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.

Patient P4 came for contraceptive method. Patient had regular cycle but increase in bleeding recently. Hx of CS, and endometritis after the second CS which has been treated. Which of the following is contraindication for IUD?
A. Hx of endometritis
B. Abnormal bleeding ✅
C. Other things not relevant I couldn't remember

Better recall: This patient was using IUD before, but she got pregnant nonetheless. Delivered with C-Section. Then she developed endometritis. Which of the following represent contraindication:
A- previous CS
B- history of Pelvic infection
C- history of contraceptive failure
D- genital bleeding✅

The C/Is are:
1- Anatomic abnormalities and in the uterus ( Fibroid, bicurnicate, endometrial or cervical cancer )
2- Unexplained Uterine bleeding
3- Endometritis or pelvic infection in the past 3 months.


You should pay attention to the time of endometritis in the scenario:

If > 3mth
Choose Bleeding
If < 3 months
Choose Endometritis if Bleeding is explained by another cause.

If ( Unexplained bleeding ) written like this in the scenario? It’s 100% the correct answer.


جاني في سبتمبر
وال Endometritis كانت قبل سنه
وحطيت Bleeding

Healthy female with perianal discharge at 3 and 7 oclock ( no mass, no vitals ), what are you going to order?
A- MRI
B- Colonoscopy ✅

If K/c of Crohns? MRI
If not? Colonoscopy first

Fistulas can be the first presentation of CD.

SLE pt on medication and present to the ER with urinary incontinence and lower limb weakness during examination you found hyperreflexia and paraplegia, what you will order ?

-LP + MRI brain
-LP + MRI spine ✅
-LP + CT brain
-LP + MRI MRA MRV brain

Young SLE female pt on treament. Developed urinary incontinence, hypereflexia, paraplegic or paresthesia.
(Sx mostly neuro) what the most important test to do immediately?
Lumber puncture & MRI brain
Lumbar puncture & ct brain
Lumbar puncture & MRI spine ✅
LP, MRI, MRA, and MRV of the brain

Answer is LP and MRI of the spine.
This is a case of Transverse myelitis as a neurological complication of SLE.
Management is IV steroid and Cyclophosphamide.

3yrs child , the mother noticed blood in his diaper for 2 days , no abdominal pain or constipation , he has similar episode 3months back .. what is the Dx ?
A- juvenile polyp
B- Michele’s diverticulum ✅
C- Intussusception
D- hirschsprung disease

Pediatric age 6 years old Case about lower GI Bleeding with blood seen coming from ileocecal valve during colonoscopy
A. Angiodysplasia
B. Crohns
C. Meckle diverticulum ✅

573- 11 month old child, brought by his parents they reported a 1 day history of fresh blood in
stool associated with foul smell and dark brown stool on examination the child was pale (they
didn’t mention pain or any abdominal examination), What’s the best diagnostic tool:
A- barium enema
B- barium meal
C- radioisotope scan ✅
D- US abdomen

Answer is Meckle’s diverticulum.

Note: Painless lower GI bleeding is the most common symptom of Meckle’s diverticulum.

Another Q: Best diagnostic tool?
Nuclear scan as Radioisotope scan ✅.

23 years old male, have proteinuria & was diagnosed with nephrotic syndrome 2ndry to minimal change in glomerulonephritis (written exactly like this).
What is the most appropriate treatment to decrease protein levels in the urine?
A- Prednisone ✅
B- ACEi
C- No treatment needed
D- forgot but irrelevant

Answer is Prednisolone.
See UTD below.

DM Rt leg swelling .. Angiography showed diffuse disease 2 days later developed firm tender partially mobile swelling irreducible nonexpansile below the inguinal crease .dx ?
A. Psoas abscess
B. Saphena varix
C. Femoral hernia
D. Pseudoaneurysm ✅


This Q is present in DrThawabh course. I will follow DrThawabh’s Answer here.

A female patient presented with joint stiffness, she also has photosensitivity, malar rash with healed ulcers, her proximal muscle strength is 3/5. Labs
ANA +ve
Rheumatoid factor +ve
CBC shows anemia
Which of the following serves the highest diagnostic value?
A-Anti DsDNA
B-Anti CCP
C-Anti RNP✅

Answer is AntiRNP
Mixed Connective tissue disease.

