Surgery Alaa Notes

For SMLE 2019

]٢٠:٣٧ ٢٢.١٢.١٩[ ،. ‫ اسالة ديسمبر متكرر منها كثير‬، ‫نوتات قوية ومهمة للمراجعة قبل االختبار‬
‫لعلها تفيد احد‬.. ‫ اعتذر على التاخير بحاول انزل نوتات هنا على الجراحة‬.

1Thyroid

🍓After total thyroidectomy(( hypocalcemia ))what to do?! measure magnesium

🍓Patient admitted for thyroid surgery because of progress compression symptoms Hemithyrodectomy done and biopsy showed
8mm papillary carcinoma next? = follow up (( papillary carcinoma = after hemothyrodoctomy no need to radiantion )
. ‫ هنا مايحتاج اعمل استئصال كامل للغدة بس متابعة الحالة‬papillary ‫يحتاج اتاكد الن بيقولوا اذا كان نتيجة العينة الورم كان‬
‫ يحتاج اشيل الغدة كاملة‬follical ‫بينما لو كان‬

🍓After right hemithyroi dectomy On biopsy found follicular lesion 8cm from the=
Complete thyroidectomy!@

🌹Pt for thyroidectomy and with mitral valve prolapse?=

No need

midline neck mass that ascends and descends withThyroglossal cys swallowing,=

🌹pt after thyroidectomy , develop hypocalcemia despite calcium replacement more than one time , next :
check serum magnesium level

Pt came after thyroid surgery with dysphagia and ))horseness(( of voice. Which nerve injured?
A. Recurrent.

🍓A patient post thyroidectomy can not make high pitch sounds. Damage to which nerve is responsible?Superior laryngeal nerve
‫هذا السوال عليه اختالااف يقولوا ريكارنت نيرف وبعضهم قالوا هذا الجواب‬

🌹Patient with hyperthyroidism for 10 m and treated with anti hyperthyrdism But his condition did not improve ultrasound done
and show multi nodule and diagnosed as Graves’ disease what is the best next step ? A.total thyroidectomy B.subtotal
thyroidectomy C. iodin therapy ✅ D.increase the dose of drug
‫ مانفع نعمل استئًال جزئى للغدة‬radio ioden ‫ مانفع نروح لالشعة‬+ ‫ امشوا بالترتيب اول حاجة ادوية تنزل مستويات الغدة‬hyperthyodism ‫خطوات عالج‬

Treatment Graves’ disease

First start with propylthiouracil (PTU) or methimazole (MMI)
ƒ PTU also inhibits peripheral deiodination of T4 to T3
• symptomatic treatment with `-blockers
• thyroid ablation with radioactive 131I if PTU or MMI trial does not produce disease remission
• subtotal or total thyroidectomy (indicated rarely for large goitres, suspicious nodule for CA, if patient is intolerant to
thionamides and refusing RAI ablation)

🌹Neck mass biopsied showing (thyroid folicullar cells)? Ectopic thyroid ✅ ‫ = فول‬follical ‫اطلب ساندويتش فول من برة‬

🌹thyroid nodule hard ultrasound report Next step?

A.FNA ✅. B.lobectomy
🌹 Pt with symptoms of hyperthyroidism and he is on medical treatment for 10 months with no improvement what next!@
C-Radioactive iodine✅✅ ‫لو الحالة وحدة حامل ال نختاره الن ممنوع على الحوامل‬

🌹Thyroid enlargement (hot nodule) FNA normal What is next step= start antithyroid therapy

🍓Thyroid nodule, cold, investigation? A. FNA

Patient with thyroid nodule asymptomatic And thyroid function test all within normal
US done What’s next:
A. FNA.(bez function thyroid normal)✅✅ B. Start antithyroid medication. C. thyroid scan

FNA is recommended for all palpable solitary or dominant nodules, independent of size. FNA is preferred over thyroid scan or
ultrasonography as the initial diagnostic test for thyroid nodules. ... When TSH is suppressed or the patient is thyrotoxic, a nuclear
scan maybe indicated before FNA

🌹 Pt with thyroid nodule and hyperthyroidism lab , radioactive iodine shows the nodule hot, but all the remaining thyroid is cold.
Initial Management: antihyperthyroid drugs in Hashimoto’s increases risk of: A. thyroid lymphoma

🌹A patient post total thyroidectomy developed neck swelling 5 hours after the surgery. most appropriate =. bedside evacuation

🌹Medullary thyroid cancer mange? Total thyroidectomy

🌹 normal follicular thyroid cells, how to manage: hemithyroidectomy

🍓female , with lateral mass (lymph node) , thyroid was normal , biopsy showed normal
follicular cell, what is the diagnosis? follicular metastasis

Normal thyroid, cervical lymph node bx showed normal follicular thyroid cell dx? apparent

on specimen it’s shows follicular thyroid cells = apparent thyroid gland.✅

🌹 Pt with normal thyroid and swelling in the neck this swelling is cervical LN and FNA showed normal follicular thyroid tissue :
_Remove this LN. _Refer to surgery ✅ ✔️. _Radio. _Chemo

🌹 Thyroid nodule measuring 4 cm hemithyroidectomy

🌹Thyroid nodule measuring less tnsn 1 cm =follow up

🍓All things is normal but have pain in his nick they chick his left neck and found small mass 5*7 mm what is the most important
thing to do :
A. FNA. B. complete his thyroid investigation✅
......

🍓medullary thyroid carcinoma management? total thyroidectomy

🍓hematoma after thyroidectomy. Next? A. OR. B. bedside evacuation✅

🌹Patient post thyroidectomy, during the ward he has expanding neck swelling with difficulty of breathing what to do?
A. Immediate bed side opening of wound

🌹High TSH , low T4 ,T3 , high ESR diagnosis? Subacute thyroiditis 🌹

🌹Complication after thyroid surgery > nerve injury (Hoarseness of voice = recurrent LN)

🌹Insufficient thyroid FNA, what would you do next?= repeat FNA✅

🌹Strongest indication of thyroid surgery

A. -pediatric B. -presence of eye symptoms. C. -presence of anti tsh . D. -failed antithyroid meds.✅✅
🌹pt with hyperthyroidism feature and irregular irregular pulse first test?
Thyroid function tests

🍒25 years female with thyroid nodule TSH and T4 normal , FNA cytology done and
according to Bethesda classification ((Stage IV )))what is the most accurate management == LOBECTOMY
lobe= 4 = iv

besthesda Stage VI = Near total thyroidectomy

🍒 Stage lV =LOBECTOMY
‫ حرف‬L ‫ الي هو اول حرف مع أول‬I ‫ بعدين يجي‬V
🍒 Stage III=repeat FNA and observation
‫ كلمة‬repeat ‫ حرف‬I ‫متكرر ثالث مرات‬
🍒 Stage VI= Near total thyroidectomy= ‫ نشيل الغدة كلها‬، ‫ المرحلة االخيرة‬.

🍒 unilateral neck swelling in the RT side by investigations : hot thyroid nodule TSH is high, T3, T4 low No LN enlargement
Treatment?
A- antithyroid drug✅. B- RT thyroidectomy. C- Hemithyroidectomy. D- radioactive iodine

🍒 Patient came for 3 months neck pain, thyroid function test all normal, ultrasound:
single solid thyroid mass in right lobe. Best next management ?
A.Thyroid scan. B.FNA✅.

🍒 Euthyroid thyroid nodule, what you will do? Fine Needle Aspiration ✅ ✔️
‫ ربط‬: Euthyroid ‫ بما انه طبيعي نحتاج الى ابرة رفيييعة جدا‬، ‫ يعني وظائف الغدة طبيعية‬Fine needle.. .. . .. . .

🍒 pt with enlarged lymph node and normal thyroid FNA of LN showed norm'l follicul'r thyroid tissue : Abx. B- Remove the LN
C- Refer to surgery ✅

🍒 toxic nodule and rest of the gland is suppressed = If small go for radio If large or cuusing compression, go for
hemithyroidectomy

🌹Patient with congested throat symptoms and 2 cm palpable cervical lymph nodes. What is the most appropriate investigation=
FNA of the lymph nodes✅

🌹Pt with diffuse thyroid enlargement on exam there is 1 nodule in each lobe, labs showed hyperthyroidism what will you do? A.
Thyroid scan. B. FNA from both nodule

🌹 48 yo lady with diffuse goiter, high T4 low TSH, US show bilateral thyroid nodules , right 3x4 in size , left is 1x2 size what to
do? A. FNA both B. FNA the larger one C. total thyroidectomy✅

🌹Patient with spiral fracture, parathyroid hormone high, ca high.. Most likely diagnosis? Parathyroid adenoma ✅

🌹parathyroidectomy pt have increase in ca ? Missed adenoma

🌹 Indication of elective parathyroid gland removal?= Evidence of osteoporosis.

After near total thyroidectomy the patient have persistent calcium decreased despite giving him calcium multiple times. What to
give him ? Mg

Post ope complication:

🌹 Pt Postoperative blood transfusion develope fever and pain at site of infusion

febrile non hemolytica reaction
....
🌹 Pt post op triple A repair become unstable even with fluid replacement and have negligible urine in cath decreased vascular
resistance and increased cardiac out put.Type of shock ? septic✅
...
🌹 female had a hip fracture now had DVT as I remember now she is on heparin but her platelet is low 58 so what will you do?
A. Shift to SC enoxaparin
B. Stop heparin and start other anticoagulant✅
‫الن سار له‬
heparin induce thrombocytopenai
....
🌹 Patient morbid obesity for treatment what will u do before?
A. endoscope ✅
....
🌹Pt with progressive abdominal pain post sleeve, what to do: CT .
....
🌹 pt. with heart failure and admitted for surgery for some disease and connected
to IV fluid, post-op 2 days later complained of SOB and bilateral basal.crepitation, how could this be prevented:
A. IV Furosemide immediate post-op B. monitoring IV fluids daily✅
‫فراقبوا كمية السوائل‬،‫مرض مثل فشل القلب والكلى انتبهوا يشربوا او ياخذوا سوائل كثير الن فشل االعضاء هذه صعب جدا تطلع الماء برة الجسم فيتراكم بالجسمم‬
...
🍓Scar post surgery increasing in size?Keloid
.....
🍓during laparoscopy doctor just start the procedure pt become hypotensive 84/50 what’s the cause:
A. cold gas B. increase preload
C. rapid inflation of the abdomen✅
Peritoneal stretching > vagal stimulation
.....
🌹 Most common complication post operative?-
- wounds infection.
- pneumoni'.
-Atelectasis ✅
.....
- 24 hrs postop patient has dyspnea and hypoxia cause? lower lobe atelectasis ✅
.....
🌹patient with abdominal mass after lifting heavy objects mass not change with cough. Dx?
a) rectus sheath hematoma✅
b) hernia
.....
🌹Pt 56 c/ o sudden RLQ pain after lifting heavy object ; and mass in RLQ ; Cough
negative ; abd muscle tense even with clenching . He is on anticoagulation due toA fib What the most appropriate mgx ? (Rectus
sheath hematoma treatment = rest and analgesic and stop anticoagulants
. . . . . .. . .
🌹Morbid obese pt with GERD wich procedure is good for him ? Roux y
....
🌹13yo obese boy found to have large hiatal hernia and grade 3 reflux asking
about bariatric surgery choice: A. Roux-en-Y Gastric Bypass
....
🌹Obese male tried lifestyle not effective He is diabetic hypertensive what to do , Weight 125 ,Hight 173 , What next ? ( You
should calculate BMI )
A. Medication lower weight
B. bariatric surgery ✅
...
🌹Women obese HTN diabetes controlled BMI 28 Tried excersise and lifestyle
modification but didn’t work What to do?
A. Bariatric surgery
B. Orlistat (druge for obsity)✅

🌹Case of pt with constipation for 1 week then developed watery diarrhea, he has tender abdomen and small distention =
A. Constipation ✅B. Acute colitis
.....
🌹29 Years old male did sleeve gastrectomy 6 days ago, came to the ER complaining of persistent vomiting since operation, on
exam nothing significant,ABG normal( there were numbers),Us normal. Best management? reassure
‫ ف هنا االعراض طبيعي ف نطمن المريض بينما لو حصل له الم شديد‬.‫الن طبيعي ا مع عمليات تكميم المعدة يحص ل هذه االعراض وهو استمرار القيء وتعب وهذيان‬
‫ جدا في بطنه او استفرغ دم هذا ماينفع نطمنه الزم يروح للمستشفى‬.
-- ----- ----- -----
🌹Diabetic and HTN .., BMI > 40 (you calculate .. height and weight were given) .. he tried to reduce weigh but still obese .. he is
not on medications .., NEXT:
Sleeve surgery ✅✅
‫ ويشكتي من اعراض السمنة ومضاعفاتها مثل سكر وضغط‬٣5 ‫ او اذا شخص كتلة جسمه فوق‬، ٤٠ ‫شوفوا متى نعمل عملية السمنة ؟؟ اذا شخص كتلة جسمه فوق‬
‫ نختار‬٣5 ‫ بينما لو اقل من‬، ‫ وكليسترول‬A
-- ----- ----- -----
🌹Patient done gastric sleeve after 3 days come irritable and have some blotting what to do? D-reassurance ✅
.....
🍒-Patient morbid obesity for treatment what will u do before?
a. endoscope ✅
...
🌹70 year old pt fall on the ground surgeon will do hip replacement surgery before surgery procedure what is the best prophylaxis
thrombolytic drug for him ? LMWH , enoxaparin .
.....
🌹After surgery by 4 days patient developed MI .. what to give ? angioplasty
....
🌹Pt with pelvic fx and bleeding per rectum >> urethrogram > retroperitoneal urethra injury Mx?
A-Folly's cath
B-Supra pupic cystostomy✔️ C-Labroscopic repair
.....
🌹Membranes urethra injury, management?
A. Fully Catheter
B. Retropubic catheter ✅
C. Retropubic repair
🌻 Membranous urethra injury is posterior injury ….

