Pediatric with decreased appetite and fatigue , she had pallor and splenomegaly, and systolic murmur. Labs showed showed only IDA (low MCV, low hg) borderline reticulocytes (1.3), RBC (4)
I am not sure it they said iron was normal or not but I think it wasn’t mentioned
Provided this same exact picture ,what should be replaced?
A- Iron
B- Folate
C- VitB12
D- Erythrocytes

Another recalls:
Child has fatigue and splenomegally
Hb low
RBC low
MCV low
Retic normal
Iron normal
What to replace in this case?
A Iron
B.B12
C.Folate
D. Erythrocytes ✅

Child has fatigue and splenomegaly , Hb low,RBC low ,MCV low ,Retic normal ,Iron normal , What to replace in this case ?
A.Iron
B.B12
C.Folate
D.Erythrocytes ✅


Bdran: Answer is Erythrocytes. According to the other recalls the Iron profile was provided and it’s normal.
Since the Diagnostic test of IDA is iron profile this patient doesn’t have IDA.
So, replacing iron will have no rule in this case. A is excluded.

Exclude Vit B12 and folate since the lab shows Low MCV.

The only microcytic anemia that fits with this case is Thalassemia and to say wether major or minor we Need Hb electrophoresis.

Note: if the scenario didn’t mention Iron profile and gives you hints like:
- Drinking milk for a period of time
- high RDW
- Kolionychia and other signs of IDA
Answer will be Iron ✅


بحسب خبرتي المتواضعه في الـ SMLE اذا جاتك الصوره غير والسيناريو غير اعتمادك على السيناريو هو افضل خيار.
الصورة كأنّ فيها Hypersigmented neutrophil وتتعارض بشكل مباشر مع السيناريو.

15 month boy came to ER complaining of abdominal discomfort, emesis, stool with blood and mucus on phisycal examination he has increase abdominal sound
X-ray report shows obstractive bowel ( written like this )
A- give antibiotic
B- Go to OR and do surgery
C- Barium enema ✅
D- bowel rest, IV hydration and wait until symptoms gone


Answer is C.
15 months with these Sx?
Could be wither IBD, amebiasis, or intussusception.
I will go for Barium enema to confirm the diagnosis of intussuception.
Currant jelly stool is a mixture of blood and mucous and sloghed mucosa. ( Amboss )

In intussusception X ray will show a intestinal obstruction which is non specific finding.

next step would be US
Conformatory is Enema.

Management will be:
Fluid, electrolyte correction and Non- operative procedure by enema either with fluid or with air.
But Not to wait for the Sx to be gone you must act because it’s a mechanical problem, waiting for Sx to be gone will not be helpful.

When to go for OR?
- Failed enema 3 times.
- signs of peritonitis
- Unstable patients.

آخر ساعه من يوم الجمعه.
لاتنسوني وجميع المسلمين من طيب
دعواتكم.

رزقنا الله وإياكم فرحه تمحو كل حزن وفرج لكل صابر وشفاء لكل مريض ومعافاه لكل مُبتلى وغُفراناً لكل ذنب..

13 Dec

ER. Abdominal pain generlized tenderness hx of open laparotomy 10 years ago abdomen distended imaging multiple air levels distended small intestine fever no vitals what is the best?
A. Exp lap
B. Diagnostic laparoscope
C. Abx

Answer is CT scan ✅

This is a classic Question about adhesions.
They usually paints the scenario with Hx of surgical abdomen ( Laparotomy, sleeve, appendectomy ) and then presents with intestinal obstruction symptoms and multiple air levels on x ray.

CT scan is the preferred step in the approach to diagnose the adhesions.

This exact Question came to one of my colleagues and CT scan is present among choices ✅

Copd patient presented with exacerbation he was fully conscious. He was started on high flow oxygen then he started to deteriorate with decreased level of consciousness. PH 7.18 PaO2 15 kpa . What is the initial thing you would do?
A- intubation and ventilation
B- decrease oxygen flow ✅
C- give salbutamol?
D- give ipratropium?

COPD patients should never receive High flow oxygen.

Pt had RTA in er, only has a bruises in lower abdomen and abdominal pain, what is the most appropriate nest step ?
Bp : 110/80
Temperature : 37.2
HR : 88
RR : 19

A. CT
B. Fast
C. Initial assessment and resuscitation ✅
D. Exploratory laboratory

Primary survey should be the first step.

