Male came to the clinic with right scrotal enlargement and when asked to cough it pulsate and separated from the testis, ask about diagnosis.
A- Varicocele
B- direct inguinal hernia
C- indirect inguinal hernia

Abdulrahman: I will go with indirect inguinal hernia, since it is the one that usually descends into the scrotal sac. Although, you need more info to decide. Here is a way to differentiate each choice:

- Varicocele: They present as a lump, often described as feeling like a “bag of worms” or with a “dragging sensation”, and may disappear while lying flat. It is important to examine the patient lying down, standing up and whilst performing a valsalva maneuver.

- Inguinal hernias (direct and indirect): can pass into the scrotum via the external inguinal ring, entering the inguinal canal initially at the internal ring (indirect hernia) or through Hesslebach’s triangle (direct hernia). Passing into the scrotum they run alongside the spermatic cord. On examination, you cannot “get above” an inguinal hernia within the scrotum (i.e. cannot palpate its superior surface). A cough may exacerbate the swelling and may disappear upon lying flat.

known SCA and received blood transfusions 3 week ago , now he came for hepatitis A vaccine, what to do ?
A- give the vaccine
B- ask him to coma after 3 month
C- come after 6 month
D- come after 9 months

Abdulrahman: The answer is A (Dr. Safdar also agress), since recent blood transfusion is not a reason to delay killed-vaccines like hepatitis A. Here are the actions done in cases of delaying live vaccines:

baby diagnosed with Cystic fibrosis. ..he has + sweat chloride test his brother is normal. to confirm diagnosis of cystic fibrosis....
A- CFTR gen in parent
B- CFTR in sibling
C- Chloride test. .parent
D- Chloride test in sibling

Abdulrahman: The answer is B (also answered by Dr. Safdar). Sweat chloride test is good for screening. The best (confirms the diagnosis) is genetic (CFTR)
If the question was asking about the diagnosis of CF in the sibling, then the answer is chloride test in the sibling.
If the chloride test in sibling was normal AND sibling has no symptoms, then CF is unlikely.
If chloride testing in sibling was normal and sibling has symptoms, then we move the DNA test of sibling (the 2 CF-causing mutation).

AF female 50 on warfarine , palpitation Stable , no medical historywhat's the next ?
A- Stop warfarin
B- Exchange warfarin by ASA
C- Continue on Same medication

Better recall: 55 years old female came to the clinic for regular follow up. 6 months age she was diagnosed with atrial fibrillation. Now she is asymptotic and has no palpitations, her medical history is significant for transit ischemic attack and hypertension. She is on Warfarin, Beta blockers, and statins. What is the most appropriate management for her?
A- Discontinue warfarin
B- Continue warfarin
C- Continue warfarin and start aspirin
D- Discontinue warfarin and start clopidogrel

Abdulrahman: The answer is to continue warfarin, since warfarin is given in cases of atrial fibrillation to prevent emboluses from forming.

شرح بسيط لكيف تحلّون أسئلة الMost appropriate في أي قسم بالإختبار:

Infertile women for three years came to clinic with her husband, she wants to conceive but she couldn’t, semen analysis is normal, induction of ovulation by clomiphene citrate was done, (i think every thing else is normal regarding labs) what to do next:
A-IVF
B-IUI
C-laparoscopy
D-induction again(with another drug not clomiphene)

Abdulrahman: I will most likely go with B, since she most likely has a cervical problem and not a hormonal problem (her menstruation is fine). We have to do a tubal patency test beforehand to decide. Here are the reasons for management from UTD:
- Another hormone (aromatase inhibitors?): Anovulatory WHO 2 patients who have a poor outcome with clomiphene (no ovulation or thin endometrium) may have a better response with aromatase inhibitors. WHO 2 patients are women may secrete normal amounts of gonadotropins and estrogens. However, FSH secretion during the follicular phase of the cycle is subnormal.
- Laparoscopic ovarian drilling by diathermy or laser is a surgical treatment to induce ovulation in anovulatory PCOS patients.
- Intrauterine insemination (IUI): cervical factors infertility are best treated by IUI to bypass cervical factors (eg, scanty or abnormal mucus that might impair fertility).
- In vitro fertilization (IVF): is the next option for patients with cervical factor infertility who fail to conceive with IUI.


