August complete .pdf - SMLE 2019 AUGUST Corrected by Glory...

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Unformatted text preview: SMLE 2019 AUGUST Corrected by: Glory Team Glory team August ● Anal fissures with skin tag not respond to drug, want procedure? A- Internal sphernctomy B- External sphrenctomy C- Anal curettage with remove tag Correct answer is C N.B: For the skin tag it’s called sentinel pile and it’s come with 20% of patient with anal fissure; it’s one of the diagnostic factors. (Source: Best practice) ● Pic for cystourethrogram, ask dx: 1- Cystourethra reflex 2- Renal agensis 3- Urethta stone Correct answer is 1 INCLUDEPICTURE "C:\\var\\folders\\m7\\hk4xywwx6tj_nkdq9bzjtq sw0000gn\\T\\com.microsoft.Word\\WebArchiv eCopyPasteTempFiles\\page1image29591584" \* MERGEFORMAT N.B: vesicoureteral reflux ● Q about dx of Mitral stenosis The best initial test for all valvular heart disease is echocardiogram. Transesophageal echo is generally both more sensitive and specific than transthoracic echo. The most accurate test is Catheterization ● Meconium aspirations > nitrous oxides. ● benign and malignant Phyllodes tumor treatment 1- mastectomy 2- wide local excision Correct answer is 2 rare fibroepithelial breast tumors that can be benign or malignant, 35-55 y/o Glory team August small: Wide local excision (wide margined zone) or lumpectomy ‘with <1cm margined zone’ large: Mastectomy. malignant you should give chemo or radio with it. N.B: No need to take LN with small or larger if there is no s/s of malignancy, if the question come without size it’s better to choose excision not mastectomy ‘Source: breastcancer.org and Kaplan CK 2 lecture notes’ ● Neonatal hypoglycemia> give glucose in central line Correction of Neonatal hypoglycemia We start with *D10* in *peripheral* line. If no response Shift to *D12.5* in *central* line. ● Acute pancreatitis with high amylase, ask investigation A- Amylase urine. B- CT abdomen. Correct answer is B Answer: CT or US will show enlarged pancreas with peripancreatic fluid and fat stranding, abscess, hemorrhage, necrosis, or pseudocyst. if severe; “sentinel loop” or “colon cutoff sign” on x-ray of the abdomen. ● jaundice with us show stone in GB and in CBD, tx. a. Laparoscopic cholecystectomy b. ERCP Correct answer is B Answer: since gallstone present in both GB and CBD so case of choledocholithiasis (if with infection present so Cholangitis ‘Charcot’):Initial: NBO, IV fluids, Abx (Cipro + Metronidazole, or Ampicillin + Genta. + Metronidazole). Urgent: ERCP ‘remove the CBD stone and definitive treatment of cholangitis’. Elective: Lap cholecystectomy (definitive treatment for gallstones) ● Q about renal impairment with arteriovenous anastomoses or shunt, what’s the type of arteriovenous: 1- Brachioradialis 2- Radiocephalic Correct answer is 2 Answer: AV fistula types for dialysis: Radio cephalic (1st choice) at forearm, Brachiocephalic (2nd choice) at elbow and Brachioradialis. ● Palpable gallbladder, with pain less jaundice, didn’t mention painful gallbladder, ask about Dx: Glory team August 1. GB cancer 2. Cholthisis 3. Pancreatic cancer. Correct answer is 3 Primary sclerosing cholangitis with palpable gall bladder + obstructive jaundice is Klatskin tumor Otherwise any palpable GB with obstructive jaundice is periampullary Ca . ● A lot Q about Abortions. ● placenta abrution dx , mx ● Management of hyperkalemia with/ without ECG changes. ** see glory file. Glory team August ● About fixed hard lump irregular margins > breast cancer. ● Thyroid nodule >>>>>>>> ● Cardiac tamponade best diagnosis by?? ECHO. INCLUDEPICTURE "C:\\var\\folders\\m7\\hk4xywwx6tj_n kdq9bzjtqsw0000gn\\T\\com.microsoft. Word\\WebArchiveCopyPasteTempFil es\\4dbc3792-efe0-4c92-8b33fe62852e0972" \* MERGEFORMAT ● about COPD, total lung capacity, PEFV1, another parameter I can’t remember, ask about which increase and decrease. COPD: Increase in Lung capacity or air compliance Decreased