Old patient had percutaneous cholecystostomy, presented after 24hrs with

upper GI bleeding what is the most important investigation?
A. angiography. ✔️✔️
....
Female with thyroid mass asymptomatic us shows hard nodule what are the next steps?
A. Thyroid scan with iron
B. Fna ✅

Operative:

🍒Indication of surgery for Aortic stenosis?

A. pt symptoms✔️
B EF less than 50
.....
🌹after surgery what is best dvt prophylaxis? enoxaparin and mechanical
...
🌹 lady was admitted and discharged just a day before she experienced severe right leg pain and edema. (Basically she was
discharged and the next day she got this presentation) diagnosis:
A. DVT✅
B. Acute thrombotic disease
C. Acute embolic disease
.....
🌹 Patient has resection rectal surgery .. next days has left leg pain what do you give ? Enoxaparin
......
🌹 Patient was stabbed in the right lower side of his chest, FAST revealed free abdominal fluid = A-Thoracotomy B-
Laparotomy ✅✅.
...
🌹 pt complain of malena and epigastric pain diagnosed as peptic ulcer and received ppi but not improved endoscpy done showed
multiple ulcers in the antrum what is the most accurate management : a.antrectomy✅
‫ فالعالج القرحة هذه ه‬antrum ‫ في‬ulcer ‫ فالسؤوال هنا يقول انه حصل‬antrum ‫ ؟ المعدة تقسم الى ثالث اجزاء اخر جزء من المعدة اسمه‬antrum ‫تعرفون ايش هو ال‬
.antrectomy. ‫ عالجها‬antrum ‫باستئصال الحزء الي حصل فيه قرحة ومن اسمها‬
.....
Patient known case of peptic ulcer disease in medications but failed to respond, upper endoscopy done and revealed multiple
ulcers in antrum. What is the best treatment?
A. Pyloroplasty and vagotomy✅✅✅ B. Total gastrectomy C. partial gastrectomy
. ‫ وهللا ااعلم‬A . ‫ اختاروا‬antrectomy ‫لو مافي‬
Vagotomy was a way to reduce the acidity of the stomach, by denervating the parietal cells that produce acid. This was done with
the hope that it would treat or prevent peptic ulcers. It also had the effect of reducing or eliminating symptoms of
gastroesophageal reflux in those who suffered from it.🍬
...
🌹 anterior abdominal stab wound , the omentum is bulging out through wound ? Exploratory laparotomy✅
..... .. . .. .. . . . .
🍒Pt diabetes pregnant and baby has diaphragmatic hernia and baby driver and do for him resuscitations and stabilization what
next step = surgery
….
Pt is with non-acth dependent cushing for rr adrenalectomy ..what is the
postoperative management ?!
A. postoperative fludrocortisone
B. postoperative metatone
C. preoperative hydrocortisone✅
D. pre operative (drug for pheochromocytoma forget its name )

🌹Echinococcus syptomatic ((calcified)= Surgery(cystopericystectomy)✅

....
🌹 Case of liver cyst (echinoccosis) treatment ?. Albendazole ✅ ✔️
(‫= اذا )هاي مع قلب‬. Hydatid ‫ من اسم‬+ Hy= ‫ قلب‬، ‫ = ألب‬Albendazole = ‫نربطها‬
....
🌹 hydatid cyst 10*15 cm with multiple ((daughter cyst )) inside the main one. What is the treatment?
deroofing surgery
....
🌹Picture of Ct hydatid liver cyst: One large, manage:
A. open cyst deroofing ✅
B. albendazole
.‫ المتجمع داخلها‬pus ‫ يعني افتح الكيس بالمنظار واشيل‬deroof ‫ لكن لو كبير الزم اشيله كلمة‬، ‫ وهو يختفي باذن هللا‬alben ‫ صغيرة نعطيه دواء‬cyst ‫لو كان‬

🌹Pic of Hydatid cyst on U/S it was big but daughter cysts was mentioned. What should you do: Surgical Deroofing
= daughter. ‫ديرفينج = ظفييرة‬
....
amebic liver disease, what drug to give: Metronidazole
🔥🔥‫ و متروا حصل فيه حريق نطفي المتروا ب الميبوا‬، ‫ ميبوا كريم حروق‬، ‫ربط‬
..... .....
🌹 Classic amebic abscess scenario with clinical and imaging findings. Management?
○ Metronidazole ✅.
○ Drainage.
○ Aspiration
-- ----- ----- -----
🌹 Long scenario with liver abscess culture reveals anti amoeba histolytica treatment?
B-metronidazole ✅✅
.......
🌹Large cyst >10cm or complicated:- Surgery
…
🌹Patient with hydatid cyst, complex with septations and 10x15 in size, initial step in treatment?
A. Cephalosporin
B. Mebendazol ✅✅ its type of albenazol
C. Percutaneous aspiration
D. Percutaneous drainage

Peripheral artery disease:

🌹Acute limb ischemia with absent distal pulse, diminished sensory and
altered motor ex, mx?
A. Embolectomy.
B. Above knee amputation.
C. Cath and thrombolysis
D_heparin ✅
…
🌹 pain ,paresthesia ,pallor ,,Hx of MI before weeks ,Dx?
A. Acute arterial thrombosis✅
B. Acute arterial embolism
C. DVT

🌹An elderly man came with lateral malleolus ulcer, he is hypertensive but
not diabetic What is the first thing to do:
A. venous duplex
B. check pulse ✅
C. ABI

🌹Sudden right lower limb pain. Diminished sensation + altered motor. Pt on anticoagulant for afib.Best next step:
A. CTA✅ B. Us C. emblectomy
.....
🌹What is best to confirm arterial disease= . Ct angio✅
....
🌹Patient with HTN and diabetes came with ingrown toe : what is the most important thing to do before the surgery :
A- check pulse ✅ B- check the other toe
....
🌹 Old male with htn and dm presented with claudication examination reveals
right femoral intact pulse and diminished popliteal and distal pulse and left diminished pulse intervention?:
A. CT angio ✅
B. conventional angio C. mra D. venous US
....
🌹 50 years old patient, know case of DM, HTN presented with leg pain associated
with hair loss , ABI more than 0.9, what is your diagnosis:
A. acute thrombus ischemia
B. Chronic limb ischemia ✅✅
acute ‫ معناها‬٠.٤ ‫الن لو قال اقل من‬
.....
🌹Diabetic patient with pseudo hyper epithelialization in situ= ulcer Debridement
....
🍒lateral malus ulcer with abaent pulse most IMP investigation?
A. CTA✅
.....
🌹Dm pt with unilateral leg erythema Increases in dependant position, Cold, Femoral pulse is present, distal pulse can be palpated
No tenderness, no swelling, no fever Otherwise unremarkable Dx?
A.Cellulitis
B. Arterial insufficiency ✅✅ C.Superficial thrombophlebitis
....
🌹Patient with diabetes and hypertension smoking 40 c per day came to er complaining of leg pain on examination on lower limp
the pulse was intact on femoral and pupletial artery’s and diminished on distal pulse first question was what is the best appropriate
next step ?
A. morphin B. heparin ✅ C.ct angio D.vascular us
.....
🌹Pt have deep thigh injury what to do
A.torniquete
B. put pressure above site of injury ✅ C.put pressure on injury
.....
🌹Pulse abdomen mass in middle abdomen what (next step to confirm) management ?
A. angiography B. CT✅✅ C. US
N.B: dx is abdominal aortic aneurysm intial US, confirmation and management plan according to CT angio
.....
🌹Pulsatile abdominal mass Abd X ray showed no air level What (((nexst step ))) investigation to order:
A. abd UC✅ iB. CT angio
.....
🌹60 years old patient come with epigastric pain radiating to back . He’s smoker and long standing for DM and HTN . Abdominal
examination show pulstile
subra umblical mass . What’s Dx ?
A. Abdominal aortic aneurysm✅
B. secondary liver metastasis C. renal cell carcinoma
......
🍒Surgery was done for diabetic septic foot ,no wound healing for 2month what is the cause? A.Neuropathy
B. Poor blood supply ✅✅
....
🌹PT admitted due to MI after 2 days of discharge developed sever pain in his leg Dx?
1/ acute arterial thrombosis
2/ Acute Arterial Embolus ✅
3/ DVT
Areythmia ‫ الي تعمل‬Mi ‫ بسبب مضاعفات‬Embolism ‫ فغالبا جلطة تحركت من القلب‬MI ‫هنا قال انه بعد يومين من‬
Thrombolism ‫ يعني من زمان فيمكن يمشي اكثر مع‬MI ‫الن فيه سؤوال مشابه وقال عنده هستوري ب‬
.....
🌹 claudication with distance peripheral artery disease. ABI = ankle brachio index🌹
.....
🌹 what is the first symptom to be find in compartment syndrome =
a. pain ✅.
b. paresthesia between toes.
c. swelling

intac puls or absent puls:‫ لما يقولك السيناريوا‬doplex ‫ و‬C.t angio ‫متى نختار‬

absent puls ‫لو لقيت بالسيناريوا يقول‬

‫(( على طول اعمل له‬next step )) ‫ بعدها‬puls ‫يعني فحصته بالعيادة لقيت مافيه‬
doppler ultrasound
‫الن الدوبالر اسرع واسهل‬
..
‫اذا عملت له دوبالر وماوضح معايا اي شريان بالضبط المسدود اروح للمرحلة الي بعدها واسوي‬
C.t angio
. ‫ يوضح لي فيه انسداد وضيق لكن مايوضح اي شريان بالضبط‬doppler ‫الن‬

‫ نختار‬investigantion ‫لذلك لو سال ايش افضل‬

C.T angio

US Doppler .‫ طبعا‬next step ‫لو قال‬

.....

lymphatic ‫ او‬venus ‫ معناها الشريان سليم ولكن المشكلة في‬puls intac ‫بالنسبة لو ال‬

‫وخاصة لو قال‬
non poitting Edema , thikness , pigmentantion skin =
mean there is lymohatic obstruction
lymphatic ‫هذه الكلمات تمشي مع‬