4 Diseases that usually comes together in the choices

Epididymo-orchitis
Testicular torsion
Appendicular torsion
Inguinal hernia

How Can I differentiate?

Let’s take them one by one.

◻️ Epididymo-orchitis:
- Gradual pain in the scrotum
Usually >24h.
- Tender edematous cord
- Red scroutm
- Fever, Dysuria, urethral discharge can be present
- High WBCs and inflammatory markers.

Mx: Antibiotics.

◻️Testicular torsion:
- Scrotal pain less than 12 hours ( مهم )
لانه بعد ١٢ ساعه يصير Necrosis ومايحس بالالم.
- Previous episode or trauma.
- High riding testis ( Horizontal )
- negative phren sign and absent cremasteric reflex.
- Low doppler flow

Mx: Surgical exploration ASAP.

◻️Appendicular torsion:
- Tenderness over the upper pole
- Vertical ( Longitudinal ) testis
- Blue dot sign

Mx: NSAIDs and Rest.

◻️Inguinal hernia:
- Mass extended to the groin.



Let’s take some Questions:

A child has scrotal pain since 1 day, on exploration the cord was edematous and inflamed with red right hemiscrotum, what is the diagnosis?
A. Testicular torsion
B. Inguinal hernia
C. Testicular appendages torsion
D. Epididymoorchitis ✅

14 years old came with sever sudden scrotal pain and on examination high riding and sever tenderness on palpate.. dx?
A. Testicular torsion ✅
B. Orchitis
C. Hydrocele

2 years boy signs of testicular torsion , redness pain , absent cremastric reflex , previous episode same sx2 weeks (I think )
A- Surgical exploration ✅
B- NSAID
C- Antibiotic
D- Testicular elevation

12 y boy presented with 2 days of tenderness in upper pole of right testis with right scrotal inflammation (redness …),the testis is in longitudinal position (no high riding testis) diagnosis?
A-Testicular torsion
B-Appendicular torsion ✅
C-Cry..orchitis
D- Hydrocele

12 year old with testicular pain for 2 days. Vertical testes, tender apex, with skin changes.
Most likely diagnosis?
A-Epididymo-orchitis,
B-torsion of testicular appendix✅
C- testicular torsion


Child came with painfull red swollen hemiscrotum. On examination, mass was palpated with -ve cough impulse. The mass was tender and extended to the inguinal area. Left testes cannot be palpable. Which of the following is the most likely diagnosis?
A- testicular torsion
B- Epidydomorchitis
C- Incarcerated inguinal hernia ✅
D- Testicular appendicular torsion


pediatric patient came with pain and redness in Rt hemiscrotum , on examination , there is bulging or something like that extended from scrotum to inguinal area , tender , red , Rt testes not palpable , what is the Dx?
A-testicular torsion
B-testicular appedoges torsion
C-epidydemoorchitis
D-incarcerated inguinal hernia✅

Female after trauma to anterioc chest clear breath sounds bilaterally with pounding pulse,distended jvp bp110/70 pulse 90 (nearly)
A- Cardiac tamponade
B- Cardiac contusions✅
C- Tension pneumothorax
D- Pleural effusion

Another recall: A patient with Anterior chest trauma with bruising in the sternum. Patient vitally stable, clear cardiac and respiratory exam, except for pounding pulse. ECG: Arrhythmia X-ray: Sternal Fracture. Echo: Normal What is the diagnosis:
A. Pneumothorax
B. Cardiac contusion✅
C. Cardiac Tamponade
D. Ventricular rupture

Answer is Cardiac contusion.
Arrhythmia on ECG and Sternal fracture Plus Non-complete Beck’s triad Makes the answer more with Cardiac contusion

جاني فالاختبار

Pt has long history of cardiovascular disease with chest pain, he was anxious. On examination: peripheral cyanosis, JVP around 8 cm above normal, nicotine stain on his fingers, he wants to quit smoking. What is the next step:
A- Motivational therapy ✅
B- Bupropion
C- Varenicline
D- Nicotine replacement therapy

9-month Hx of MI came to clinic for smoking cessation he was in respiratory distress raised JVP nicotine tear in his hand what is the most appropriate drug?
- A. Nicotine replacement therapy
- B. Varenicline ✅
- C. Bupropion

53 years old male patient heavy smoker presented with SOB,cyanosis and distended JVP. The patient is heavy smoker for many years and wants to quit now. What is the *best* way to help him quit?
A. Varenicline ✅
B. Nicotine replacement therapy
C. Bupropion
D. Behavioral therapy.

