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).
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.
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.
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.
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.
female after sexual attack on exam hymen tear in
a-2 o'clock
b-4""""""""""""""
c-6""""""""""""
D-8""""""""""""""""
Another recall: Child that’s a victim of sexual abuse, which position of the hymen would be the laceration?
A. 12 oclock
B. 4 oclock
C. 6 o'clock
Abdulrahman: The answer is 6 o’clock. UTD: Deep notches or clefts (>50 percent of the width of the hymenal rim) in the posterior/inferior rim of the hymen (below the line drawn through 3 o'clock to 9 o'clock with the patient supine) may be caused by previous blunt force or penetrating trauma. I don’t think they will make you choose between these tight locations.
a-2 o'clock
b-4""""""""""""""
c-6""""""""""""
D-8""""""""""""""""
Another recall: Child that’s a victim of sexual abuse, which position of the hymen would be the laceration?
A. 12 oclock
B. 4 oclock
C. 6 o'clock
Abdulrahman: The answer is 6 o’clock. UTD: Deep notches or clefts (>50 percent of the width of the hymenal rim) in the posterior/inferior rim of the hymen (below the line drawn through 3 o'clock to 9 o'clock with the patient supine) may be caused by previous blunt force or penetrating trauma. I don’t think they will make you choose between these tight locations.
Cause of electrolyte disturbance in glioblastoma?
A- Cerebral salt wasting syndrome
B- Excessive consumption of water
C- SIADH
Another recall: pt diagnosed with glioblastoma came with extreme thirst and irritable foe which she has been admitted to the ICU her Na: 129 , what is the diagnosis:
A- excess water consumption
B- SIADH
C- hypocalcemia
Better recall: Patient has frequent seizures and cognitive impairment. Diagnosed to have glioblastoma multiforme. Labs show decreased Na, decreased K, decreased Cl (I think also decreased Ca but not sure). What is the cause of the electrolyte abnormalities?
A- Salt wasting nephropathy
B- Excessive water intake
C- SIADH
Abdulrahman: The answer is cerebral salt wasting syndrome due to the glioblastoma.
A- Cerebral salt wasting syndrome
B- Excessive consumption of water
C- SIADH
Another recall: pt diagnosed with glioblastoma came with extreme thirst and irritable foe which she has been admitted to the ICU her Na: 129 , what is the diagnosis:
A- excess water consumption
B- SIADH
C- hypocalcemia
Better recall: Patient has frequent seizures and cognitive impairment. Diagnosed to have glioblastoma multiforme. Labs show decreased Na, decreased K, decreased Cl (I think also decreased Ca but not sure). What is the cause of the electrolyte abnormalities?
A- Salt wasting nephropathy
B- Excessive water intake
C- SIADH
Abdulrahman: The answer is cerebral salt wasting syndrome due to the glioblastoma.
A neonate 2 days old infant came to hospital with continues crying complaints of seizure and decreased feeding last day. Inactive child with generalized increase muscle tone. CSF analysis is normal. What is the most likely diagnosis?
A. Neonatal tetanus
B. Hypoxic ischaemic encephalopathy
Better recall: 2 days old baby brought to the hospital because of reluctant to feed and seizure since last night. On exam the baby weight is 3Kg, inactive, has a generlized increased tone. CSF: clear, Glucose 3 mmol (normal 2.8-5), protein 0.22 (normal 0.22-0.33), cells 10 (normal up to 10). Which of the following is the most likely diagnosis?
A. Neonatal sepsis
B. Neonatal tetanus
C. Hypoxic ischemic encephalopathy
D. Pyogenic infection
Abdulrahman: Most likely the answer is hypoxic ischemic encephalopathy. Neonatal sepsis and pyogenic infection will have a similar presentation. The most common cause of seizure in the neonatal period is hypoxic ischemic encephalopathy (HIE).
Nelson: Infants with severe stage 3 hypoxic-ischemic encephalopathy are usually hypotonic, although occasionally they initially appear hypertonic and hyperalert at birth.
