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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
40 weeks gestation G3 p2 presented in labour ruptured membrane 5cm cervical dilatation for 3h 60 % effaced head station - 1. Baby non stress test reassuring mother good vitals What is the appropriate plan of management?
A- urgent c/s
B- observation
C- augmentation of labour by oxytocin
D- other non relvant
Abdulrahman: I will go with B. In most cases, the rupture of membrane occurs during labor or within 24 hours before starting labor. Preterm premature rupture of the membranes (PPROM) is said to occur when the membranes break before the 37th week of pregnancy. She is 40 weeks in this case. She’s going through the normal physiology of labor and is presenting in the first stage. Both her and the baby are having reassuring signs. Prolonged labor requires that, in the face of regular uterine contractions, the cervical dilation is <6 cm for a duration of >14 h in a multipara women. In this case, it is 3 hours in a multipara women, which is normal.
A- urgent c/s
B- observation
C- augmentation of labour by oxytocin
D- other non relvant
Abdulrahman: I will go with B. In most cases, the rupture of membrane occurs during labor or within 24 hours before starting labor. Preterm premature rupture of the membranes (PPROM) is said to occur when the membranes break before the 37th week of pregnancy. She is 40 weeks in this case. She’s going through the normal physiology of labor and is presenting in the first stage. Both her and the baby are having reassuring signs. Prolonged labor requires that, in the face of regular uterine contractions, the cervical dilation is <6 cm for a duration of >14 h in a multipara women. In this case, it is 3 hours in a multipara women, which is normal.
Male pt, smoker, hx of appendectomy, his brother has Crohn's. What's the risk factor to develop Crohn's??
A- Male
B- Smoking
C- Family hx
D- Hx of appendectomy
Taghreed: The answer is C. Schwartz: IBD is a genetic disease, though one that is polygenic, explaining why IBD frequently affects multiple family members across more than one generation, while also explaining the large number of genes implicated in the development of IBD. The genetic variant is arguably the most strongly associated with IBD, being strongly connected with Crohn’s disease.
A- Male
B- Smoking
C- Family hx
D- Hx of appendectomy
Taghreed: The answer is C. Schwartz: IBD is a genetic disease, though one that is polygenic, explaining why IBD frequently affects multiple family members across more than one generation, while also explaining the large number of genes implicated in the development of IBD. The genetic variant is arguably the most strongly associated with IBD, being strongly connected with Crohn’s disease.
18ms boy circumcised mother said urine smell foul fever 39 for 1d what indicated uti in this pt
A- Fever duration
B- Being a male
C- Fever 39
D- Age not sure
Abdulrahman: The answer is C. UTD: The overall prevalence of UTI is approximately 7% in febrile infants and young children but varies by age, sex, and circumcision status. The increased risk of culture-confirmed UTI are identified in the age group of 2 to 23 months are summarized:
A- Fever duration
B- Being a male
C- Fever 39
D- Age not sure
Abdulrahman: The answer is C. UTD: The overall prevalence of UTI is approximately 7% in febrile infants and young children but varies by age, sex, and circumcision status. The increased risk of culture-confirmed UTI are identified in the age group of 2 to 23 months are summarized:
Another similar question: Baby uncircumcised have fever, Q: what is the indicator that increases the probability of the baby having UTI?
A- Duration of fever
B- uncircumcised
C- Fever of 38.1
D- Being a male
Abdulrahman: The answer here is B, due to the 10-fold risk of having UTI in uncircumcised boys.
Taghreed: Nelson: Approximately 3% of girls and 1% of boys have a UTI during their prepubertal years with the highest incidence in the first year of life. It is only during the first year of life that the incidence of UTIs in males exceeds that in females; during this period uncircumcised boys are at 10-fold greater risk of developing a UTI compared to circumcised boys. After 12 months of age, UTI in healthy children usually is seen in girls.
A- Duration of fever
B- uncircumcised
C- Fever of 38.1
D- Being a male
Abdulrahman: The answer here is B, due to the 10-fold risk of having UTI in uncircumcised boys.
Taghreed: Nelson: Approximately 3% of girls and 1% of boys have a UTI during their prepubertal years with the highest incidence in the first year of life. It is only during the first year of life that the incidence of UTIs in males exceeds that in females; during this period uncircumcised boys are at 10-fold greater risk of developing a UTI compared to circumcised boys. After 12 months of age, UTI in healthy children usually is seen in girls.
Which of the following is true regarding single umbilical artery?
