Patient with ventral hernia the hernia area is tender ?
A. obstructed
B. incarcerated
C. strangulated hernia

Another recall:
43 year old lady developed paraumbilical ventral hernia that is irreducible and no cough impulse with vomitng and air fluid level, the skin is red upon examination, which of the following is the appropriate differential diagnosis?
A- incarcerated hernia
B- strangulated
C- obstructed
D- irreducible

Another recall:
Heavy leftr sport female came with priumblical pulging not affected with cough , in examination there was tenderness and pain ?
A- Strangulated hernia
B- Incarcenited hernia

Bdran: Answer is strangulated hernia.

Note:
Incarcerated:
Only irruducible.

Obstructed:
Irreducible and Sx of bowel Obs ( abdominal pain + pain at the site of the hernia , Vomiting, Distension )

Strangulated:
Irreducible + ((Tender)) + change of skin color ( could be Red, Blue or Black )
Fever+ signs of ischemia and sepsis.

20 y.o healthy male. Acute left-sided chest pain. Stable. ECG normal. CXR is shown. Most appropriate treatment?
A. lncentive spirometer
B. Barium swallow study
C. Thoracotomy
D. Chest Tube

Bdran: Answer should be Observation. If not in choices? Choose chest tube. Here is an approach to Pneumothorax management:

Ref: UTD and Amboss.

A patient wants to give a doctor a gift?
A. Refuse
B. Accept
C. Accept and report to department

Another recall: If patient that you treated gave an expensive watch as a gift, what will you do?
A-Accept it and tell to not do it again
B-Refuse it
C-Accept it

Another recall: you treat old age female patient .... relative give you gift of traditional meal
a – accept
b - inform the facility Administration
c – refuse

Bdran: Depends on the type of the gift. If the gift was money or jewelry like a watch or any expensive valuable gift you have to refuse it. If the gift was regular non-expensive like a book, pen or a meal, it’s ok to accept it.

8 yrs old failure to thrive in divorce parent , lives w mother and she’s on antidepressants
medication what to do?
A. Reassurance
B. Increase caloric intake
C. Other option was not related

Bdran: Answer is Increase caloric intake.
The underlying cause of failure to thrive is always related to inadequate nutrition.

Ref: UpToDate.

5 months baby boy came to ED, due to low grade fever, cough & wheez.
O/E: has substernal & intercostal retractions
T= 37 C
RR= 55/min
BP 98/55
SpO2= 90%
What is most appropriate management?
A. home oral Abx
B. supportive management of IV fluid & monitoring
C. ventilatory support
D. septic work up

Bdran: Answer is Supportive management of fluid and monitoring.

The diagnosis here is bronchiolitis.

How to think of bronchiolitis?
Age less than 2 years with clinical features of bronchiolitis.
C/P: initially URTI ( low grade fever, rhinorrhea, cough, sometimes hemoptysis ) followed by LRTI ( wheezing or crackles on Auscultatio ).

If the patient is in distress he will show signs like intercostal retractions.

Management is supportive with only fluid and oxygenation and monitoring.
If the O2 sat was 90 or more then oxygen is not usually required.

Ref: Amboss.

هذا الرابط فيه الثلاث كتب تبع الجراحة اللي استعملتها بالتصحيح
الرابط من د.عبدالرحمن القويز الله يبيض وجهه

https://drive.google.com/drive/mobile/folders/1vVb20lGKIRP1UAqzluZRsuqUhcDgIgcu

اذا عندك شيء عن المرمرز شاركنا بالله ملخبط فيها

—

🔽

للتذكير يا أحبّه

‏«تكفير سنة كاملة يكون بصيام يوم واحد»

‏قال النبي ﷺ: ( صيام يوم عاشوراء، أحتسب على الله أن يُكَفِّر السَّنَة التي قبله ) .

‏يوافق صيام يوم عاشوراء
‏" يوم الجمعة ١٤٤٥/١/١٠هـ "

‏و يستحب صيام يوم قبله أو يوم بعده
‏قال رسول الله ﷺ: ( لئن بقيتُ إلى قابِل، لأصومن التاسع )

إن لم تصوموا فذكّروا
ولاتنسوني من صالح دُعائكم

A 45-year-old smoker came to the clinic for his diabetes follow-up. During discussion, he
acknowledged that smoking is not good for his health. He plans to quit this year. According to the
Stages of Change Model, at what stage of change is this patient?
A. Precontemplation
B. Contemplation
C. Preparation
D. Maintenance

Bdran: Answer is contemplation.

- The precontemplation stage included current smokers not thinking of quitting within the next 12 months.

- The contemplation stage included smokers not thinking of quitting within the next month, but considering quitting within the next 12 months.

The preparation stage includes smokers who were thinking of quitting smoking in the next month, as well as those who attempted to quit for at least 24 hours during the previous 12 months.

https://www.cdc.gov/pcd/issues/2017/16_0376.htm#:~:text=As%20an%20integrative%20biophysiological%20model,4)%20taking%20action%20to%20quit%20(

Ref: CDC.

A 2 years old boy who took BCG vaccine came with his mother becuase of his grandfather had open TB and they live in the same house, the boy asymptomatic but the mother worried what should you do?
A- nothing since he took BCG vaccine
B- PPD, X-ray and wait for the result
C-IGRA, X-ray and give INH
D-IGRA, X-ray and give 4 TB drug

Bdran: Answer is C
According to the CDC
PPD will be false +Ve due to recent BCG vaccine

In infants and young children with history of contact with active patient we give a window prophylaxis for Latent TB infection and test them again after 8-10 weeks from exposure.

Best test for latent TB is IGRA.

Ref: CDC