Illustrated: The clinical manifestations start immediately or up to 48 hours after asphyxia, and can be graded:
- Mild: the infant is irritable, responds excessively to stimulation, may have staring of the eyes, hyperventilation, hypertonia and has impaired feeding
- Moderate: the infant shows marked abnormalities of movement, is hypotonic, cannot feed and may have seizures
- Severe: there are no normal spontaneous movements or response to pain; tone in the limbs may fluctuate between hypotonia and hypertonia; seizures are prolonged and often refractory to treatment; multi-organ failure is present.
As for neonatal tetanus, UTD: they present with refusal to feed and difficulty opening the mouth due to trismus in an infant previously able to feed and cry normally. Sucking then stops and facial muscles spasm, which may result in risus sardonicus (sardonic smile). The hands are often clenched, the feet become dorsiflexed, and muscle tone increases. As the disease progresses, neonates become rigid and opisthotonus (spasm of spinal extensors) develops. To add to this info, there is no mentioning in any of the references of seizures in neonatal tetanus (which is seen in our case).
A. Neonatal tetanus
B. Hypoxic ischaemic encephalopathy
Better recall: 2 days old baby brought to the hospital because of reluctant to feed and seizure since last night. On exam the baby weight is 3Kg, inactive, has a generlized increased tone. CSF: clear, Glucose 3 mmol (normal 2.8-5), protein 0.22 (normal 0.22-0.33), cells 10 (normal up to 10). Which of the following is the most likely diagnosis?
A. Neonatal sepsis
B. Neonatal tetanus
C. Hypoxic ischemic encephalopathy
D. Pyogenic infection
Abdulrahman: Most likely the answer is hypoxic ischemic encephalopathy. Neonatal sepsis and pyogenic infection will have a similar presentation. The most common cause of seizure in the neonatal period is hypoxic ischemic encephalopathy (HIE).
Nelson: Infants with severe stage 3 hypoxic-ischemic encephalopathy are usually hypotonic, although occasionally they initially appear hypertonic and hyperalert at birth.
Illustrated: The clinical manifestations start immediately or up to 48 hours after asphyxia, and can be graded:
- Mild: the infant is irritable, responds excessively to stimulation, may have staring of the eyes, hyperventilation, hypertonia and has impaired feeding
- Moderate: the infant shows marked abnormalities of movement, is hypotonic, cannot feed and may have seizures
- Severe: there are no normal spontaneous movements or response to pain; tone in the limbs may fluctuate between hypotonia and hypertonia; seizures are prolonged and often refractory to treatment; multi-organ failure is present.
As for neonatal tetanus, UTD: they present with refusal to feed and difficulty opening the mouth due to trismus in an infant previously able to feed and cry normally. Sucking then stops and facial muscles spasm, which may result in risus sardonicus (sardonic smile). The hands are often clenched, the feet become dorsiflexed, and muscle tone increases. As the disease progresses, neonates become rigid and opisthotonus (spasm of spinal extensors) develops. To add to this info, there is no mentioning in any of the references of seizures in neonatal tetanus (which is seen in our case).
left chest Stab in child who came well and do thoracocentesis then the child be hypotensive what do you do next?
A- Thoracotomy
B- Explatory laparotomy
C- Chest tube
Abdulrahman: This is a very poor recall. It could be a case of cardiac tamponade or the child suddenly became unstable due to another reason. Since the stab wound in the chest, you wouldn’t do an exploratory laparotomy. Here is an approach to this case and the indications for a thoracotomy:
A- Thoracotomy
B- Explatory laparotomy
C- Chest tube
Abdulrahman: This is a very poor recall. It could be a case of cardiac tamponade or the child suddenly became unstable due to another reason. Since the stab wound in the chest, you wouldn’t do an exploratory laparotomy. Here is an approach to this case and the indications for a thoracotomy:
36 old male at ER C/O Right abdominal Pain , O/E : fever, anorexia , weight loss, tenderness in RQ and Lower intercostal margines also patient is toxic Temp. 37.9 (I think but it was elevated) wbc high, bilirubin high US : cystic lesion without septates CT : homogenous (not sure) and “THICK WALL with Peripheral enhancement what’s most appropriate Mx :
A- Early laparoscopic cholecystectomy
B- Emergent stent chole
C- Cholecystectomy after 3 months
Abdulrahman: I am not sure if these choices are wrong or it is the same scenario with different choices. Because the case is going with an amoebic liver and not cholecystitis (especially the thick wall and the peripheral enhancement). In any case, we can’t do a cholecystectomy in these patients until their condition has been treated.
