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.
Elderly patient with fever pleuritic chest pain and early clubbing , plural tap showed pH 7 , what is the diagnosis ?
A-Empyema
B-Chronic bronchitis
C-Parapneumonic effusion
D-Emphysema
Abdulrahman: Based on this info, I will go with either empyema or parapneumonic effusion.
- A pleural fluid pH <7.3 is associated with the same pathologies that cause low pleural fluid glucose levels (e.g., infection).
- Empyema that develops from an adjacent pneumonia is a subclass of a complicated parapneumonic effusion. While a complicated parapneumonic effusion and empyema represent a spectrum of infection within the pleural space, no pus is directly visualized in patients with a complicated parapneumonic effusion.
- We also have to check the protein and in the LDH in the pleural tap to differentiate between exudative and transudative causes of pleural effusion (light’s criteria). Here are normal values for pleural fluid, light’s criteria for pleural effusion, and the causes of clubbing:
A-Empyema
B-Chronic bronchitis
C-Parapneumonic effusion
D-Emphysema
Abdulrahman: Based on this info, I will go with either empyema or parapneumonic effusion.
- A pleural fluid pH <7.3 is associated with the same pathologies that cause low pleural fluid glucose levels (e.g., infection).
- Empyema that develops from an adjacent pneumonia is a subclass of a complicated parapneumonic effusion. While a complicated parapneumonic effusion and empyema represent a spectrum of infection within the pleural space, no pus is directly visualized in patients with a complicated parapneumonic effusion.
- We also have to check the protein and in the LDH in the pleural tap to differentiate between exudative and transudative causes of pleural effusion (light’s criteria). Here are normal values for pleural fluid, light’s criteria for pleural effusion, and the causes of clubbing:
45y man no Family hx of colon cancer, no risk factor, came for screening ?
A- start screening at 50y
B- start screening now
Another recall: 45 female no family hx of any cancer and medically free ask for colon cancer screen:
A- no need
B- in age 50
C- do now
Abdulrahman: The answer is to do it at 50 years of age (Dr. J and Dr. Thawaba agrees with this). The new guidelines suggest we start at 45, but I don’t think that the new colonoscopy screening guides are applied in the SMLE. We start at 50 and do colonoscopy every 10 years.
A- start screening at 50y
B- start screening now
Another recall: 45 female no family hx of any cancer and medically free ask for colon cancer screen:
A- no need
B- in age 50
C- do now
Abdulrahman: The answer is to do it at 50 years of age (Dr. J and Dr. Thawaba agrees with this). The new guidelines suggest we start at 45, but I don’t think that the new colonoscopy screening guides are applied in the SMLE. We start at 50 and do colonoscopy every 10 years.
Child came with 10 cm neck swelling that is soft and bogy how you will manage ?
A. surgery
B.sclerotheraby
C.chemotherapy
D.radiation
Another recall: Cyst measures 10× 9 in the side of the neck by FNA clear lymphatic fluid. What is the appropriate management ?
A.Chemotherapy
B.Radiotherapy
C.Sclerotherapy
D. Surgery
Another recall: Child came with 10 cm neck swelling that is soft and bogy how you will manage ?
A- surgery
B- sclerotheraby
C- chemotherapy
D- radiation
Another recall: 2 or 3 yo with swelling behind the ear, and FNA showed was clear lymphatic fluid. What to do:
A- Surgery
B- Sclerotherapy
C- Radiotherapy
D- chemotherapy
Another recall: Rt neck lump 10cm spongy in palpating, fna show lymphatic fluid
A- Surgery
B- Sclerotherapy
C- Chemotherapy
D- Radiotherapy
Another recall: Case of an infant with a lateral neck mass 10*10 cm aspiration revealed a clear lymphatic fluid, what’s the most appropriate ttt?
A- surgical excision
B- Radiotherapy
Abdulrahman: The answer is sclerotherapy. This was also answered by Dr. Thawaba and Dr. J. Sclerotherapy is the first-line treatment for problematic macrocystic hygroma (lymphangioma). Surgical removal of macrocystic LM is indicated if the lesion is symptomatic and sclerotherapy is no longer possible, or resection is possibly curative because the lesion is small and well localized.
A. surgery
B.sclerotheraby
C.chemotherapy
D.radiation
Another recall: Cyst measures 10× 9 in the side of the neck by FNA clear lymphatic fluid. What is the appropriate management ?
A.Chemotherapy
B.Radiotherapy
C.Sclerotherapy
D. Surgery
Another recall: Child came with 10 cm neck swelling that is soft and bogy how you will manage ?
A- surgery
B- sclerotheraby
C- chemotherapy
D- radiation
Another recall: 2 or 3 yo with swelling behind the ear, and FNA showed was clear lymphatic fluid. What to do:
A- Surgery
B- Sclerotherapy
C- Radiotherapy
D- chemotherapy
Another recall: Rt neck lump 10cm spongy in palpating, fna show lymphatic fluid
A- Surgery
B- Sclerotherapy
C- Chemotherapy
D- Radiotherapy
Another recall: Case of an infant with a lateral neck mass 10*10 cm aspiration revealed a clear lymphatic fluid, what’s the most appropriate ttt?
