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

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:

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.

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).

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.

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:

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:

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)

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:

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.

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).

Patient elderly was found to have irregular irregular pulse pt is stable vitally only Heart rate is 170. What is the most appropriate next step in management:
A- digoxin
B- Amiodarone
C- propranolol
D- cardioversion

Better recall: 55-year-old k/c of bronchial asthma , DM , HTN came to ER with acute episode of palpitation. HR : 160 bpm with irregular rythm , BP 120/80 SPO2 92% on RA
what of the following is most appropriated next step :
A. Cardioversion
B. Amiodarone
C. Adenosin
D. Propranolol

Abdulrahman: The answer is B since this is most likely a case of Atrial fibrillation and you want to control the rhythm. If he’s asking about rate control, give BB, CCB, or digoxin. Atrial fibrillation is the most common irregular heart rhythm that starts in the atria. SVT is a narrow-complex tachycardia that has a regular, rapid rhythm. In cases of SVT, give adenosine. Since he’s asthmatic, we don’t give beta blockers.

Child 12 years chest pain and palpitation. Vitals stable ECG shows "narrow qrs tachycardia of
255 p wave present no fibrillation and regular rhythm" my description, they will give picture Dx:
A-Afib
B-Flutter
C-Svt
D-V. Tach

Abdulrahman: The answer is SVT. In SVT, if the patient is stable, do a vagal massage then give adenosine. If unstable and pulseless, do CPR. If unstable and there is a pulse, go for cardioversion.

A patient has a sudden onset of seizure. He is medically free, has no family history of epilepsy, and no history of recent infection. He has never had any previous episodes of seizures or lapse in consciousness. He is not on any medications. Electrolytes and other blood tests were all normal. What is the next investigation that should be done for this patient?
a. ECG
b. EEG
c. Brain imaging if adult
d. Lumbar puncture

Abdulrahman: The first thing to do in cases of seizure without loss of consciousness is to do a head CT without contrast.