‫ الي اطلبها اول اول شيء‬investignation ‫ايش‬

Ultrasound or venus ultrasound

DVT .‫عشان استبعد‬

.....
 :‫االسالة‬

.....
🌹 Crush injury to his feet , after stebalization of the patient , o/e cold and decreased pulse in the affected foot . What is the (((best
next step ))
u will do ?
A. ct angio
B. angio
C. duplex US ✅✅
D. compartment compression
….
🌹 wi th Reversible Eye manifestation for 20 min? TIA ✅ ✔️
transient ischemic attack
‫ يعني عابر شيء مؤقت ويرجع للطبيعي‬transient ‫من اسمها‬
.....
🌹 Female patient after cryotherapy for varicose 2years ago complainig of leg and
foot pain what nerve is damaged A- siatic.
B- saphenus ✅.
C- femoral
D- obbirator
= sphen ‫ ازرق = سفينة‬varicose vien ‫لون‬
.....
🌹Female 30s asking for cosmetic treatment of varicosity in her thigh,
asymptomatic, no other varicosity, how would u investigate?
A. Duplex ✅
B. CT venography
C. No need for further investigation
…..
🌹lady who have Spider nevi she she wants to treat it cosmetically:( they mean before treatment what should you do )
A) No need for investigation
B) US doppler✅
…
🌹 ▪️most common location for arterial ulcer >> Lateral. No pulse>> arterial
…
🌹 ▪️Most common location for venous ulcer >> medial. pulse >>> Venous
*But the pulse will be the clue .*
🌷arterial ulcer= Lateral + No pulse🌷 🌷venous ulcer = medial + pulse 🌷
medial ‫ عادي في االمان‬venus ‫= يعني جدا حساس على الحافة يادوبك لو سار له اصابة راح يهدد حياة الشخص بينما‬latral ‫ربط= الشريان على الحافة‬
....
🌹 female present with bilateral lower limb swelling non putting not known to have any medical illness :
A-CT angio
B-duplex ultrasound✅
....
🌹 Patient with unilateral left leg non-pitting edema, skin thickening and hyperpigmentation (dermal fibrosis) for 2 months. Next
best appropriate step?
○ CT angiography.
○ MRV.
○Duplex US ✅ (initial and the next)
NOTES: Non-Pitting edema is due to Lymphedema, Ultrasound is useful to exclude other etiologies like DVT, venous
insufficiency and can also help in identifying tissue changes and masses that might be the cause of lymphatic compression.
🌹 Patient with unilateral left leg non-pitting edema, skin thickening and hyperpigmentation (dermal fibrosis) for 2 months.
Management?
Lymphatic bypass
Compression bandages (combination of physical therapies; two-stage approach) ✅
NOTES: Nonspecific treatment of lymphedema includes exercise, elevation, compressive garments, manual lymphatic drainage,
intermittent pneumatic compression, and surgery (excisional procedures, microsurgery).
. . . .. . . .. . .
🌹 same question but swelling unilateral ask about management
- A- lymph by pass.
- B- anticoagulant.
- C-lymphatic massage ✅
.....
Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:
1) _ Exercises. Light exercises in which you move your affected limb may encourage lymph fluid drainage
2)_ Compression garments. Long sleeves or stockings made to compress your arm or leg encourage the flow of the lymph fluid
out of your affected limb.
‫ الي هو (شراب ضاغط ) مثل شراب طويل يكون مرة ضيق على الرجل‬.
3)_ Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm
or leg.
. . .. . . . . . .. .
🌹Female on her fifties develop unilateral leg non-pitting edema with skin discoloration (dark) and thickening of skin ,mx?
-lymphathic bypass. -anticoagulant
-lymphatic massage and pressure dressing ✅✅
.....
🌹presentation lymphedema, what is the important thing in hx to ask about?
A. Medication
B. Family hx
C.Trauma ✅✅
D. Smoking
: ‫ مثل‬truma events ‫ للمرة االولى بعد ما يحصل اي‬lymphedema ‫ممكن يحصل‬
such as bruises, cuts, sunburn, and sports injuries
‫فمهم في الهيستوري نسالهم هل حصل سابقا اي تروما ؟‬
.....
🌹Bilateral great saphenous vein mange ?
A. sclerotherapy
B. something endoscopic
C. ablation ✅
...
🌹Lateral malleolus ulcer. Diabetic. Intact pulse. Best initial test?
A- Douplex affected leg✅
B- Douplex both legs
C- CT angio
...
🌹progressive Non pitting edema, no DM or HTN. Best Investigation?
A- venous douplex ✅ B- CT C- MRA
....
🌹Male, diabetic, HTN, came with ulcer in lateral left malleolus for 3 months, (((pulse is intact)))?
A. MRA. B. Ct angio. C. Conventional angio.
D. Venous duplex for left lower limb✅
.
🌹Pregnant lady in 15 WK gest comes with marked upper & lower limp oedema.
BP 150/95 What is your best management?
A.complete evaluation ✅
B.atenolol
Note :Edema happens in normal pregnancy but upper & lower could be significant.
...... ....... .....
🌹Diabetic patient present with leg redness increase with dependent position, on examination, diminished pulse and cold skin
What is the most likely diagnosis?
Peripheral arterial disease ✅🌹
…
🌹 Patient present with painful of cord like swelling of left leg and she has hx of vircous vein 20 years back Best initial
treatment?
a) NSAID ✅. b) Celxan. c) Heparien
.....
🌹Varicose veins Tx for therapeutic reason: - Endovascular laser ablation

🌹 Varicose veins Tx for(( cosmetic))) = -Sclerotherapy 🌹

🌹Pt w/t varicose veins c/o swelling and heaviness, no pain, pulse intact .. everything normal .., NEXT
:A- Duplex US✅.
.. . . . .. .
🌷spider veinous case , what is the management? -Endoscopic laser ablation
‫ الن‬spider vein ‫ عالمة على‬liver cirroais ‫ ومن مضاعفات‬cirrosis ‫ تعمل‬esophageial varicosis ‫ فعالج هذا الدوالي‬، ‫و دوالي المريء هذه تعمل نزيف‬
‫ يكون ب‬laser ablation. . . .
….
Female presented with vascular malformation in the leg (hemangioma
maybe) increasing. What is the indication of removal?
A-Pain✅✅. B-Ischemia C-Cosmetic
…
🌹 What is hard sign of vascular surgery:-
_Weak pulse _Skin color change. _bruit ✅
the presence of hard signs mandates immediate action. The presence of hard signs of vascular injury mandates immediate
operative intervention.
....... ........ ......
🌹 Hard sign to detect vascular injury
A. multiple fracture B. change color C. decrease pulse D_pulsetile bleeding✅
…
● Smoker elderly with preserved femoral and popliteal pulse put diminished
dorsalis pedis, Mx ?
A. Localized thrombolysis
B. Heparinization and observer✅

Compartment syndrome:

Patient with thigh hematoma, which of the following will indicate surgery? Pain✅.
‫ وهذا ممكن يسبب‬thigh hematoma ‫يقولك عنده‬
Compartment syndromes = Due to bleeding will compresstion to Tissue and blood vessle .
Compartment ‫ طيب من عالمات‬، ‫ قبل ما تتكور الحالة ويحصل بتر‬، ‫ الزم فورا يروح للعمليات‬Compartment syndromes ‫ف لو ظهر اعراض و عالمات‬
‫ فالجواب هنا متى اطلعه للعمليات لما يحس بااللم الن االلم من العالمات‬، ‫ وكمان تخديى وتغير اللون واشياء ثانية‬، ‫هو الشعور بااللم ويكون الم ش ديييد‬syndromes
‫الهامة ل بداية حصول كومبارمنت سيندوم‬

🌹Patient came after limb trauma, with severe pain and paresthesia between his toes and it was pale. X ray shows fractures,
intracompartmental pressure was 35mmhg what to do?
A. Internal fixation
B. closed reduction
C. external fixation
external fixation with 4 fasciotomy✅
....
🌹pt involved in RTA stable, but there is left leg swelling and paresthesia between toes xray showed fracture tibia pressure in
posterior leg compartment is 35 mmHg :
b.external fixation with multiple fasciotomies ✅✅
🌹 30 years old had trauma which resulted in fracture of his right tibia and fibula After a while he started to complain of numbness
and severe pain within that area What would you do?
A.Heparin
B.Embolization
C.Fasciotomy ✅✅
.....

Testicular:

🌹Infant with Bilateral non tender scrotal edema and redness extending to groin. What's the diagnosis
A. Testicular torsion
B. Epididymo-orchitis
C. Edema of testicular appendages
D. Idiopathic testicular edema
......
🌹Patient came with testicular enlargement after an exercise what will you do for him? US

🌹decrease in left testicular size post hernia repair ?

A. Testicular artery occlusion
B pampiniform plexus occlusion✅
....
🌹Pain with absent cremasteric reflex: A- Surgical consult ✅
B- US C- Culture
.‫ وهذه حالة طارئة الزم فورا جراحة‬testicolar torstion ‫ ايش اول شيء يجي في بالنا؟؟‬: absent absent cremasteric ‫نشوف بس كلمتين‬

🌹5 years old child found to have one testes in the scrotum and the other in
the ingunal area what to do? A-orchiopexy ✅ ✔️(( surgery to move an undescended (cryptorchid) testicle into the scrotum))
....
🌹Pt recent abdominal surgery presented by fever&otheres. what is the most cause
A-sepsis B- subphrenic abscess✅

(Other names. Subdiaphragmatic Abscess. Specialty. Infectious disease, gastroenterology. Subphrenic abscess is a disease
characterized by an accumulation of infected fluid between the diaphragm, liver, and spleen.)
.....
🌹female patient complains of urinary dribbling, dyspareunia, dysuria. What is the most likely diagnosis?
A. Overflow incontinence
B. Urethral diverticulum✅
C. Stress incontinence
A urethral diverticulum occurs when an unwanted pocket or sac forms along the urethra.
......
🌹yearsold boy brought by his parents, he has nausea, severe vomiting for 20 minutes and now semi comatose. The
parents mentioned that he has same episode two weeks ago for 5 minutes without deterioration in consciousness. On
examination there is right testicular mass that does not transilluminate with light. What is the best action to do ?- Surgical
exploration. ✅
.......
🌹Testicular pain absent cremaster reflex (for 4hours) , clinical pic of (torsion) what to do?
Surgical exploration ✅
 Appendsitis:

🌹Female (obese) with typical appendicitis: Right iliac pain and tenderness
Nausea and vomiting. Loss of appetite. Leukocytosis What is the proper management:
A. Abd ct ✅ obese
B. Abd us
.....
Post appendectomy female came with LR abdomen mild tenderness Ex
Normal By CT there is 2*2 collection in Retrocecal :
A. Exploring laparotomy
B. percutaneous drainage
C. laparoscopic
D. conservative with Anitbiotic✅
5 ‫ فقط واالبحاث قالت انه امن وفعال بينما لو اكثر من‬antibiotic ‫ سم نختار‬5 ‫لو اقل من‬
antibiotic ‫ = مع‬percutnus ‫نختار‬
......
Pathophysiology of appendicitis in 58 male ?
A. change in blood distribution
B. peripheral vasoconstriction ✅
C. decrease heart index
...
🌹Patient obese came complaining of rt iliac fossa and tendrenss :
A- CT abdominal ✅HE IS OBESE
....
🌹Young unilateral testicular swelling since 1 day, on exploration viable but cord edematous :
A-Torsion
B- Incarcerated inguinal hernia
C- Appendicular torsion✅
....
🌹Post appendectomy day-4 presented with abdominal pain and feculent discharge most appreciate step? A. IV antibiotics✅ B.
Ex lap
.‫ يعني تجمع بكتيريا اهم اهم خطوة والزم هو نعطيه مضاد حيوي‬pus ‫يقولك عنده‬

🌹Case scenario ....appendicitis but not ruptured( best )investigation

a. CT abd✅ b. US abd c. Exploratory
.....
🌹Peds 8 yrs old with RLQ pain and rebound tenderness what's confirmatory test?
A. US abdomen ✅B. MRI abdomen
C. CT abdomen
...
🍓Post appendectomy came with mild pain and collection 2x2 Asking about management:
A. Per cutaneous drainag
B. Conservative with Abx✅
5 ‫اقل من‬

🍓Post-appendectomy, 0.5 cm carcinoid found on the tip of the appendix, mx?

