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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A 24-year-old lady presents with a hard, mobile, well-circumscribed painless left breast mass that has been increasing in size from the past few months and was NOT related to her menstrual cycle. The most like Diagnosis is?
A. Fat cyst
B. Fibroadenoma
C. Fibrocystic changes
D. Phyllodes
Abdulrahman: Answer is D. The mass has been growing for the past few months and it is not related to the menstrual cycle (both are red flags for phyllodes tumor). If it was mentioned that it has been growing slowly for the past 6 months or 1 year and/or related to the menstrual cycle, I would have gone with fibroadenoma. I disagree with Dr. J in this question. Here is how a fibroadenoma question will look like in the exam:
A. Fat cyst
B. Fibroadenoma
C. Fibrocystic changes
D. Phyllodes
Abdulrahman: Answer is D. The mass has been growing for the past few months and it is not related to the menstrual cycle (both are red flags for phyllodes tumor). If it was mentioned that it has been growing slowly for the past 6 months or 1 year and/or related to the menstrual cycle, I would have gone with fibroadenoma. I disagree with Dr. J in this question. Here is how a fibroadenoma question will look like in the exam:
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].
taghreed:The ACG recommends vancomycin or fidaxomicin for the treatment of an initial episode of non-severe disease.
A- Iv fidaxomici
Abdulrahman: The treatment of clostridium difficile is oral vancomycin or oral Fidaxomicin or oral metronidazole [2nd line].
taghreed:The ACG recommends vancomycin or fidaxomicin for the treatment of an initial episode of non-severe disease.
Most common type of murmur associated with rheumatic fever?
A- AR
B- MR
C- MS
D- PS
Abdulrahman: Not sure if they are asking about late or early. I will go with MR. UTD: The mitral valve is more commonly involved than the aortic valve, and mitral regurgitation is the most common finding of RHD.
- Early: mitral regurgitation.
- Late: mitral stenosis (Rheumatic fever is the most frequent cause of mitral stenosis).
A- AR
B- MR
C- MS
D- PS
Abdulrahman: Not sure if they are asking about late or early. I will go with MR. UTD: The mitral valve is more commonly involved than the aortic valve, and mitral regurgitation is the most common finding of RHD.
- Early: mitral regurgitation.
- Late: mitral stenosis (Rheumatic fever is the most frequent cause of mitral stenosis).
RTA patient was transfused with 4 L of blood , which of the following would be the complication?
A) Citrate toxicity
B) Hypocalcemia
Another recall: Male patient recieve 4 liter blood transfusion, what is the most important complications?
A. Hypokalemia
B. Hypocalcemia
C. Citrate toxicity
D. Hyper albunemia
Abdulrahman: Both citrate toxicity and hypocalcemia can happen with this amount of blood transfusion. I will go with hypocalcemia as being the most important one. Remember that blood products contain citrate to prevent clotting from happening. Citrate will bind to calcium (causing hypocalcemia). UTD: Recipients of massive transfusions may therefore develop electrolyte disturbances, with hypocalcemia, hypomagnesemia, and hyperkalemia.
A) Citrate toxicity
B) Hypocalcemia
Another recall: Male patient recieve 4 liter blood transfusion, what is the most important complications?
A. Hypokalemia
B. Hypocalcemia
C. Citrate toxicity
D. Hyper albunemia
Abdulrahman: Both citrate toxicity and hypocalcemia can happen with this amount of blood transfusion. I will go with hypocalcemia as being the most important one. Remember that blood products contain citrate to prevent clotting from happening. Citrate will bind to calcium (causing hypocalcemia). UTD: Recipients of massive transfusions may therefore develop electrolyte disturbances, with hypocalcemia, hypomagnesemia, and hyperkalemia.
Patient with hx of pancreatitis months ago and now referred to surgery clinic for mild abdominal pain and , what initial inves?
A-U/S
B- CT
C- endoscope
Abdulrahman: The answer is A (initial) and CT with contrast (confirmatory), since this patient has a history of pancreatitis and you’re suspecting a pseudocyst. UTD: Pancreatic pseudocysts may be seen on transabdominal ultrasound, but contrast-enhanced CT or MRI is typically obtained to confirm the diagnosis and to further classify the fluid collection
A-U/S
B- CT
C- endoscope
Abdulrahman: The answer is A (initial) and CT with contrast (confirmatory), since this patient has a history of pancreatitis and you’re suspecting a pseudocyst. UTD: Pancreatic pseudocysts may be seen on transabdominal ultrasound, but contrast-enhanced CT or MRI is typically obtained to confirm the diagnosis and to further classify the fluid collection