in FEV1 & FVC. ● Simple q about adenomyosis> came with Hx of uterus surgery, Adenomyosis usually enlarged uterus with tenderness. Definitive diagnosis is only made by Hysterectomy, best modality MRI. ● Patient post MI developed palpitation >> ECG >> wide QRS suggests bundle branch block ((asking for Dx))? LBBB ● COPD exacerbation ((hypoxia, acidosis, hypercapnia 7.99)) >> management > a. face mask b. mechanical ventilation. Correct answer is B In general non-invasive mechanical ventilation is preferable in COPD but consider invasive if non-invasive has failed or :severe hypoxemia PaO2 <40mmhg severe resp.Acid ph<7.25. hypercapnia >60mmhg. respiratory arrest. cardiovascular collapse. INCLUDEPICTURE "C:\\var\\folders\\m7\\hk4xywwx6t j_nkdq9bzjtqsw0000gn\\T\\com.mi crosoft.Word\\WebArchiveCopyPas teTempFiles\\page9image29498688 " \* MERGEFORMAT Glory team August ● COPD pt. / developed, c/m only from left pleuritic chest pain, Pneumothorax 2cm btw chest wall and pleura >> Management a. needle aspiration b. chest tube c. Observation Correct answer is B ● pregnant lady known case of asthma, on LABA, ICS, SABA ((uncontrolled/late night attacks)) >> Q. Management? Montelukast, if not pregnant leukotriene. ● Pt with left Lateral neck mass ((third triangle just below angle of mandible)) ... U/S thyroid normal and post. Cervical lymph node enlargement, on specimen it’s shows follicular thyroid cells >> dx. A- thyroid carcinoma/ or lateral aberrant. B- apparent thyroid gland. C- ectopic thyroid gland. D- thyroglossal cyst. Correct answer is A ● 7 y old female started breast development, and pubic hair start to appear and acne >> dx. A- ovarian tumor, B- central C- gonadotropin Correct answer is B ● Type of HBV vaccine >> A- live, B- attenuated, C- recombinant Correct answer is C ● Pt with hx. Of retinal detachment surgery 7 day ago and he is going into surgery.... >> Q. Wt to use to prevent DVT A- Enoxaparin B- Pneumatic INCLUDEPICT C- mixed pneumatic and enoxaparin URE D- aspirin "C:\\var\\folders Correct answer is B \\m7\\hk4xyww ● Immunocompromised pt. his younger brother developed chicken box >> how to manage him x6tj_nkdq9bzjtq A- Vaccine sw0000gn\\T\\c B- IVIG om.microsoft.W C- nothing ord\\WebArchiv Correct answer is B N.B: Varicella-zoster immune globulin is recommended for people who cannot receive theeCopyPasteTem vaccine and 1) who lack evidence of immunity to varicella, 2) whose exposure is likely to result inpFiles\\8a2547e infection, and 1-a7c3-4cd13) are at high risk for severe varicella. Reference: CDC ● Hydatid cyst and echinococcus cyst >> Management Medically albendazole a6305e6d2ccca961" \* MERGEFORM AT Glory team August Surgically if large in size , have multiple daughter cystes , ruptured , and if there is biliary communication ● ● Pt after head trauma he couldn’t make the spoon reach his mouth to eat >> where is the lesion A- Temporal B- partial, C- occipital, D- cerebellum Correct answer is D Child after period of illness ((can’t remember is URTI or GI )) developed symmetrical lower limb ascending weakness >> (( GBS )) ● DM, Lateral malleus ulcer with distal pulse >> Q. Investigation? venuse US N.B:Since distal pulse is intact the ulcer is most likely venous, ● DVT w/o distal pulse >> Investigation Answer: US Doppler ● Damage to the cerebellum can lead to: this is information’s not answers. 1. 2. 3. 4. 5. ● loss of coordination of motor movement (asynergia), the inability to judge distance and when to stop (dysmetria), the inability to perform rapid alternating movements (adiadochokinesia), movement tremors (intention tremor), staggering, wide based walking (ataxic gait) Some of the tests your doctor may rely on to diagnose peripheral artery disease are: 1. Physical exam. 2. Ankle-brachial index (ABI)> 3. Ultrasound. 4. Angiography 5. Blood tests. Correct answer is 2 ABI for chronic peripheral artery disease. ● Female, unilateral leg swelling, progressive, pitting edema >> Q. Investigation? Initial: Doppler, best: MRV Glory team August ● Child with bilateral inguinal hernia >> Management All children with a bilateral presentation should undergo bilateral inguinal hernia repair under a single anesthesia, * bilateral lap herniotomy* ● Pt. After going into open hernia repair. developed bulging mass with cough same area >> Management Recurrent hernia > If first was lap treat it open, If first was open treat it lap. ● Which of the following indicate searching for organic cause in a child>>? A- peri umbilical abdominal pain B- last more than 10 min C- around morning D- before sleep time Correct answer is D ● Meningitis case, LP shows gram- ve diplococci, he is close to his brother. How will you manage the brother? oral rifampine ● Pregnant routine screening with UA suggest infection >> (( asymptomatic UTI )) treated by? Nitrofurantoin, if after delivery: not treated. ● Pregnant 28w, with UTI. Which antibiotic CANNOT be used? A- nitrofurantoin, B- fluoroquinolones, C- amoxicillin Correct answer is B N.B: all fluoroquinolones are contraindicated in children, adolescents, and pregnant or breast-feeding women. Reference: The fluoroquinolones. in PubMed ● Pregnant ( early pregnancy ), allergic to penicillin developed UTI. Treatment? Glory team August ● A- cephalosporin B- fluoroquinolones C- nitrofurantoin D- amoxicillin Correct answer is C N.B: Use of this agent is restricted the last several weeks of pregnancy Reference: American Academy of Family Physicians and medescape ACEI angioedema (ramipril) Angioedema is a well-described side effect of treatment with both ACE inhibitors and ARBs. The presentation of this form of angioedema is classical with the predominant changes being found in the upper respiratory tract. Tongue swelling can be a particularly prominent finding in this disorder. There is currently no diagnostic test that specifically identifies those at risk for development of angioedema. Once angioedema has occurred with an ACE inhibitor or an ARB the offending agent should not be readministered. Angioedema can be treated with antihistamines, epinephrine, and/or steroids, although the specific efficacy of these agents has not been prospectively studied. Most episodes of angioedema are managed with antihistamine therapy alone. Common Clinical features: swelling of thelips, tongue, face. And abdominal pain (intestinal angioedema) ● Mechanism of action of metformin? A- decrease insulin resistance B- increase blood glucose consumption C- increase insulin secretion Correct answer is A Metformin reduces liver (hepatic) production of glucose, decreases the intestinal absorption of glucose, and enhances insulin sensitivity by increasing both peripheral glucose uptake and utilization ● Child with nephrotic syndrome. Management? Prednisolone mainly steroid N.B: The most widely used protocol is to initially give oral corticosteroids (60 mg/m 2 per day of prednisolone), unless there are atypical features. After 4 weeks, the dose is reduced to 40 mg/m 2 on alternate days for 4 weeks and then weaned or stopped. ● Child develop seizure A- IV lorazepam B- intra nasal diazepam C- rectal diazepam Correct answer is A N.B: if Status Epilepticus if vascular access, give IV Lorazepam If No, give Buccal Midazolam or Rectal Diazepam Reference: Illustrated Textbook of Pediatrics ● SLE Pt developed seizures at home and then come to ER what to give A- cyclophosphamide, or prednisone if on cyclo. B- hydroxychloroquine, Seizures as a rare adverse effect of chloroquine therapy in systemic lupus erythematosus patients: a case report and literature survey In neonate phenobarbital SLE encephalopathy is indicated for Cyclophosphamide but treating acute seizures by phenytoin ● Description of a patient with 3 symptoms of SLE. What the fourth symptom of the 11 according to (RHEUMATOLOGY, SLE organization) to diagnose this pt with SLE? Glory team August 1. type of rash can’t remember, 2. RF positive 3. Hemolytic anemia. 4. positive ANA Correct answer is C New ameican guidlines no ANA in the criteria plus they mention in exam according to what guidelines you will diagnose SLE ● Child with mass in his left flank, UA shows hematuria. Dx? 1. wilms tumer 2. neuroblastoma Correct answer is 1 most common manifestation of Wilms tumor is an asymptomatic abdominal mass; an abdominal mass occurs in 80% of children at presentation. Abdominal pain or hematuria occurs in 25%. Hypertension, gross hematuria, and fever are observed in 5-30% of patients Neuroblastoma is more accurately described as an abdominal mass. ● PSGN child with Hx. Of URTI two weeks ago, developed glomerulonephritis. Dx? Answer: RPGN is usually caused by one of the three following mechanisms: anti- GBM antibody disease without or with pulmonary hemorrhage “Goodpasture`s syndrome”, pauci-immune glomerulonephritis, and severe immunocomplex glomerulonephritis Reference: Saudi Journal of Kidney Diseases and Transplantation ● Rapidly progressive glomerulonephritis, Histo SHOWS: 1. crescent shape formation 2. IgA deposition Correct answer is 1 ● 4y old child came with his parents for umbilical hernia. Wt to do? A- reassurance B- repair C- Till age 5Y D- Repair it at age of 5 Correct answer is A N.B: Watchful waiting is recommended for children who have no symptoms. In 95% of cases, umbilical hernias less than 1 cm in diameter usually close on their own within 5 years of age. After age 5, repair is recommended. Reference: Amircan College of Surgeons and Medscape ● 4 months Child with mid-shaft hypospadias, came for circumcision. What u will do? A- Do it Glory team August B- not possible since they will use it for the repair C- should be delayed Correct answer is B N.B:The tubularized incised plate (TIP)repair is now commonly used for distal and midshaft hypospadias, and it need a flap ● Microscopic polyarteritis? Polyarteritis nodosa is present with Wight loss, Testicular pain, Levidu reticularis, Abdominal pain, Polyneuropathy and HBV positive ● Granulomatosis with polyangiitis (Wegener's) Wegener granulomatosis (Granulomatosis with polyangiitis) is present with Glomelronephritis , persistent rhinorrhea , mouth and nasal ulcer, saddle nose, bloody from nose-ANCA, Treated by cyclophosphamide ● Dm diagnosis criteria: Type 2 Diabetes ADA Diagnosis Criteria Diagnostic criteria by the American Diabetes Association (ADA) include the following: A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion or an optional criterion remains a point of controversy.In the presence of hyperglycemic symptoms (polyurea, polydipsia, polyphagia, weight loss, blurry vision) a confirmatory test is not required (no need to repeat). In the absence of hyperglycemic symptoms a repeat confirmatory test is required. ● Cushing case ACTH high cortisone high after suppressing what investigation? brain CT but MRI is better for sure. ● ● 2 years old Sickler had a crisis 3 weeks ago with blood transfusion came for 2nd dose hep A asking when to vaccinate INCLUDEPICTURE A- gives 2nd dose now "C:\\var\\folders\\m7\\hk4xywwx B- check hep A titer 6tj_nkdq9bzjtqsw0000gn\\T\\com. C- wait 3 months microsoft.Word\\WebArchiveCopy Correct answer is A PasteTempFiles\\page25image295 Vaccine contraindicated in pregnancy. 23600" \* MERGEFORMAT A- MMR B- Varicella C- Both are contraindicated. ● post hysterectomy type of hormonal replacement 1. estrogen alone (this is the answer if it was with an oophorectomy) Glory team August 2. combinedWomen who have both the uterus and ovaries removed usually just get estrogen replacement therapy (ERT) alone. But women who have only the ovaries removed need both estrogen and progestin. ● Pt with DM not hypertensive developed proteinuria>> Start ACE ● contraindications of ECV-12 ● Child with wheezing and cough on and off poorly responding to bronchodilators His father is a smoker and they have family HX of asthma what is the best indicator if the child has C-Fibrosis. A- poor response to meds, bronchodilators. B- Poor weight gain. C- father smoking D- family hx of asthma Correct answer is B also, could be nasal polyp, also sinitis ● Child with Down syndrome what is the most striking feature A- simian crease B- hypotonia C- Small toe Correct answer is A ● Pt with liver cirrhosis have UGIB what to give before endoscopy A- vitamin K B- octreotide C- PPI Correct answer is B Variceal bleeding: Octreotide decreases the inflow of blood to portal system by constricting the splanchnic arterioles and significantly reduces intravesical pressure. ● 15 months old babbles but he doesn't follow 2-word commands, hearing examination done when he was 6-week-old and it was normal what to do: Glory team August A- refer to ENT B- schedule audiogram C- reassure parents as it is normal variation Correct answer is C The baby can understand 2 step commands at 2 years of age ● 40 years old female LMP 2 months ago came to ER with on/off vaginal spotting she has been trying to get pregnant for 3 years what is the first step: A- confirm the pt state of pregnancy B- Ask about infertility reason C- Pelvic US Correct answer is A ● Small intestine obstruction did appendectomy 5 years back X ray air fluid level, Ct done What investigations done next: Small Intestinal obstruction is usually caused by Adhesions, Bulge (hernias) or Cancers. The 1st cause of SBO in adults is Postoperative adhesions (Hx of appendectomy) X ray is done -CT also is Done The questions is not complete so it could be The next step or the next investigation to be done: MRI effective in defining the location and etiology of obstruction.(Medscape) Tx according to the obstruction type: Complete: Laparotomy and lysis of adhesions Incomplete: Conservative Tx +NGT decompression (Surgical Recall + Medscape) ● Child with fever conjunctivitis, coryza and cough with intercostal recession and low O2 sat tachycardic Tachypneic what is the optimal initial step: - i A- Intubation B- O2 therapy Correct answer is B This is Could be a case of Bronchiolitis so the initial Tx is :O2 Oxygen by nasal prongs must be given for at least 15 hours a day (couldn’t Find Direct information ,but it is usually canula) Current Medical Diagnosis & Treatment 2019 ● Pt with cough and wheeze chest x ray normal spirometer normal What to do next: A- challenge test B- repeat spirometer Correct answer is A Challenge Test: if spirometry is normal or near-normal and asthma is still suspected; a negative test is helpful in ruling out asthma. The Color Atlas and Synopsis of Family Medicine, 3e ● Child born with complete heart block What is the cause A- Rubella B- DM C- lupus Correct answer is C Glory team August In Neonatal Lupus Heart block results from the deposition of antibodies into the cardiac conduction system, leading to local inflammation and irreversible damage to the atrioventricular node CURRENT Diagnosis & Treatment: Rheumatology, 3e ● Asherman syndrome what layer of endometrium is affected? A. Basalis B. Functionalis Correct answer is A Basal layer. the endometrium is divided into a functional layer, which lines the endometrial cavity, and a basal layer, which regenerates the functional layer Destruction of the basal endometrium prevents endometrial thickening in response to ovarian steroids. Williams Gynecology, 3e Chapter 16 ● Pt with dorsum of the left-hand numbness over the thump index and middle finger what nerve is affected A- Radial B- median C- Ulnar D- Axillary Correct answer is B ● Case of women pain in her hand or palm and wrist due to overwork in keyboard which is affected? A- Ulnar B- Radial C- Anterior interosuss D- Posterior interossus N.B: Median nerve is the answer, C is a branch of it. N.B: anterior interosseous syndrome will present with motor deficits only. No sensory changes should be appreciated. And if there’s pain it will be in the forearm and cubital fo...
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