نزلت درجات ديسمبر
بشرونا ..

اللي استفادوا من القناة بشكل عام وارسلوا الله يبيض وجيهكم على الدعاوي اللي توصلني على الخاص والله ياخوان اني ما ادري وش اقول واني مبسوط جداً.. شيء يثلج الصدر صراحه ❤️

عسى الله يوفقكم جميعاً ويسر اموركم ويختار لكم اللي فيه الخير والخيره


بالنسبة للي يعلق معاه رابط النتائج يدخل عن طريق ممارس بلس ويدخل على خانة " اختباراتي " وان شاء الله تطلع له مع رابط تحميل الرسم البياني..

‏سلام عليكم ورحمة الله وبركاته
‏مساء الخير دكتور بدران
‏كيف حالك عساك طيب ؟
‏تكفى اذا تقدر تسأل في قناتك اذا يعرفون احد اعترض على درجة اختبار SMLE وتعدلت الدرجة حقته او لا ؟
‏لاني اختبرت الشهر الماضي وطلعت وانا واثق ومتفائل جداً من حلي وضامن فوق ٩٠ لكن طلعت الدرجة ٨٥!
‏ودي اعترض لكن الاعتراض ب ٥٠٠ ريال واخاف مافيه فايده
‏فاودي اعرف اذا فعلاً فيه احد قد اعترض وتعدلت نتيجته






احد يعرف؟

هذي الرساله للي حاب يستفسر عن شيء بالتقديمات.. واللي عنده جواب يجاوب نستفيد من بعض.

مسيتوا بالخير جميعاً، راح أكون معاكم للي بيختبرون في يناير وفبراير وبساعدكم والخّص اللي اقدر عليه إن شاء الله..

أي سؤال تحتاجون مساعده فيه أنا موجود بإذن الله

طريقة التواصل تلقرام مباشرة: @itsBdran

For exam takers in Jan and Feb, anyone in need of assistance to solve any Qs, Don’t hesitate to contact me at @itsBdran

اللي مارديت عليهم ارسلولي نقطة بالله، المحادثات تلخبطت للاسف

شكراً للجميع

A 50 year old sustained blunt trauma to the chest with persistent pneumothorax and significant air leak through double intercostal tubes most appropriate next procedure ?
A. Reposition of ICT
B. Prompt thoracotomy
C. Endotracheal intubation
D. Fiberoptic bronchoscopy ✅

Patient on Double intercostal tubes and still there’s air leak?
More likely to be Tracheo-bronchial injury and diagnosed by Brochoscopy.

Ref: Thawabh.

Pregnant women 15 weeks GA presented with right abdominal pain associated with nausea and vomiting.
Obstetrician Dr excluded pregnancy related diagnosis
What is the most likely diagnosis:
A- cholecystitis
B- Appendicitis ✅
C- pancreatitis

Case of pregnant 16 weeks developed right side abdominal pain (did not specify upper or lower). Temp 73.8
Most common cause
A) gastritis
B) pancreatitis
C) cholecystitis
D) appendicitis ✅

Female 16 week pregnant, came with right sided abdominal pain (RUQ) associated with nausea and vomiting. The doctor ruled out all pregnancy related abdominal pain. What's the most likely diagnosis?
A- Gastritis
B- Pancreatitis
C- Cholecystitis ✅
D- Appendicitis

Remember this:
( Appendix will change in position during the 3rd trimester )

15 weeks and right UPPER quadrant abdominal pain?
Cholecystitis.

3rd trimester and right UPPER quadrant abdominal pain?
Appendicitis

15 weeks and right abdominal pain without specifying upper or lower?
Appendicitis as its the most common surgical emergency.

Nurse work in pulmonary clinic C/O with fever, productive cough. She is not
responding to antibiotics (chest Xray show opacity left upper lobe) which of the
following most likely diagnosis ?
A- Streptococcus pneumoniae
B- Hemophilus pneumonia
C- Mycobacterium Avium complex
D- Pulmonary TB ✅


- Not responding to Antibiotics.
- Apical site opacity.

Most likely she is having Pulmonary TB.

A 6 year old girl presents with reddish urine. Her parents state that she had constipation for 2 weeks and now has incontinence (Not specified if urine or stool). Examination reveals abdominal tenderness with no organomegaly.
Vitals:
BP 115/76
HR 76
RR 27
T 38.9 C
Labs:
WBC 9.5 WNL
Hgb 79 Low
Urine:
Leukocytes 20-25 High
RBC 30-35 High
Protein + High
Blood +++ High

What is the most likely diagnosis?