Nothing = If carcinoid tumor less than 2cm > appendicectomy only
More than 2cm or at base of appendix> right hemicolectomy
.....
🍓After appendectomy dr found a carcinoid mass more than 5 cm on the tale of appendix Next?
C.T scan abdomen and chest for staging
......
🌹Most surgical emergencies in pediatrics ? Appendicitis
..
🌹Old age came with symptoms if appendicular mass and treat it What you will do
A. Colonscopy 6 weeks ✅
B.12 weeks
....
🌹after initial conservative treatment of appendicular mass :
A.Open appendectomy after 12 weeks B.Laparoscopic appendectomy after 12 weeks ✅✅
‫ = ربط‬Append
.....
🌹Appendicular abscess 15cm*17cm in a 33 y old man. How to manage
A. antibiotics ✅ B.Surgical
(No drainage in the options)
.....
🌹 During app. Surgery appendix not find !? . How to find it = Follow tenia colli
....
🌹pt febrile , abdominal pain , rebound tenderness at mcburney's point , wbc high , x ray show right fossa ?
A- appendectomy✅✅
B- gall bladder US
C- urology consultation
.....
🌹After open appendix, seroma collection and leak from gap of sutures , no inflammation, what to do?
a-Dressing✅ b-Evacuation c-Ab
Minor, small seromas don’t always need medical treatment. That’s because the body may naturally reabsorb the fluid in a
few weeks or months.
the seroma if it’s large or painfu = Drain

🌹 Post appendectomy case 1 week , not complain ,but upon exam there was seroma with in gaping wound .what u will do ?
A. repeat and care of the dressing✅
B. drainage C. ct abdomen

🌹Perforated appendicitis post laparotomy, presented with fever, abdominal pain CT done showed foreign material ,
reexploration done, gauze was found intraabdominal ،intraabdominal ،What to do?
A-Issue complaint against assistant B-Call your lawyer and report the incident
C-apologize to the patient and tell her what happened ✅ ✔️
…..
🌹Young male with right lower abd pain and tenderness, low grade fever On abd xray: radioopaque material (small at iliac
crest site) What to do?
-urgent uro consultation-non contrast CT -appendectomy ✅
.......
🌹Case of acute appendicitis, fecolith and abscess seen on CT management?
- open Appendectomy and drainage -lap appendectomy and drainage✅
-percutaneous drainage
.‫ تكونت وهي تحصل نتيحة التهاب الزائدة‬stool ‫يقولك كان فيه قطعة‬
.‫ الزم نطلعها وبعدها نعمل العملية إزالة الزائدة‬Drain ‫يفضل اول شيء‬
.....
🌹After laproscopic appendectomy . Pt come with retrocecal collections. :
A. surgical drainege ❌❌
B. percatenous drainage ✅✅
....
🌹Appendicitis case with abscess how would u manage it :
A.open B.laparoscopic C.antibiotics
D. percuatanous drainage ✅
..... ..... . ......
8 days Post appendectomy with abdominal pain, distention, inability to
pass stools, In exam: feculent material discharge with signs of peritonitis
A- CT
B- IV antibiotic
C- Exploratory laparotomy✅

Prostate:

A 73-year-old man presents pain in his right thigh. This has been getting progressively worse for the past 9 months despite being
otherwise well. An x- ray is reported as follows: X-ray right femur Radiolucency of subarticular region suggestive of osteolysis.
Some areas of patchy sclerosis Bloods tests show: Calcium 2.38 mmol/l Phosphate 0.85 mmol/l Alkaline phosphatase 544 u/L
Prostate specific antigen 4.4 ng/ml. What is the most appropriate action?
A. Vitamin D supplementation
B. Check serum testosterone
C. Referral to an orthopaedic surgeon
D. Referral to a urologist ✅could be prostatic Ca mets to the bones.)
E. IV bisphosphonates (
…..
🌹75 y male c/o(( back pain, difficulty passing urine)), psa: 84(high) , ALP: 410
(high)
A. prostatitis B. prostatic cancer ✅
C. urinary bladder ca D. BPH
High ALP indicates bone metastasis.
....
🌹 80 y old man with bilateral hydronephrosis on Us images
A. Prostate enlargement / Ca
B. Bladder ca > come more aggressive pain, hematuria
C. urethral stricture
D_Bph ✅
.....
-Part of urethra affected by surgical (trauma) in males
a. membranous b. penile D.Bulbar✅
N.B: Membranous for pelvic fracture after MVA
....
🌹Old patient with loain pain . Us shows biliteral hydronephrosis =enlarged prostate
.....
🌹By Cyctoscopy: Redness in the dome of bladder What is the most likely diagnosis:
A-ischemic colitis
. B-diverticular disease.
C-Transitional bladder cancer✅
…..
🌹Old M c/o urinary sx, prostate median lobe hypertrophy, what is best for this pt?
Annual Prostate-specific antigen ✅
.‫ هذا انتيجين يرتفع لما يكون فيه ورم في البروستات من اسمها‬:high Prostate-specific ‫🍬للعلم‬
…..
🌹 Old pt came with difficulty urination and low back pain with high Prostate-specific antigen dx?! A- Prostatic cancer✅✅.
‫ او قالك من االول وانا‬Benign prostatic hyperplasia ‫خذوا هذا السر ( اي احد كبير في العمر وجاء يقولك عنده الم في اسفل الظهر وكان عنده تاريخ سابق ب‬
‫ واكثر اكثر مكان يروح له ل‬، ‫ يعني بدء السرطان ينتشر‬spinal ‫( لل‬metastasis ) ‫ وسار له‬prostata cance ‫ نشك على طول انه عنده‬difficult urination ‫عندي‬
.‫ فيجيك ب الم في الظهر‬spinal ‫مرض سرطان البروستات هو‬
.... .....
🌹 Urethral trauma with bleeding post MVC. Next step?
Suprapubic catheter✅✅
‫ماينفع نختار فولي كاث الن فيها اصابة ماينفع ندخل القسطرة واليوريثرا ماهي سليمة‬
retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture
-- ----- ----- -----
🌹75yeard old male with ((( back pain ))) and urinary symptoms (obstructive) ,ALkaline phosphatase hight and (((PSA
80))) what is the most likely Dx
-BPH.
-prostatic cancer ✅✅
** PSA = Prostatic specific antigen = if above 4 = ‫معناها سرطان الن هذا انتيجين مايرتفع اال في االورام البروستاتا‬
.......... ....... ...... ......
🍓65 yrs came with mild decrease in urination , us showed median lob hypertrophy of prostate , PSA and digital rectal was normal
, urine analysis and renal function normal what to do?
A. annual renal function tese ✅
B. Periodic investigation of PSA
C. Beta blockern
D. Cystoscopy

Hemorrhoids

🌹 sclerosing patient with history of rectal bleeding, anoscopy show swelling at 3,7 o'clock,
sclerosing therapy is planned what is the most appropriate to do sclerosing therapy
A. external hemorrhoids
B. internal hemorrhoids✅✅
C. prolapsed hemorrhoids
D. thrombosed hemorrhoids
.....
🌹 post hemorrhoidectomy pt has urinary retention. Cause:
a. Trauma
b. Anesthesia affect✅
.....
🌹Patient after hemorrhoids operation develop Suprapupic pain with inability to pass urine what is cause? Inadequate analgesic
...
🌹 20s years old presented with pain during defecation menimum amount of blood, on
examination the doctor seen a posterior midline fissure. He couldn’t do PR exam as the patient was in severe pain Vitally stable
What’s your next step?
A. EUA (Examine under anasthesia EUA) ✅
.....
🌹 Old patient who has constipation on and off with streakin of blood in the stool with no fulness in the rectum ( no mention of
pain )?
A. Sigmoid cancer
B. rectal cancer ✅✅ old age
C. chronic hemorrhoid.

🌹 Old pt-fatigue sign of anaemia hb8 , stools with streak of blood -has hemorrhoids stage 2 ?
A. Sigmoid ca.
B.rectal ca✅✅
c.chronic hemorrhoid
)) ‫ لو انت جراح وجاك مريض ((كبير بالعمر‬، Rectal cancer ‫ الزم الزم تستبعد وجود‬hemorrhoid ‫ اي مريض يكون كبير بالعمر وعنده‬: ‫سمعوا هذه المعلومة‬
cancer‫ كويس الن كثير بنالقي صدفة عندهم‬rectum area ‫ الاازم بالمرة تفحص‬hemorrhoid ‫وعنده‬
...
🌹 Hemorrhoids produce the symptom of pruritus (itching) .
....
🌹 Patient came with painless blood after defecation, whats the diagnosis?
A. Abscess B. Fistula Hemorrhoids✅
….
🌹 Sclerotherapy use in management
A. Internal hemorrhoids ✅
B.External hemorrhoids
‫ = سكليروا = سكين = الزم يدخل جوه‬internal
....
🌹Hemorrhoids type 4, what is the management: Hemorrhoidectomy
….
🌹case of hemorrhoid. what is the Indication of sclerotherapy? A- Internal✅. B- Externa
…
🌹Patient with (perianal) painful (swelling)-vitals normal, (wbc normal)
A-pile. B-perianal abscess
C(-perianal) hematoma✅.
D-anal fissure
.....
🌹Anal fissure with sentinel pile not responsive to medical therapy. Next step?
A)_Lateral external sphincterotomy. B)_ Lateral internal
c)_ sphincterotomy(LIS) ✅
n . ‫ مع‬n ‫ ( = حرف‬Anal = internal ) ‫ربط‬
Lateral internal sphincterotomy is an operation performed on the internal anal sphincter muscle for the treatment of chronic anal
fissure. The internal anal sphincter is one of two muscles that comprise the anal sphincter which controls the passage of fece
....
🌹 streaks of blood after defecating and pain?
Anal fissures ( lateral Sphincterotomy)✅
*s*treaks of blood = fi*ss*ures
‫ من اسمها قال‬sreaka ‫ يعني تمزق‬fissure
...... ..... ...
🌹pt with intermittent perianal pain and discharge, on P/E theres low-lying fistula with an opening in posterior wall above anal
verge. What to do?
A. MRI
B. Fistulogram
C. Fistulotomy✅
D. Lateral sphincterotomy
....‫ وعالجها نشيل الفيستوال‬fistula ‫واضح انه عنده‬
🌹Perianal pain on examination no lesion, finger exam showed internal swelling
with purulent discharge on the anal canal , Dx
: A. perianal hematoma
B. internal abscess✅
....
🌹 Male adult with perianal swelling and discharge, then ruptured =
A. Anal fissure
B. hemorrhoid
C. anal abscess
D. fistula✅
Discharge ‫ و‬swelling ‫ وتعمل‬perianal ‫فستيوال غالبا تكون مكانها‬
.....
🌹Pt with anal abscess then you found fistula on examination draining pus , the opening is in the posterior rectum wall:
management:
A. MRI
B. fistulography
C. fistulotomy/ectomy ✅
....
🌹31 year old male with constipation and during perianal exam there was sever pain and linear laceration at 6 and 12 oclock whats
the dx:
A_ Anal fissure ✅
B. anal fistula.
C. hemorrhoids
.....
🌹pt with bleeding after defecation ( painless )
A. Anal fissure B. Hemorrhoid ✅
….
🍓pt presented with 3 months bleeding after stool, a perianal mass, and weight loss. Histology confirmed adenocarcin oma. CT
finding shows no lymph node involvement and mass limited to 3cm from anal verge. What's treatment modality?
A. Radiotherapy
B. Abdominoperineal resection✅
C. Chemotherapy
D. Low resection only
Less than 6cm from anal verge > Abdominoperineal resection
More than 6cm > Lower anterior resection.
......
🌹 Case of perianal swelling , per rectal bleeding , investigated : it is 1 cm from anal verge biopsy: adenocarcinoma (rectal) Mx:
A-Abdomen perineal resection ✅ ✔️ B-low anterior resection C-chemo/radio
.....
🍓Adenocarcinoma of colon, 1cm from anal vege?
A. low anterior resection of rectum (LAR)
B. Abdominoperineal resection✅
......
🍓patient with anal swelling and discharged, swelling is rapture, No fever:
A- fistula abscess✅
. B- thrombosed pile
....
🍓Anal itching and pain post defecation and ask ddx?
A. internal hemorrhoid
B. Anal fisure ✅ ‫يعملوحكة‬

🍓Anal fissure failed medical Treatment?

