Another similar question: Pt with oesophageal cancer how to do staging?
A- CT
B- Esophageal US
C- CXR
Abdulrahman: Both CT and Esophageal US are used for staging, however, I will go for Esophageal US.
- CT is used for locating, content, and mets.
- Esophageal US is used for infiltration depth and regional lymph nodes invasion.
To stage an esophageal cancer according to TNM:
- We use CT for N and M
- While T we use endoscopic US
A- CT
B- Esophageal US
C- CXR
Abdulrahman: Both CT and Esophageal US are used for staging, however, I will go for Esophageal US.
- CT is used for locating, content, and mets.
- Esophageal US is used for infiltration depth and regional lymph nodes invasion.
To stage an esophageal cancer according to TNM:
- We use CT for N and M
- While T we use endoscopic US
Patient with stab wound in anterior neck. he is Alert but in labs oxygen sat 82%. What to do NEXT:
A- Oxygen mask
B- Cricothyroidotomy
C- Endotracheal intubation
D- Tracheostomy
Abdulrahman: The answer is C. He has a stab wound in the neck, so the oxygen mask will leak. You can do endotracheal intubation through the neck wound itself. Of course in the full question they will tell you if the patient is in the hospital (endotracheal intubation) or in the scene of the injury or the ambulance (oxygen mask as a temporary measure until intubation is done).
A- Oxygen mask
B- Cricothyroidotomy
C- Endotracheal intubation
D- Tracheostomy
Abdulrahman: The answer is C. He has a stab wound in the neck, so the oxygen mask will leak. You can do endotracheal intubation through the neck wound itself. Of course in the full question they will tell you if the patient is in the hospital (endotracheal intubation) or in the scene of the injury or the ambulance (oxygen mask as a temporary measure until intubation is done).
Pt known case of dm and htn she's on medication metformin bid and her symptoms is controlled her labs are normal except hgb is 8 what to add her?
A- nothing to add
B- give iron
C- Change
Abdulrahman: This question is missing important info (age, other choices, and the labs exactly). Metformin can cause megaloblastic anemia (B12 deficiency), but not to the extent where it causes megaloblastic anemia. We can’t start her on iron without any iron level studies.
A- nothing to add
B- give iron
C- Change
Abdulrahman: This question is missing important info (age, other choices, and the labs exactly). Metformin can cause megaloblastic anemia (B12 deficiency), but not to the extent where it causes megaloblastic anemia. We can’t start her on iron without any iron level studies.
Child with sx of meningitis, on examination he has papilledema, council parents about what complication:
A. Hearing loss
B. Vision loss
C. Septic shock
Abdulrahman: Papilledema carries a high risk of vision loss, while one of the complications of meningitis is hearing loss. Make sure you read the question clearly as to whether he is asking about this patient directly or generally in patients with meningitis. From Om-Alqura:
- Most common complication of meningitis in general —> Hearing loss
- Expected complication of meningitis in case of papilledema is presented —> Vision loss
A. Hearing loss
B. Vision loss
C. Septic shock
Abdulrahman: Papilledema carries a high risk of vision loss, while one of the complications of meningitis is hearing loss. Make sure you read the question clearly as to whether he is asking about this patient directly or generally in patients with meningitis. From Om-Alqura:
- Most common complication of meningitis in general —> Hearing loss
- Expected complication of meningitis in case of papilledema is presented —> Vision loss
RA pt using ansid for joint pain came with unstable state what is intial investigation?
A- Erict X-ray
Better recall: A 53 years old male, known case of RA on NSAIDs. Presented to the ER with severe sudden abdominal pain, nausea and vomiting. On examination there is generalized tenderness and guarding. Which of the following is the investigation of choice?
A- Erect CXR.
B- Supine abdominal X-ray.
C- FAST
D- Colonoscopy.
Abdulrahman: The answer is A, since this patient most likely has a gastric or duodenal perforation (long history of using NSAIDs). We have to do an erect chest x-ray to detect if there is air under the diaphragm, which suggests pneumoperitoneum. Here is an example:
A- Erict X-ray
Better recall: A 53 years old male, known case of RA on NSAIDs. Presented to the ER with severe sudden abdominal pain, nausea and vomiting. On examination there is generalized tenderness and guarding. Which of the following is the investigation of choice?
A- Erect CXR.
B- Supine abdominal X-ray.
