Adult with Hypertension and Dm has 2 months history of Small perianal painful Swelling Bp: 160 / 100 ?
A-Perianal abscess
B-Preanal fistula
C-Thrombosed pile

Another Recall: 28 years old patient came with severe perianal pain and swelling. On examination, there is 1x1 cm perianal swelling with tenderness. Vitals: normal, no fever. Labs: WBC 8 (normal). Which of the following is the most likely diagnosis ?
A. Anal fistula
B. Anal fissure
C. Perianal abscess
D. Perianal hematoma

Abdulrahman: This is most likely a case of perianal hematoma or a thrombosed pile (external hemorrhoid).
- Anal fistula: pain and discharge and an obvious opening
- Anal hematoma and thrombosed pile: swelling and painful, but vitally stable
- Anal abscess: swelling, painful, high wbc, and the patient will have fever
- Anal fissure: very painfull, and a fissure (crack) will be seen

Pediatric abdominal dissension costpiation PR examination empty rectum while withdrawing the finger gush of stool comes out what is your next action
A-Referral to GS
B-Reassuring
C-Enema

Another recall: 4 y/o boy has chronic constipation despite eating high fiber diet and stool softeners, examination shows empty rectum but after DRI huge gush of stool, management?
A-Surgery
B-Increase stool softener dose
C-Refer to oncology
D-Increase high fiber diet

Abdulrahman: This is a case of Hirschsprung’s disease. We start with a barium enema rectally (not orally) to know the extent of the disease. To confirm the diagnosis, we do a rectal air suction biopsy (will show lack of ganglionic cells and/or hypertrophy of cells). Management is through rectal washing and transanal endorectal pull-through.

Elderly was completely healthy except for elevated BP for the first time
A. Ambulatory BP measurement
B. Start anti HTN
C. Measure the BP two times later on in the clinic
D. Measure BP two time in hom

Abdulrahman: The answer is D (initial). According to the USPSTF and UTD, we start with measuring the BP two times at home, then give the patient an ambulatory BP monitor.

5 y o vomiting and diarrhea for 4 days O/E pt looks dehydrated, hypocative, sunken eyes , doughy skin , dry mecus membranes , cap refill is 4 seconds Bp 90/70 and tachycardic rest of vitals are normal
What is his Na level
A-Low
B-High
C-No corrolation
D-normal

Abdulrahman: It depends if the child has normal diarrhea (hyponatremia) or gastroenteritis (hypernatremia). Since the child has a case of acute diarrhea and vomiting, I will go with B.

Which part of the urethra is the most vunlerable to injury
A- membranous
B- bulbar
C- prostatic
D- Penile

Abdulrahman: The answer is A. The membranous part of the urethra is the most vulnerable to be injured (our question), but the bulbar is the most commonly injured.

A child starts to develop an awareness for strangers and separation anxiety. How old is the child in months?
A- 6 months
B- 7 months
C- 12 months
D- 24 months

Better recall: Child started to develop sense of individuality. She recognize strangers and frightens when separated from her parents.
A- 6
B- 7
C- 10
D- 12

Abdulrahman: I’ll go with 10 months, since it’s the closest answer. He’s experiencing stranger anxiety (6 months), sense of individuality (7 months) and separation anxiety (9 months)

Pt female 54 case CHF symp controled on acei + furosemide just complianed of intermittent dry cough what to do
A- Stop furosemide
B- Increase furosemide
C- Add beta agonist
D- Do pul function test

Another recall: pt. On furosemide and Acei. Come with non productive cough whats the most appropriate next step ?
A-increase furosemide
B- polmonary function test
C- add inhaler
D- decrease furosemide

Abdulrahman: The choices don’t make any sense. I need a better recall, since I think the question is missing an important choice or info. So we do know that ACE-I causes dry coughing as a side effect. We have to change it to ARBs (if it was one of the choices).
- We don’t need to decrease or stop furosemide, since it has nothing to do with his symptoms.
- There are no signs of pulmonary edema, so we don’t have to increase the dose of furosemide.
- Beta blockers can cause tachycardia, which is not preferred in CHF.
- We don’t have to do pulmonary function tests, since there are no indications for it in this case.

Ped having petechial rash, epistaxis, fever, labs: low hgb, low plt, high wbc how to dx
A- Bone marrow
B- Bleeding profile
C- Blood bulture
D- Electrophoresis

Abdulrahman: This could be a case of acute lymphocytic leukemia (ALL). ALL is the neoplasm of early lymphocytic precursors. ALL is the most common malignancy in children under age 15. Labs will show high WBC and low hgb and platelets. We have to order a blood smear first, but we confirm the diagnosis with a bone marrow biopsy. Histology reveals a predominance of lymphocytes.