lateral internal anal sphincterotomy
....
🌹Anal fissures with skin tag not respond to drug, want procedure?
A- Internal sphernctomy✅✅
B- External sphrenctomy
C- Anal curettage with remove tag
....
🌹Post partum woman with painful defecation and bleeding and pain after defecation; what is the cause
A. anal fissure ✅✅ B. Haemorrhoids C. thrombosed pile

🌹pt with Anal dischsge and he gave history of ruptured aanal abcess :
Anal fistual ✅. Anal' fissure Anal piles

🌹Patient have pain with and after defication and some blood with it diagnosis?
A-hemorrhoids. B-anal fistula.
C-anal fissure‫✅✅ التمزق يعمل الم‬. D-abscess

Wound:

🌹 First evaluate surgical wound by *inspection *✅

🌹 If there’s signs of infection* (pulurent discharge, redness, tenderness) then wound exploration

if superficial > clean, dressing and you may give abx

🌹 If deep collection suspected >* order CT

🌹 If small collection less than 4cm >* abx

🌹 If large 4cm and more* > percuteanous drainage + abx

🌹 If signs of peritonitis > Laparotomy

.....
🌹10 cm laceration in anterior thigh what to do?
a-Tourniquet b-Compress ✅. c-Vascular consult d-Band or tourniquet above femoral artery
‫انتوا تخيلوا الموقف لو اصابكم اي جرح كبير ونزل دن كثير ايش اول شيء تسوونه ؟؟ اول شيء بتاخذون قماش وال منديل ( تضغطون) على الجرح عشان يوقف‬
.‫نزيف‬
... .... ....
🌹 Elderly pt sacral ulcer manag=
A-Depriment and skin graft(if necrosis)
B- Primary closure
C- Daily dressing✅
….
🌹 Elderly pt underwent for a major surgery ..he need blood transfusion 15 PRBCs .. after that he start bleeding from wounds,
nose, from NGT (stomach) .. what is the cause:
A- vWBD.
B- thrombocytopenia✅.
C- hemophilia. D- no DIC in choices
... ....
🌹 25 years old with perforated appendix did laparotomy, after 5 days wound is tender and pus discharge what to do.
a-wound dressing
b-exploratory laparomtmy.
c-iv abx✅
..
🌹 Girl with stab wound in the right anterior axillary line below the costal margin, stable
A. Observation.
B. immediate surgical exploration. Perform FAST✅
.....
🌹 Neck stap wound = if ask about Next step = wound explorontion
(clinical exsmnation) = if ask plan or managmant choice = C.T angio to neck ( stable pt) = if not stable Surgical explorantion.
….
🌹trauma to neck asking about investigation to different zone:
🧁 Zone I and Zone III > C.Tangio
III‫ ثالث كلمات‬C.t ang ‫كلمة‬
🧁if symptomatic > Surgical exploration
.....
🌹 Pt with neck injury in zone I , vitaly stable , what’s next :
A. neck exploration ✅
B. CT face and neck
....
🍓Neck injury->pt had Subcutaneous emphysema_> next step?
A. Ct neck✅. ‫حصل له مضاعفات ف على طول سيتي‬
B. explore neck
..
🍓Neck trauma stable anterior to the angle of the mandible Manag ?
A. CTA✅ B. exploration
‫ ماقال‬next step
....
🌹18 yrs with stabbing wound 10cm of thigh what next step management:
A. compress on wound ✅B.tourniquet upper thigh
……
🌹 Neck trauma in area retro auricular above the angle of the mandible (area 1 was
not mentioned), patient stable and oriented. Most appropriate step?
A. CT angio. B. Neck exploration✅
....
🍓Patient has stab wound affect the duodenum and vital signs are stable what is your management ?
A. Ct scan✅
B. Laparotomy C. Conservative
.......
🍓pt with forearm fracture and open wound 1cm , what’s TTT :
A. close reduction. B. wire. C. cast
D. debridement , irrigation , fixation✅
‫اذا فيه جرح ولو صغير جدا الزم‬depridemnet
…..
🍓Pt post operative and leak 20ml fluid from the wound:
A. Dressing B. Wound exploration✅ C. Lap
......
🍓Post open appendectomy case with pain in wound site on examination u see
pus oozing from site of surgery what will u do next?
a. percutaneous
b. US abd
c. iv antibiotics✅
d. open surgery
‫ اذا قالكم‬pus or ooze ‫ نختار‬Antibiotic
‫ اذا قال فيه‬absess ‫ والمريض عنده‬Fever ‫ نختار‬open
…
🍓Pt has infected wound has pus come out from it what next step?
A-Inspection B-exploration of wound✅
....
🌹After herniotomy surgery for 5yrs boy came with fever and pus discharge and part of mesh seen ? A.give iv antibiotics
B.draining of pus
C.draining of pus and remove mesh ✅
D. observation
.....
🍓X Ray showing both distal ulna and radius fracture with volar displacement On examination a 1 cm wound was seen at the
volar aspect of the wrist Asks about initial management:
A. Closed reduction with above elbow cast
B. Closed reduction with below elbow cast
C. Irrigation of the wound and Closed reduction with below elbow cast✅
.....
Young male with MVA came by ambulance to ER conscious, with thigh
wound covered with sucking gause : call surgeon in duty
......
🌹Trauma patient with a wound on his thigh subcutaneous fat is lost vasculature
underneath is exposed what provides the best management
A. Debridement with primary closure
B. Primary repair
C. Debridemnt with secondary closure✅
D. Debridement with vacuum assisted closure
....
🌹 25 year old male Pt 8th day post surgery with wound site redness & tenderness with purulent discharge.. most appropriate?
A. IV antibiotics
B. CT abdominal
C.open drainage✅
D.exploratory laparoscopy
.....
🌹Patient post surgery, there surgical wound redness, tenderness with no discharge, abdomen is soft and lax .what to do?
A. Antibiotic ✅
B. wound drainage C. CT abdomen
.....
🌹Patient post surgery, there pus coming from surgical wound with tenderness and leukocytosis, abdominal examination was done
it was soft lax with no tenderness all over, what to do?
A. Antibiotics ✅✅
B. wound opening
C. CT abdomen
open...‫ نختار‬Fever ‫ والمريض عنده‬absess ‫ اذا قال فيه‬Antibiotic ‫ نختار‬pus or ooze ‫اذا قالكم‬
…
🌹Patient was hit with wood 5 days ago, now he comes with severe RLQ pain. On examination there is a small opening with pus
discharge, put when tried to extend his thigh there was severe pain and you couldn't move it. What to do?
A. CT✅
B. wound drainage C. antibiotics
...
🌹Patient post resection and colostomy presents with spiking fever for 1 week. Chest is clear. Abdomen is clear. Wound is clear.
Fever 38.2 Next step?
A- CT abdomen ✅B- Reassure
....
🌹person with car accident on left thigh show neurovessle fat and tissue out mange ?
debridment and skin grafting
....
🌹k/c HTN with lateral mules ulcer, next appropriate management?
A- wound examination ✅.
B- duplex. C- Ankle brachial indexes
.....
🌹Pt was stabbed by knife into his neck (ant to the right ear way through his mandibule )
Hé is stable with 1 or 2 cm wound ozing blood What is the (next) step in managment :
A-CXR. B-C.T angio. C-wound exploration ✅
 ‫ بعد الفحص نوديه‬forgen body ‫ نشوف هل فيه اي‬، ‫ نسوف عمقه‬، ‫ انه نفحص الجرح‬stap wound ‫ اول شيء نعمل ل‬next step , ‫طيب هو السؤوال يقول‬
c t‫لل‬
.... .... ....
🌷Patient with perforated appendicitis after surgery had pus from wound, pain
localized to the surgical site. No guarding no fever what best initial treatment is:
A. Antibiotics✅✅ B. Open drainage. C. Imaging guided drainage D. Wound exploration
‫ مازال مستمر وماراح بالمضاد الحيوي الزم‬pus ‫ لو ال‬culture ‫نركز هو قال اول شيء نسويه والمصادر تقول نعطيه مضاد حيوي ك اول خطوة مع اخذ مزرعة‬
. . ‫ وخااصة لو المريض قالك عنده حرارة‬، ‫افتح الجرح واشيل الغرز‬
.....
You may be started on antibiotics to treat the surgical wound infection. The length of time you will need to take the
antibiotics varies, but will typically be for at least 1 week. You may be started on IV antibiotics and then changed to pills
later. Take all of your antibiotics, even if you feel better.
…
🌷- Patient post surgery presents with disch'rge from middle of the wound. Next step?
- Daily dressing.
- Wound inspection✅✅
- Wound explor'tion
‫ اول خطوة في اي فحص الاازم اول شيء‬inspection
....... ....
Patient with right lower chest stab wound. Fast showed free abdominal fluid. What is your next step? A. exploratory laparotomy
✅ B.thoracentesis C.chest tube
....... ...... .....
Patient with stab wound what to do next ? Local wound exploration✅
…

Radiology:

🌹An elderly with IHD day 2 post cholecystectomy presented with sudden chest pain SOB and vitally hypotension and
tachycardia whats best ?
A. CXR
B. ECG ✅ the best
C. CT angio
D. LL duplex US
....
🌹Elderly with weight loss (10kg) and anorexia in endoscopy there is large ulcer in stomach , biopsy was taken and the result is
invasive adenocarcinoma . What is the next step:
A. endoscopic US
B. CT abdomen and chest and pelvis✅ ‫عشان اشوف الورم انتشر ال ال‬
C. abdominal US
.....
🌹Best diagnostic method for pulmonology embolism?
A. D- dimer B. Spiral CT✅
pulmonary angiography : best definitive diagnostic test...
......
🌹Chronic thromboe-embolism confirme =
A. QV ratio B. spiral CT C. D dimer✅
....
🌹 supraclavicular LN met what you do for primary site : Gastroduodenoscopy
....
🌹How to diagnose Adhesion post operative? CT, but Initially > abdominal X-ray (Air-fluid level, Bowel dilatation)
....
🌹Old patient with worsening of his constipation, labs shows positive occult blood in stool. Colon cancer suspected what to do?
A. Colonoscopy✅ B. sigmoidoscopy C. CT abdomen
...
🌹 Pt melena and fresh blood per rectum, upper and lower endoscopy negative,
next investigation: Capsule endoscopic
‫ ومالقينا سبب النزيف‬endscope ‫ نستعمله لما نكون عملنا‬، ‫الكابسوال هذه فيه ا كاميرا صغيرة ندخلها للجهاز الهضمي ويمشي على كل الجهاز الهضمي ظن بدايته لنهايته‬
. ‫ فنلتجا للكبسولة هذه‬.

🌹Old Man with falling trauma CT brain is normal but he is complaining of

bilateral foot pain: Check pulse > analgesia > X-ray
.....
🌹best diagnostic for Coarctation of the aorta for neonate ? echocardiogram is the most commonly used test to confirm the
diagnosis ( Not ultrasound or C.t )
.....
🌹 A man who is a known case of diabetes presented with hemiparesis 15 hours after some procedure
A. tpA B. Warfarin C. Ct angio✅
‫ عشان‬angio ‫ اخترنا‬، ‫ فنعمل سي تي انجيوا‬small vessl brain ‫ الن قال عمل بروسيجر فممكن سار له ارتفاع شديد بالسكر واثر على‬strok ‫احتمال يكون جاه‬
blood vessel‫نشوف‬

🌹Pt with bronchogenic carcinoma, presented with progressive SOB,

there’s elevated jvp, clear lung and quiet heart sounds. What will confirm your dx:
A. CXR B. ECHO ✅C. ECG
.....
🌹Pt presented with stabbed wound after wound exploration you found anterior abdominal fascia penetration, (his vitals were
stable) what's your next step?
A. CT abdomen ✅
B. MRI abdomen
C. Exploratory laparotomy
D. Diagnostic laparoscopy
.....
🌹 Best way to clear show cervical spine:
A. Clinical judgement or assessment. B. Lateral cervical x-ray✅

🍓child episode of PR bleeding, fresh ; black stool (have both melena and hematochezia) ; NGT showed greenish fluids ;
colonoscopy was negative what is next to detect source of bleeding ?
A. upper endoscopy.
B. Tc 99m✅.
C. Barium. D. US
.... ......

