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).

Lactating women present with right breast pain for 6 day . On examination hot tendered swelling lateral to the right areola Pt started to take floxacillin Us /Cystic lesion, thickened content , ddx could be galactocele , abscess , complicated cyst for correlation. What next
A- I&D
B- repeated aspiration
C- Exisional biopsy
D- I forgot could be reassurance or antibiotic

Abdulrahman: This could be a case of breast abscess (mass lateral to the areola, cystic lesion with thickened content, tender, and hot) The choice between aspiration and percutaneous drainage. It also depends on the size.

Indications for percutaneous drainage:
- One abscess (not multiple)
- Small abscess (<5cm)
- The abscess is not drained
- No thinning of the skin (risk of rupture)
- Not necrosed skin

A 60-year-old man is admitted to the Coronary Care Unit with an acute myocardial Infraction. His hemodynamic parameters 2 hours later are: Blood pressure :80/50 mmHg Heart rate 40 /min Oxygen saturation °C 95% on room air Which of the following would be the appropriate management?
A. IV 0.6 mg atropine sulphate
B. Normal saline infusion
C. IV isoproterenol
D. IV dobutamine

Abdulrahman: The answer is A. This patient has bradycardia and hypotension. Om-Alqura also answered this question:

solitary thyroid nodule 4 mm with neck pain ,tsh and t4 normal ,the next step?
A- FNA
B- Flow up with images

Better recall: 24 years old male presented with neck pain for 3 months. Examination and palpation of the neck was normal. TFT was given (all normal). US showed 4x7 mm solid left thyroid nodule. Benign lymph nodes. Most appropriate management?
A- Radioidone scan
B- FNA
C- Follow up imaging
D- Left hemithyroidectomy

Abdulrahman: The answer is follow up with imaging, since the cutoff for FNA is >1cm.

Female small inguinal hernia:
A. Open with mesh
B. Reassuring
C. Small open surgery
D. Laparoscopic

Better recall: Woman in her fifties asymptomatic has a small femoral hernia, what is the best :
management?
A. Conservative
B. Mesh repair
C. Open repair
D. Laparoscopic

Abdulrahman: Since the question asks about the best management, the answer is repair with mesh.

If you have a disease that has high incidence female and equal prevalence in male and female How did that happen
A- Case fatality is high in female
B- Male patient die more from this disease
C- Female carry this disease for longer period
D- Male carry this disease for shorter period

Abdulrahman: The answer is A. High incidence in females + equal prevalence in both genders = More females are dying compared to males.

12 yo girl with weight loss, diarrhea for 10 months? With occasionally bloody diarrhea, periumbilical abd pain after meals asking about dx ?
A- peptic ulcer
B- Crohns

Another recall: 13 years old with 10 month history of periumblical abdominal pain , post prandial pain , vomiting , diarrhea,stool associated with blood sometime , ?
A. Peptic ulcer disease
B. Crohn’s

Abdulrahman: The answer is B, since she doesn’t have risk factors for peptic ulcer and is in the normal age of distribution(onset before 30 years and a second smaller peak at age 60).

82 year old male with very painful micturition what is the most approppriate management
A- Abx for uti
B- Foley catheter
C- Cysoscopy and turp

Abdulrahman: The answer is B. We have to insert a foley’s catheter, since the patient is having symptoms of urinary retention. We can’t give antibiotics straight away without even a urine analysis.

51 Y M with New ascites & Cirrhosis due to nonalcoholic steatohepatitis.DM2, HTN, dyslipidemia. On metformin, lisinopril, and atorvastatin Low-Na diet started Creatinine 1.1, urine protein-crea ratio 16 mg/g. The most appropriate additional treatment is?
A- Discontinue atorvastatin
B- Initiate low-protein diet
C- Discontinue lisinopril
D- Initiate lactulose

Abdulrahman: The answer is C. The same case is written in this website with the answer:

Case of cirrhotic patient with diffuse abdominal pain and fever and
leucocytocis
Ct ascites
Appropriate next step
A- Antibiotics

Abdulrahman: This patient most likely has spontaneous bacterial peritonitis (SBP). If diagnostic paracentesis is in the choices, go for it. If not, go for antibiotics. BMJ: Diagnosis is made, first by eliciting the presence of ascites, then by looking for signs and symptoms consistent with peritoneal irritation, and finally by confirmation with peritoneal fluid testing. Owing to the high prevalence of SBP in hospitalized patients with cirrhosis and ascites, diagnostic paracentesis should be performed on all patients with these two conditions, even in the absence of symptoms suggestive of infection.