C- FAST
D- Colonoscopy.
Abdulrahman: The answer is A, since this patient most likely has a gastric or duodenal perforation (long history of using NSAIDs). We have to do an erect chest x-ray to detect if there is air under the diaphragm, which suggests pneumoperitoneum. Here is an example:
5 y girl presented with pubic hair and smell like adult. What is initial investigation?
A- FSH
B- Testerone
C- 17 hydroxy...
D- Dihroxy…
Abdulrahman: The answer is D. This is most likely a case of premature adrenarche and not precocious puberty, so we will have to do dehydroepiandrosterone sulphate (DHEAS).
Hacker & Moore:
- Precocious puberty: The criteria for diagnosis include development of female secondary sexual characteristics (breast budding, menstruation, and pubic hair) and accelerated growth before age 8 in girls and age 9 in boys. We start the investigations with FSH & LH.
- Incomplete isosexual precocity: is the early appearance of a single secondary sexual characteristic. These conditions include premature thelarche, the isolated appearance of breast development before the age of 4 years (unilateral or bilateral) that resolves spontaneously within months and that is probably secondary to transient estradiol secretion; premature adrenarche, the isolated appearance of axillary hair before the age of 7 years that is the result of premature androgen secretion by the adrenal gland; and premature pubarche, the isolated appearance of pubic hair in girls before the age of 8 years. Premature adrenarche will present with the development of pubic hair, oily skin, oily hair and body odor.
A- FSH
B- Testerone
C- 17 hydroxy...
D- Dihroxy…
Abdulrahman: The answer is D. This is most likely a case of premature adrenarche and not precocious puberty, so we will have to do dehydroepiandrosterone sulphate (DHEAS).
Hacker & Moore:
- Precocious puberty: The criteria for diagnosis include development of female secondary sexual characteristics (breast budding, menstruation, and pubic hair) and accelerated growth before age 8 in girls and age 9 in boys. We start the investigations with FSH & LH.
- Incomplete isosexual precocity: is the early appearance of a single secondary sexual characteristic. These conditions include premature thelarche, the isolated appearance of breast development before the age of 4 years (unilateral or bilateral) that resolves spontaneously within months and that is probably secondary to transient estradiol secretion; premature adrenarche, the isolated appearance of axillary hair before the age of 7 years that is the result of premature androgen secretion by the adrenal gland; and premature pubarche, the isolated appearance of pubic hair in girls before the age of 8 years. Premature adrenarche will present with the development of pubic hair, oily skin, oily hair and body odor.
Pregnant pt come with painful breast mass, tinder and redness, asking about diagnosis:
A- mastitis
B- abscess
C- duct Ectasia
D- something
Abdulrahman: This is most likely a case of breast abscess and not mastitis.
- Breast abscess: The diagnosis of should be suspected based on clinical manifestations (localized inflammation of the breast associated with fever and a fluctuant, tender,warm, and palpable mass)
- Mastitis: usually occurs in lactating women and will present with tender, firm, swollen, and diffuse erythematous breast (not mass).
A- mastitis
B- abscess
C- duct Ectasia
D- something
Abdulrahman: This is most likely a case of breast abscess and not mastitis.
- Breast abscess: The diagnosis of should be suspected based on clinical manifestations (localized inflammation of the breast associated with fever and a fluctuant, tender,warm, and palpable mass)
- Mastitis: usually occurs in lactating women and will present with tender, firm, swollen, and diffuse erythematous breast (not mass).
Hydatic cyst question. CT show daughter cysts. What is the definitive management?
A- Surgical deroofing
B- Aspiration
C- Right hepectomy
Another recall: scenario about hydatid cyst 10*13 with daughter cysts, what is the management?
A. Surgical deroofing
B. Percutaneous aspiration
C. Right hepatectomy
Abdulrahman: The best management is surgical deroofing, since this is a WHO stage CE3b. Initially, Albendazole or Mebendazole.
A- Surgical deroofing
B- Aspiration
C- Right hepectomy
Another recall: scenario about hydatid cyst 10*13 with daughter cysts, what is the management?
A. Surgical deroofing
B. Percutaneous aspiration
C. Right hepatectomy
Abdulrahman: The best management is surgical deroofing, since this is a WHO stage CE3b. Initially, Albendazole or Mebendazole.