🌹Chlid overweight with X-ray? slipped epiphyseal plate 🌹

🌹Old with back pain radiated to back , CXR air under diaghram = perforated peptic ulcer

🌹 Pt in ICU with coffee ground vomit? Stress gastritis

🌹 K/c of ulcerative on med presents with abd pain Invistigation show enlarged transver colon 15 cm or mm? Management?
A.Total colectomy with ileostomy B.Proctocolsctomy with ileal pouch
C- steroid ✅

🌹 30 something morbidly obese male , how to decide best reduction surgery he will have ?
A.Barium enema
B. ct abdomen C. ultrasound abdomen D. GI endoscopy✅
....
🌹 farmer, wood brick in his abdomen 4days ago, 3 days ago he developed severe pain in the same area, on exam there was green
discharge coming out, what will you do?
A. take culture from the discharge.✅ B. CT abdomen. C. Drainage

🌹Stap in abdomen right anterior axially line, below costal margin, patient stable conscious what to do?
a-Ct abdomen✅ b-Us FAST

🌹cervical trauma in ICU patient after motor vehicle accident = C.T🌹

🌹3 weeks post gastrectomy presented with progressive abdominal pain increasing in intensity. What is the next appropriate
investigation?
1_US 2_ X-ray 3_ CT ✅4_Laparotomy
......
🌹 Patient complained of abdominal pain 3 weeks after sleeve gastrectomy, what is the diagnostic test?
1-US 2-CT with contrast✅
3- Plain abdominal X Ray
.....

🌹 Old male patient admitted as a case of large intestinal obstruction, underwent rigid sigmoidoscopy which showed a mass in
sigmoid region, biopsy was taken and resulted as adenocarcinoma, what’s your next step?
A. Colonoscopy ✅
B. CT abdomen
C. MRI pelvis D. Sigmoidectomy
............... ....
🌹 CT in truma important for = retroperitoneal injury✅

Spleen

🌹 Splenic laceration and thoracic aortic injury. You want to transfer the patient. What is important?
A. Transfer him to laparotomy
B. Transfer him to thoracotomy ✅
C. Angiogram
......
🌹 Post splenectomy came complaining of left side pain, Reduce air entry in the left side, Dx?
A. Subphrenic abscess ✅✅
B.Post splenectomy overwhelming syndrome
.....
🌹RTA patient, presents 2 days later with ascending aorta injury and splenich laceration, the best immediate management is:
A.Take the patient for thoracotomy
B. Take the patient for laprotomy ✅ C.Call vascular surgeon
.....
🌹 Patient after pacreatitis episode develops upper GI bleeding picture , scope was done,
gastric fundus bleeding was found ,sclerotherapy done Duplex ultrasound showed: splenic vein thrombosis with patent portal vein
whats is your management:
A-Splenctomy ✅ ✔️
....
🌹A 12 year old received a nonspecific blunt trauma on his abdomen and later presented with generalized abdominal pain.
Imaging of the spleen showed a 7mm hematoma and 4 cm tear(grade 3). Your management:
A. splenectomy
B. Spleen preserving surgery ✅
C. Conservative
....
🌹Spleen injury 1= consertive treatment
.....
🌹Spleen injury 3=partial resect. ( preserving surgery )
....
🌹4 cm tear with hematoma 7cm grade 3
A. splenectomy
B. splenic conservative surgery✅
..
🍒Laceration spleen grade 4 ? Splenectomy 🍒
....
🍒You are in (( small hospital or something )) and you have a patient with aortic injury and spleen laceration grade 3 or 4 and you
want to transfer him , how do you call ?
A.ICU B-Vascular surgeon
C. General surgeon ✅✅
..........
🍓30 years old male after RTA had a splenectomy, what will be low after hours from the surgery?
A. insulin✅ B. glucose C. vasopressin ‫ الن فيه جزء من البنكرياس الصق في السبليين‬.
.......
🍓 Patient child with fever , abdominal pain and splenomegaly and the spleen is tender what culture is important
A/Single blood culture
B/Multiple blood cultures✅
C/bone marrow aspirate culture
most likely typhoid: Bone morrow as most Sensitive, but invasive so multiple blood culture better .
…..
🌷If splenectomy > pneumococcal, HIB, meningococcal > given 2 weeks before the
surgery of splenectomy✅✅🌷
‫ و االنفلونزا احتمال كبير جدا بعد عملية ازالة الطحال يصابوا بهذه‬meningitis ‫ للنيمونيا و ال‬vaccin ‫الن ازالة الطحال يقلل المناعة جدا جدا لو ما اعطيناهم هذا ال‬
‫ سبحان هللا‬spleen ‫ عشان تعرفوا نعمة‬، ‫العدوى بسهوووولة‬

🌷 Patient 3 days post splenectomy develop fever 38.5 what is the cause of bacteremia?
A- UTI ✅ ✔️ B- Peritoneal transfer
N.B: fever day 3-5 post op is UTI.
....
-Pt postoperative day 3 has gram negative bacteremia how it rech to blood ?
A-translocation B-UTI✅✅ C- gut

Alcoholic present with hematemesis. Imaging shows splenic vein thrombosis. Management? ○Splenectomy✅

.‫ هذا العالج الوحيد لهذه الحالة‬Splenectomy . ‫ على طول اكتب العالج‬splenic vien thrombosi ‫📣اول ما نشوف كلمة‬
 Hernia:

🌹 Woman in her fifties asymptomatic has a small femoral hernia, what is the best management:?
A. Observation
B. Open with mesh
C. Simple open
D. Laparoscopic repair✅
*Femoral hernia*= We prefer to repair a femoral hernia *laparoscopically* because of its ease of access.
Old people > femoral we do open
….
🌹 Solder with bilateral inguinal hernia ? Lap w mesh
...
🌹30 year-old has a large indirect inguinal hernia sac that is reducible with mild effort. Bowel sounds are heard in the hernia sac.
This hernia is the result of which of the following?
A. A defect in the abdominal wall with protrusion of abdominal contents through the internal inguinal ring, canal and external ring
B. A traumatic defect in the abdominal wall
C. A congenital defect in the abdominal wall allowing protrusion of abdominal Contents through the inguinal canal✅
D. A defect in the abdominal wall caused by constipation
.......
🌹Pt 56 c/ o sudden RLQ pain after lifting heavy object ; and mass in RLQ ; Cough negative ; abd muscle tense even with
clenching . He is on anticogulation due to A fib . What the most apporpieate mgx ?
^ here I am thinking of Rectus sheath hematomea == rest and anaglesic
.....
🌹Man developed rt abd swelling after lifting heavy object, painful irreducible , nocough impulse ..dx?
A. Ventral hernia B. hematoma✅
....
🌹hernia, how to manage:
A- laparoscopic repair with mesh ✅
B- open repair with mesh + same options without mesh!
....
🌹pt did herinal repair with mesh 12y ago and came by obstruction sign and no sign hernia repair ?
A. Adhesion ✅✅
B. Late onset crhons
‫اي عملية تكون في البطن ومر عليها ( سنوات) من اهم المضاعفات الي كصير تحصل لهم هو وجود التصاقات دتخل البطن هذه االلتصاقات تسبب انسداد في االمعاء‬

🌹What type of mesh used in ventral wall hernia? A. Subly✅ B. Onlay

V= S
....
🌹 40 years old man underwent open hernia relain and 2 weeks later presented with tenderness at the site of hernia repair and
severe parasthesia/numbness/tingling around his thigh that went down his leg= management=
A. remove mesh staples. ✅✅
B. Neurectomy and mesh removal.
C. NSAID
....
🌹 Pt with Reducable hernia comes with intestinal obstruction manifestation and
on exam was redness and on Xray : multiple air fluid level =
A. incarcerated (very sever pain + nusia+ vomting + herniated tissue becomes trapped and cannot easily be moved back into place
B.strangulated(come with shock)
C. obstructed(Bez say Reducable )✅
.....
🌹60 yo pt Post ventral hernia surgery with mesh 6yrs ago pt came with abdominal distention and on radiology cut off sign and
target sign and soft tissue mass
A. late onset crohns
B. adhesions with mesh
C. small bowel cancer✅
....
🌹 t for elective ventral hernia repair, HTN and DM, on examination high JVP, LL edema, basal crepitation, your management:
A. open surgery
B. lap with mes
C. delay operation until addressing current symptoms✅✅✅
……
🌹 Patient with femoral small hernia asymptomatic = Observe without surgery
....
🌹8 month infant with right inflamed red hemi scrotum, on examination there was red firm irreducible painful scrotal swelling
which is extended to to left inguinal region. Left testis couldn't be palpated. What is the diagnosis?
A. Torsion appendix testis.
B. testicular torsion
c- epididymo orchitis.
D. incarcerated inguinal hernia✅
……
🌹Inguinal intractable pain with hyperaesthesia with pain radiating to thigh 3 weeks post inguinal hernia with mesh, upon physical
exam, no recurrence or surgical site infection, what's the mx:
A- Nerve block
B- Systemic Anti-Inflammatory✅
C- Neurectomy with mesh removal
D- mesh removal
....
🌹 after lap hernia repair with mesh, wound draining pus, your management:
A- explore wound + remove mesh
B- put surgical drain
C something + daily dressing ✅
.....
🌷patient has persistent pain after hernia repair, what to do?
NSAIDS then nerve block ✅🌹
....
• 45-year-old female developed hernia located inferior and lateral to pubic tubercle. Type?
○ Femoral✅
○Obturator.
InFerior = Femoral
-- ----- ----- -----
🌷Patient came after 5days of hernial repair complain of inguinal mass , there is no erythema , no tender and not associated with
cough , what is most likely the cause :
A) Serosa ✅
B) Hematoma
C) wound infection ‫مافي حرارة او الم او احمرار‬
D) recurrent hernia ‫مايطلع مع الكحة‬
...... ....
-🌷Surgery for hernia w/t mesh, complains of neuropain radiates to thigh, he’s already on analgesia and once he stop it pain come
back, not improve next?
A- NSAIDs.
B- Nerve block. ✅
C- Remove mesh
D- Remove stapes of mesh

Persistence pain after hernia repair & he’s already on analgesia and once he stop it pain come back, not improve so we go
to nerve block.
.... ......
🍒 Bilateral inguinal hernia, how to manage:
A. lap repair with mesh✅
B. open repair with mesh
C. lap repair without mesh
….
underwent hernia repair for right inguinal hernia, presented now complaining of that ipsilateral testicular size is decreased after
hernia repair. Dx?
A. Testicular artery occlusion.
B. tight mesh
C. pampiniform plexus compression✅
pampiniform plexus compression= lump in one of your testicles+ swelling in scrotum.
…..
🌹Lower limb paresthesia after hernia repair with mesh ?
A. nerve block ✅.
B. remove mesh
C. neurectomy ........
.....
🌹Elderly pt e hx ( .. months) of open hernial repair operation with mesh , complaining of groin swelling reach scrotum +ve cough
impulse how to manage ? A. Lap with mesh ✅.
........
🌹 Pedia no family with inguinal hernia, pedia surgeon advise treatment
A.Refer to police B.Refer to social worker C
. Ask ethical comity ✅🌹D.Refuse
........
🌹60 yrs old female with femoral hernia, asymptomatic, accidental finding mx?
A.observation✅
B.open
C. open with mesh
D.laparoscopic
.. .
🌹Old man came to you with Inguinal reducible hernia, and he was advised to do hernia repair, and PE exam was normal he is
asymptomatic what will you do:no surgical treatment
...
🌹Case of hiatus herni' and ask about immediate management: Lifestyle modific'tion ✅✅
….
🌹Making a few lifestyle changes may help control the symptoms and signs caused by a hiatal hernia. Try to: Eat several smaller
meals
…
🌹Pt do hernia repair "not sure about the type" then he present with mass in the inguinal hernia firm, regular, transpulsation "there
was no Erythema or tender"and no fever :
A. saphenous
B. psudoanyresm✅✅ C. Abscess
…….
#Pseudoaneurysm = A complication of laparoscopic inguinal hernia repair
…..
🌹year-old weight lifter developed abdominal hernia that is irreducible, tender. Imaging
shows air-fluid levels in small bowel and no free air in large bowel. Type?
A- Irreducible.
B- Incarcerated✅✅.
C- Strangulated
....
🌹incarcerated hernia is a part of the intestine becomes trapped in the sac of a hernia—the bulge of soft tissue that pushes through
a weak spot in the abdominal wall. If part of the intestine is trapped, stool may not be able to pass through the intestine.
...
🌹strangulated hernia occurs when the blood supply to the herniated tissue has been cut off. Pt like Toxic hypotensive tachy ....etc.
.....
4 y/o came to clinic w/t umbilical hernia without any Sx .., next:
A- Reassure ✅✅✅.
B- Surgery C- Band
… 18 year old healthy male was playing baseball and suddenly he felt abdominal pain. On examination he has para-umbilical
mass. His vital signs Bp 100/76 RR 30 HR 100 O2 sat. 95% oxygen mask. What is your(( next)) step in management?
A.Abdominal US✅. B. CT scan. C. Erect CXR. D. Reassurance and send home