Similar question: Female coming to the fertility clinic to conceive ovulation is normal and did semen analysis for the husband and it’s normal , what the is most appropriate?
A. Tubal patency test
B. The other three are hormones

Abdulrahman: The answer is A. UTD: Assessment of fallopian tube patency: perform HSG as the first-line test for evaluation of tubal patency because of its therapeutic, as well as diagnostic, benefits. If HSG is not available, non or minimally invasive alternatives to HSG for investigation of tubal subfertility include chlamydia antibody testing and/or hysterosalpingo-contrast sonography (HyCoSy).

43 year old man has Hypertension, ACEI is initiated and his Creatinine rises from 1.2 to 1.5, his potassium is increasing, next best step?
A- Add thiazide diuretic
B- Continue same regimen
C- Switch to amlodipine
D- Add beta blocker

Dayel: I Would go with B. Rise of K and Cr levels are expected in any pt taking ACE-I, we don't stop until Cr raises 30% or serum K above 5.6mmol/L. Pubmed: ACE inhibitor therapy should not be discontinued unless serum creatinine level rise above 30% over baseline during the first 2 months after initiation of therapy or hyperkalemia (serum potassium level >or=5.6 mmol/L)

Abdulrahman: Agree with Dayel if the BP is controlled. If it is not controlled, we should add a thiazide. If the potassium is more than 5.5, add amlodipine.

A patient with a history of radiofrequency ablation is at risk for hypothyroidism. He comes for a checkup and his labs show a TSH of 5 (Normal is 0.5 - 5.0). What will you do to establish a diagnosis?
A- Repeat TSH in 4 weeks
B- Measure T4 levels
C- Thyroid scan
D- Thyroid US

Abdulrahman: The answer is A. We don’t do any tests right now since he doesn’t have abnormal results and we don’t suspect a pituitary disease.

Here is a better recall for the second question.

ثلاث قنوات عظيمة لحلول الأسئلة بطلها زملائنا الي خلصو امتياز
الله يوفقهم و الله يسر لهم جالسين يقدمون شي رهيب من إجازتهم لحلول بعض الأسئلة

قناة د. عبدالرحمن القويز اثق في حلول الجراحة ✌️ ما شاء الله 👍
https://t.me/QuickRecall

قناة د. ريان صاحب حساب تويتر الملخصات الشهير مد توك يجاوب على أسئلة الباطنه
https://t.me/MD1TALKSMLE


قناة أطباء تخصصو بالجراحة 👌
https://t.me/SMLE_Surgery

اثق في حلولهم 💯

شكراً للي كتب الرسالة وشاركها والله ومستعد أدفع له تكاليف التسويق 😂❤️

أعتذر جداً منكم على التأخير في إن الملف ينزل, بس والله جالسة تجيني أسئلة جديدة وجالس أضيفها بالملف عشان يصير الملف شامل بقدر الإمكان لكل الأسئلة الصعبة, لأن بعدها بالغالب راح أوقف تصحيح. تحملوني شويات عشان أجيب لكم أسئلة زيادة أجاوب عليها ❤️

12 year old received a nonspecific blunt trauma on his abdomen and later presented with generalized abdominal pain. Imaging of the spleen showed a 7 mm hematoma and 4 cm tear (grade 3). Your management:
A. splenectomy
B. Spleen preserving surgery
C. Conservative

Another recall: Child with grade 3 spleen injury after blunt abdominal trauma ,and he is stable ,management:
A close observation
B spleen preserving surgery
C splenectomy

Abdulrahman: The answer is close observation/conservative , since he is a child and stable. Dr. J: The grade of injury doesn’t indicate the need for surgery. If he had to go to OR and you controlled the bleeding, go for splenorrhaphy (better than splenectomy). Adult or pediatric, if no active bleeding, go for conservative. If there is extravasation, go for angioembolization. If unstable splenectomy (or spleen preserving sugary/splenorrhaphy if there is no active bleeding in OR). Here is a similar question from Dr. Thawaba:

Patient with pelvic fracture with extra peritoneal bladder injury, what is the appropriate management
A. Suprapubic catheterization
B. Catheter Drainage for 2 weeks then reassess
C. Catheter drainage for 2 weeks then repair

Abdulrahman: The answer is B. You have to reassess first then repair if indicated.

Similar question: A victim of an RTA came with a pelvic fracture and blood at the meatus. What is the next step?
A. Insert a foley catheter
B. Ureteroscope urethrogram
Abdulrahman: The answer is B.

Similar question: Male after accident normal urethra but there is extraperitoneal bladder injury
A. immediate repair
B.suprapupic catheter
C.admit and observe
Abdulrahman: The answer is B.