Patient with anal fissure not responding to drug, what procedure is most suitable for his condition?
A. Lateral internal sphincterotomy ✅.
B. Anal curettage
C. Lateral External sphincterotomy.

Another Recall:
25-year-old man presented to the Emergency Department with severe pain during and after defecation for 3 days associated with passage of a small amount of fresh blood after defecation. Physical examination confirmed an acute posterior anal fissure. Digital and proctoscopic examination were not performed due to the anal pain. Which of the following is the most appropriate management?
A. examination under anaesthesia
B. lateral internal anal sphincterotomy
C. chemical sphincterotomy with diltiazem ✅
D. botulinus toxin paralysis of anal sphincter


Schwartz:
first line management of Anal fissures is usually to minimize the trauma incidence by bulk agents, stool softeners, warm baths and analgesic cream. CCB ( as Diltiazem ) helps to heal the fissures and have fewer side effects.

Failed Medical therapy? Lateral internal sphincterotomy is recommended.

Years old female medically & surgically free, with no family history of colon cancer, which colon
cancer screening test iS appropriate for her?
A. 5 years Colonoscopy
B. Annual Fecal Occult Blood ✅
C. Annual sigmoidoscopy

Another recall:
45-year-old women medically free with no personal or family history of cancer. Asking about when to to start colon cancer screening?
A- no need for screening for her case
B- Start now and every 5 years
C- Start at 50 years with annual colonoscopy
D- Strat at 50 with annual Fecal occult blood ✅

Schwartz:
Recommended colon cancer screening tests for average risk patients:
1- Colonoscopy every 10 years
2- flexible Sigmoidoscopy, Air contrast barium enema every 5 years
3- Annual Fecal Occult blood Test ( FOBT ).

جاني فالاختبار.

A 45 years old male smoker has an adenoma removed from his colon. Pathology report shows a benign lesion. What advice should you give this patient to prevent him from getting colon cancer?
A. Eat a low-fiber diet.
B. Eat a high-protein diet.
C. Colonoscopy every year.
D. Stop smoking and start exercising ✅

Let’s exclude:
A- Should be high fiber diet.
B- No relation.
C- if there’s 5 or more adenomas.


Another recall:
After resection of a pedunculated polyp the results was benign adenoma and patient has no family history of colon cancer what to advice for reduction of colon cancer?
A- Prophylactic sigmoidoscopy
B- Prophylactic colectomy
C- Annual colonoscopy
D- Life style modification (healthy diet and exercise) ✅

For anyone in need of assistance to solve December Qs don’t hesitate to send your question to: @itsBdran.
Best of luck to you all.

10 weeks pregnant complaining of biliary colic for the past 5 weeks. What is the most appropriate management
A - Laparoscopic cholecystectomy now
B - Laparoscopic cholecystectomy after delivery
C - Laparoscopic cholecystectomy in second trimester ✅
D - Laparoscopic cholecystectomy in third trimester


Biliary and Pregnancy:
- If the pregnant women had first episode of “ Biliary colic” the Management is Conservative.

- if the pregnant women had recurrent attack of biliary colic the management is Lap chole at the 2nd trimester.

- If the pregnant women had first attack of “ Acute cholecystitis “ the management is Lap chole at the 2nd trimester.

1st trimester is always conservative management.
If in 3rd trimester delay the procedure after the delivery.

Ref: DrThawabah.

4 months old girl, during Pneumatic otoscope unilateral non-purulent effusion and decrease tympanic membrane motility , no fever pr other symptoms, and no hx of previous infectious diseases, breast feeding very well and no use of pacifier, What’s the best next step?
A- use amoxicillin tx
B- use of amoxicillin and clavulanate
C- Observe and F/U for 48hrs
D- Refer for ENT to evaluation for tympanostomy
tube ✅

جاني في نوڤمبر بالنص وجبت ١٠٠ في البيديا.
Answer is D.
This is an Otitis media with effusion ( Serous )

Let’s exclude:
A and B and C if the presentation was acute Otitis media
You will give the patient Amoxicillin and evaulate after 48h.

Ref: 2 ENT consultants.

19 yrs old dysmenorrhea resolve on 3rd day and resolve after few , Sxs associated with sever pain radiated to upper thigh, she had this for several years and getting worse
A- Primary dysmenorrhea ✅
B- premenstrual
C- secondary dysmenorrhea
D- endometriosis

Physical Sx and the presentation is typical for Primary, the only exception is that it’s getting worse.
جاني في نوڤمبر وحطيت A.

65 yrs old male complaining of sever Lower GI BLEEDING
What is most common cause
A- Angiodysplasia
B- IBD
C- Diverticulosis ✅

Answer is C. This Question is written in Washington manual book for surgery.

child with sore throat and fever that increase with time for 2 weeks , he had same complaain before 3 weeks and dental extraction before 2 months also have purpura rash in lower limb and confirm a systolic murmur best heard
at the apex radiating to the axilla.
Urine dipstick showed :
Mild protienuria and microscopic hematouria
What is the most likely diagnosis?
A. Infective endocarditis ✅
B. Group A streptococcus

Answer is A.

Dental extraction and new heart murmur is typical for infective endocarditis. According to safdar: infective endocarditis can cause glumerulonephritis as well.

Child pt with decreased IQ, pica (eat dirt) < they wrote it :) With
Hepatosplenomegaly ! Labs showed *Hypochromic microcytic anemias.
What is the highest diagnostic labs?
A- blood lead levels ✅
B- CBC with blood smear (they already do it )
C- Iron studies

Answer is A.
This Q came to my exam in November. There was no Iron studies in the choices!!
I don’t remember the Q exactly but the choices were wrong except for A which is diagnostic for lead poisoning since the child is Eating dirt and have low IQ.

What is the age in month of child talk 6-10 words, know 2 body parts, immature pencil grasp?
A-17
B-19 ✅
C-12
D-24

Answer is B.
This Question came in my Nov. exam. The scenario was ( Points ) to 2 body parts not ( Know ) and another milestone of a 18m but I can’t recall.

29-A 55 years old male Known case of chronic peptic ulcer. Came with multiple vomiting attacks. On imaging there is a mass from ulcer obstructing gastric outlet. On Examination the Patient is Dehydrated. Which of the following is most common manifestation?
A- High urinary K
B- Hypokalemia ✅
C- Respiratory alkalosis
C- Metabolic acidosis

I wrote this Question from my September exam.
Answer is Hypokalemia.
Gastric Outlet Obstruction can result in Hypokalemia, Hypochoremia, Metabolic alkalosis.
Ref: UTD.