Tumor:

🌹*S*clerotic lesion in distal femur:

A. o*s*teosarcoma ✅
B. chondrosarcoma
C. ewing’s sacroma
..
🌹old with weight loss epigastric pain with supraclav lymph node :
A. gastric cancer
.....
🌹Patient w incidental finding of macroadenoma of pituitary during evaluation of
her headaches, physical and medical hx was unremarkable, what’s the best
next step?
A. - ant pituitary hormone scan ✅
B. - Referral to neurosurgery
......
🌹Mid-thigh lump with normal overlying skin and (+ve fluctuating) test. diagnosis?
A. Lipoma B. Sarcoma C.Aneurysm D. Sebaceous cyst✅
...
🌹Patient came the weight loss and abdominal distention, Ct found: Soft tissue mass retro-peritonal , and multiply hypo-dense or
hyper (forget ) liver lesions :
A- liposarcome✅
B- germ cell tumor
C- lymphosarcoma
….
🌹what makes lymphadenopathy malignant more than infectious:
A. less than 5 y
B. duration less than 4 weeks
C. cervical lymphadenopathy
D. supraclavicular lymphadenopathy✅
....
🌹Old man has progressive dysphagia e mass in mid esophagus ,chest x-ray normal . What is the most likely cause A.
adenocarcinoman
B. SSC
C. Lymphoma
SCC > middle and upper Adeno > lower
= lower ‫ادينوا = دنوا لالسف‬
.....
🌹Man with high grade dysplasia of the esophagus. How will you manage?
Refer him for surgery
 ....
🌹Smoker with chronic dyspepsia, endoscopy biopsy is squamous cell with
low grade dysplasia, what is your management?
A. PPI and rescope every 6_12 month✅
B. Refer for distal Esophageal resection
C. Observe
....
🌹 Most common/important risk factor for esophageal cancer is:
B. Heavy smoking✅
D. Barrett's esophagus
.....
🌹Low grade dysplasia barrett's esophagus, what is the management:
A. Pantoprazole✅ B. ranitidine
b= p
....
🌹what is the most common small bowel cancer ? Adenocarcinoma
‫ادينوا = دنوا = صغير‬
...
🌹Epigastric pain diarrhea and peptic ulcer with + secretin ?
A. Gastrinoma ✅B. Carcinoid
....
🌹klatskin tumor= is cholangiocarcinoma located at bifurcation of common hepatic duct = CA 19-9.
....
🍓Pt known case of lung cancer and had history of (epilepsy) and on medication,
medication is contraindicantion to this pt ?
A _ nicotine replacement medication B_ Bupropion = epilepsy
......
🍓colon cancer surgery after that he had 7ml/h urine output for 8 hours , blood pressure and heart rate was normal what is the best
management :
A. 500 NS challenge✅✅.
B. diuretic. C. Inotropes
....
🍓23 ylo women Typical IBS scenario her uncle in 60s has colon cancer, all blood
labs normal except mild low Hb 11 (12-15) Ask about Dx?
A. UC. B. Colon cancer✅. C. IBD
.....
🌹Adult patient came to a clinic with a small mass on her forearm since childhood. Asking about the management:
A.Laser B.Excision
C.follow up ✅ D.radiotherapy
.....
🌹pt with hypertenstion and by ct abdomen show hypoechoic on adrenal gland = biopsy ‫حتى نتاكد هل هو خبيث او ال‬
.....
🌹if mass more than 6 cm do Adrenalectomy if less than 4 cm , usully observantion . 🌹
.......
🍒adrenal tumor with high cortisol symptoms next management :
A. Surgical resectio ✅🍒
B. Chemotherapy C. Radiation
......
🌹 Old man came with vague abdominal pain with 20cm×20cm mass , finding in u/s
multiple hypoechoic masses ( or nodule ? ) What is the diagnosis :
A) libosarcoma ✅
B) lymphosarcoma
....
🌹abdominal pain with 20cm×20cm mass , finding in u/s multiple hypoechoic masses
== libosarcoma
....
🌹Sarcoma metastasis to ? lung
.....
🌹Sarcoma Biopsy most Diagnostic test:
A. Incisional biopsy ✅
B. Excisional
C. Needle core
= incistion‫ساركوما = سكين = تقطيع‬

🌹Sarcoma "no incisional in choices "? Core needle biopsy

....
● Most important about retroperitoneal sarcoma :
A. compress over the organs . ✅
B. Met to the near organs

🌹 Sarcom' of the thigh. Whats the best imaging for staging work up?
- CT ✅ sarcoma = c.t = s=c
......
🌹pt with mass 2 cm away from anal verge on proctoscopy it appears cauliflower:
A. Anal cancer
B.Chondalymia acuminta ✅
C=c
...
🌹70 year old male Weight loss fatigue proctoscopy shows mass 2 cm from anal verge cauliflower like friable mass ?
A. anal ca ✅
B. rectal ca
C. colon ca
D. condylomata acu❌ (there is wight loss + mass )
.......
🌹Cancer in body of stomach with no metastasis and no lymph node =
A.gastrectomy
B. wide local local excision with clear margins ✅

Chest tube:

🌹by x.ray there is pneumothorax 2 cm :

A observanton ✅
B- chest tube
......
🌹Pt with trauma has mild respiratory symptoms, no deviation of trachea, ...etc (all mild symptoms) , What is the dx?
A- tension pneumothorax
B- simple pneumothorax✅
.....
🌹 25 years male involved in RTA in ER he is fully continues and no abnormality in vital signs admitted for observation and a
FAST scan done ,.what do you expect to find
A. Pneumothorax
B. major vessel bleeding in the thorax C. peritoneum free fluid✅
......
🌹Pt came to ER after MVA with multiple trauma and hypotension, tachycardia, x ray shows cardiomegaly and sternal fracture ,
Dx ? hemopericardium ✅
......
🍓Thoracocentesis , where to insert ( which rib) ? 9 to 10
‫ طويلة‬Thoracocentesis ‫كلمة‬
.....
🍎 Thoracocentesis: between 9 & 10 ribs midaxillary line.
🍎 Needle thoracotomy: 2nd rib space
....
🌹Elderly smoker with progressive SOB, on CXR massive Rt pleural effusion what's your next step?
A. Thoracocentesis✅
B. Intercostal tube under water seal
Thoracocentesis .‫ نطلع السوائل ب‬plural effustion ‫عنده‬
…
🌹 lateral pleural effusion ask about site of needle insertion ? 8-10
Latral = 10
....
🌹Case about pleural effusion on chest tube after a while there was blood in the water under seal (Hemorrhagic Pleural Effusions
and Hemothorax), how to manage?
A-Thoracentesis
B-Tube thoracostomy(chest tube✅ ✔️
C-thoracotomy
....... ....... ....
Patient had fall 50 meter, absent lung sound on the right side, CXR was
provided but not clear:
A. Intubate
B. Thoracostomy✅
....
🌹pt fall from hight and Vitaly insatable and Pic of Cxr with symptoms and signs of hemothorx and ask 'bout ttt :
Chest tube ✅✅.
Thor'cotomy.
Abx Anelgesics
chest tube‫ على طول عالجها‬hemothorx ‫معروف اول مانشوف‬
....... ....... ....
🌹A man presented with a gun shot wound in his chest that he received an hour ago, and you’ve done needle thoracentesis. 15
mins later 100 ml of blood is drained, what is the next most appropriate action?
A. needle thoracentesis
B. Thoracostomy✅
…..
🌹 Patient who had had multiple traumas in MVA, they mention presence of free
fluid in the abdomen and spleen laceration + thoracic aortic rupture. Next
A. Thoracotomy✅
B. Laparotom
...
🍓RTA , presented with slow breath and decrease breath sound left lower lobe lung xray picture showed infiltrate in lower left
lobe and he has lower limb fracture His blood pressure and HR was normal ,What is your management
A. thoracostomy tube✅
B. thoracotomy
C. angiography with stent
.....
🌹young adult was playing football with his friend, the ball strongly hit his chest, after sometimes he had SOB, what is the
diagnosis?
A-Pneumothorax
B-Pulmonary Contusion ✅ ✔️
C-Tension Pneumothorax
. .. . . .. . . .
🍓RTA pt in hospital with limited facilities Found to have tension pneumothorax and fracture femur You insert chest tube And
immobilize the fracture Pt stable Decided to transfer him To tertiary hospital , On the way to ambulance He suddenly collapsed,
What is appropriate next step?
A. Intubate.
B. Check chest tube insertion and functioning✅

🌹Patient involved in RTA was transmitted to near by limited facilities hospital and the physician decided to refer him to
advanced facilities hospital Patient is unconscious:What is the most important thing he should be maintain:-intubation ✅

🌹left hemithorax :
A. Chest tube of left hemithorax ✅
B. Needle decompression
.....
🌹A known Copd patient presented with sob but was not in distress vitals stable examination was normal.. no tracheal deviation
and equal air entry on both sides..cxr shows a 2cm pneumothorax.. wat will u do
A. Oxygen and observation
B. Chest tube✅
…
🌹Young patient comes with dyspnea and chest pain after a long flight. Upon examination: patient is tall, thin. CXR finding:
pneumothorax ,, .management:
A. Thoracocentesis (with effustion)
B. Thoracostomy tube ✅
C. Conservative management❌
Thoracostomy inicantiom =
Pneumothorax (spontaneous, tension, iatrogenic, traumatic)
Pleural collection - Pus ( empyema), blood (hemothorax).
...
🌹Patient with pneumothorax tube thoracostomy inserted after 15 min water seal bottle is filled with blood PB: 90/60 HR: 100
Rr:22 =
A- thoracotomy. ✅
B- thoracostomy tube

Thoracotomy is indicated when total chest tube output exceeds 1500 mL within 24 hours
.....
*Patinet who was hit in the chest while playing football, after it SOB, tracheal shift , hypotension and raised JVP , diagnosis : -
Tension pneumothorax ✅
intupation:

Child with CXR finding hyperlucency of upper left zone with compression of adjacent lobe with shift to the right, what to do?
A. thoracotomy
B. Thoracostomy✅
C. Intubation
....
Pt with small stab wound in anterior aspect of neck. On exam he is Alert
and conscious but in labs oxygen sat 82%. What to do
A. Oxygen mask✅
B. Cricothyroidotomy
C. Endotracheal intubation

🌹Proper ET position how to chick :

A. co2 monitor✅✅
B. chest movement.
C. easy insertion.
....
🌹RTA , facial fractures , unconscious, what is opportunity in mx?
A. Cervical spine. B. airway✅
....
🌹Multi trauma pt, with many facial fractures, next step?
A. secure airway ✅ B. C-collar

