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.

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.

Couple want to conceive and they are relatives, husband’s sister has sickle cell what to do
A- In vitro fertilization
B- Do genetic testing after child is born
C- Do genetics for couple and see result
D- Do nothing god bless them

Another recall: A newly married couple presented to the clinic. The father has a sister with sickle cell disease. He is married to his first degree cousin. Which one of the following is true regarding genetic counseling?
A- No need because it’s low risk
B- Needs genetic counseling
C- Screen the child after birth

Another recall: Married couple (they’re cousins) came to clinic to conceive. Husband has sister with SIckle cell disease what to do?
A-IVIF
B-genetic counseling cuz they’re cousins
C-screen babies after birtch for sickle diseas
D-nothing

Abdulrahman: The answer is genetic counseling for the parents, because sickle cell disease is inherited in an autosomal recessive pattern and they are first-degree relatives and could have SS trait.

Pt with S&S of bowel obstruction On the way to CT he has Upper GI bleeding Next
A- endoscopy
B- colonoscopy
C- CT
D- laporotomy

Abdulrahman: The answer is A. We definitely have to do an upper endoscopy to identify and stop the cause of bleeding.

Smoking most common risk factor for?
A- COPD
B- LUNG CANCER
C- hypertension

Another recall: In cigrate many harmful chemicals, regarding nicotine what is the most important thing u r concerned about?
A- COPD
B- Lung Ca
C- Addiction

Another recall: Nicotine cause ?
A- Addiction
B- COPD
C- IHD
D- Cancer

Abdulrahman: The answer is addiction. If addiction is not in the choices, go for COPD, since the majority of COPD patients are smokers, while the majority of lung cancer patients are not necessarily smokers.

Cancer pt came to the clinic with back pain, investigation shows high calcium, his oncologist said “ you will not live more than one month “. What is the most important action?
A- IV fluid
B- SC morphine

Abdulrahman: The answer is A. Give him fluids then palliative treatment (morphine).