A- UTI ✅
B- HSP
C- Autoimmune hemolytic anemia
D- PSGN

- Clues:
Fever, Constipation, +ve leucocytosis in urine.

- Man got shot by gun in his Rt. thigh, then developed hematoma in the medial thigh.
The patient developed pain and parasthesia in his Rt. leg, pulse was abscent from femoral artery and below (no vitals or labs), what is the best next step?
A- CT angio
B- Wound exploration
C- Wound exploration and repair in the OR ✅
( No fasciotomy in choices )

- Man got shot by gun in his Rt. thigh, then developed hematoma in the medial thigh.
The patient developed pain and parasthesia in his Rt. leg, pulse was abscent from femoral artery and below (no vitals or labs), what is the best next step?
A- CT angio
B- Wound exploration
C- Wound exploration and repair in the OR ✅
D- fasciotomy

- A 27-year-old man sustains a single gunshot wound to the left thigh. In the ER, he is noted to have a large hematoma of his medial thigh. He complains of paresthesias in his left foot. On examination, there are pulsatile hematoma with weak pulses palpable distal to the injury and the patient is unable to move his foot. Which of the following is the most appropriate initial management of this patient?
A- CT Angiography
B- Immediate exploration and repair in the OR ✅
C- Observation
D- Bedside local wound exploration

- Patient after trauma developed expanding hematoma on the medial side of the thigh with weak pulses,
1- wound exploration in the ER
2- take him directly to OR ✅

- A gunshot in the left leg, hematoma in the medial aspect of the thigh what’s the next step?
A- angiography
B- Apply direct pressure first ✅

- Male victim of gunshot to the thigh, pale and unconscious, BP 90/60 pulse 130, next?
A- orotracheal intubation ✅
B- blood transfusion
C-shift to OR
D-RL infusion


To be organized:
1- exploration of hematoma in OR is indicated if hard signs are present as expanding, pulsatile, absent distal pulse, evidence of distal ischemia.

2- Following ABCDE approach is a priority to any Question if asked about the next step:
* If intubation is needed, should be the first step.
* If Airway is patent and the patient is breathing normally the next would be applying direct pressure to stop the bleeding.

Pregnancy typical DVT symptoms then developed PE, how to dx?
A- Ct
B- D dimer
C- V/Q
D- Us for lower limbs ✅


30 year old female pregnant with new symptoms of dyspnea, productive cough and fatigue. Doppler US was negative what is the next test to do:
A: cta
B: d dimer
C: spirometery
D: ventilation and perfusion scan ( V/Q scan ) ✅

PE and DVT In pregnancy the first thing to do is US of the lower limb if negative —> V/Q scan.

Frequently asked Q:

I deal with ( Most appropriate ) as it means next appropriate step.

90% of Questions will be clear in the exam ( next step or best or definitive or anything )

But if you experienced a Q ends with ( Most appropriate ) I recommend to answer it as if he’s asking about next step.

Healthy patient presenting with dysphagia with no family history of esophageal cancer, asking about the strongest risk factor for esophageal cancer?
A. Esophageal stricture.
B. Barrett's esophagus. ✅
C. GERD.
D. Smoking.

Asking about “Strongest”
And he didn’t specify which cancer SCC or Adenocarcinoma.

Adeno — Barrets
SCC — Smoking

I’d go with Barrets for this Q.

اذكر هذا السؤال تهاوشنا عليه كثير

بس مو مشكله
تماعط الشوش مع الآخرين طريق جيّد للوصول الى الحقيقه.

A case of chronic Hepatitis C, presented with a RUQ mass. Investigations show a 6*6 of hepatocellular mass. What is the best management?
A-Chemotherapy
B-Radiotherapy
C-Transcatheter arterial chemoembolization (TACE)
D-Surgical resection

If child A score? D
If not? C

Patient HCV with cirrhosis contolled symptoms, liver lesion, biopsy showed HCC 8cm lesion no LN or any invasion, labs within normal (bili, albumin, inr):
TACE
Radio
Surgical resection✅
Palliative

