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:
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)
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.
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.
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:
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].
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.
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.
A patient with Crohn’s disease treated with azathioprine and infixmab and other medication presented complaining of pus out from anal. Vital signs stable also no fever. what is the next step?
A- Pelvic MRI
B- BroadIVAntiBiotic
C- Swabandculture
D- increse inflixmal dose
Abdulrahman: This is most likely a case of complex fistula, since it is presenting in a patient with crohn’s who is presenting with a fistula that is most likely infected. In this case, go for broad-spectrum IV antibiotics first then pelvic MRI (Dr. Thawaba also agrees with this answer). Remember that he is taking azathioprine and infliximab (both are immunosuppressants that will lower the threshold for him to have sepsis)
A- Pelvic MRI
B- BroadIVAntiBiotic
C- Swabandculture
D- increse inflixmal dose
Abdulrahman: This is most likely a case of complex fistula, since it is presenting in a patient with crohn’s who is presenting with a fistula that is most likely infected. In this case, go for broad-spectrum IV antibiotics first then pelvic MRI (Dr. Thawaba also agrees with this answer). Remember that he is taking azathioprine and infliximab (both are immunosuppressants that will lower the threshold for him to have sepsis)
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