ابغاكم تعرفون ٣ معلومات بس:

1- Most important initial step in smoking cessation is Motivational support to the patient.

2- Most effective drug is Varenicline and it’s also Safe in Cardiac Patients

3- If written in the Q ( Hospitalized patient ) Best option is Nicotine replacement therapy.

زي ماتلاحظون السؤال الثاني كاتب لك Came to the clinic “
He is not Hospitalized.

السؤال الثاني جاني في نوڤمبر

Peripheral Arterial Disease ( PAD ) Investigations:

1st ( Start By simple ) Laboratory tests:
CBC, Hgb, RBS, Lipid profile, RFTs.

2nd ( Vascular Labs ):
- Doppler US to detect the pulse by Sound.
- Ankle-Brachial Index at rest and exercise if drop > 20% —> ischemia
- Segmental pressure measurement: to find the location of stenotic artery.

3rd ( Imaging )
If Asked Next?
Start by Duplex US
If asked the Gold standard or best investigation to detect PAD?
Choose Conventional Angiography.


Usually we start by US if not diagnostic we use CTA
If the patient have renal impairment and we cannot use CTA due to the contrast usually we go for MRA.

If none of the above is Diagnostic?
Conventional Angio is the gold standard for theraputic and diagnostic purposes.

Note: If the patient have PAD then presented suddenly with leg pain and suspicion of Acute ischemia? Give Heparin.
Heparinization immediately required.



Now with the Qs:

DM with hx of pad, had pain when he walks 300m and relieved by rest what will you do
A- CTA
B- vascular ultrasound
C- conventional Angio
D- MRA

Next? B ✅
Best or Gold standard or most diagnostic? C ✅

Scenario of critical limb ischemia, what’s the most diagnostic investigation?
A- CTA
B- MRA
C- Conventional angiography ✅
D- ultrasound

Patient with chronic limb ischemia, presented with sudden leg pain, diminished popliteal and distal pulses in right leg, and diminished distal pulse with intact popliteal in the left, what's the appropriate next action?
A. Heparin ✅
B. CT angio
C. US
D. conventional angio

Reference: Washington Manual Book for Surgery.

A 4-month-old uncircumcised boy. He has low-grade fever. Many negative symptoms. He looks well and changed diaper multiple times.
Temp: 39.1
Urine analysis:
High WBC.
Positive nitirte.
Posiitve leukocyte.
What is the most appropriate management?
A. Oral cephalexin. ✅
B. Oral azithromycin.
C. IV ceftriaxone.
D. IV cefuroxime.

جاني بالنص في نوڤمبر

اللي اختبارهم بكره وبعده ويحتاجون مساعده في أي سؤال ارسلوا لي عالخاص : @itsBdran

For exam takers on Wednesday and Thursday and in need of assistance in Solving Questions don’t hesitate to contact me at @itsBdran

الله يوفقكم جميعاً
ويرزقكم اعلى الدرجات يارب..

UTD: You do Venous duplex in Spider Nevi ( Telangectasia ) only if associated wtih Sx or have Risk factors for chronic venous insufficiency.

37 yo male have spider nevi over righ thigh want to do cosmotic
examination normal pulse and no varicosity
what investigation to do?
1-no need ✅
2- venous duplex
3- venous CT angio
4- venous plethysmography

46 yo female known to have varicose veins for 6 years presented with bilateral leg swelling and pain after prolonged standing
No hx of claudication
After examination there’s various veins in the great sephonus vein territory
What is the investigation of choice:
A. CT venography
B. Venous duplex ✅
C. venous plethysmography
D. No investigation required