A- Early laparoscopic cholecystectomy
B- Emergent stent chole
C- Cholecystectomy after 3 months
Abdulrahman: I am not sure if these choices are wrong or it is the same scenario with different choices. Because the case is going with an amoebic liver and not cholecystitis (especially the thick wall and the peripheral enhancement). In any case, we can’t do a cholecystectomy in these patients until their condition has been treated.
Pt known celiac and he’s on glut free diet x 2ys Now he’s having diarrhea, abd pain, bloating
How to dx for sure
A- Duodenal biopsy
B- Endomysial ab
C- Anti Tissue ab
D- Stool analysis
Another recall: An adult with celiac disease not responding to gluten free diet , you suspect non compliance of the patient how will you confirm your suspicion?
A-Food diary
B-Biopsy
C-Tissue transglutaminase antibody
D-Anti-endomysial antibody
Abdulrahman: The answer is tissue transglutaminase antibodies. In the first question, he is a k/c of celiac disease, so why would you “dx for sure” again? I think he wants to know if the patient is compliant or not (same as the second question). UTD: IgA anti tissue transglutaminase (tTG) or IgA (or IgG) deamidated gliadin peptide (DGP) should be used to monitor the response to gluten-free diet. We perform serologic testing 6 and 12 months after the initial diagnosis of celiac disease and annually thereafter. For whichever assay that will be used, a pretreatment antibody level should be determined at the time of diagnosis. Exclusion of gluten from the
diet results in a gradual decline in serum IgA anti-gliadin and IgA tTG levels (half-life of six to eight weeks).
How to dx for sure
A- Duodenal biopsy
B- Endomysial ab
C- Anti Tissue ab
D- Stool analysis
Another recall: An adult with celiac disease not responding to gluten free diet , you suspect non compliance of the patient how will you confirm your suspicion?
A-Food diary
B-Biopsy
C-Tissue transglutaminase antibody
D-Anti-endomysial antibody
Abdulrahman: The answer is tissue transglutaminase antibodies. In the first question, he is a k/c of celiac disease, so why would you “dx for sure” again? I think he wants to know if the patient is compliant or not (same as the second question). UTD: IgA anti tissue transglutaminase (tTG) or IgA (or IgG) deamidated gliadin peptide (DGP) should be used to monitor the response to gluten-free diet. We perform serologic testing 6 and 12 months after the initial diagnosis of celiac disease and annually thereafter. For whichever assay that will be used, a pretreatment antibody level should be determined at the time of diagnosis. Exclusion of gluten from the
diet results in a gradual decline in serum IgA anti-gliadin and IgA tTG levels (half-life of six to eight weeks).
A patient presented to the clinic complaining only of perianal discharge (no abdominal pain or bleeding), on examination three sinuses were noted at the 3 5 7 o'clock positions. Proctoscopy was clear. What is the most appropriate next step?
A- Colonoscopy
B- MRI
C- Fistulogram
D- US
Abdulrahman: The answer is an MRI of the Pelvis. Since the patient is presenting with multiple perianal sinuses, we have to do a pelvic MRI to check for crohn’s disease (CD), since it can present initially with perineal sinuses. If choice B is not an MRI of the pelvis, go for colonoscopy. CD can affect any part of the gastrointestinal tract from the mouth to the anus and frequently will include perianal disease.
A- Colonoscopy
B- MRI
C- Fistulogram
D- US
Abdulrahman: The answer is an MRI of the Pelvis. Since the patient is presenting with multiple perianal sinuses, we have to do a pelvic MRI to check for crohn’s disease (CD), since it can present initially with perineal sinuses. If choice B is not an MRI of the pelvis, go for colonoscopy. CD can affect any part of the gastrointestinal tract from the mouth to the anus and frequently will include perianal disease.