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تقبّل الله منا ومنكم صالح الأعمال

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16 yrs girl with burning sensation when voiding, she had sexual intercourse last week and her husband used a condom, says “I always pee right after sex”, no vaginal discharge and, examination shows suprapubic tenderness, urinalysis shows positive nitrites, positive leukocyte esterase, 50 white blood cells/high-power field and many bacteria, urine 13-hCG is negative. which cause of this patient’s infection?
a. ascending infection
b. poor genital hygiene
c. sexually transmitted infection
d. hematougenous spread of infection.

Bdran: Answer is A. Ascending infection.
This is a typical scenario of Acute simple cystitis ( Lower Urinary tract infection ) in females:
- Dysuria, Urgency, Suprapubic pain and tenderness in the absence of vaginal discharge.
-Urinalysis: Positive nitrates, Positive leucocytes esterase (reflecting pyuria which is the presence of WBCs in the urine), positive bacterial growth

The most common pathogenesis of UTIs is by Ascending infection from the vaginal introitus and urethra up to the bladder.

Let’s exclude:
B - usually the real cause of Lower UTI is Ascending infection, poor genital hygiene is only a risk factor.

C- No vaginal discharge, her husband used a condom so STD is less probably.

D- Hematogenous spread is rare in cases of Lower UTI and most likely seen in immunocompromised patients and older patients, her age is only 16 years.

Reference: UTD.

الاسئلة اللي غيرت جوابي فيها عن جواب صفدر:

Last Review – Few days before the exam:
أشياء مُهمه مر عليها قبل اختبارك بكم يوم لأنها سريعة النسيان.

- Vaccinations schedule
- Milestones
- Bethesda system for thyroid
- BIRADs for breast
- Vaginal infections
- GCS
- Child Pugh score
- APGAR score
- Pictures file

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.