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.

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.