Child A ( Labs within normal ) and no mets and single lesion ✅

Pt known to have Hepatitis b and chronic liver disease found to have liver nodule on ultrasound and CT was done Showed 4 cm HCC with high vascularity with normal Portal vein and no invasion! He is well now with controlled ascites with medication. His labs Albumin: 3.1 Blirubin : very high 40 normal was up to 2 INR:1.5 His ALT and AST were within normal What is the most appropriate next step in management :
A) surgical resection
B) radiotherapy
C) trascatheter arterial embolization ✅

Class B and 4 cm single lesion with no Mets ( Transplant is better answer if not in choices? TACE ✅ )

Pt known to have Hepatitis b and chronic liver disease found to have liver nodule on ultrasound and CT was done Showed 6 cm HCC with high vascularity with normal Portal vein and no invasion! He is well now with controlled ascites with medication. His labs
Albumin: 3.1
Blirubin : very high 40 normal was up to 2
INR:1.5
His ALT and AST were within normal
What is the most appropriate next step in management :
A- surgical resection
B- radiotherapy
C- trascatheter arterial cath embolization ( TACE ) ✅

Here patient is at least Class B and 6 cm lesion so He’s bot a candidate for either resection or transplant.
Answer is TACE ✅


ممكن هذا أكثر سؤال لاحظت انهم يغيرون فيه، ركزوا شوي في المانجمنت:

لازم تحفظون حاجتين:
⁃ child pugh score
⁃ Criterias


1- When to do surgical resection?
All the following should be present.
⁃ Single lesion with no metastasis.
⁃ Child pugh score A or non-cirrhotic patients.
Even though it’s the gold standard management, it’s done in only 5% of patients due to rare candidates.

2- When to do transplant?
( Milan Criteria )
⁃ single lesion 5cm or less
⁃ 3 lesions 3cm or less
⁃ No Metastasis
⁃ Any child pugh score

3- if not resection or transplant candidate?

5cm or less?
Radiofrequency ablation

More than 5cm?
TACE ( Trans-arterial Catheter Embolization ).

Chemo and radiotherapy? ( Mostly excluded )
Usually it’s the last options and no significant effect.


للاختصار:
لاحظت ان دايم خيارات هذا السؤال
ثابته

1- Chemo❌
2- radiotherapy ❌
هذولي احذفوها دايم
يبقى
3- Resection?
If Child A and single lesion with no Mets

4- TACE?
If not a candidate for resection or transplant and lesion is 5cm or more.


Ref.: Schwartz.

Case of 60s male with 6 months history of Weight loss, loss of appetite, vague abdominal pain , epigastric region.
What is the most appropriate means of investigation for diagnosis?
A- Abdominal x-ray
B- Abdominal CT
C- Gastroduodenoscopy
D- Gastrografin swallow



Old age, weight loss, vague abdominal pain in epigastric region most likely a case of gastric cancer.

Next step CT scan.
Diagnostic test is EGD with biopsy.

اللي شايلين هم البنك هل بيتجدد في الفترة القادمة مع تقليل عدد الاسئلة والوقت..

أول شيء انسى إن احد يعطيك علم اكيد ١٠٠٪؜ لين تشوف الاختبار بنفسك.. وحتى الهيئة ماعتقد راح تصرّح عن محتوى الاختبار بأي شكل من الاشكال.. عشان كذا الله وحده اعلم، بطلوا تتعبوا انفسكم وتدورون اجابة لهالسؤال..

وجهة نظري الشخصية:
الافكار بتكون نفسها، يعني لو تكون فاهم الاسئلة والاجوبة كويس وتقدر تجاوب مهما تغير السؤال حتى لو تجميعات الفين وحطبه بتجيب الدرجه طرق.. ماتوقع يشطحون بعيد مو اختبار Part هو..
بإستثناء الشطحات ام سؤال او سؤالين
اللي دايم تقابلنا فالاختبار
فنصيحتي لطلاب سادس او اللي بيسرفس ويحاول يرفع درجته ركزوا على فكرة السؤال مو السؤال نفسه..


طيب لو لاقدر الله تجدد البنك كامل، هل هي نهاية العالم؟
انا اشوف انه مايفرق، يعني الجميع رح يعاني مثلك وبتقل النسب والدرجات وكلكم بتواجهون صعوبة الاختبار ماحد رح ياكل المقلب لحاله

بالنهاية وكلوها الله والتوفيق بيد الله، لاسويت اللي عليك خلاص هنا انتهت مهمتك.