Similar question: Child with arthritis , fever, epistaxis, gingival bleeding, results : platelets : is low , Hb is : low , whays the investigation ?
A- Bone marrow aspiration
B- Electrophoresis
C- Anti dsDNA
D- ANA

Abdulrahman: The answer is A (Dr. Safdar also agrees with this). This is most likely a case of aplastic anemia. We have to order a bleeding profile to rule out the other ddx. A bone marrow biopsy is crucial (confirmatory) to determine cellularity or the extent of depletion of the hematopoietic elements. The clinical presentation of aplastic anemia is:
- Anemia (low hgb in our case) due to reduced red cell number
- Infection (fever) due to reduced white cell numbers (especially neutrophils)
- Bruising and bleeding (petechial rash and epistaxis) due to thrombocytopenia.

The answer could also be ANA, since the patient has features of SLE (arthritis, thrombocytopenia, leukopenia, autoimmune hemolytic anemia (low hgb), and fever). Systemic lupus erythematosus can happen in children. In most cases, lupus starts during a child's teenage years (the average age is 12). It is rarely seen in children before the age of 5.

women with 11*12 breast mass, examination showed no palpable LN. Core biopsy was taken
and showed malignant phyllode tumor, what’s the next appropriate step?
a. WLE
b. PET scan
c. Chest CT without contrast
d. Simple mastectomy

Abdulrahman: The answer is D, because the size is large. If not there, go for a wide local excision (Dr. J and Dr. Thawaba agree with this answer). Schwartz:

Parent's brought their child to the hospital for inability to move his arm X-ray showed a fracture at both distal ulna and radial bone. The child looks healthy and dressed well, and has good hygiene they recall that 2 days ago the mom. dropped a plate on the child's arm and noticed he couldn't move his arm and after 2nd day the child couldn't move his arm they didn't notice any bruising so they thought it's just a strain. Which of the following is indicative of child abuse?
A. Type of fracture
B. Delayed presentation
C. Consistent story of the parents
D. the appearance of the baby

Abdulrahman: The answer is B. I actually found this same scenario in the Illustrated Textbook of Pediatrics. The outcome is that this is not a case of child abuse and the delayed presentation is the only worrisome feature that is of concern.

A 71 Years Old Male Came to Clinic with 2 Year History of Slow and Progressive Memory Loss. Patient is Able to Perform Activity of Daily Living Such as Dressing Himself. Ptient was Kind But Previous 3 Months Pa?ent is Agitated and Aggressive. What is the Likely Diagnosis for This Patient?
A- Lewy Body Dementia
B- AlZheimer’s Disease
C- MultiInfract Dementia

Another recall: 70 old male with forgetfulness, progressive gradually for years. devolop signs of aggression and violence after he was calm ,caring ,and kind
A- Lewi body
B- Alzheimer’s
C- Vascular dementia

Abdulrahman: The answer is vascular dementia and preferred if it’s frontotemporal lobe due to behavioral changes which is commonly related to that brain region. From the Review Psychiatry Questions for SMLE V2 file: The patient is still able to function and be dependent on his daily activity, the main concern currently is his behavior, so I excluded the other choices. In dementia, changes in personality and behavioral disturbances tend to develop early or late. Psychosis, hallucinations, delusions, and paranoia can occur in approximately 10% of patients with dementia; these symptoms may occur only temporarily in a higher percentage of patients. 3 Behaviors such as agitation, paranoia, and physical aggression often replace clear verbal communication in people with Alzheimer’s disease, Lewy body dementia, or frontotemporal dementia

65 years old k/c Dm female with pneumonia admitted in icu x ray show unilateral plural effusion : What is the cause of her poor prognosis
A- age
B- plural infusion
C- dm

Better recall: 62 years old patient KC of DM .. diagnosed as pneumonia and sepsis
His lab normal except high WBC. X ray showed: pneumonia and pleural effusion .
Which one of the following indicates poor prognosis?
A-High WBC
B-X ray finding
C-Patients age
D-DM

Abdulrahman: The answer is age in both questions. Here is the pneumonia severity index (PSI):

45 y/o female complete mammogram screening when to do it again ?
A-acer 1 year
B-acer 2 Years
C-no need
D-forgot but i think acer 6 months

Abdulrahman: The answer after one year. The Screening starts at 45 years of age with a mammogram in Saudi Arabia:
- 45 – 54 y: annually
- Above 55: biennial (every 2 years)
- High risk: 10y before the youngest age in 1st degree relative (25 years is the lowest to screen).

توهم مرسلين لي هالإيميل وفيه نفس الكود. أنا اشتركت بUTD و BMJ Best Practice عن طريقهم

السلام عليكم ورحمة الله وبركاته جميعاً،

الأجوبة الحالية بالقناة قاعد أعدلها لكم لأن كل شوي أحصل إجابة أفضل من المصادر، الريكولات الأفضل، وحتى من ناس تواصلوا معي الله يجزاهم خير وصححوا كم من إجابة.

بإذن الله راح أرسل لكم الملف النهائي (تقريباً ١٢٥ صفحة) خلال الأيام الجاية ❤️

الإجابة هذه تعدلت إلى Hypoxic ischemic encephalopathy لأن Stage 3 ممكن يظهر بHypertonia