RUQ pain, for 12 hours, no fever, no jaundice. U.S findings “ non thickened G.B wall with multiple gall stones, CBD is obsecured “, what’s your diagnosis:
A- Acute Pancreatitis
B- Obstructive jaundice
C- Acute Cholecystitis
D- Ascending cholangitis

Another recall: A female patient presents with right upper quadrant pain for 12 hours. She is afebrile and not jaundiced. An ultrasound reveals a non-thickened gallbladder wall with multiple stones. The CBD is obscured. What is the most likely diagnosis?
A- Acute Pancreatitis
B- Obstructive jaundice
C- Acute Cholecystitis
D- Ascending Cholangitis

Abdulrahman: Both are very poor recalls. It’s not B or D, since the patient is not jaundiced and there is some inflammation that is obscuring the CBD. It could be a case of acute pancreatitis or suspected cholecystitis since there are no signs of imaging for inflammation.

Summary of chest cavity emergencies

Pt who’s kno. Case of CHF present with af , what medication you will give to control the rate :
A- digoxin
B- adenosine
C- amlodipine

Another recall: Patient known case congestive heart failure with atrial fibrillation. Which of the following could be given for rate control:
A. Digoxin
B. Lidocaine
C. Adenosine
D. Verapamil

Abdulrahman: The answer is digoxin, since we want to control the rate (not rhythm). Beta blockers would be a better choice. Calcium channel blockers (e.g., verapamil and diltiazem) are used as a second line after BB, but you avoid using them in patients with decompensated heart failure (LV systolic dysfunction/low ejection fraction).

Old (mostly 50) female NO PAST SURGICAL NOR MEDICAL hx and she presented with complaints of urine incontinence with coughing and sneezing (obvious for stress incontinence) most appropriate management?
A. Pelvic floor exercise
B. Urethral sling
C. Colporrhaphy
D. Burch procedure

Abdulrahman: The answer is A, since it is the first line management in such cases (strengthening the pelvic floor muscle).

Elderly pt fell down on his leg 2 weeks ago from that time he was bed ridden presented with shortness of breath and dyspnea and found to have high renal profile Which of the following if found in the urine indicates that he is suffering from cholesterol embolism?
A- granural cast
B- hyaline cast
C- esinophiluria
D- RBS cast

Another recall:Patient with acute kidney injury, how to know if the cause is cholesterol emboli? options include
A- red cell cast
B- epithelial cast
C- Hyaline cast
D- Eosinophiluria

Abdulrahman: Both C and D are correct. I would go with eosinophiluria, since approximately, 20–70% of patients with cholesterol crystal embolism (CCE) have eosinophilia/uria.

Diabetic patient with pseudo hyper epithelializing in situ, what you should do?
A- Amputate toe
B- Ulcer Debridement
C- Follow up
D- Repeat biopsy

Another recall: Diabetic pt had ulcer in big toe after biopsy show hyperepitheliomatous hyperplasia:
A- surgical deperment

Another recall: Diabetes with ulcer in big toe of foot for 5 y came for follow up ex there is white discoloration and biopsy show hyperepithelialization next step?
A- Surgical depridment.
B- big toe Amputation
C- observation

Abdulrahman: The answer is to repeat the biopsy. We found this question from a book:

Case about 6 months old , only on breastfeeding till last 2 weeks his mother started introducing fruits purée and fruit juices to him , he became lethargic , vomiting , ....,.., on examination there was Splenohepatomegaly !! Asking about the Dx ?

Another recall: 6 m boy presented with abnormal movement and yellowish discoloration for 1 week .
He is exclusively breast feeding 2 week ago his mother started to interduce fruit and fruit juice, since that , pt started vomiting, irritable, On examination:
Hepatospleenomegaly
Distended abdomin
Generalised jaundice
Urine: positive reducing substances( normal is negative)
Dx?
A. Tyrosinemia
B. galactosemia
C. Alpha 1 anti trypsin def
D. conginital fructose intolerance

Abdulrahman: The answer is Congenital fructose intolerance (also answered by Dr. Safdar)

Infant Has Cataract jaundice he has brother who has same presentation don’t recall the rest but it was Galactosemia presentation ,Urine / +ve for urine-reducing substances test (normal negative “written like this “) How to confirm Dx?
A. HIDA SCAN
B. Urine-reducing substances test
C. Coom test
D. Alpha anti
E. Alpha antitrypsin test

Another recall: 3 day old baby girl with seizures, bilateral cataract, jaundice Positive urine reducing substances What’s the best diagnostic tool?
A. Hida scan
B. Coombs test
C. Urine reducing substances
D. Alpha 1 anti trypsin

Another recall: Urine / +VE for Urine-reducing substances test (normal negative “written like this “) Which of the following has the HIGHEST DIAGNOSTIC VALUE
A. HIDA SCAN
B. urine-reducing substances test
C. Coombs test
D. alpha antitrypsin test

Abdulrahman: The answer is urine-reducing substances, as this is most likely a case of galactosemia. UTD: galactose-1-phosphate uridyl transferase (GALT) activity in red blood cells (RBCs) is the gold standard for diagnosis.

Female 16 week pregnant, came with right sided abdominal pain (RUQ)associated with nausea and vomiting. The doctor ruled out all pregnancy related abdominal pain. What's the most likely diagnosis?
A- Gastritis
B- Pancreatitis
C- Cholecystitis
D- Appendicitis

Abdulrahman: The symptoms and signs are vague. The answer could be C or D. Because he specified in the question the gestational age (16 weeks), it is still early for the uterus to enlarge and cause the appendix to change its location. In this case, the RUQ pain can be cholecystitis. If the question was in the late trimesters, I would go for D, because I think the question is supposed to ask if you knew that the appendix changes its position during pregnancy. Also, appendicitis is the most common non-obstetric cause of surgical emergency in pregnancy.

Introducing high allergen food like peanut
A- 6 mo
B- 9 mo
C- 10 mo
D- 12 mo

Abdulrahman: The answer is 4-6 months. The American Academy of Allergy, Asthma, and Immunology and the American Academy of Pediatrics (AAP) recommend introducing common food allergens at around six months of age when other complementary foods are introduced, and the 2020-2025 Dietary Guidelines for Americans echoes this recommendation. Introducing peanuts, for example, at or around six months of age can help reduce the risk of developing a peanut allergy. But be careful, introducing peanuts in nut form can cause aspiration and choking. Here is a summary for foods to avoid in children:

Long Case about abdominal pain diarrhea. fecal culture show colstridium difficilie ? What is the tt ?
A- Iv fidaxomici

Abdulrahman: The treatment of clostridium difficile is oral vancomycin or oral Fidaxomicin or oral metronidazole [2nd line].

30 yrs old male pt had an open hernia repair few yrs ago presenting now with inguinal hernia on one side extending to hemiscrotum and it’s reducible. What is appropriate to do next:
A- laparoscopic repair with mesh
B- Open repair
C- CT abdomen
D- ultrasound

Abdulrahman: Answer is A. The only two SOLID indications for laparoscopic repair of inguinal hernia are: recurrent and bilateral hernias. Morbid obesity is a relative indication. A note from Dr. Lena: Washington manual: when the previous hernial repair is open the next should be laparoscopic repair and vice versa. But we can’t do laparoscopic repair here because it's extending to the scrotum, which laparoscopic repair is contraindicated.