Pediatric, known case of congestive heart failure and hypertension presented with dyspnea on exertion And decreased exercise tolerance X ray showed cardiomyopathy:
A- stat iv frusemide ✅
B- digoxin
C- reassure as this is expected of disease

Another recall: a child known to have congestive heart failure and dilated cardiomyopathy, present with cough and shortness of breath A chest X-ray was given "" not the exact one but similar"" What consultation you will give?
A- give digoxin
B- give inhaled. can't remember exactly the one, but was one of the asthma drugs
C- tell them it's a normal progression of his disease

69- 6 YO known case of congestive heart failure, present in ER with SOB after playing, HR : 200 other examination normal, ask about apportiate mangment.

A- iv fursamide ✅
B- observation as symptom expected of his diagnosis.


جاني في نوڤمبر.
كان معاه صورة Xray فيها Cardiomegaly.

Answer is IV furosemide

65 years old man admitted for elective ventral hernia repair, K/C of hypertension and BA, upon examination bilateral crepitation, ascites and bilateral edema, what to do?
A- Proceed with hernia repair.
B- Don’t repair unless obstruction has occurred ✅
C- Delay until situation is controlled.

هذا جاني فالاختبار..
طيب عشان تفهمون ليش حطيت B
ركزوا معي

Smoking
Obesity
Diabetes
COPD
Asthma
Congestive heart failure

All of these are relative contraindications to elective ventral hernia repair.

Relative contraindications means:
You don’t repair the hernia unless incarcerated or strangulated.

As elaborated in this case patient has asthma and signs of congestive heart failure.

DrThawabah also agrees with this answer ✅.

UTD

Dr Thawabah

الابروتش اللي انا ماشي عليه في الـ Hemorrhoids:

Note: You should know the grades first.

Grade 1 and 2:
- start by conservative management ( High fiber diet, increase fluid intake, Avoid fatty meals, Regular exercise, sitz bath )

- If failed?
Rubber band ligation.

Grade 3:
- Start by conservative as above.
- if failed?
Does the patient have bleeding?
Yes? rubber band
No? hemorrhoidectomy

Grade 4 or thrombosed?
- Hemorrhoidectomy.

If the patient is 40 or above?
COLONOSCOPY!

Grades of internal hemorrhoids.

55 years old male, presented with exertional dyspnea and syncope, on examination he was found to have systolic ejection murmur that radiates to the carotids, on ECG there is left ventricular hypertophy. How would you manage this patient?

A- antihypertensives with tight BP control
B- refer for surgical correction ✅
C- give vasodilator
D- give diuretic

جاني فالاختبار..
Answer is B.
The murmur described in the question is a murmur of Aortic stenosis ( AS ).
Surgery is indicated for AS if:
- Symptomatic ( SAD )
Syncope, Angina, Dyspnea
- EF < 50%
- Going for cardiac surgery for other reason.

17 Dec


32 years old male, known to have rheumatoid arthritis.
He is controlled on steroids & hydroxychloroquine.
Physical Exam is normal.
Which is the best treatment regimen for this patient?
A- Taper steroids & start Methotrexate ✅
B- Taper steroids & start ibuprofen
C- continue same management
D- forgot but irrelevant

The blood glucose levels are high in this recall👆👆

P.t known case of RA controlled on HCQ 400mg and Prednisone 15mg
Well controlled for period ( forget )
All labs include LFT ( N )
EXCEPT ( high FBG and HbA1c )

- what’s your next action :
A- taper Steroid and start MTX ✅
B- taper steroid and start Ibuprofen
C- continue same Mx


Answer is taper steroids and add MTX.
جاني في سبتمبر

الله يوفقكم جميعاً ويسر لكم اموركم
ويفرحكم بدرجات اكثر مما تتمنون يارب..

نصيحتي للي اختباره قريب:
Questions
Questions
Questions
لاتضيع وقتك وتراجع معلومات الا اذا كانت جداول او معلومات سهل نسيانها..
مراجعة اسئلة وفاء بسرعه ليلة الاختبار اعتبره حجر اساس في الاوبي

وياحبذا لو تكون مصور الاسئلة اللي تنساها دايم وتراجعها بيكون افضل شيء

لاتستهين بأي ريكول او أي سؤال يمر عليك بتلقاه قدامك فالاختبار خصوصاً الاسئلة اللي نزلت قريب من يوم اختبارك

غير كذا الاختبار والله انه بسيط وسطحي والاسئلة اللي تطولون فيها اقل من ٥٪؜

فالكم التوفيق يارب

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.

اللي يحتاج مساعده في اسئلة ديسمبر او الاسئلة بشكل عام ارسل سؤالك عالخاص @itsBdran

اللي مارديت عليهم يرسلون نقطة.