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:

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.

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.

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.

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”

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 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.

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:

مستعدين نبدأ المضاربة مع آخر سؤال بالملف؟ 😂

What indicates adequate systemic perfusion?
A. Cardiac index
B. Mixed venous O2 saturation
C. Central venous pressure
D. pulmonary capillary wedge pressure

Another recall:Septic shock case indicates adequate systemic perfusion?
A- Cardiac index
B- Mixed venous oxygen saturation (SMVO2)
C-Central venous oxygen saturation (SCVO2)

Abdulrahman: The answer is Mixed venous oxygen saturation (SMVO2/SvO2). I will take time to explain the answer.

وبكذا نكون انتهينا من كل الأسئلة اللي بالملف (154 صفحة) بإذن الله راح أنزّل لكم الملف الليلة أو بكره بالكثير ❤️

السلام عليكم ورحمة الله وبركاته جميعاً،
شكراً والله لجميع اللي جالس يرسل لي من تصحيح لأجوبتي وينبهني على أشياء ثانية ويستفسر. صدق الرسائل كثيرة وبحاول إني أجاوب على الكل (حتى اللي فتحتها ومارديت عليها تراني حافظها عندي ❤️). أنا أعتذر والله عن استقبال الأسئلة الجديدة بسبب انشغالي الفترة القادمة، ولكن لو عندكم أي استفسار آخر، أنا حاضر.

بالنسبة لملف Doctor J، ما أتوقع راح تنزل النسخة المعدلة قريب بسبب إن الدكتور مسافر في إجازة الفترة هذه. أعتذر منكم والله ❤️

مركز الاختبار في العقارية مول (الرياض):

المواقف دخلتها من خلف المول. راح يوجهونكم الأمن لمكان الإختبار والمصعد اللي يطلعكم مباشرة على مركز الإختبار ❤️

https://goo.gl/maps/FQE9h7wFkNp7bKwy6

هذا ملف حلو شامل للMilestones (اعتمدوا جدول Nelson اللي بالصفحة الأولى):