A- Associated with african race
B- Associated with maternal diabetes
C- Major malformation in 80% of cases
D- Low fetal mortality
Taghreed: The answer is B.
- UTD: Single umbilical artery (SUA) has been associated with maternal smoking, diabetes, hypertension, and seizure disorders
- Radiopaedia: The estimated prevalence is ~0.4-1% of pregnancies. There may be an increased incidence of twin pregnancies and maternal diabetes.
Abdulrahman: To add to Taghreed, Abnormalities of the umbilical cord occur with a higher frequency in twins and are primarily associated with monochorionic twins. Let’s exclude the other choices:
- Major malformation in 80% of cases: Hacker and moore: The absence of one umbilical artery is associated with other congenital anomalies (e.g., renal agenesis) in 30% of cases.
- Associated with African race: UTD: SUA has been reported to occur more frequently in pregnancies at the extremes of maternal age and in Eastern Europeans, and less frequently in Japanese and Africans.
- Low fetal mortality: Diagnostic Gynecologic and Obstetric Pathology book: Single umbilical artery occurs, on average, in approximately 1% of term births (reported rates range from 0.3% to 1.5%). This finding is associated with increased rates of stillbirth, neonatal death, congenital anomalies (renal and cardiac in particular), and chromosomal anomalies.
A- Associated with african race
B- Associated with maternal diabetes
C- Major malformation in 80% of cases
D- Low fetal mortality
Taghreed: The answer is B.
- UTD: Single umbilical artery (SUA) has been associated with maternal smoking, diabetes, hypertension, and seizure disorders
- Radiopaedia: The estimated prevalence is ~0.4-1% of pregnancies. There may be an increased incidence of twin pregnancies and maternal diabetes.
Abdulrahman: To add to Taghreed, Abnormalities of the umbilical cord occur with a higher frequency in twins and are primarily associated with monochorionic twins. Let’s exclude the other choices:
- Major malformation in 80% of cases: Hacker and moore: The absence of one umbilical artery is associated with other congenital anomalies (e.g., renal agenesis) in 30% of cases.
- Associated with African race: UTD: SUA has been reported to occur more frequently in pregnancies at the extremes of maternal age and in Eastern Europeans, and less frequently in Japanese and Africans.
- Low fetal mortality: Diagnostic Gynecologic and Obstetric Pathology book: Single umbilical artery occurs, on average, in approximately 1% of term births (reported rates range from 0.3% to 1.5%). This finding is associated with increased rates of stillbirth, neonatal death, congenital anomalies (renal and cardiac in particular), and chromosomal anomalies.
About cause of pt hyperthyroidism take 20 mg carbimazole didn’t improve on his sx ?
A- Increase dose to 40
B- Thyroid scan
C- Fna
Abdulrahman: This is a very poor recall of the case, there is no indication to go for either thyroid scan or do an FNA, The answer is A, since we can go up to 40mg in most patients. Rarely, patients require more than this dose.
A- Increase dose to 40
B- Thyroid scan
C- Fna
Abdulrahman: This is a very poor recall of the case, there is no indication to go for either thyroid scan or do an FNA, The answer is A, since we can go up to 40mg in most patients. Rarely, patients require more than this dose.
Child came with abdominal pain and tenderness / vitally was stable aware , in examination a bruise in her right upper part of the abdomen and the abdomen is distended she said that she felt from her bicycle 2 weeks ago Next step in management:
A- Us
B- CT
C- exploration
Abdulrahman: The answer is CT. I agree with Dr. Abeidi in this question: “Traumatic pancreatitis. Although US can be done as an initial investigation, it is rarely useful when it comes to imaging the pancreas. CT is more sensitive and would always be ordered in such a clinical scenario”
A- Us
B- CT
C- exploration
Abdulrahman: The answer is CT. I agree with Dr. Abeidi in this question: “Traumatic pancreatitis. Although US can be done as an initial investigation, it is rarely useful when it comes to imaging the pancreas. CT is more sensitive and would always be ordered in such a clinical scenario”
UC increases risk of colon cancer in?
