia.
B- Iron deficiency anemia.
C- Sickle cell disease.
D- Physiological anemia.
Another recall: Asymptomatic baby 4 m come to the clinic by his mother, labs show hemoglobin 9 and low MCH low MCV what is the diagnosis?
A- sickle cell
B- physiological anemia
C- thalassemia trait
Abdulrahman: The answer is thalassemia trait since he’s 3 or 4 months (also answered by Om-Alqura). Let’s discuss the other choices:
- Iron deficiency anemia and physiological anemia: We think about it after 6 months of age. rapid growth and an inadequate intake of dietary iron places children 2 years and under, particularly between 9 and 18 months of age, at the HIGHEST risk of any age group for iron deficiency. It is not the case in our case, since he’s only 3 months old.
- Sickle cell anemia: will have a different presentation and the MCV will be normal (not low)
Pediatric patient had a fall from 1 story high and direct trauma to the head, presents with hemotympanium, No loss of consciousness, no vomimng, neuro exam Normal. Ear: Ruptured tympanic membrane with intact external auditory canal Most likely bone fracture?
A- Mastoid
B- Maxillary
C- Basal skull
Abdulrahman: The answer is C. One of the signs of a basal skull fracture is a hemotympanum.
A- Mastoid
B- Maxillary
C- Basal skull
Abdulrahman: The answer is C. One of the signs of a basal skull fracture is a hemotympanum.
60 YO male patient k/c of DM and HTN presented to ER with neck pain and sweating for one hour. He has a previous history of récurrent chest, pain which resolve spontaneously after resting, ECG done and showed non- specific ST segment and T wave changes. Troponin is normal, What is your next step?
A- Repeat troponin arter 6 hours
B- Discharge the patient
C- Do stress ECG test
D- Give aspirin and nitroglycerin
Abdulrahman: This was also one of the most controversial question in our year and all the sources are between A and D. In real life, you would do both. Since they already did ECG and took troponin samples, they should have already given him aspirin and nitroglycerin and are asking you if you should give it again or not. Anyway, I will follow Om-Alqura’s answer as A. You can listen to their excellent explanation in their cardiology video from last year:
A- Repeat troponin arter 6 hours
B- Discharge the patient
C- Do stress ECG test
D- Give aspirin and nitroglycerin
Abdulrahman: This was also one of the most controversial question in our year and all the sources are between A and D. In real life, you would do both. Since they already did ECG and took troponin samples, they should have already given him aspirin and nitroglycerin and are asking you if you should give it again or not. Anyway, I will follow Om-Alqura’s answer as A. You can listen to their excellent explanation in their cardiology video from last year:
Patient with 8 hours post-operation, urine output is 50 cc, what to do next?
A- dialysis
B- catheter
C- fluid and electrolytes imbalance
D- follow up
Abdulrahman: The answer is C. This patient could be dehydrated or is having some sort of electrolyte imbalance post-op. I would go with B if the choice was to check the catheter if it was inserted properly to measure the urine, since this could be a mistake that could happen and leads to false results of urine output.
A- dialysis
B- catheter
C- fluid and electrolytes imbalance
D- follow up
Abdulrahman: The answer is C. This patient could be dehydrated or is having some sort of electrolyte imbalance post-op. I would go with B if the choice was to check the catheter if it was inserted properly to measure the urine, since this could be a mistake that could happen and leads to false results of urine output.
New born just delivered was found microcephaly and hepatosplenomegaly next :
A- Brain radiography
B- Us abdomen
C- Liver function
Abdulrahman: This recall is missing a lot of info to judge. I would go with congenital infection screening. If not there, go for LFTs. This child most likely has a congenital infection (TORCH infections). For example, Congenital CMV infection can be diagnosed by testing a newborn urine, saliva, or blood. We encountered a similar question in our year. Here is the question and the answer:
A- Brain radiography
B- Us abdomen
C- Liver function
Abdulrahman: This recall is missing a lot of info to judge. I would go with congenital infection screening. If not there, go for LFTs. This child most likely has a congenital infection (TORCH infections). For example, Congenital CMV infection can be diagnosed by testing a newborn urine, saliva, or blood. We encountered a similar question in our year. Here is the question and the answer: