SMLE-oriented Types of shock:

1- Cardiogenic:
- History of Cardiac cause as ischemic heart disease.
- Increased Pulmonary capillary wedge pressure PCWP. ( أهم حاجه )
- High vascular resistance.

2- Hypovolemic:
- History of RTA, Bleeding.
- low PCWP.
- High vascular resistance.

3- Neurogenic:
- History of RTA, Spinal injury.
- Bradycardia ( أهم حاجه )
- Warm extremities

4- Septic:
- Septic focus: Post op or Pnemonia and sepsis or Obstetrics complications and also fever.
- Tachycardia
- Increased COP ( أهم حاجه )
- Warm extremities.

5- Anaphylactic:
- Wheezing, Urticaria and allergic Sx.
- History of Bee sting, allergic medication or allergic food.

ياحبايب الله يمسيكم بالخير، عشان
الاستفسارات كثرت.

الرسائل المُثبته:
١- بداية حل نوڤمبر الى يوم ٢٢.
٢- تجربتي الشخصية.
٣- ملفات الاشهر من جون الى اكتوبر.
٤- ملفات ممكن تفيدكم.
٥- حسابي على التلقرام، اللي وده يستفسر او يحتاج مساعده في ديسمبر او غيره.

20 days old came with fever for 1 day and no focus of infection
Temp 38.3 something like that
1- discharge home
2- tell the mother to came back when there is difficulty in feeding
3- admission to observe the fever and then discharge
4- start IV Abx after doing blood , urine and csf culture ✅

Another recall:
Young pt k/c of myeloid leukemia c/o fever for 1 Days PE unremarkable urine analysis normal blood culture and stool still pending, Vitaly stable
Fever: 38.8
All lap within normal except
Wbc: (1)
Plt: (20 )
sure No other findings, What is the most appropriate management?
A-Iv antibiotics ✅
B-Close observation
C-iv antibiotic and viral agent
D-Oral antibiotic and antifungal

Another recall:
acute leukemia patient, presented with fever after few days of chemotherapy. Found to be neutropenic. What is your next step in management? *Absolute neutrophil count <500
a. Septic workup and wait for results
b. Symptomatic treatment with paracetamol
c. Septic workup + oral antibiotics
d. Septic workup + IV broad spectrum antibiotics✅



First Scenario is missing important info which is WBC is 1 ( Low ) that makes the scenario is about ( Neutropenic fever ). Neutropenic fever is managed by IV Antibiotics usually Meropenem and septic workup which is culture from every possible site of infection like, blood, urine, sputum, Csf.

70s years old female with small mass of a slowly growing vulvar lesion that never heals. Black shaped. History of bleeding with trauma. Dx?
A. Basal cell Carcinoma ✅
B. Fox-Fordyce disease
C. Neurofibroma
D. Syringoma

جاني في نوڤمبر
السيناريو والصوره نفسها بالضبط.

55 y.o Patient k/c smoker only. Presents with signs and symptoms of MI. ECG shows lead II,III,AVF
depression. Hist vitals are: BP: 150/92 Pulse: 99 Which of the following is the most considerable risk factor
for MI in this case?
A. HTN
B. Smoking ✅
C. Age

A 63 years old male, not to have hypertension and is a smoker. Presented with retrosternal chest pain, localized and non radiating.
ECG Showing ST Depression in Lead II, III and aVF.
Blood Pressure: 156/93
Which of the following risk factors is strongly associated with his presentation?
A- Smoking ✅
B- Hypertension
C- Age
D- Male Gender

Another recall:
55 y.o Patient k/c smoker only. Presents with signs and symptoms of MI. ECG shows lead II,III,AVF depression. Hist vitals are:
BP: 150/92
Pulse: 99
Which of the following is the most considerable risk factor for MI in this case?
A. HTN
B. Smoking ✅
C. Age

He is not a Known case of HTN. The vitals only shows high blood pressure. Answer is Smoking.

جاني فالاختبار.

41 weeks pregnant given pethidine and Phenagran. Cervix is dilated 9 cm. Meconium stained liquor is draining. CTG shown in the Picture: ( Not the same Pic but it was Prolonged Late deceleration ).
Which of the following is the most appropriate next step in management?
A- Give naloxone
B- Watch and reassess after 30 mins
C- change mothers position ✅
D- Increase oxytocin infusion.

هذا السؤال توني تذكرته من الاوبي في نوڤمبر وكتبته..
الصوره تقريبيه لكن نفس الفكرة Prolonged late deceleration.
كنت محتار بين A و C
حطيت C وجبت ١٠٠ فالاوبي.