A- Duration of disease more than 8 years
B- Extension beyond splenic flexure
C- If it was associated with primary sclerosing cholangitis
D- Family history of colorectal cancer
Taghreed: The answer is C. They all play a role in increased risk, but C is more accurate. UTD: the extent of colitis and duration of disease are the two most important risk factors for CRC ,Other factors that are associated with an increased risk of CRC include endoscopic and histological severity of inflammation, positive family history of sporadic colorectal cancer (twofold increased risk), post inflammatory pseudopolyps (twofold increased risk), and the presence of primary sclerosing cholangitis (fourfold increased risk). The CRC risk begins to increase 8 to 10 years following the onset of symptoms in patients with pancolitis. In one prospective study, the cumulative incidence of CRC was 2.5 percent after 20 years and 7.6 percent after 30 years of disease. Patients with left-sided colitis have almost the same risk of CRC and dysplasia as those with pancolitis, but the risk of CRC increases only after 15 to 20 years.
Abdulrahman: I do think that A is the answer. Dr. J: A. The risk of colon cancer depends on the duration of the disease. C will not increase risk of colon cancer (it will increase risk of cholangiocarcinoma). Even if the patient doesn’t have PSC, he still has a risk for cancer.
A- Duration of disease more than 8 years
B- Extension beyond splenic flexure
C- If it was associated with primary sclerosing cholangitis
D- Family history of colorectal cancer
Taghreed: The answer is C. They all play a role in increased risk, but C is more accurate. UTD: the extent of colitis and duration of disease are the two most important risk factors for CRC ,Other factors that are associated with an increased risk of CRC include endoscopic and histological severity of inflammation, positive family history of sporadic colorectal cancer (twofold increased risk), post inflammatory pseudopolyps (twofold increased risk), and the presence of primary sclerosing cholangitis (fourfold increased risk). The CRC risk begins to increase 8 to 10 years following the onset of symptoms in patients with pancolitis. In one prospective study, the cumulative incidence of CRC was 2.5 percent after 20 years and 7.6 percent after 30 years of disease. Patients with left-sided colitis have almost the same risk of CRC and dysplasia as those with pancolitis, but the risk of CRC increases only after 15 to 20 years.
Abdulrahman: I do think that A is the answer. Dr. J: A. The risk of colon cancer depends on the duration of the disease. C will not increase risk of colon cancer (it will increase risk of cholangiocarcinoma). Even if the patient doesn’t have PSC, he still has a risk for cancer.
a gunshot in the left leg, hematoma in the medial aspect of the thigh what’s the next step?
A- angiography
B- Apply direct pressure first
Another recall: A 27-year-old man sustains a single gunshot wound to the left thigh. In the ER, he is noted to have a large hematoma of his medial thigh. He complains of paresthesias in his left foot. On examination, there are pulsatile hematoma with weak pulses palpable distal to the injury and the patient is unable to move his foot. Which of the following is the most appropriate initial management of this patient?
A- CT Angiography
B- Immediate exploration and repair in the OR
C- Observation
D- Bedside local wound exploration
Abdulrahman: Not sure if both are the same question. But, I would go with direct pressure first to stop the bleeding. After that, I will go to the OR and repair it since he needs intervention based on his symptoms (weak pulses, paresthesia, inability to move the foot). You never do bedside local wound exploration in these cases. Remember that CTA is diagnostic only. Conventional angiography is also incorrect if it were in the choices, because this is an emergency case.
A- angiography
B- Apply direct pressure first
Another recall: A 27-year-old man sustains a single gunshot wound to the left thigh. In the ER, he is noted to have a large hematoma of his medial thigh. He complains of paresthesias in his left foot. On examination, there are pulsatile hematoma with weak pulses palpable distal to the injury and the patient is unable to move his foot. Which of the following is the most appropriate initial management of this patient?
A- CT Angiography
B- Immediate exploration and repair in the OR
C- Observation
D- Bedside local wound exploration
Abdulrahman: Not sure if both are the same question. But, I would go with direct pressure first to stop the bleeding. After that, I will go to the OR and repair it since he needs intervention based on his symptoms (weak pulses, paresthesia, inability to move the foot). You never do bedside local wound exploration in these cases. Remember that CTA is diagnostic only. Conventional angiography is also incorrect if it were in the choices, because this is an emergency case.
Screening for 37 female her mother had brest Ca, sister ovarian Ca
A- breast US
B- mammogram
C- don't remember the rest
Another recall: 35y old pt worried her mother had breast Ca and her sister had ovarian Ca. How to screen her
A. Mammo
B. US
C. BRCA
Abdulrahman: The answer is C. The indications for BRCA screening can be seen here:
A- breast US
B- mammogram
C- don't remember the rest
Another recall: 35y old pt worried her mother had breast Ca and her sister had ovarian Ca. How to screen her
A. Mammo
B. US
C. BRCA
Abdulrahman: The answer is C. The indications for BRCA screening can be seen here: