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Flashcard

Medicine Part 1
Medicine Part 2
Gynecology & Obstetrics
Surgery
Pediatrics Part 1
Pediatrics Part 2
Ethics

Surgery

ThyroidQ: Hypocalcemia after total thyroidectomy
Q: Hypocalcemia after total thyroidectomy A: Urgent correction + Measure Mg level.

🔹 Hint: Commonly associated, can cause refractory hypocalcemia.
ThyroidQ: Papillary thyroid cancer
A: Surgery (Partial or total)
🔹 Hint: Most common thyroid cancer, good prognosis.
ThyroidQ: Follicular thyroid cancer
A: TOTAL thyroidectomy + Radiotherapy
🔹 Hint: Spreads hematogenously, requires aggressive treatment.
ThyroidQ: Medullary thyroid cancer
A: TOTAL thyroidectomy
🔹 Hint: Associated with MEN 2A/2B, arises from parafollicular C cells.
ThyroidQ: Midline neck mass mobile with swallowing
A: Thyroglossal cyst
🔹 Hint: Moves with tongue protrusion, congenital remnant.
ThyroidQ: Hoarseness after thyroidectomy
A: Recurrent laryngeal nerve injury
🔹 Hint: Affects vocal cord movement, can be temporary or permanent.
ThyroidQ: Can’t make high-pitch sound after thyroidectomy
A: Superior laryngeal nerve injury
🔹 Hint: Affects cricothyroid muscle, voice modulation issue.
ThyroidQ: Anti-thyroid drugs
A: PTU (Propylthiouracil) + MMI (Methimazole)
🔹 Hint: Used for hyperthyroidism, PTU preferred in pregnancy (1st trimester).
ThyroidQ: Hematoma after thyroidectomy
A: Bedside evacuation
🔹 Hint: Can cause airway obstruction, requires immediate action.
ThyroidQ: Thyrotoxicosis not responding to regular anti-thyroid drug dosage
A: Increase dose to maximum → If no response, give Radioactive Iodine (except pregnancy) → If no response, send for surgery (Partial thyroidectomy)
🔹 Hint: Stepwise escalation of treatment, surgery is the last resort.
ThyroidQ: Neck mass biopsy showed thyroid tissue
A: Ectopic thyroid
🔹 Hint: Thyroid tissue outside normal anatomical location, congenital origin.
ThyroidQ: Thyroid nodule
A: FNA before any intervention
🔹 Hint: First-line investigation for thyroid nodules.
ThyroidQ: Normal thyroid + Normal follicular thyroid tissue in lymph node
A: Refer to surgery (Aberrant thyroid)
🔹 Hint: Ectopic thyroid tissue in lymph node, needs surgical removal.
ThyroidQ: Large thyroid nodules
A: Hemithyroidectomy
🔹 Hint: Partial removal preferred for large nodules.
ThyroidQ: Small thyroid nodules
A: Follow-up
🔹 Hint: Observation approach for small, non-suspicious nodules.
ThyroidQ: Painful lateral neck mass
A: Thyroid investigations ????
🔹 Hint: Rule out thyroid pathology before proceeding further.
ThyroidQ: High TSH + Low T4, T3 + High ESR
A: Subacute thyroiditis
🔹 Hint: Self-limiting inflammatory thyroid disorder, usually post-viral.
ThyroidQ: Insufficient FNA sample
A: Repeat
🔹 Hint: Inconclusive results require a second attempt.
ThyroidQ: Failed anti-thyroid medications on maximum dosage
A: Surgery
🔹 Hint: Definitive treatment for uncontrolled hyperthyroidism.
ThyroidQ: Irregular pulse
A: Thyroid function tests
🔹 Hint: Atrial fibrillation can be linked to thyroid dysfunction.
ThyroidQ: Bethesda score for thyroid FNA
A: (Classification system for thyroid cytology)
🔹 Hint: Determines malignancy risk and guides further management.
ThyroidQ: Toxic nodule with suppressed rest of the gland (small)
A: Radiotherapy
🔹 Hint: Small toxic nodules can be treated non-surgically.
ThyroidQ: Toxic nodule with suppressed rest of the gland (large)
A: Hemithyroidectomy
🔹 Hint: Large toxic nodules require surgical removal.
ThyroidQ: Multi-nodular goiter with large nodules
A: Total thyroidectomy
🔹 Hint: Prevents compressive symptoms and malignancy risk.
ThyroidQ: Spinal fracture + High PTH + High calcium
A: Parathyroid adenoma
🔹 Hint: Classic signs of primary hyperparathyroidism.
ThyroidQ: Hypercalcemia after parathyroidectomy
A: Missed adenoma
🔹 Hint: Residual adenoma can cause persistent hypercalcemia.
ThyroidQ: Elective parathyroidectomy
A: Osteoporosis
🔹 Hint: Performed to prevent complications of chronic hyperparathyroidism.
Operative surgeryQ: Post-operative collection
A: Percutaneous drainage
🔹 Hint: Minimally invasive method to manage fluid accumulation.
Operative surgeryQ: Fever and pain at the site of blood transfusion
A: Febrile non-hemolytic transfusion reaction (Due to pyrogens in blood)
🔹 Hint: Most common transfusion reaction, managed with antipyretics.
Operative surgeryQ: Low systemic resistance + anuria + increased cardiac output
A: Septic shock
🔹 Hint: Life-threatening condition requiring urgent intervention.
Operative surgeryQ: DVT on heparin developed heparin-induced thrombocytopenia
A: Switch to other anticoagulant except enoxaparin
🔹 Hint: Direct thrombin inhibitors (e.g., argatroban) are preferred.
Operative surgeryQ: Progressive abdominal pain post-sleeve gastrectomy
A: Do CT-abdomen
🔹 Hint: Rule out complications like leaks or strictures
Operative surgeryQ: Bradycardia during laparoscopy
A: Rapid expansion of parietal peritoneum causing reflex vagal stimulation
🔹 Hint: Slowing of heart rate due to pneumoperitoneum effects.
Operative surgeryQ: Prevention of pulmonary edema in post-op heart failure patient
A: Careful fluid administration and IV fluids daily monitoring
🔹 Hint: Avoids fluid overload in heart-compromised patients.
Operative surgeryQ: Scar increasing in size
A: Keloid
🔹 Hint: Excessive collagen deposition, common in darker skin.
Operative surgeryQ: Hypotension immediately after starting laparoscopy
A: Rapid inflation of the abdomen leading to peritoneal stretching and vagal stimulation
🔹 Hint: Can cause vasodilation and bradycardia, managed by slowing insufflation.
Operative surgeryQ: Most common postoperative complication
A: Atelectasis
🔹 Hint: Common in bed-ridden patients, managed with deep breathing exercises.
Operative surgeryQ: Dyspnea and hypoxia on day 1 postoperative
A: Atelectasis
🔹 Hint: Early respiratory complication due to poor lung expansion.
Operative surgeryQ: Abdominal mass after lifting heavy weight without impulse on cough
A: Rectus sheath hematoma (esp. if on anticoagulant) → Rest + Analgesia + Stop anticoagulant if needed
🔹 Hint: Internal bleeding in rectus sheath, often self-limiting.
Operative surgeryQ: Common drug treatment of obesity
A: Orlistat
🔹 Hint: Lipase inhibitor, reduces fat absorption.
Operative surgeryQ: Indications for bariatric surgery
A: BMI >40 or BMI 35-40 + obesity-related disorder (e.g., DM, HTN, DLP, OA, OSA, NASH)
🔹 Hint: Surgery considered for severe obesity or complications.
Operative surgeryQ: Indications for bariatric surgery
A: BMI >40 or BMI 35-40 + obesity-related disorder (e.g., DM, HTN, DLP, OA, OSA, NASH)
🔹 Hint: Surgery considered for severe obesity or complications
Operative surgeryQ: Best bariatric surgery for morbidly obese + GERD
A: Roux-en-Y procedure
🔹 Hint: Reduces acid reflux, preferred in GERD patients.
Operative surgeryQ: Persistent vomiting after sleeve gastrectomy ± bloating
A: Reassure + Anti-emetic 🔹 Hint: Common early post-op issue, usually resolves.
Operative surgeryQ: Hematemesis after sleeve gastrectomy
A: Exploration
🔹 Hint: Could indicate a serious complication like staple line bleeding.
Operative surgeryQ: What to do before bariatric surgery?
A: Endoscopy
🔹 Hint: Rules out GI pathologies before surgery.
Operative surgeryQ: Best prophylaxis against DVT
A: Enoxaparin or mechanical compression devices
🔹 Hint: Prevents thromboembolic events post-surgery.
Operative surgeryQ: Pelvic fracture + bleeding per rectum + retroperitoneal urethral injury in urethrogram
A: Suprapubic cystostomy
🔹 Hint: Bypasses urethral injury for bladder drainage.
Operative surgeryQ: Membranous urethra injury
A: Suprapubic cystostomy
🔹 Hint: Prevents further damage and allows healing.
Operative surgeryQ: Post cholecystectomy hematemesis
A: Do Angiography ????
🔹 Hint: Suspect hepatic artery pseudoaneurysm or bile leak.
Operative surgeryQ: Surgery for Aortic Stenosis (AS)
A: Symptomatic AS
🔹 Hint: Indicated when symptoms appear or severe obstruction occurs.
Operative surgeryQ: Unilateral lower limb (LL) edema
A: Suspect DVT
🔹 Hint: Common presentation of deep vein thrombosis.
Operative surgeryQ: Stab in right lower chest + abdominal free fluid in FAST
A: Laparotomy
🔹 Hint: Possible diaphragmatic or liver injury, needs exploration.
Operative surgeryQ: Peptic ulcer not responding to medical treatment
A: Surgery vs. Vagotomy
🔹 Hint: Considered if refractory to medications or complications arise.
Operative surgeryQ: Stab abdomen + bulging omentum through wound
A: Exploratory laparotomy
🔹 Hint: Suspect bowel injury, surgical intervention needed.
Operative surgeryQ: Diaphragmatic hernia in babies
A: Surgery
🔹 Hint: Urgent correction to allow lung expansion.
Operative surgeryQ: Pre-op management for non-ACTH dependent Cushing’s before adrenalectomy
A: Start hydrocortisone preoperatively
🔹 Hint: Prevents adrenal crisis post-surgery.
Operative surgeryQ: Management of single, non-complicated Hydatid (Echinococcus) liver cyst ≤5 cm
A: Albendazole (or Mebendazole)
🔹 Hint: Medical treatment is sufficient for small cysts.
Operative surgeryQ: Management of single, non-complicated Hydatid liver cyst (6-10 cm)
A: Albendazole (or Mebendazole) or PAIR (Puncture-Aspiration Injection-Reaspiration)
🔹 Hint: Larger cysts may require PAIR.
Operative surgeryQ: Management of Daughter cysts or honeycomb multi-septated cysts
A: Albendazole + Surgery
🔹 Hint: Complex cysts need combined therapy.
Operative surgeryQ: Large Hydatid liver cyst >10 cm or complicated
A: Surgery
🔹 Hint: Risk of rupture or infection, requiring surgical intervention.
Operative surgeryQ: Large Hydatid cyst >10 cm + multiple daughter cysts
A: De-roofing surgery
🔹 Hint: Needed for extensive or multilocular cysts.
Operative surgeryQ: Amoebic liver disease
A: Metronidazole + Surgery if complicated
🔹 Hint: First-line treatment is medical; surgery only for abscess rupture.
Operative surgeryQ: Pus from an operative wound
A: IV Antibiotics
🔹 Hint: Indicates infection, requiring systemic antibiotics.
Operative surgeryQ: Oozing from an operative wound (seroma)
A: Dressing (Drainage if collection or painful)
🔹 Hint: Usually self-limiting but may need intervention if large.
Operative surgeryQ: Surgeon forgot foreign material inside the patient
A: Tell the truth
🔹 Hint: Ethical obligation to disclose errors.
Operative surgeryQ: Post-operative urine retention
A: Anesthesia effect
🔹 Hint: Common due to temporary bladder dysfunction.
Operative surgeryQ: Post-op urine retention after urological surgery
A: Give strong analgesia
🔹 Hint: Pain relief may restore normal voiding.
Operative surgeryQ: Post-op leak of large amounts of fluid
A: Exploration
🔹 Hint: Could indicate anastomotic leak or fistula.
Operative surgeryQ: Intestinal obstruction with a history of previous abdominal surgery
A: Adhesions
🔹 Hint: Most common cause of small bowel obstruction post-surgery.
Operative surgeryQ: Progressive abdominal pain in post-gastrectomy patient
A: Do CT-abdomen
🔹 Hint: Rule out complications like leakage or obstruction.
Operative surgeryQ: Child requires surgery but no family members available
A: Ask the ethical committee
🔹 Hint: Consent must be ethically and legally managed.
Operative surgeryQ: Post-operative intestinal obstruction + Absent bowel sounds
A: Paralytic ileus (Anesthetic effect vs. hypokalemia)
🔹 Hint: Common early post-op issue, managed conservatively.
Operative surgeryQ: Surgeon found a mass in the stomach during elective cholecystectomy
A: Cholecystectomy only
🔹 Hint: Avoids unnecessary interventions in a planned surgery.
Operative surgeryQ: Esophageal rupture
A: Surgical drainage vs. Thoracotomy
🔹 Hint: Early intervention crucial to prevent mediastinitis.
Operative surgeryQ: Necrotic sacral ulcer + Exposed subcutaneous fat
A: Debridement + Secondary closure with graft
🔹 Hint: Prevents infection and aids healing.
Operative surgeryQ: Most common viral cause of otitis media
A: RSV (Respiratory syncytial virus)
🔹 Hint: Common in infants and young children.
Operative surgeryQ: Post-op intra-abdominal collection <5 cm
A: Antibiotics + Observation
🔹 Hint: Small collections may resolve without intervention.
Operative surgeryQ: Post-op intra-abdominal collection >5 cm
A: Percutaneous drainage
🔹 Hint: Large abscesses need drainage to prevent sepsis.
Peripheral arterial diseaseQ: Acute limb ischemia treatment
A: Heparin (Start once suspected, even before any investigation)
🔹 Hint: Prevents clot progression, time-sensitive emergency.
Peripheral arterial diseaseQ: Pain + paresthesia + pallor in a limb + recent MI
A: Acute arterial thrombosis (not embolism)
🔹 Hint: Thrombosis forms at site of pre-existing atherosclerosis.
Peripheral arterial diseaseQ: Lateral malleolus ulcer
A: Check peripheral pulse → If absent or weak, do CT-angiography
🔹 Hint: Differentiates arterial vs. venous ulcer.
Peripheral arterial diseaseQ: Sudden limb pain + diminished sensation + altered motor function
A: Acute limb ischemia → Do CT-angiography
🔹 Hint: Rapid diagnosis is critical to prevent limb loss.
Peripheral arterial diseaseQ: Claudication
A: Chronic limb ischemia → Do CT-angiography
🔹 Hint: Evaluates arterial flow and occlusion severity.
Peripheral arterial diseaseQ: Ankle-Brachial Index (ABI) Values:
A: Normal: 1-1.4
🔹 ≤ 0.4: Acute ischemia or severe disease
🔹 > 0.4: Chronic ischemia, mild to moderate disease
🔹 Hint: Simple bedside test to assess arterial perfusion.
Peripheral arterial diseaseQ: DM with ulcer + pseudo-hyperepithelization
A: Ulcer debridement
🔹 Hint: Removes non-viable tissue to promote healing.
Peripheral arterial diseaseQ: Cool extremity + unilateral erythema increases in dependent position
A: Arterial insufficiency
🔹 Hint: Blood flow compromised, often due to PAD.
Peripheral arterial diseaseQ: Deep thigh injury
A: Compression above the level of injury
🔹 Hint: Prevents excessive bleeding and shock.
Peripheral arterial diseaseQ: Pulsating midline abdominal mass
A: Do abdominal US
If confirmed AAA, do CT-angiography
🔹 Hint: Rule out abdominal aortic aneurysm (AAA).
Peripheral arterial diseaseQ: Delayed or no wound healing after surgery
A: Poor blood supply
🔹 Hint: Common in diabetics and vascular diseases.
Peripheral arterial diseaseQ: First step in claudication
A: ABI (Ankle-Brachial Index)
🔹 Hint: Quick screening test before imaging.
Peripheral arterial diseaseQ: First symptom in compartment syndrome
A: Pain
🔹 Hint: Disproportionate pain is the earliest sign.
Peripheral arterial diseaseQ: First investigation for suspected limb ischemia
A: Doppler
🔹 Hint: Non-invasive and quick screening tool.
Peripheral arterial diseaseQ: Best investigation for suspected limb ischemia
A: CT-angiography
🔹 Hint: Provides detailed vascular imaging.
Peripheral arterial diseaseQ: Non-pitting edema
A: Lymphatic → Do venous Doppler
🔹 Hint: Differentiates venous vs. lymphatic causes.
Peripheral arterial diseaseQ: Limb pain after varicose vein surgery
A: Damage to saphenous nerve
🔹 Hint: Common complication due to proximity of nerve.
Peripheral arterial diseaseQ: Most common site for venous ulcer
A: Medial side of the leg
🔹 Hint: Due to venous stasis
Peripheral arterial diseaseQ: Most common site for arterial ulcer
A: Lateral side of the leg
🔹 Hint: Caused by poor arterial supply.
Peripheral arterial diseaseQ: Arterial ulcer vs. Venous ulcer
A: 🔹 Arterial: Lateral + No pulse
🔹 Venous: Medial + Pulse
🔹 Hint: Pulses help differentiate ulcer type.
Peripheral arterial diseaseQ: Management of lymphedema
A: Exercise, elevation, compression bandage, manual lymphatic drainage, intermittent pneumatic compression, surgery
🔹 Hint: Multifaceted approach, surgery for severe cases.
Peripheral arterial diseaseQ: Lymphedema
A: Ask about trauma
🔹 Hint: Secondary causes must be ruled out.
Peripheral arterial diseaseQ: Varicose veins treatment
🔹 Therapeutic: Endovascular laser ablation 🔹 Cosmetic: Sclerotherap y
🔹 Hint: Treatment depends on severity.
Peripheral arterial diseaseQ: Generalized edema in pregnancy
A: Always pathological → Do full workup
🔹 Hint: Could indicate preeclampsia or renal issues.
Peripheral arterial diseaseQ: Sign of arterial injury
A: Pulsatile bleeding
🔹 Hint: Suggests active high-pressure vessel injury.
Peripheral arterial diseaseQ: Hard signs in vascular surgery
A: Weak pulse, skin color change, bruit, pulsatile bleeding
🔹 Hint: Immediate surgical intervention needed.
Peripheral arterial diseaseQ: Indication for removal of hemangioma
A: Pain
🔹 Hint: Removed if symptomatic or causing complications.
Compartment syndromeQ: Normal intra-compartmental pressure
A: 0-8 mmHg
🔹 Hint: Baseline pressure within muscle compartments.
Compartment syndromeA: Compartment syndrome
🔹 Hint: Critical threshold requiring urgent intervention.
A: Compartment syndrome
🔹 Hint: Critical threshold requiring urgent intervention.
Compartment syndromeQ: First symptom of compartment syndrome
A: Severe pain (due to nerve ischemia)
🔹 Hint: Pain is out of proportion to the injury.
Compartment syndromeQ: Other symptoms of compartment syndrome
A: Numbness, color change
🔹 Hint: Progression leads to sensory and vascular compromise.
Compartment syndromeQ: Management of compartment syndrome
A: Fasciotomy + Treatment of the cause
🔹 Hint: Decompression is essential to prevent necrosis.
Compartment syndromeQ: Compartment syndrome with fracture
A: External fixation + Fasciotomy
🔹 Hint: Relieves pressure while stabilizing fracture.
Testicular diseasesQ: Infant with bilateral painless testicular edema extending to the groin
A: ?? Idiopathic testicular edema ???
🔹 Hint: Consider hydrocele or lymphatic congestion, needs further evaluation.
Testicular diseasesQ: Testicular enlargement after exercise
A: Do US
🔹 Hint: Rule out varicocele, hernia, or testicular pathology.
Testicular diseasesQ: Absent cremasteric reflex
A: Testicular torsion → Surgical emergency
🔹 Hint: Requires immediate detorsion to save the testis.
Testicular diseasesQ: Decreased testicular size after inguinal hernia repair
A: Pampiniform plexus occlusion
🔹 Hint: Complication leading to ischemia and atrophy.
Testicular diseasesQ: Unilateral undescended testis
A: Orchiopexy (Surgery to move it to the scrotum)
🔹 Hint: Done before 1 year to prevent malignancy and infertility.
Testicular diseasesQ: Most common cause of fever and abdominal pain in post-abdominal surgery patients
A: Subphrenic abscess
🔹 Hint: Common complication, diagnosed with imaging.
Testicular diseasesQ: Dysuria + Dyspareunia + Urinary dribbling
A: Urethral diverticulum
🔹 Hint: Usually in females, diagnosed via MRI or urethroscopy.
Testicular diseasesQ: Testicular mass not transilluminating + Signs of increased ICP
A: Surgical exploration
🔹 Hint: Could indicate metastasis from testicular cancer (e.g., choriocarcinoma).
Testicular diseasesQ: Testicular pain + Absent cremasteric reflex
A: Testicular torsion → Do surgical exploration
🔹 Hint: Time-sensitive, must be corrected within 6 hours.
Testicular diseasesQ: Unilateral testicular pain + Normal testis + Edematous spermatic cord
A: Appendicular torsion (not testicular)
🔹 Hint: Torsion of the testicular appendix, managed conservatively.
AppendicitisQ: Best investigation for suspected appendicitis in a thin patient
A: US abdomen
🔹 Hint: First-line imaging for pediatric and thin patients
AppendicitisQ: Best investigation for suspected appendicitis in an obese patient
A: CT abdomen
🔹 Hint: More accurate in obese patients where US is limited.
AppendicitisQ: First imaging modality for suspected appendicitis
A: US abdomen
🔹 Hint: Non-invasive, avoids radiation, especially in young patients.
AppendicitisQ: Best diagnostic modality for appendicitis
A: CT abdomen
🔹 Hint: Gold standard for definitive diagnosis.
AppendicitisQ: Pathophysiology of acute appendicitis
A: Peripheral vasoconstriction ???
🔹 Hint: Likely secondary to luminal obstruction and ischemia.
AppendicitisQ: Appendicular carcinoid management if <2 cm
A: Appendectomy
🔹 Hint: Small carcinoid tumors are low-risk.
AppendicitisQ: Appendicular carcinoid management if >2 cm
A: Right hemicolectomy
🔹 Hint: Larger tumors have metastatic potential.
AppendicitisQ: Investigation for appendicular carcinoid
A: CT abdomen and chest for staging
🔹 Hint: Determines metastasis and treatment approach.
AppendicitisQ: Most common surgical emergency in children
A: Appendicitis
🔹 Hint: Presents with RLQ pain, fever, and vomiting.
AppendicitisQ: Treated appendicular mass – When to do colonoscopy?
A: After 6 weeks ???
🔹 Hint: Ensures no underlying malignancy.
AppendicitisQ: Treated appendicular mass – Next step?
A: Laparoscopic appendectomy after 12 weeks
🔹 Hint: Delayed surgery to allow inflammation resolution.
AppendicitisQ: How to find the appendix during surgery if not visible?
A: Follow tenia coli
🔹 Hint: Converge at the base of the appendix.
AppendicitisQ: Radio-opaque material in right iliac fossa at right iliac crest in abdominal X-ray
A: Appendicitis
🔹 Hint: Possible fecolith, confirm with imaging.
AppendicitisQ: Appendicitis with abscess or fecolith
A: Laparoscopic appendectomy + Drainage
🔹 Hint: Abscess requires additional drainage.
AppendicitisQ: Feculent discharge after appendectomy
A: Exploratory laparotomy
🔹 Hint: Suggests bowel injury or fistula.
UrologyQ: High PSA + Hypercalcemia + High ALP + Osteolytic lesions
A: Think of prostatic cancer with bone metastasis → Refer to urologist
🔹 Hint: Prostate cancer commonly metastasizes to bone.
UrologyQ: Bilateral hydronephrosis
A: Think of prostatic enlargement (e.g., BPH)
🔹 Hint: Prostate obstruction can cause backflow and kidney damage.
UrologyQ: Most common site of urethral injury
🔹 Surgical trauma: Bulbar urethra
🔹 Pelvic fracture: Membranous urethra
🔹 Hint: Helps determine mechanism of injury.
UrologyQ: Management of ruptured urethra
A: Suprapubic cystostomy
🔹 Hint: Allows urinary diversion without worsening injury.
UrologyQ: Diagnosis of urethral injury or stricture
A: Retrograde urethrogram
🔹 Hint: Preferred imaging for evaluating urethral integrity.
UrologyQ: Cystoscopy showing redness in bladder dome
A: Transitional cell carcinoma
🔹 Hint: Common bladder cancer, linked to smoking.
UrologyQ: Prostate median lobe enlargement
A: Annual PSA
🔹 Hint: Screening helps detect malignancy early.
UrologyQ: Difficulty initiating urination
A: Overflow incontinence
🔹 Hint: Common in BPH due to chronic retention.
Hemorrhoids and fissuresQ: Treatment of internal hemorrhoids
A: Sclerotherapy
🔹 Hint: Non-surgical method for small hemorrhoids.
Hemorrhoids and fissuresQ: How to examine a severely painful anal fissure?
A: EUA (Examination under anesthesia)
🔹 Hint: Avoids unnecessary pain during examination.
Hemorrhoids and fissuresQ: Hematochezia in the elderly
A: Colorectal cancer must be ruled out
🔹 Hint: Always suspect malignancy until proven otherwise.
Hemorrhoids and fissuresQ: Perianal itching
A: Look for hemorrhoids or fissure
🔹 Hint: Common causes include irritation and inflammation.
Hemorrhoids and fissuresQ: Perianal itching
A: Look for hemorrhoids or fissure
🔹 Hint: Common causes include irritation and inflammation.
Hemorrhoids and fissuresQ: Painless blood after defecation
A: Hemorrhoids
🔹 Hint: Classic presentation of internal hemorrhoids.
Hemorrhoids and fissuresQ: Hemorrhoids treatment
🔹 Internal: Sclerotherapy (Early-stage) 🔹 Severe cases: Rubber band ligation or hemorrhoidectomy
🔹 Hint: Treatment depends on severity.
Hemorrhoids and fissuresQ: Perianal painful swelling + Leukocytosis
A: Perianal abscess
🔹 Hint: Infection requiring drainage.
Hemorrhoids and fissuresQ: Perianal painful swelling + No leukocytosis
A: Perianal hematoma
🔹 Hint: Due to ruptured vein, usually resolves spontaneously.
Hemorrhoids and fissuresQ: Anal fissure not responding to conservative therapy
A: LIS (Lateral internal sphincterotomy)
🔹 Hint: Relieves spasm and promotes healing.
Hemorrhoids and fissuresQ: Perianal fistula
A: Fistulotomy
🔹 Hint: Surgical opening to allow drainage and healing.
Hemorrhoids and fissuresQ: Anal pain + Pus during rectal examination
A: Internal abscess
🔹 Hint: Requires drainage to prevent further spread.
Hemorrhoids and fissuresQ: Complication of perianal abscess
A: Fistula formation
🔹 Hint: Chronic infection leads to abnormal connections.
Hemorrhoids and fissuresQ: Approach for anorectal cancer
🔹 <6 cm from anal verge: Abdomino-perineal resection 🔹 >6 cm from anal verge: Lower anterior resection
🔹 Hint: Surgical approach depends on tumor location.
Wounds and traumaQ: First step in a comatose patient
A: Intubation
🔹 Hint: Airway protection is the top priority.
Wounds and traumaQ: Fractured mandible requiring resuscitation
A: Cricothyroidotomy
🔹 Hint: Used when standard airway management is difficult.
Wounds and traumaQ: First step in a facial burn
A: Elective intubation
🔹 Hint: High risk of airway edema; secure airway early.
Wounds and traumaQ: Absolute contraindication to nasal intubation
A: Facial bone fracture
🔹 Hint: Risk of cribriform plate injury and brain penetration
Wounds and traumaQ: First step in a multi-trauma patient
A: Secure the airway
🔹 Hint: A, B, C approach—airway comes first.
Wounds and traumaQ: Facial bone fractures
A: Secure the airway
🔹 Hint: Airway obstruction is a major concern.
Wounds and traumaQ: RTA with temporal bone fracture + sudden collapse or LOC
A: Epidural hematoma
🔹 Hint: Classic “lucid interval” followed by deterioration.
Wounds and traumaQ: Parkland formula for burn fluid resuscitation
🔹 4 mL × body weight (kg) × % TBSA burn
🔹 First 8 hours: 50%
🔹 Next 16 hours: 50%
🔹 Hint: Used to estimate fluid needs in burn patients.
Wounds and traumaQ: First step in examination of wounds
A: Inspection
🔹 Hint: Look before touching to assess severity.
Wounds and traumaQ: Infected wound
A: Wound exploration
🔹 Hint: Identifies retained foreign bodies or deep infection.
Wounds and traumaQ: Superficial wound management
A: Cleaning + Dressing + Antibiotics
🔹 Hint: Prevents infection and promotes healing.
Wounds and traumaQ: Good prognosis indicator in burns
A: Adequate urine output (UOP)
🔹 Hint: Reflects proper fluid resuscitation.
Wounds and traumaQ: Suspected deep collection
A: Do CT scan
🔹 Hint: Identifies abscesses or deep infections.
Wounds and traumaQ: Wound + Signs of peritonitis
A: Laparotomy
🔹 Hint: Suggests perforation requiring surgical intervention.
Wounds and traumaQ: First aid for lacerations or bleeding wounds
A: Compression
🔹 Hint: Immediate measure to control bleeding.
Wounds and traumaQ: Elderly with sacral ulcer
A: Daily dressing
🔹 Hint: Prevents infection and promotes healing.
Wounds and traumaQ: Cause of bleeding after massive blood transfusion
A: Thrombocytopenia (Post-transfusion purpura)
🔹 Hint: Due to platelet dilution or immune reaction.
Wounds and traumaQ: Stab chest + Stable patient
A: Immediate surgical exploration + FAST
🔹 Hint: Rule out internal injuries before intervention.
Wounds and traumaQ: Most common finding in FAST (Focused assessment with sonography for trauma)
A: Peritoneal free fluid
🔹 Hint: Suggests internal bleeding.
Wounds and traumaQ: Stab wound in the thigh
A: Compression
🔹 Hint: First step to control bleeding.
Wounds and traumaQ: Stab abdomen affecting the gut
A: CT abdomen
🔹 Hint: Identifies organ injury and guides management.
Wounds and traumaQ: Neck injury – First step if stable
A: Wound exploration
🔹 Hint: Checks for deeper involvement.
Wounds and traumaQ: Neck injury – First step if unstable
A: Surgical exploration
🔹 Hint: Prevents airway or vascular compromise.
Wounds and traumaQ: Investigation for neck injury
A: CT-angiography neck
🔹 Hint: Identifies vascular injury.
Wounds and traumaQ: Neck zones classification
🔹 Zone 1: Below cricoid cartilage (Major vessels, lungs, trachea) 🔹 Zone 2: Between cricoid and mandible (Most injuries here) 🔹 Zone 3: Above mandible (Pharynx, skull base)
🔹 Hint: Guides surgical approach to neck trauma.
Wounds and traumaQ: Wound with lost subcutaneous fat + exposed vasculature
A: Debridement with secondary closure
🔹 Hint: Prevents infection and promotes healing.
Wounds and traumaQ: Few days post-op with tender red wound + pus
A: Open drainage
🔹 Hint: Sign of surgical site infection or abscess.
Wounds and traumaQ: Blunt abdominal trauma few days ago + severe pain
A: CT abdomen
🔹 Hint: Rule out organ injury or internal bleeding.
Wounds and traumaQ: Blunt abdominal trauma with pain and discharge
A: Antibiotics
🔹 Hint: Possible secondary infection or perforation.
Wounds and traumaQ: Post-colostomy with spiking fever + Normal abdominal/chest exam
A: CT abdomen
🔹 Hint: Check for abscess or intra-abdominal infection.
Wounds and traumaQ: Skin loss
A: Grafting
🔹 Hint: Restores tissue coverage and function.
Wounds and traumaQ: Lower chest stab with free abdominal fluid
A: Exploratory laparotomy
🔹 Hint: Likely diaphragmatic or abdominal organ injury.
Wounds and traumaQ: Loss of sensation in medial side of leg but intact motor
A: Saphenous nerve injury
🔹 Hint: Pure sensory nerve from femoral nerve.
Wounds and traumaQ: Loss of sensation in mid-thigh but intact motor
A: Obturator nerve injury
🔹 Hint: Common in pelvic surgeries or fractures.
Wounds and traumaQ: Coma + Dilated pupils
A: Epidural hematoma
🔹 Hint: Rapid deterioration due to middle meningeal artery rupture.
Wounds and traumaQ: Wrist hyperextension injury – Distal phalanx pain + Palm tenderness
A: Rupture of flexor digitorum profundus tendon
🔹 Hint: Loss of DIP flexion
Wounds and traumaQ: Wrist hyperextension injury – Proximal phalanx pain + Palm tenderness
A: Rupture of flexor digitorum superficialis tendon
🔹 Hint: Loss of PIP flexion.
Wounds and traumaQ: Most common site of aortic injury in blunt chest trauma
A: Proximal to left brachiocephalic artery (Left subclavian artery)
🔹 Hint: Deceleration injuries cause tearing here.
Wounds and traumaQ: First investigation in blunt abdominal trauma
A: US (FAST scan)
🔹 Hint: Quick, non-invasive detection of internal bleeding.
Wounds and traumaQ: Battle sign
A: Skull base fracture
🔹 Hint: Bruising behind the ear due to basilar skull fracture.
Wounds and traumaQ: Cause of hypotension in RTA patient with quadriplegia
A: High spinal injury
🔹 Hint: Loss of sympathetic tone (neurogenic shock).
Wounds and traumaQ: Bleeding per ear after head trauma
A: Middle cranial fossa fracture
🔹 Hint: Commonly associated with CSF otorrhea.
Wounds and traumaQ: Bleeding per nose after head trauma
A: Anterior cranial fossa fracture
🔹 Hint: May be associated with CSF rhinorrhea.
Wounds and traumaQ: Bleeding per mouth after head trauma
A: Posterior cranial fossa fracture
🔹 Hint: Associated with brainstem injuries.
Wounds and traumaQ: Skull base fracture affecting jugular foramen
A: Loss of taste in posterior 1/3 of tongue + Dysphagia (Glossopharyngeal nerve injury)
🔹 Hint: Glossopharyngeal nerve runs through jugular foramen.
InterventionsQ: Post-operative patient with history of IHD developed chest pain and palpitations
A: Do ECG
🔹 Hint: Rule out myocardial infarction or arrhythmia.
InterventionsQ: Newly diagnosed stomach cancer – Next step?
A: CT chest, abdomen, pelvis (To assess metastasis)
🔹 Hint: Determines staging and treatment approach.
InterventionsQ: Suspected thromboembolism
A: D-Dimer
🔹 Hint: High sensitivity, but low specificity for ruling out thrombosis.
InterventionsQ: Supraclavicular lymphadenopathy – How to investigate the primary source?
A: Gastroduodenoscopy
🔹 Hint: Virchow's node often indicates gastric malignancy.
InterventionsQ: Suspected post-operative adhesions with obstruction
🔹 First investigation: Plain X-ray abdomen 🔹 Confirmation: CT abdomen
🔹 Hint: X-ray detects dilated loops; CT confirms obstruction.
InterventionsQ: Suspected colon cancer
A: Colonoscopy
🔹 Hint: Gold standard for diagnosis and biopsy.
InterventionsQ: Melena with normal upper & lower GI endoscopy
A: Capsule endoscopy
🔹 Hint: Detects small bowel bleeding sources.
InterventionsQ: Falling trauma patient c/o foot pain
A: X-ray + Check for pulsations + Analgesia
🔹 Hint: Rule out fractures and vascular injury.
InterventionsQ: Stab abdomen penetrating the abdominal wall
A: CT abdomen
🔹 Hint: Identifies intra-abdominal injuries.
InterventionsQ: Best initial imaging modality to view cervical spine
🔹 First: Lateral cervical X-ray 🔹 Confirm by: CT scan
🔹 Hint: X-ray for screening, CT for detailed assessment.
InterventionsQ: Obese child with history of falling presented with hip pain
A: SCFE (Slipped Capital Femoral Epiphysis)
🔹 Hint: Common in overweight adolescents, requires urgent management.
InterventionsQ: Special role of CT in abdominal trauma
A: Retroperitoneal injury
🔹 Hint: Detects injuries to kidneys, pancreas, and vessels.
InterventionsQ: Penetrating stab wound
A: CT scan
🔹 Hint: Assesses depth and organ involvement.
InterventionsQ: Liver mass 3 cm on ultrasound
A: Triphasic CT
🔹 Hint: Differentiates HCC from benign lesions.
InterventionsQ: Sigmoid volvulus management (Stable patient)
A: Sigmoidoscopy and detorsion
🔹 Hint: Minimally invasive method to relieve obstruction.
InterventionsQ: Hepatocellular carcinoma (HCC) > 5 cm
A: TACE (Transcatheter arterial chemoembolization)
🔹 Hint: Used for non-resectable tumors to slow progression.
InterventionsQ: Which drug is contraindicated in intestinal obstruction?
A: Nitrous oxide (Causes bowel distension)
🔹 Hint: Worsens obstruction by expanding gas pockets.
InterventionsQ: Hypospadias management
A: Refer to pediatric surgeon
🔹 Hint: Early correction prevents complications in adulthood.
SpleenQ: Patient with thoracic aortic injury + splenic laceration
A: Emergency thoracotomy
🔹 Hint: Aortic injury is life-threatening and prioritized.
SpleenQ: Patient with thoracic aortic injury + splenic laceration
A: Emergency thoracotomy
🔹 Hint: Aortic injury is life-threatening and prioritized.
SpleenQ: Post-splenectomy patient with left-side pain + reduced air entry on the left side
A: Subphrenic abscess
🔹 Hint: Common post-splenectomy complication.
SpleenQ: Splenic vein thrombosis
A: Splenectomy
🔹 Hint: Persistent thrombosis may require spleen removal.
SpleenQ: Grades of splenic injury
🔹 Grade I + II: Conservative treatment
🔹 Grade III: Partial splenectomy
🔹 Grade IV + V: Total splenectomy
🔹 Hint: Management depends on injury severity.
SpleenQ: What is expected to be low after splenectomy?
A: Insulin
🔹 Hint: Part of the pancreas is often removed with the spleen.
SpleenQ: Tender splenomegaly
A: Typhoid → Do multiple blood cultures or BM biopsy (better but invasive)
🔹 Hint: Typhoid fever causes splenomegaly and bacteremia.
SpleenQ: Vaccination after splenectomy
🔹 Pneumococcal
🔹 HIB (Haemophilus Influenzae B)
🔹 Meningococcal
🔹 Given before 2 weeks and up to 2 weeks after splenectomy
🔹 Hint: Prevents post-splenectomy infections.
HerniaQ: Pus discharge after mesh repair of hernia
A: Pus drainage + Mesh removal + Antibiotics
🔹 Hint: Mesh infection requires removal for complete resolution.
HerniaQ: Pus discharge after mesh repair of hernia
A: Pus drainage + Mesh removal + Antibiotics
🔹 Hint: Mesh infection requires removal for complete resolution.
HerniaQ: Femoral hernia repair
A: Laparoscopic, except in elderly
🔹 Hint: Elderly patients often require open repair due to frailty.
HerniaQ: Mechanism of large indirect inguinal hernia (IIH)
A: Congenital defect in the abdominal wall
🔹 Hint: Failure of processus vaginalis closure.
HerniaQ: Sudden abdominal pain after lifting heavy object + Tense muscles + Not reducible + No impulse on cough
A: Rectus sheath hematoma → Rest + Analgesia
🔹 Hint: Self-limiting, usually due to rupture of inferior epigastric artery.
HerniaQ: Classic management of hernia
A: Laparoscopic repair with mesh
🔹 Hint: Reduces recurrence and strengthens the defect.
HerniaQ: Type of mesh relay in ventral hernia
A: Sublay
🔹 Hint: Positioned behind the rectus muscle to reduce complications.
HerniaQ: Post-hernia repair with tenderness at site + Numbness around thigh & leg
A: Remove mesh staples
🔹 Hint: Nerve irritation from staples causing pain.
HerniaQ: Post-hernia repair with numbness around thigh & leg but NO tenderness
A: NSAIDs
🔹 Hint: Neuropathic pain from nerve compression.
HerniaQ: Small asymptomatic hernia
A: Observe
🔹 Hint: Surgery only if symptomatic or enlarging.
HerniaQ: Tender red swollen hemiscrotum + Irreducible swelling up to inguinal canal + Unable to palpate testis
A: Incarcerated inguinal hernia
🔹 Hint: Needs urgent surgical intervention.
HerniaQ: Persistent pain after hernia repair
: NSAIDs → If failed, do nerve block
🔹 Hint: Neuropathic pain post-surgery, nerve entrapment possible.
HerniaQ: What passes through deep inguinal ring?
A: Round ligament
🔹 Hint: In females, carries vessels and nerves.
HerniaQ: Hernia inferior and lateral to the pubic tubercle
A: Femoral hernia
🔹 Hint: Higher risk of strangulation compared to inguinal hernias.
HerniaQ: Painless swelling after hernia repair without redness or inflammation
A: Seroma
🔹 Hint: Common fluid collection, usually self-resolving.
HerniaQ: Bilateral inguinal hernia
A: Laparoscopic mesh repair
🔹 Hint: Minimally invasive, reduces recovery time.
HerniaQ: Ipsilateral testis decreased in size after hernia repair
A: Pampiniform plexus compression
🔹 Hint: Can lead to testicular atrophy.
HerniaQ: Treatment of hiatus hernia
A: Lifestyle changes
🔹 Hint: Weight loss, avoiding large meals, elevating head at bedtime.
HerniaQ: Post-inguinal hernia repair with painless mass & transpulsation
A: Pseudoaneurysm
🔹 Hint: Arterial injury during surgery causing localized swelling.
HerniaQ: Suspected complicated hernia – First step?
A: Immediate US
🔹 Hint: Identifies strangulation or obstruction.
HerniaQ: First step in neonatal diaphragmatic hernia
A: Large pore orogastric tube insertion → THEN intubation
🔹 Hint: Avoids air entry into the stomach, which worsens condition.
HerniaQ: Cut-off sign + Target sign in plain abdominal X-ray
A: Small bowel cancer
🔹 Hint: Indicates obstructing neoplasm.
HerniaQ: Differences between incarcerated, obstructed, and strangulated hernia
🔹 Incarcerated: Irreducible only 🔹 Obstructed: Mechanical obstruction (Bowel blockage but blood supply intact) 🔹 Strangulated: Occluded blood supply (Risk of ischemia and necrosis)
🔹 Hint: Strangulation is the most serious and requires emergency surgery.
TumoursQ: Sclerotic bony lesion
A: Osteosarcoma
🔹 Hint: Common in young patients, often at metaphysis of long bones.
TumoursQ: Liver lesion filling from periphery on CT angiography
A: Hemangioma
🔹 Hint: Benign vascular tumor, characteristic "peripheral nodular enhancement."
TumoursQ: Newly diagnosed pituitary adenoma – Next step?
A: Pituitary hormone levels
🔹 Hint: Determines functional vs. non-functional adenoma.
TumoursQ: Thigh mass + Normal overlying skin + Positive fluctuation
A: Sebaceous cyst
🔹 Hint: Benign cyst filled with keratin/sebum.
TumoursQ: Retroperitoneal mass with hepatic lesion
A: Liposarcoma
🔹 Hint: Common deep soft tissue malignancy.
TumoursQ: Esophageal cancer types
🔹 SCC: Upper and mid-esophagus 🔹 Adenocarcinoma: Lower esophagus
🔹 Hint: SCC linked to smoking/alcohol, adenocarcinoma to GERD/Barrett’s.
TumoursQ: Most common small bowel cancer
A: Adenocarcinoma
🔹 Hint: Often found in the duodenum, linked to Crohn’s disease.
TumoursQ: Peptic ulcer + Positive Secretin Stimulation Test
A: Gastrinoma
🔹 Hint: Zollinger-Ellison Syndrome (Excessive acid secretion).
TumoursQ: Tumor at bifurcation of CBD + High CA-19.9
A: Klatskin tumor (Hilar cholangiocarcinoma)
🔹 Hint: Biliary obstruction symptoms, poor prognosis.
TumoursQ: Abnormal bowel habits + MCHC anemia in elderly
A: Colon cancer
🔹 Hint: Iron deficiency anemia in older adults raises suspicion.
TumoursQ: Adrenal tumor treatment
🔹 < 4 cm: Observation 🔹 > 4 cm: Adrenalectomy
🔹 Hint: Larger tumors have higher malignancy risk.
TumoursQ: HTN + Hypoechoic adrenal mass
A: Biopsy
🔹 Hint: Rule out pheochromocytoma before biopsy to avoid crisis.
TumoursQ: Sarcoma diagnosis
A: Incisional biopsy (Better) or core needle biopsy
🔹 Hint: Needed to confirm soft tissue malignancy.
TumoursQ: Complication of retroperitoneal sarcoma
A: Compression of abdominal organs
🔹 Hint: Mass effect leads to symptoms.
TumoursQ: Investigation for thigh sarcoma
A: CT scan
🔹 Hint: Evaluates tumor size and invasion.
TumoursQ: Cauliflower mass 2 cm from anal verge
A: Condyloma acuminata
🔹 Hint: Caused by HPV, common genital wart.
TumoursQ: Friable cauliflower mass 2 cm from anal verge + Weight loss
A: Anal cancer
🔹 Hint: Requires biopsy confirmation.
TumoursQ: Gastric cancer in the body of the stomach without metastasis
A: Wide local excision with clear margins
🔹 Hint: Early-stage disease, surgical treatment preferred.
TumoursQ: Most common site of metastasis of colon cancer
A: Liver
🔹 Hint: Portal venous drainage spreads cancer to the liver.
TumoursQ: Confirmation of Meigs syndrome
A: Biopsy
🔹 Hint: Ovarian tumor + Ascites + Pleural effusion.
TumoursQ: Gastric cancer with liver metastasis
A: Chemotherapy
🔹 Hint: Palliative treatment to slow progression.
TumoursQ: Gastric cancer with tense ascites
A: Ascitic fluid tapping
🔹 Hint: Relieves symptoms, diagnostic for malignancy
Chest traumaQ: Pneumothorax 2 cm
A: Observation
🔹 Hint: If stable and asymptomatic, monitor closely.
Chest traumaQ: Pneumothorax + Rapidly worsening SOB + Raised JVP + Tracheal shift + Hypotension or shock
A: Tension pneumothorax
🔹 Hint: Life-threatening emergency requiring immediate decompression.
Chest traumaQ: Tension pneumothorax management
A: Immediate needle decompression → Then ICT (Intercostal tube) insertion
🔹 Hint: Relieves pressure and restores lung expansion.
Chest traumaQ: Pneumothorax without tracheal or mediastinal shift
A: Simple pneumothorax
🔹 Hint: No hemodynamic compromise, managed based on size
Chest traumaQ: Sternal fracture + Enlarged cardiac shadow + Tachycardia + Hypotension
A: Hemopericardium
🔹 Hint: Suggests cardiac tamponade, requires urgent intervention.
Chest traumaQ: Site of thoracocentesis
A: Between 9th - 10th space mid-axillary line
🔹 Hint: Avoids lung injury while draining pleural fluid.
Chest traumaQ: Management of hemothorax and pyothorax (empyema)
A: Intercostal chest tube (ICT)
🔹 Hint: Drains blood or pus from pleural space.
Chest traumaQ: SOB after blunt chest trauma + Normal X-ray
A: Lung contusion
🔹 Hint: Microvascular injury causing alveolar hemorrhage.
Chest traumaQ: Sudden collapse in a patient with chest tube
A: Check chest tube position and function
🔹 Hint: Malfunction can lead to tension pneumothorax.
Chest traumaQ: Pneumothorax classification by size
🔹 Small: Less than 2 cm
🔹 Large: 2 cm or more
🔹 Hint: Size determines management.
Chest traumaQ: Pneumothorax treatment
🔹 Small + Asymptomatic: Observation
🔹 Small + Symptomatic: Needle thoracotomy or chest tube
🔹 Large: Chest tube
🔹 Hint: Severity guides intervention.
Chest traumaQ: How much does a 2 cm pneumothorax occupy?
A: 49% of the hemithorax
🔹 Hint: Important for assessing severity.
Chest traumaQ: Pleural effusion draining >1500 ml/24 hours
A: Chest tube
🔹 Hint: Indicates high-volume fluid accumulation needing drainage.
Chest traumaQ: RTA with multiple rib fractures requiring transfer to another hospital
A: Intubate
🔹 Hint: Ensures airway protection during transport.
Chest traumaQ: Flail chest management
A: Adequate analgesia + Assisted ventilation
🔹 Hint: Prevents respiratory failure from paradoxical movement.
Chest traumaQ: First step in a comatose patient with thigh stab wound (1 cm) + Active bleeding
A: Intubation (Before compression, IV fluids, or transfusion)
🔹 Hint: Airway is always the priority in trauma.
OrthopedicsQ: Shoulder dislocation with difficulty in adduction and internal rotation
A: Posterior dislocation
🔹 Hint: Common in seizures and electrocution injuries.
OrthopedicsQ: Severe neck pain radiating to jaw and shoulder ± Upper limb numbness
A: Cervical disc prolapse
🔹 Hint: Commonly affects C5-C6, C6-C7 levels.
OrthopedicsQ: Compression fracture
A: Osteoporosis (Not osteopenia, regardless of DEXA scan result)
🔹 Hint: Common in elderly, postmenopausal women.
OrthopedicsQ: DEXA Scan Interpretation
🔹 Normal: T-score ≥ -1
🔹 Osteopenia: T-score -1 to -2.5
🔹 Osteoporosis: T-score ≤ -2.5
🔹 Hint: Measures bone mineral density.
OrthopedicsQ: Paper-like cells in bone marrow
A: Gaucher disease
🔹 Hint: Lysosomal storage disorder, glucocerebrosidase deficiency.
OrthopedicsQ: How to examine for scoliosis?
A: Look at the wall, bend the back, let arms fall free
🔹 Hint: Adam’s forward bend test.
OrthopedicsQ: Sudden back pain in a patient with cancer
A: Give steroids (For possible cord compression) + Do MRI
🔹 Hint: Prevents neurologic deterioration from spinal metastasis.
OrthopedicsQ: Back pain increases when walking downstairs
A: Spinal canal stenosis
🔹 Hint: Relieved by flexion (leaning forward).
OrthopedicsQ: Treatment of spinal canal stenosis
A: Acetaminophen + Physiotherapy (+ Surgery if worsening or no response)
🔹 Hint: Non-surgical first, surgery for severe cases.
OrthopedicsQ: Vitamin D deficiency in children
A: Rickets
🔹 Hint: Bone softening, bowing of legs, delayed growth.
OrthopedicsQ: Flat foot ligament involvement
A: Spring ligament (Calcaneonavicular ligament)
🔹 Hint: Provides arch support.
OrthopedicsQ: Tibia is anterior to femur
A: Anterior cruciate ligament (ACL) injury
🔹 Hint: Positive Lachman or Anterior drawer test.
OrthopedicsQ: Medial knee pain + Tenderness
A: Tendonitis
🔹 Hint: Often involves pes anserinus (Pes anserine bursitis).
OrthopedicsQ: First investigation in knee pain
A: X-ray
🔹 Hint: Rule out fractures, OA, or structural changes.
OrthopedicsQ: Knee pain increases with walking, improves with rest
A: Osteoarthritis (OA)
🔹 Hint: Wear-and-tear arthritis, common in elderly.
OrthopedicsQ: Joint pain increases with movement, relieved by rest
A: Osteoarthritis (OA)
🔹 Hint: Degenerative joint disease.
OrthopedicsQ: Joint pain increases with rest, relieved by movement
A: Rheumatoid arthritis (RA)
🔹 Hint: Inflammatory arthritis, affects small joints.
OrthopedicsQ: Morning stiffness
A: Rheumatoid arthritis (RA)
🔹 Hint: Stiffness >1 hour, improves with activity.
OrthopedicsQ: First step in treating fractures
A: Analgesia
🔹 Hint: Pain control before immobilization.
OrthopedicsQ: Cervical osteoarthritis not responding to NSAIDs
A: Use soft neck collar
🔹 Hint: Provides temporary support and relieves symptoms
OrthopedicsQ: Tenderness along tibial tuberosity in a growing child
A: Osgood-Schlatter lesion
🔹 Hint: Overuse injury, common in active adolescents
OrthopedicsQ: Polyarthralgia involving small joints of the hand + No morning stiffness + No active arthritis
A: OA of fingers → Use finger splint
🔹 Hint: Helps reduce pain and improve function
OrthopedicsQ: Osteophytes + Joint space narrowing
A: Osteoarthritis (OA)
🔹 Hint: Classic radiographic signs of OA.
OrthopedicsQ: Steps of treating neck osteoarthritis (OA)
🔹 Physiotherapy → NSAIDs → Soft cervical collar → Ice → Injectable Steroids
🔹 Hint: Stepwise approach, conservative first.
OrthopedicsQ: Elderly with height loss
A: Do bone scan
🔹 Hint: Rule out osteoporosis and vertebral fractures.
OrthopedicsQ: Elderly with chronic joint pain not responding to paracetamol
A: Add Tramadol ???
🔹 Hint: Weak opioid for moderate pain.
OrthopedicsQ: Patient with history of cervical laminectomy for degenerative cervical disc disease causing myelopathy + Gait instability & incontinence
A: Recurrence
🔹 Hint: Progressive compression or surgical failure.
OrthopedicsQ: Urine incontinence after cervical discectomy
A: Nerve injury
🔹 Hint: Possible spinal cord or autonomic nerve damage.
OrthopedicsQ: FDA-approved monoclonal antibody for osteoporosis (e.g., PTHrH-excreting cancers, bone metastasis)
A: Denosumab
🔹 Hint: RANKL inhibitor, prevents bone resorption.
OrthopedicsQ: Hand OA not controlled on NSAIDs
A: Add Methotrexate
🔹 Hint: New evidence suggests it may slow joint damage.
OrthopedicsQ: Elderly with lumbar fracture
A: Alendronate
🔹 Hint: Bisphosphonate for osteoporosis treatment.
OrthopedicsQ: Open fractures management
A: Irrigation + Debridement + External fixator
🔹 Hint: Prevents infection and stabilizes fracture.
OrthopedicsQ: Most common site of posterior shoulder dislocation
A: Subacromial
🔹 Hint: Typically caused by seizures or electrical shock.
OrthopedicsQ: Supracondylar fracture humerus management
🔹 Normal brachial pulse: Reduction
🔹 Absent brachial pulse: Surgical exploration
🔹 Hint: Assess vascular status first.
OrthopedicsQ: SOB after femoral fracture
A: Fat embolism
🔹 Hint: Classic triad: respiratory distress, petechiae, neurological symptoms.
OrthopedicsQ: Colles’ fracture in pediatrics
A: Closed reduction + Cast
🔹 Hint: Minimally displaced fractures usually heal well in children.
OrthopedicsQ: Greenstick fracture management
A: Closed reduction + Cast
🔹 Hint: Common in children due to flexible bones.
OrthopedicsQ: Elderly patient can’t stand from a chair – What is he at risk for?
A: High risk of fall
🔹 Hint: Fall risk increases with muscle weakness and balance issues.
OrthopedicsQ: Comminuted fracture of lower tibia
A: Open reduction + Internal fixation + Elevation
🔹 Hint: ORIF stabilizes complex fractures.
OrthopedicsQ: Femoral shaft fracture with 30-degree angulation in a child
A: Closed reduction + Hip spica
🔹 Hint: Non-surgical management preferred in growing bones.
OrthopedicsQ: Femoral shaft fracture with 30-degree angulation in a child
A: Open reduction + Intramedullary nail
🔹 Hint: Surgical fixation needed for proper alignment.
OrthopedicsQ: Most important step before reducing any fracture
A: Check blood vessels
🔹 Hint: Prevents ischemia from unnoticed vascular injury.
OrthopedicsQ: Trauma to lateral knee + Positive valgus test
A: MCL (Medial Collateral Ligament) sprain
🔹 Hint: Valgus stress test assesses MCL integrity.
OrthopedicsQ: Knee trauma + Femur moves forward relative to tibia
A: ACL (Anterior Cruciate Ligament) injury
🔹 Hint: Tibia normally stabilizes under femur.
OrthopedicsQ: Knee trauma with (+) anterior drawer & Lachman’s tests
A: ACL injury
🔹 Hint: Both tests check anterior tibial displacement
Skin lesionsQ: Unhealed diabetic ulcer for years + Pseudoepitheliomatous hyperplasia
A: Debridement
🔹 Hint: Removes non-viable tissue and promotes healing.
Skin lesionsQ: Skin lesion present since childhood
A: Observation
🔹 Hint: Monitor unless symptomatic or suspicious.
Skin lesionsQ: Infected necrotic open wound after a few days
A: Clostridium perfringens (Gas gangrene)
🔹 Hint: Produces gas, causes crepitus and rapid tissue destruction.
Skin lesionsQ: Exposed neurovascular bundle after trauma
A: Debridement + Skin graft
🔹 Hint: Protects vital structures and promotes healing.
Skin lesionsQ: Suspected melanoma
A: Excisional biopsy
🔹 Hint: Complete removal for diagnosis and staging.
Skin lesionsQ: Suspected sarcoma
A: Incisional biopsy
🔹 Hint: Takes a tissue sample for histopathological diagnosis.
Skin lesionsQ: Skin rash as in the picture
A: Molluscum contagiosum
🔹 Hint: Dome-shaped, umbilicated papules, caused by poxvirus.
Skin lesionsQ: BI-RADS (Breast Imaging Reporting and Data System) categories
🔹 0: Incomplete, needs additional imaging
🔹 1: Normal
🔹 2: Benign
🔹 3: Probably benign (Follow-up needed)
🔹 4: Suspicious (Biopsy recommended)
🔹 5: Highly suggestive of malignancy
🔹 6: Proven malignancy
🔹 Hint: Guides breast cancer diagnosis and management.
Skin lesionsQ: Atypical ductal hyperplasia management
A: WLE (Wide Local Excision)
🔹 Hint: Pre-malignant lesion requiring surgical removal.
Skin lesionsQ: Invasive ductal papilloma management
A: Wide local excision
🔹 Hint: Prevents progression and recurrence.
Skin lesionsQ: Color of discharge in ductal papilloma
A: Red
🔹 Hint: Indicates blood-stained nipple discharge.
Skin lesionsQ: Color of discharge in duct ectasia
A: Green
🔹 Hint: Thick, sticky discharge due to dilated ducts.
Skin lesionsQ: Genetic mutation in familial breast cancer
A: BRCA gene
🔹 Hint: BRCA1 & BRCA2 increase breast & ovarian cancer risk.
Skin lesionsQ: Investigation of malignant phyllodes tumor
A: CT chest with contrast
🔹 Hint: Evaluates for lung metastasis.
Skin lesionsQ: Loss of sensation in the medial side of the arm after mastectomy
A: Intercostobrachial nerve injury
🔹 Hint: Common complication affecting sensation.
Skin lesionsQ: Breast abscess management
A: Incision and drainage
🔹 Hint: Ensures proper drainage and healing.
Skin lesionsQ: Most common organism in acute mastitis
A: Staphylococcus aureus
🔹 Hint: Commonly from breastfeeding-related infections.
Skin lesionsQ: Treatment of acute mastitis
A: Antibiotics + Continue breastfeeding
🔹 Hint: Helps clear infection and prevents engorgement.
Skin lesionsQ: Painful oval breast mass
A: Breast cyst
🔹 Hint: Fluid-filled sac, can be aspirated if symptomatic.
Skin lesionsQ: Painless, mobile oval breast mass
A: Fibroadenoma (Breast mouse)
🔹 Hint: Benign, common in young women.
Skin lesionsQ: Well-defined breast mass for years, now increasing in size
A: Phyllodes tumor
🔹 Hint: Can be benign or malignant, requires excision.
Skin lesionsQ: Solid breast mass with multiple cystic spaces + Posterior acoustic enhancement
A: Phyllodes tumor
🔹 Hint: Fast-growing, requires histological confirmation.
Skin lesionsQ: Treatment of phyllodes tumor
🔹 Benign/Suspicious/Cystophyllodes: Wide Local Excision (WLE)
🔹 Malignant: Simple mastectomy
🔹 Hint: Local control is key to prevent recurrence.
Skin lesionsQ: Characteristics of fibroadenoma
🔹 Mobile
🔹 Painless
🔹 Changes size with menstrual cycle (Estrogen-dependent)
🔹 Hint: Common benign breast tumor in young women.
Skin lesionsQ: Breast mass with bloody discharge
A: Mammogram
🔹 Hint: Evaluate for malignancy or ductal pathology.
Skin lesionsQ: Normal mammogram + No family history – When to repeat?
A: After 2 years
🔹 Hint: Routine screening interval for low-risk individuals.
Skin lesionsQ: Breast mass in pregnancy – Best imaging?
A: Ultrasound (US), NOT mammogram
🔹 Hint: Mammogram contraindicated due to radiation exposure.
Skin lesionsQ: Small breast mass – First step?
A: Fine Needle Aspiration (FNA)
🔹 Hint: Minimally invasive and provides cytological diagnosis.
Skin lesionsQ: Suspected breast cancer – Investigation sequence
🔹 1st: US (if <40 years or pregnant), Mammogram (if >40 years)
🔹 2nd: Biopsy
🔹 3rd: Staging
🔹 Hint: Imaging, histopathology, and metastasis evaluation.
Skin lesionsQ: Female patient requests a female doctor
A: Respect her wish
🔹 Hint: Patient autonomy and cultural sensitivity.
Skin lesionsQ: Breast pain before menstruation
A: Reassure
🔹 Hint: Cyclical mastalgia, common due to hormonal changes.
Skin lesionsQ: Strongest risk factor for breast cancer
A: Age
🔹 Hint: Incidence increases with age, especially after menopause.
PancreasQ: Epigastric pain radiating to the back + Elevated Amylase & Lipase
A: Acute pancreatitis
🔹 Hint: Classic presentation, often due to gallstones or alcohol.
PancreasQ: Investigation of suspected pancreatitis
A: CT abdomen
🔹 Hint: Confirms diagnosis, detects complications.
PancreasQ: High amylase in a patient with GBS (Gallbladder stones)
A: Do US (To rule out CBD stone)
🔹 Hint: CBD stones can cause biliary pancreatitis.
PancreasQ: First step in the treatment of cholangitis
A: IV fluids
🔹 Hint: Stabilization before definitive treatment (ERCP).
PancreasQ: Abdominal pain related to meals + History of treated pancreatitis 1 month ago + US showed cyst in pancreas
A: Pancreatic pseudocyst
🔹 Hint: Late complication of pancreatitis.
PancreasQ: Treatment of pancreatic pseudocyst
🔹 <6 cm & <6 weeks: Most resolve spontaneously
🔹 >6 cm & >6 weeks: Endoscopic drainage
🔹 Infected pseudocyst: Percutaneous drainage (Not endoscopic)
🔹 Hint: Size and duration determine management.
PancreasQ: Abdominal pain related to meals + History of treated pancreatitis 1 month ago + US showed cyst in pancreas + Leukocytosis
A: WOPN (Walled-off pancreatic necrosis)
🔹 Hint: Differentiated from a simple pseudocyst by infection.
PancreasQ: Changes in chronic pancreatitis
🔹 Hyperglycemia: ↓ Insulin + ↑ Gluconeogenesis
🔹 Increased lipolysis: Fat malabsorption
🔹 Hypocalcemia: Calcium precipitation in the abdomen
🔹 Hint: Endocrine and exocrine pancreatic dysfunction.
PancreasQ: Painless cholestatic jaundice
A: Cancer head of pancreas
🔹 Hint: Classic sign, needs urgent imaging (CT, MRCP).
PancreasQ: Acute pancreatitis treatment
🔹 IV fluids + Antibiotics + Analgesics + Urgent surgical consultation
🔹 Hint: Supportive care, early surgery if necessary.
PancreasQ: GIT complication of cystic fibrosis
A: Acute pancreatitis
🔹 Hint: Due to thickened pancreatic secretions blocking ducts.
PancreasQ: Alcoholic presented with severe epigastric pain radiating to the back
A: Alcoholic pancreatitis
🔹 Hint: Chronic alcohol use damages pancreatic cells.
PancreasQ: Prognostic criteria in acute pancreatitis
🔹 Ranson's Criteria: Predicts severity based on lab values and clinical signs.
🔹 Hint: Guides intensive care needs.
PancreasQ: Acute biliary pancreatitis due to CBD stone – Treatment steps
🔹 1st: IV fluids + Analgesia
🔹 2nd: ERCP and stone removal
🔹 3rd:
Mild to moderate: Laparoscopic cholecystectomy in the same admission
Severe: Laparoscopic cholecystectomy after 4-6 weeks
🔹 Hint: ERCP relieves obstruction; cholecystectomy prevents recurrence.
Neurovascular injuriesQ: Carpal pain after carpal tunnel surgery – Best management?
A: Protect incision, avoid lifting/gripping, hand therapy
🔹 Hint: Pain should resolve in weeks; therapy speeds recovery.
Neurovascular injuriesQ: Pillar pain after carpal tunnel surgery
A: Physiotherapy
🔹 Hint: Common complication, therapy improves mobility and pain.
Neurovascular injuriesQ: Most common site of radial nerve injury
A: Spiral groove of humerus
🔹 Hint: "Saturday night palsy," common in fractures.
Neurovascular injuriesQ: Loss of sensation in anatomical snuffbox & dorsum of medial hand + Wrist drop
A: Radial nerve injury at spiral groove
🔹 Hint: Affects wrist extensors, causing wrist drop.
Neurovascular injuriesQ: Pain while typing + Hypoperfusion of superficial palmar arch
A: Ulnar artery affected
🔹 Hint: Consider ulnar artery thrombosis or Guyon’s canal syndrome.
Neurovascular injuriesQ: Thenar muscle atrophy
A: Median nerve injury
🔹 Hint: Affects thumb opposition (Ape hand deformity).
Neurovascular injuriesQ: Hypothenar muscle atrophy
A: Ulnar nerve injury
🔹 Hint: Causes "claw hand" deformity.
Neurovascular injuriesQ: Positive arm elevation test
A: Carpal tunnel syndrome
🔹 Hint: Compression of median nerve at the wrist.
Neurovascular injuriesQ: Loss of sensation over ear lobule and upper neck
A: Great auricular nerve injury
🔹 Hint: Common in neck surgery or trauma.
Neurovascular injuriesQ: Numbness in index finger and thumb
A: Radial nerve injury
🔹 Hint: Sensory loss over dorsum of hand and forearm.
Neurovascular injuriesQ: Pain while standing + Tenderness in midline plantar surface
A: Plantar fasciitis
🔹 Hint: Heel pain, worsens with first steps in the morning.
Neurovascular injuriesQ: Numbness in little finger + Positive Roos test
A: Thoracic outlet syndrome (Brachial plexus injury)
🔹 Hint: Compression at scalene muscles, worsens with arm elevation.
Biliary systemQ: First investigation for suspected CBD stone
A: Ultrasound (US)
🔹 Hint: Non-invasive, detects ductal dilation and stones.
Biliary systemQ: Most common cause of biliary colic
A: Gallbladder stones (GBS)
🔹 Hint: Caused by transient cystic duct obstruction.
Biliary systemQ: Day 2 post-cholecystectomy + Sudden hypotension + Chest pain + SOB
A: CT Pulmonary Angiography
🔹 Hint: Rule out pulmonary embolism (PE).
Biliary systemQ: Most common cause of cholesterol gallstones
A: Rapid weight loss
🔹 Hint: Increases bile supersaturation with cholesterol.
Biliary systemQ: Lowest risk factor for cholesterol gallstones
A: Nulliparity
🔹 Hint: Estrogen increases risk, pregnancy contributes to gallstone formation.
Biliary systemQ: Colicky abdominal pain + Dilated CBD and intrahepatic ducts
A: Constriction of the sphincter of Oddi
🔹 Hint: Causes biliary obstruction, often post-surgery or due to opioids.
Biliary systemQ: Gallbladder stones (GBS) + Normal gallbladder wall → No cholecystitis
A: Give Ursodeoxycholic Acid
🔹 Hint: Used for cholesterol gallstone dissolution in non-surgical candidates.
Biliary systemQ: Jaundice + Dark urine + Palpable gallbladder
A: CBD stone
🔹 Hint: Courvoisier’s sign suggests malignant or obstructive biliary disease.
Biliary systemQ: Biliary pancreatitis without obstruction
A: Laparoscopic cholecystectomy
🔹 Hint: Prevents recurrent pancreatitis.
Biliary systemQ: Accidental resection of the bile duct during surgery
A: Hepatojejunostomy
🔹 Hint: Restores bile flow after iatrogenic bile duct injury.
Biliary systemQ: RUQ pain + Fluid around the gallbladder
A: US-guided aspiration
🔹 Hint: Suspect gallbladder perforation or abscess.
Biliary systemQ: RUQ pain worsens with morphine
A: Biliary colic → Give Meperidine
🔹 Hint: Morphine exacerbates sphincter of Oddi spasm.
Biliary systemQ: Multiple gallbladder stones (GBS)
A: Laparoscopic cholecystectomy 🔹 Hint: Standard treatment to prevent complications.
Biliary systemQ: Post-PTC (Percutaneous Transhepatic Cholangiography) + Fever + Anterior boggy mass on PR
A: Percutaneous drainage
🔹 Hint: Suggests hepatic abscess or infection.
Biliary systemQ: RUQ pain + Jaundice + Fever + CBD stone
A: Ascending cholangitis
🔹 Hint: Charcot’s triad – requires urgent ERCP.
Biliary systemQ: Type of gallstones in Sickle Cell Disease (SCD)
A: Pigment stones (Due to hemolysis)
🔹 Hint: Excess bilirubin from RBC breakdown.
Biliary systemQ: Type of gallstones in Sickle Cell Trait (SCT)
A: Mixed stones
🔹 Hint: Combination of cholesterol and pigment stones.
Biliary systemQ: Post-op spiking fever
A: Deep collection → Do CT scan
🔹 Hint: Suspect abscess or bile leak.
Biliary systemQ: ICU patient with MI + Pneumonia on Tazocin + Develops cholestasis
A: US-guided cholecystostomy drainage
🔹 Hint: Avoid surgery, drainage helps relieve sepsis.
Biliary systemQ: CBD stone management
A: ERCP
🔹 Hint: First-line treatment to remove stones.
Biliary systemQ: Acute cholecystitis management
A: Laparoscopic cholecystectomy ASAP (Preferably within 72 hours)
🔹 Hint: Reduces complications like perforation.
Biliary systemQ: Most common site injured during cholecystectomy
A: Duodenum
🔹 Hint: Close proximity increases risk of accidental injury.
Biliary systemQ: RUQ pain + Thick gallbladder wall + Pericystic fluid + Stones
A: Laparoscopic cholecystectomy
🔹 Hint: Acute cholecystitis, needs early intervention.
Biliary systemQ: Post-cholecystectomy + Jaundice + High amylase + Dilated CBD
A: Missed stone
🔹 Hint: Requires ERCP for stone removal.
Biliary systemQ: Post-cholecystectomy + Discharge from the wound
A: Exploration
🔹 Hint: Rule out bile leak or surgical site infection.
Biliary systemQ: Gallbladder polyp management
🔹 >50 years old or with gallstones: Cholecystectomy
🔹 <50 years old: Follow up with US every 6 months
🔹 Hint: Malignancy risk increases with age and stone presence.
GastroenterologyQ: Massive colonic dilatation + No haustrations
A: Pan-colectomy with ileostomy
🔹 Hint: Toxic megacolon, a complication of IBD.
GastroenterologyQ: Highly vascular HCC
A: Chemoembolization
🔹 Hint: TACE (Transarterial Chemoembolization) reduces tumor blood supply.
GastroenterologyQ: HBV with multiple hepatic deposits
A: Do colonoscopy
🔹 Hint: Rule out metastatic colorectal cancer (CRC).
GastroenterologyQ: Y-shaped colon on imaging + Sigmoid volvulus
A: Sigmoidoscopy
🔹 Hint: Non-surgical decompression if stable.
GastroenterologyQ: Ulcerative colitis (UC) common indicator of colon cancer
A: Association with Primary Sclerosing Cholangitis (PSC)
🔹 Hint: PSC increases CRC risk in UC patients.
GastroenterologyQ: Sclerosing cholangitis – What to do next?
A: Colonoscopy
🔹 Hint: High association with ulcerative colitis.
GastroenterologyQ: Unstable patient with sigmoid volvulus
A: Sigmoidectomy
🔹 Hint: Avoid non-surgical decompression in unstable cases.
GastroenterologyQ: Most common site of volvulus
🔹 Children: Cecum
🔹 Adults: Sigmoid
🔹 Hint: Sigmoid volvulus more common in elderly, bedridden patients.
GastroenterologyQ: Nutrition for stroke patient with absent gag reflex
A: Jejunostomy
🔹 Hint: Avoids aspiration risk from NG tube.
GastroenterologyQ: Nutrition for comatose ICU patient
A: NG tube (Nasogastric tube)
🔹 Hint: Enteral feeding preferred if gut function intact.
GastroenterologyQ: Continuous bleeding after low anterior resection of CRC
A: Infraceliac clamp
🔹 Hint: Controls major abdominal bleeding.
GastroenterologyQ: Bleeding from aorta in ER not responding to compression
A: Immediate CT angiography
🔹 Hint: Identifies vascular injury, guides intervention.
GastroenterologyQ: RTA with seat belt sign on the abdomen – Most likely organ perforated?
A: Duodenum
🔹 Hint: High-risk injury in blunt abdominal trauma.
GastroenterologyQ: Cardiac patient with abdominal pain
A: Suspect mesenteric ischemia
🔹 Hint: Acute embolic or thrombotic occlusion of mesenteric arteries.
GastroenterologyQ: Multiple ulcers in antrum + H. pylori positive
A: Eradication, if failed → Antrectomy (Partial distal gastrectomy)
🔹 Hint: Persistent peptic ulcers need surgical treatment.
GastroenterologyQ: Treatment of GIST (Gastrointestinal Stromal Tumor)
🔹 Localized: Wide local excision (WLE)
🔹 With metastasis: Tyrosine kinase inhibitors (Imatinib)
🔹 Hint: GISTs are CD117 (c-KIT) positive tumors.
GastroenterologyQ: Constipation + LLQ mass + No weight loss or dangerous signs
A: Constipation
🔹 Hint: Benign, likely fecal impaction rather than malignancy.
GastroenterologyQ: Q: Colonic mass that bleeds easily on touchConstipation + LLQ mass + No weight loss or dangerous signs
A: Angiodysplasia
🔹 Hint: Vascular malformation, common in elderly.
GastroenterologyQ: Treatment of angiodysplasia
🔹 APC (Argon Plasma Coagulation)
🔹 BEC (Bipolar Electrocoagulation)
🔹 Hint: Endoscopic techniques to control bleeding.
GastroenterologyQ: Most common cause of small bowel obstruction
A: Adhesions
🔹 Hint: Post-surgical or inflammatory causes.
GastroenterologyQ: Most common cause of large bowel obstruction
A: Tumor
🔹 Hint: Colorectal cancer is the leading cause.
GastroenterologyQ: Gold standard investigation for intussusception
A: Barium enema
🔹 Hint: Diagnostic and therapeutic in children.
GastroenterologyQ: Risk of recurrence after surgical correction of intussusception
A: High
🔹 Hint: Requires long-term monitoring for recurrence.
GastroenterologyQ: Bleeding per rectum + Numerous colonic polyps
A: Familial polyposis
🔹 Hint: Autosomal dominant, high CRC risk.

The Saudi Medical License Exam (SMLE) is a standardized test required for doctors to obtain a medical license to practice in Saudi Arabia. It is conducted by the Saudi Commission for Health Specialties (SCFHS).

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  • Dr. Jahed.
  • Jahed3121@gmail.com
  • +880 1618450373
  • Mon-Fri 9am-6pm
  • Habiganj Sadar, Habiganj 3300

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