36 with le- neck mass, 2x2xm in posterior angle of mandible US: normal thyroid, le- large LN with cysTIc component FNA: all smear shows follicular thyroid
A- Metastatic thyroid cancer
B- Apparent thyroid
C- Ectopic thyroid
D- Thryoglossal cyst
Another recall: 33yo male with painless swelling in the posterior triangle of his neck.
On US thyroid is normal and the swelling has cystic component. FNA shows complete follicular cells. What is the most likely diagnosis?
A. Apparent thyroid
B. Metastatic cancer
C. Ectopic thyroid
D. Thyroglossal cyst
Abdulrahman: Since it is on the posterior triangle of the neck, the answer is a metastatic aberrant thyroid. Aberrant can be meant as metastatic or ectopic normal thyroid. If Papillary cancer is in the choices, go for it. Here is a similar recall or another question from Dr. Thawaba:
A- Metastatic thyroid cancer
B- Apparent thyroid
C- Ectopic thyroid
D- Thryoglossal cyst
Another recall: 33yo male with painless swelling in the posterior triangle of his neck.
On US thyroid is normal and the swelling has cystic component. FNA shows complete follicular cells. What is the most likely diagnosis?
A. Apparent thyroid
B. Metastatic cancer
C. Ectopic thyroid
D. Thyroglossal cyst
Abdulrahman: Since it is on the posterior triangle of the neck, the answer is a metastatic aberrant thyroid. Aberrant can be meant as metastatic or ectopic normal thyroid. If Papillary cancer is in the choices, go for it. Here is a similar recall or another question from Dr. Thawaba:
Pregnant woman about to deliver, past history significant for Asthma and E.Coli. What to give during delivery?
A- Betamethasone
B- Ampecilline
Abdulrahman: We don’t know at what gestational age she is. It could be this question:
A- Betamethasone
B- Ampecilline
Abdulrahman: We don’t know at what gestational age she is. It could be this question:
patient with RTA is stable and conscious with a patent airway. His blood pressure is 105/90 mmHg. His GCS score is 15. What is the most appropriate next step?
A. IV Fluid
B. FAST
Abdulrahman: The answer is A (ABC protocol)
A. IV Fluid
B. FAST
Abdulrahman: The answer is A (ABC protocol)
3 y old child diagnosed with malaria. What is type of malaria?
A- P falciparum
B- P vivax
C- P ovale
D- P malariae
Abdulrahman: There has to be some more info or the famous picture, since it is a very common and an easy question. The answer is always plasmodium falciparum when you get this picture:
A- P falciparum
B- P vivax
C- P ovale
D- P malariae
Abdulrahman: There has to be some more info or the famous picture, since it is a very common and an easy question. The answer is always plasmodium falciparum when you get this picture:
Patient presented with dysphagia to liquids more than solid. Which is the most appropriate initial investigation:
A- endoscopy
B- barium swallow
C- US
D- biopsy
Abdulrahman: The answer is A. The use of barium swallow is indicated in certain cases and is known to be a controversial initial investigation.
A- endoscopy
B- barium swallow
C- US
D- biopsy
Abdulrahman: The answer is A. The use of barium swallow is indicated in certain cases and is known to be a controversial initial investigation.
Eldry k/c HTN DM smoker since 40 years Underwent thromplysis for stenosis in hospital , HA1c = 7 What the risk condition could be happened during his admission!?
A-stroke
B-bleeding
C-PE
D-MI
Another recall: 65 year-old male patient k/c of DM, HTN and PAD, presented with severe claudication, admitted to the hospital as a case of acute limb ischemia and received thrombolytic therapy. Which of the following is a cause of death during hospital admission?
A. Bleeding
B. Hemorrhagic stroke
C. Pulmonary embolism
D. Myocardial infarction
Abdulrahman: The answer is hemorrhagic stroke due to the risk of thromblytic therapy on top of his risk factors (HTN, DM, and smoker).
A-stroke
B-bleeding
C-PE
D-MI
Another recall: 65 year-old male patient k/c of DM, HTN and PAD, presented with severe claudication, admitted to the hospital as a case of acute limb ischemia and received thrombolytic therapy. Which of the following is a cause of death during hospital admission?
A. Bleeding
B. Hemorrhagic stroke
C. Pulmonary embolism
D. Myocardial infarction
Abdulrahman: The answer is hemorrhagic stroke due to the risk of thromblytic therapy on top of his risk factors (HTN, DM, and smoker).