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.

والله بعد الرسالة هذه وصلتني أسئلة كثير منكم وأضفتها كلها للملف.

والله أعتذر صدق بس أحتاج أوقف استقبال أسئلة عشان أقدر انتهي من الملف وأرسله لكم في أقرب وقت عشان اللي اختبارهم في نهاية August.

شكراً لكم جميعاً على تفهمكم ❤️

37 ys male typical case of pnonia Cxr showed rt lower lobe consBlidaBon + moderate effusion
A- Azithro + ciftrix
B- Sam meds + serial ct
C- Same + thoracocentesis
D- Same + something else

Abdulrahman: The answer is ampicillin + gentamicin + thoracocentesis. Here is a summary of pleural effusion from Om-Alqura:

65 years man presents to your clinic and looks weak , dehydrated, pale , thin and emacitaed. he complains of anal itching , discomfort from the pas few months. On examination, you find an anal mass that is 2 cm away from the anal verge , cauliflower like and friable. What is your most likely diagnosis?
A- Anal Cancer
B- Rectal Cancer .
C- condyloma accuminatae
D….

Abdulrahman: The answer is Anal carcinoma. The location of a rectal cancer is identified by its distance from the anal verge rather than the dentate line. Low (distal) rectal cancers are located 4 to 8 cm from the anal verge, middle rectal cancers 8 to 12 cm, and upper (proximal) rectal cancers 12 to 15 cm. The anal canal is 0 to 4 cm from the anal verge. This question was also answered by Dr. Thawaba in last year’s quiz that he made:

A 46 years old asymptomatic man. His mother recently died of metastatic colon cancer. She was diagnosed with colon Cancer 5 years ago at age 69 years. Which of the following is the most appropriate colorectal cancer screening strategy for this patient?
A- Colonoscopy every 5 years
B- Colonoscopy every 10 years
C- CT Colonography every 10 years
D- Fecal immunochemical testing every 5 years

Abdulrahman: I will go with a colonoscopy every 10 years, since he has a family member that was diagnosed with cancer after the age of 60. In that case, we can start screening early, but the screening interval is the same. In Schwartz’s and UTD, it says to do it every 5 year, but as far as what I’ve found, it did not specify regarding screening if the family member is above 60 years of age or below.

A 72 year old man presented with an episode of right sided weakness that lasted 10 minutes and fully resolved and he is clinically stable, he has no other medical illness. On examination: BP 110/70, HR 95, T 36.6 Which of the following is the most appropriate next step in the management?
A. Aspirin.
B. Warfarin, INR 3-4
C. Warfarin, INR 2-3
D. No additional drug treatment

Abdulrahman: The answer here is aspirin, since he had a transient ischemic attack (high risk of developing a subsequent stroke).
Here is another similar question, but the patient has Afib: