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

27-year-old obese woman presents with right iliac fossa pain associated with anorexia, nausea, and vomiting. On examination, there is moderate right lilac fossa tenderness. Labs:
Leukocytosis. What is the most appropriate management?
A - Open surgery
B - CT
C - US
D - Diagnostic laparoscopy

Abdulrahman: The answer is CT (here Alvarado score is 6). Although, you definitely have to do a pregnancy test before doing the CT.

Similar question : 17 years with history of right iliac fossa pain rebound tenderness +ve guarding. what is the investigation next :
A- laparoscopy
B- US
C- CT scan

Abdulrahman: The answer is laparoscopy (diagnostic first then therapeutic) (Dr. J also agrees). In the full recall (couldn't find it), the patient had an Alvarado score of 7 (no other possible diagnosis other than appendicitis) and the patient is presenting in less than 48 hours. If the patient is presenting with an Alvarado score <7, go for a CT scan. This question also came up in my exam where I got 100% in surgery.

Pt with abdominal pain, imaging shows: increase thickness of sigmoid and thumb print due to edema. What is the next step??
A- Colonoscopy
B- Diagnostic laparoscopy
C- Exploratory laparotomy

Abdulrahman: The answer is A (also answered by Dr. Thawaba). UTD: The splenic flexure and the rectosigmoid junction are at high risk for colonic ischemia because they are “watershed areas.” The intestines can tolerate a state of ischemia for approx. 6 hours. Colonoscopy: Procedure of choice in mild to moderate cases of ischemic colitis.

4 y.o his went to doctor because parents recognize blood in stool this the only
symptoms Then the doctor examined him and said it’s common and can be preventable:
A- anal fissure
B- hemorrhoids
C- juvenile poly
D- Intusseption

Abdulrahman: Between these choices, anal fissures are the only one that is common and preventable. Hemorrhoids are uncommon at this age and intussusception and juvenile polyp cannot be prevented if you have non-controllable risk factors.

Rta female when you talk to her she moans O2 sat 65% no other details
A- Tracheostomy
B- Nasotracheal t
C- Endoteachial t
D- Laryngeal mask

Abdulrahman: The answer is C, since this is a trauma case. There are no indications for tracheostomy or cricothyroidotomy. You need a permanent airway since she is moaning (indicating decreased GCS). Dr. J: The best in supporting the airway is always Orotracheal. After that, cricothyrotomy. Nasotracheal is not ideal in an emergency setting. Also, if there is facial or C-spine injury, DON’T do orotracheal, go for cricothyrotomy.

7 ys girl with dark macule on her cheek dx
A- Venous malformation
B- Lymphatic malformation
C- AV malformation
D- Hemangioma

Abdulrahman: Could be A or C. If she is born with it, this is most likely capillary malformation (Sturge-weber syndrome). If it comes after birth slowly, this is hemangioma of infancy. Hemangiomas usually involutes at 2-6 years:

30 y old male came with dyspnea, chest pain, PND and orthopnea. On examination: pansystolic murmur Gallop S3 with displaced apex, no any significant medical history. Most appropriate next step:
A- Echocardiography
B- Chest x-ray and ECG
C- Beta blocker
D- Lasix

Abdulrahman: The patient is presenting (most likely in the ER) with signs of HF. As an emergency physician, you have to do ECG first and CXR and call the cardiology oncall. After that, the cardiology on call will perform the echocardiography.

A 45 years old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report : tip of appendix carcinoma. What is the most appropriate management
A- Observation
B- Chemotherapy
C- Radiotherapy
D- Right hemicolectomy

Another recall: Pt thought to have appendicitis and removed did appendectomy, pathology lab shower carcinoid tumor 1 cm. What to do additionally ?
A-follow up
B-chemo
C-radiation
D-right hemicolectomy

Abdulrahman: The answer is nothing/follow-up since the carcinoma is at the tip of the appendix. Here is the approach to carcinoids from the appendix from Dr. J:

A patient PCOS what should be investigated
A- Glucose tolerance and lipid profile
B- Thyroid profile

Another recall: Patient with PCOS, what should be investigated:
A. Glucose tolerance and lipid profile
B. Thyroid profile
C. testosterone level

Abdulrahman: We’re not sure of her age and if she is diagnosed or just has the symptoms. If she was not diagnosed, the answer is testerone levels (part of the rotterdam criteria). If diagnosed, do the glucose tolerance and lipid profile since PCOS patients have a high risk of dyslipidemia and diabetes.