Answer is C.
This is non-reassuring CTG which requires uterofetal resuscitation measures the first one is to change the mother’s position.

Typical signs and symptoms of PCOS. High BMI
In addition to weight reduction what is the initial step?
A- Danazol and metformin
B- Metformin and clomiphenate ✅
C- IVF and salicylic acid
D- Laparoscopic ovarian wedge resection and something else

برضو هذا السؤال من الاسئلة اللي جاتني فالاوبي بس في Section 3.

Sit without support, Crawl, hold things between thumb and index finger, walks around furniture, pulls up to be standing, say dada:
A- 8
B- 10 ✅
C- 12
D- 14

تو كتبته من المايلستونز اللي جاتني

39 year old female complaints of heartburn and regurgitations for 6 months burning is
primary after eating and occasionally has chest pain, not associated with weight loss or lifestyle
changes. the patient mentioned that she eats dinner 2 hours before going to bed and complains
of heartburn primarily at night.. She's taking omeprazole 20 mg per day did endoscopy . She
had distal esophagitis. her BMI is 28
What is the appropriate next step?
A. add antacids twice per day
B. ranitidine before bed
C. advice weight loss ✅
D. refer for nissen fundoplicati

المريض بيسوي عملية استئصال لعنق المعده وقررو يخلون البيشنت على
Total parenteral nutrition (TPN)
Patient on TPN, what’s a common metablic abnormality?
كان السؤال وش المتوقع بيحصل عنده من خلل في الالكترولايت
الاختيارات جاتني كذا متأكد لان هالسؤال ذاكرته وصححته هنا بالقروب
A- Hypokalemia ✅
B- hyprcalcemia
C- hyponatremia
D-Hyperphosphatemia


Answer is A.
Patients on TPN are vulnerable to develop Refeeding syndrome.
Refeeding syndrome is Characterized by several electrolyte abnormalities as:
- High Glucose, and Chloride.
- Low K, PO4, Mg.

Ref: Thawabah course.

Here’s a similar Q from thawabah files:

Pt after fell down from hight present with open fracture and dirty , what the most appropriate next step in the management ?
A- oral antibiotic
B- open fixation
C- surgical debridement ✅
D- external fixation

Answer is C.
Remember the Management of Open fracture very well and also in sequence:

1- ATLS protocol and control the bleeding.
2- IV Antibiotics and Tetanus Toxoid.
3- Closed reduction and immobilization by a cast or splint.
4- ER Irrigation, Debridement and external fixation.

Once the infection controlled and patient stabilized you can now go for OR to do:
5- Definitive Management by Open Reduction and Internal Fixation ( ORIF ) by IM nail or screws.

This sequence is Very important. Whichever comes in the choices first choose it.

Oral Antibiotics is not recommended it should be given Peripherally by IV line.

28 years old female tried to get pregnant for many years, did IVF 2 times, now she’s pregnant in i forgot which week but was 2nd trimester and US showed multiple fibroids, how to treat her without harming her pregnancy?
A- myomectomy
B- GnRH injections

Another recall:
Female with history infertility and previous abortion and try IVF two time with failure , she is having multiple uterine fibroid. Which of the following will help her the most to get pregnant
A- Myomectomy
B- Uterine artery embolization
C- Medical therapy ✅
D- GNRH to decrease the size of fibroid


Answer is Medical therapy.
( she’s Now pregnant )
UTD: Operations on the uterus is best to be avoided in the pregnancy due to risk of bleeding, Uterine rupture and pregnancy loss.

Note: if she’s not pregnant and wishes to preserve fertility answer is Myomectomy.

37 year old female primigravida at 34 GA, know to have multiple fibroids, presented now with abdominal pain and fever on examination: cervix is closed and no evidence of contractions.
What is the most appropriate management?
A- Observation ✅
B- Myomectomy
C- CS
D- Induction of labor

Answer is Observation.
Best answer would be Pain management.
Red degeneration of fibroid is a common complication in pregnancy causing abdominal pain and fever and it’s usually managed Conservatively by Pain reduction.

Man diagnosed with appendicitis due to rigidity and abdominal tenderness
During the surgery the appendix was fine, what to do now?
A- Remove the appendix and close
B- Look for meckles diverticulum ✅
C- Do open surgery and explore
D- Close without doing anything

Note: If you schedule for appendectomy and during the procedure you found normal appendix:

1- look for other DD as:
Meckel’s diverticulum, PID…
2- If open —> do Appendectomy
If lap —> NO Appendectomy.
3- if you found inflammation in terminal ilium —> refer the patient to Gastroenterology for IBD evaluation.