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.

Which of the following indicate large uncomplicated pneumothorax?
A- Symmetrical chest movement
B- Increase breath sound
C- Dull percussion note.
D- Tracheal deviation
E- Cracking sound with each heart beat

Abdulrahman: This is a very weird question. It has 5 choices… I will go with D (Dr. J answered it). Dr. J: If choice A is asymmetrical, choose it.

Male Pt came to er with headache neck stiffness hx of unprotected sex many times what Investigations:
A- HIV PCR
B- CSF FCR syphilis
C- CSF for herpes

Better recall: 29 y/o male with a few days history of Seizure and confusion, and Hx of unprotected sexual intercourse for 6 years. WBC 1.4. What is the next step?
A- HIV serology
B- CSF analysis for syphilis
C - CSF analysis for toxoplasma
D- Herpes pcr

Better recall: 29 y/o male with few days history of Seizure and confusion, and Hx of unprotected sexual intercourse for 6 years. WBC 1.4 or CD4 < 200
What is the next step?
A- HIV serology
B- CSF analysis for syphilis
C- CSF analysis for toxoplasma
D- Herpes pcr

Abdulrahman: The answer is HIV serology. This question was also answered by Om-Alqura:

70 yrs old male with comorbidities, inguinal hernia in scrotum with mild pain , By examination the doctor can reduce it back throw the inguinal canal Management?
A. Herniotomy
B. Herniorhaphy
C. Tension- free with mesh
D. No treatment

Another recall: 70 yrs old male, inguinal hernia in scrotum with mild pain , By examination the doctor can reduce it back throw the inguinal canal Management?
A.Herniotomy
B. Herniorhaphy
C. Tension- free with mesh
D. No treatment

Abdulrahman: The answer is open repair with mesh. Inguinal or femoral hernia repair can be performed with minimal morbidity and mortality in almost all patients, including those who are older and/or have medical comorbidities. Most patients enjoy a rapid recovery to presurgical health shortly after surgery. Thus, there is no contraindication to urgent repair of complicated hernias. In patients who cannot tolerate general anesthesia, Laparoscopic groin hernia repair is typically performed under general anesthesia. Thus, patients who cannot tolerate general anesthesia for medical reasons should undergo open repair under local or regional anesthesia.

Patient with Pulmonary hypertension to be evaluated for chronic thromboembolism, which investigation has the highest diagnostic yield ?
A-V/Q scan
B-Echo
C-ECG
D-Spiral chest CT with contrast

Another recall: 55 years old male patient, known case of pulmonary hypertention, with chronic thromboembolism. Which of the following has the highest diagnostic value ?
A. Chest X-ray
B. Spiral CT chest with contract
C. Ventilation perfusion scan of lung
D. Echocardiography
Abdulrahman: The answer is to start Ventilation perfusion scan of lung (V/Q scan) and spiral chest CT with contrast to confirm.

بالنسبة لملف Doctor J، ‏الإجابات اللي بالأصفر هي إجابات دكتور J والصح هي إجابة د. عبيدي. أنا اعتمدت أجوبة Doctor J بالأجوبة.