A- surgical excision
B- Radiotherapy
Abdulrahman: The answer is sclerotherapy. This was also answered by Dr. Thawaba and Dr. J. Sclerotherapy is the first-line treatment for problematic macrocystic hygroma (lymphangioma). Surgical removal of macrocystic LM is indicated if the lesion is symptomatic and sclerotherapy is no longer possible, or resection is possibly curative because the lesion is small and well localized.
Pt with a penetrated neck in zone 1 and is bleeding, what is the best management?
A- open and primary repair
B- Endovascular
C- open and ligation
Another recall: Neck penetrating injury on zone 1 with subcutaneous emphysema:
A. Neck exploration
B. CTA
C. Angio embolization
Abdulrahman: The answer is CTA. Here is the approach to neck injuries from Schwartz:
A- open and primary repair
B- Endovascular
C- open and ligation
Another recall: Neck penetrating injury on zone 1 with subcutaneous emphysema:
A. Neck exploration
B. CTA
C. Angio embolization
Abdulrahman: The answer is CTA. Here is the approach to neck injuries from Schwartz:
Trauma patient, with typical signs and symptoms of tension pneumothorax, his GCS is 8, what is your next step in management?
A- Intubation
B- Needle thoracotomy
Full recall: A 35 year old car driver crashed into a concrete block without a safety belt on. Thirty minutes after and on the way by ambulance to the hospital he begins to become breathless. On administration of 100% oxygen there is not much improvement in this condition. On arrival at the Emergency Department he has lost consciousness (GCS 8) and appears cyanosed with markedly distended jugular veins. Blood pressure 80/40
Heart rate 120 /min
Respiratory rate 34 /min
Temperature 36.6 c
Oxygen saturation 60% on room air
What immediate action should be taken?
A. Intubation and 100% oxygen
B. Rapid infusion of crystalloid
C. Needle decompression
D. IV 0.2 mg adrenaline
Abdulrahman: The answer is intubation and 100% oxygen. This is the full recall. You are not sure if this is a cardiac tamponade or tension pneumothorax. Also, this question is begging you to follow the ATLS protocol. He is unconscious (risk of aspiration and hypoxia), so we have to secure the airway with intubation (ABC). Intubation is Airway and needle decompression is Breathing. If his GCS was normal, I would have gone for needle decompression. Here is an example of how much clearer the questions will be in the exam :D
A- Intubation
B- Needle thoracotomy
Full recall: A 35 year old car driver crashed into a concrete block without a safety belt on. Thirty minutes after and on the way by ambulance to the hospital he begins to become breathless. On administration of 100% oxygen there is not much improvement in this condition. On arrival at the Emergency Department he has lost consciousness (GCS 8) and appears cyanosed with markedly distended jugular veins. Blood pressure 80/40
Heart rate 120 /min
Respiratory rate 34 /min
Temperature 36.6 c
Oxygen saturation 60% on room air
What immediate action should be taken?
A. Intubation and 100% oxygen
B. Rapid infusion of crystalloid
C. Needle decompression
D. IV 0.2 mg adrenaline
Abdulrahman: The answer is intubation and 100% oxygen. This is the full recall. You are not sure if this is a cardiac tamponade or tension pneumothorax. Also, this question is begging you to follow the ATLS protocol. He is unconscious (risk of aspiration and hypoxia), so we have to secure the airway with intubation (ABC). Intubation is Airway and needle decompression is Breathing. If his GCS was normal, I would have gone for needle decompression. Here is an example of how much clearer the questions will be in the exam :D
Pt in ICU received 15 units of blood, now blood coming out from NGT, incision, and cannula site
A- Transfusion reaction
B- Thrombocytopenia
C- Hypocalcemia
D- Von wilbrand
Abdulrahman: This could be a case of dilutional coagulopathy, since he got 15 units of blood. Patients with transfusion reaction will most likely present with bleeding, fever, and signs of shock:
A- Transfusion reaction
B- Thrombocytopenia
C- Hypocalcemia
D- Von wilbrand
Abdulrahman: This could be a case of dilutional coagulopathy, since he got 15 units of blood. Patients with transfusion reaction will most likely present with bleeding, fever, and signs of shock:
65-year-old, heavy smoker is coming for routine checkup. What is the best screening test for him?
A- Osteoporosis
B- Colon cancer
C- AAA
Abdulrahman: Both B and C are correct. I know that this is a textbook presentation of a patient who needs to be screened for AAA. However, I will go with B, because as far as I know, we don't do AAA screening in Saudi Arabia. We only check for AAA in Saudi Arabia if the patient has symptoms (and Dr. J agrees with this). The USPSTF has a Grade B recommendation for screening of AAA in asymptomatic patients. Colon cancer screening is Grade A. This is why I went for colon cancer screening as the best screening test in this case. So, since he chose me between what is best, I will go for colon cancer screening.
A- Osteoporosis
B- Colon cancer
C- AAA
Abdulrahman: Both B and C are correct. I know that this is a textbook presentation of a patient who needs to be screened for AAA. However, I will go with B, because as far as I know, we don't do AAA screening in Saudi Arabia. We only check for AAA in Saudi Arabia if the patient has symptoms (and Dr. J agrees with this). The USPSTF has a Grade B recommendation for screening of AAA in asymptomatic patients. Colon cancer screening is Grade A. This is why I went for colon cancer screening as the best screening test in this case. So, since he chose me between what is best, I will go for colon cancer screening.