🍓man with facial bones fractures after RTA, in the ER what is the first thing to do?
A. Airway✅ B. Call neurosurgeon
....
🍓 man after accident and resuscitation in small hospital u need to transfer to another hospital after stabilization, it is 30 mins far.
on xray u see fracture of 2-5 left ribs. no pneumothorax what will u do?
a. intubate✅
b. call the other hospital to inform the surgeon on call
c. chest tube insertion
.....
🍓A scenario of a woman trapped in house that was burning and lost consciousness, Some labs were given which I can't recall.
How do you manage? intubation🍓
.......
🌹 Case of flail chest ask about initial thing to do? he was stable
A. IV fluid B. Assistant ventilation✅
....
🌹40 something old pt came with anterior thigh stab wound 1 cm with active bleeding and ((unconscious)), most appropriate Mx
(I’m not sure if it was written most next appropriate mx or not but i think it was not written)
A. apply tourniquet
B. Blood transfusion/ IV fluid
C. intubation ✅✅
.....
🌹patient with trauma to face with fracture mandible resuscitation with?
A.laryngeal mask
B. cricothyroidotomy ✅✅
C.Oral endotracheal tube
..
🌹Mva with mandible fracture = Cricothyrotomy
…
🌹After an accident 18 yrs fracture of mandible and maxilla oropharyngeal tube / tracheostomyhow we improve breathing?
cricothyroidotomy
.....
🌹Absolute contraindications for NG intubation include the following:
1_Severe midface trauma. ✅
2_ Recent nasal surgery.
......
🌹Chemical product burn ttt ulcer in back =
A. wash with water for 30 mints ✅ B.intubation
C.dressing
.....
3_Burn on the face , GCS 15 he was alert and speaking. the two striking choosies were=
a. Elective intubation✅
b. ICU admission for 24 hrs
‫ربط = اغلب عمليات الوجه تكون اختيارية‬
.....
Face burns expose patients to a higher respiratory risk, and early prophylactic intubation before they enter the burn unit might be
life-saving✅
.....
Pt had chest trauma nad 3⁄4 rib fracture paradoxical chest movement? ‫يعني فيه كسر عظم الصدر نص‬
‫مكسور ونص ال‬
•analgesia
•intubation and ventilation are usually required or high concentration oxygen by mask...
. ...... ..... ......
🍒 Patient after RTA was conscious GCS 15 then suddenly collapsed u see a temporal fracture what caused his loss of
consciousness
a. subdural hematoma
b. epidural hematoma✅
c. fracture base of the skull
…
🌹(( temporal fracture )))what caused his loss of consciousness?
B. epidural hematoma ✅
....
🌹Young male with bilateral anterior without post lower limbs 2nd degree burn who weighs 70 kgs Asks about fluid replacement
according to parkland formula:
A. 2.5L to be given in the first 8 hrs and 2.5 L in 16 hrs✅
B. 5L in first 6 and in 16 hrs
parkland form= ‫نستعمل‬
4ml x TBSA (%) x body weight (kg)
‫ نقسمها على اثنين عشان‬5040 ‫ تساوي‬4 ‫ نضربها بالرقم الثابت الي هو‬70 ‫ نضربها بالوزن الي هو‬18 = ‫ االثنين مع بعض‬٩ = ‫الوحدة فيهم‬lower limp ‫ال‬
‫ ساعات‬8 ‫ يعني اثنين لتر في اول‬2500 ‫ ساعة فتساوي‬1٦ ‫ ساعات والجزء الثاني في‬8 ‫نعطي اول جزء في اول‬
...
🌹pt with 20% back burn which indicate good response== Urine output 0.9/kg/hr
...
🌹Burn case black soot over nostrils and mouth 40% carboxyhemoglobin.
(Carbon monoxide toxicity):
A. Hyperbaric oxygen. ‫ نعطيه اوكسجين كثييير حتى يطلع‬co
B. Intubation and ventilation with 100% o2. C. Carbonic anhydrase inhibitors.

Skin
Dibetic has progressive painful lump on back of neck with multiple openings :
A. cellulitis B. Abscess C. Furuncle
D. carbuncle ‫مرض السكر = كرب‬
......
🌹diabetic patients with unhealed ulcer for 5 years and biopsy showed pseudoepitheliomatous hyperplasia.
A. Biopsy B. Debridement ✅
.....
🌹Patient with liver mass Ct first stage filling periphery late washout centrally :
A-Hepatoma
B-hemangioma✅
C-metastatic
......
🍒-25yr old girl with skin lesions since childhood=
-Laser -Excision -Observer✅
....

🍒Open fracture came 4 days later to ER with signs of infection ( blue, necrosis) what's the most common organism ?
clos‫ هو‬necrosis ‫البكتيريا الي تيجي بسبب الجرح المفتوح وعدم اهتمام بنظافته وفيه عالماات‬
A-clostridium✅🍒
B- Staph aureus
C- Actinomyces israelii
.....
🌹 case about gas gangrene due to open leg fracture infected by? Clostridium perfringens
.....
🌹Case of melanoma = Excsion with safety margins
.....
Sarcoma > incisional biobsy
Melanoma > excisional biobsy
....
🌹Skin lesion irregular and dark over the knee = excisional biopsy ✅
.....
🌹 Old patient with 3*4 dark elevated skin lesion at the ant of his thigh, what’s the next appropriate step? A.excision ✅
B.Punch biopsy
C.Chemotherapy
.....
🌹 girl complains of rash in perianal area with pic provided (typically the same) Dx: molluscum contagiosum
. ‫ جبت لكم كذا صورة عشان يتركز شكلها عندكم‬، ‫شكلها مثل الحبوب الصغيرة‬
.. ‫ المول سار ملوث بال‬، ‫ معناها ملوثة‬contag ‫ معناها حبيبات صغيرة و‬moll ‫ = كلمة‬molluscum = ‫ربط‬
. .. . . . . .
🌹ptient fall on his leg with skin loss vascular structure appear and ask 'bout ttt :
Debritment and 2ry skin graft ✅✅ Debritment 'nd prim'ry closure Abx
‫ ونغطي فيها الجرح‬skin graft ‫ معناها الجلد ماهيقدر يقفل على هذا الجرح الن جدا عكيق فالزم ناخذ‬vascular appear ‫ في الجروح ؟ اذا‬skin graft ‫متى نلتجا الى‬
... . .. .
🌹Run over case, exposed neurovascular, most appropriate mx?
B.debridement + vacuum
C. debridement + graft ✅✅
....
🌹patient with post operetive 'abdominal destintion and small and large bowel obstruction and no fever 'nd a'bdomen not
tender :
Hypo Mg Hypo CL Hypo k ✅✅
= low k ‫ شلل االمعاء‬Ileus ‫كلهم صح لكن اكثر شيء يطون سبب في‬
. . .. . .
🍓 What's the cause of pain in compartment syndrome?
• Nerve ischemia✅✅ • Muscle enlargement • Bone ischemia
....
🍓55 pt present to the ER after a car accident, there's a pic of CXR show aortic dissection and lung contusion , what’s next step :
A. chest tube.
B. aortic repair and stent✅
....
🍓 Patient lost sensation over medial side of leg but motor function is intact.
Which nerve is injured?
A-Obturator
B-Femora
C-Saphenous✅✅
D-Sciatic
.....
🌹lost sensation over = Mid thigh = obturator
🌹lost sensation over = medial side of leg = saphenous
......

Diaphragmatic

🌹Child Diaphragmatic hernia first thing you do? NGT first thing to do after stabilization 🌹
.....
Newborn just delivered having diaphragmatic hernia , what’s the first thing to do: NGT
......
Diaphragmatic Hernia
Treatment
1_ immediate intubation required at birth: DO NOT bag mask ventilate because air will enter stomach and further compress
lungs.

2_ place large bore orogastric tube to decompress bowel.

......
Weber in right and bilateral + rinne test?
A-conductive hearing loss
B-right schwannoma
C- right presbycusis
D/ Left sensory ✅

Positive rinne = normal or sensorineural

Weber shift to right so it’s either right conductive or left sensorineural

🍓Colon cancer common metastasis to? A. Liver✅ B. Lung

‫ربط = القولون والكبد = كلهم من اجزاء الجهاز الهضمي مسؤوليين عن االكل‬
.....
🌹Patient complained of Rt groin pain for 2 weeks and exacerbated by exercise,
physical examination showed normal groin and genitalia, next step?
A. CT abdomen
B. MRI abdomen
C. Us
D. Re-evaluate after 2 wks✅
‫قالك انه يزيد مع الرياضة ف غالبا حصل للعضلة شد‬
overstretching the muscles during sport.t'
‫مايحتاج اشعة‬
....
🌹Pt diagnosed with small cell lung cance, presented with dehydration, serum osmo low, urine osmo high. ‫ هذه اعراض الجفاف‬. Ttt:
A. 5% dextrose
B. Normal saline✅
C. Hypotonic saline
…
🌹Male have problem initiating urination , bladder fell un empty after , no dribbling or ((urge felling)) , type of incontinence ?
A. Overflow✅ B. Reflex C. Urge
...
🌹 Bradycardia (40 bpm) during laparoscopic procedure Is due to :
A. Cold gas insufflation
B. Rapid expansion of parietal peritoneum✅
C. Increase venous return
.....
🌹60 years old patient come with sudden onset of upper abdominal pain after a few bouts of vomiting. Examination confirme sick
patient with tenderness in epigastrium and supraclavicular subconscious emphysema . What’s Dx ?
A. esophagitis
B. acute gastritis
C. perforated peptic ulcer
D. boerhaav’s syndrome✅(is spontaneous perforation of the esophagus )
subconscious emphysema ....‫الن قالكم‬
.....
🌹Pt k/c of CKD undergo apendecyomy K was 6.5 with tened T wave ??Calcium gluconate
....
🌹 Pt with dysuria and cloudy urine with bubbling for 2 months, hx of recurrent left iliac fossa pain for the past 2 years !
Colonoscopy: no diverticulosis or polyp Cystoscopy: erythema on dome of the bladder. Most likely diagnosis:
A disease Diverticular. ✅
B. sq. Cell bladder cancer C. transitional cell bladder cancer
...
🌹Female with history of regurgitation and heartburn.. all conservative management failed include PPI ..endoscopy done showed
erythema and erosion suggest esophagitis
A. manometry
B. 24 h PH monitoring✅
C. Lifestyle modification
.....
🌹45yo female has dysphagia with liquids only retrosternal pain and regurgitation of food, what is the test of high diagnostic
value?
A. UGD.
B. . Barium swallow.
C. Low esophageal manometry.✅
D. CT with contrast
....
🌹Patient had a hyperextension trauma, complains of distal phalanx pain and tenderness in the volar aspect, he also feels
tenderness in the palm, what's the dx:
A- Rupture of flexor profundus✅
B- Rupture of flexor superficialis
C- intra-articular fracture of proximal phalanx
D- extra-articular fracture of distal phalanx
Memorize them as follow :
Proximal > superficial.
Distal > dee
......
🌹50 male came with 4 time hematochezia , no weight loss , no abdominal pain dx:
A- diverticulosis ✅
B- internal piles
C- cecum cancer
....
🌹patient on TPN will increased INR what to give= vit K

🌹Perforated appendicitis post laparotomy, presented with fever, abdominal pain CT done showed foreign material ,
reexploration done, gauze was found intraabdominal ،What to do?
-Issue complaint against assistant
-Call your lawyer and report the incident
-((apologize to the patient and tell her what happened ✅))
……
● Patient with jerky carotid?
A. Hypertrophic cardio myopathy
…..
● patient came with melena and they did upper gi endoscopy and found 1cm
bleeding duodenal ulcer and they ask about the duration of ppi ?
A. oral ppi
B. iv ppi for 24 hours then convert to oral
C. iv ppi for 72 hours then convert to oral✅
....
● Patient post graham patch surgery, what is the most appropriate management?
A. High dose PPI
B. IV ppi for 24 hours followed by oral PPI
C. IV ppi for 48 hours followed by oral PPI✅
…..
6 yrs old, female presented with nausea and recurrent vomiting of every intake , pt became lethargy with decreased skin turgor
and cry with tears. Investigation revealed Normal investigations apart from :High Na Low glucose What is the best next
management :
A. isotonic saline 20ml/kg ✅
B. D10% with 1/2 saline
C. ORS
…
Hypovolemic Hypernatremia First correct the volume with half normal saline then once the
patient euvolemic shift to slow D5W infusion.
….
Old man with slow progression dysphagia, came with vomiting without blood, abd pain associate with heartburn at eating. Abd ex
normal DRE revealed slightly
change stool with blood. What is suspected diagnosis :
A. PUD.
B. CA esophagus. ✅
C. CA rectum
….
Young female c/o fatigue and jaundice high ALP and high bilirubin Us: no any finding MRCP : multiple stricture Next step to
*confirm* Dx ?
A. Liver biopsy✅
B. Antinuclear antibody
C. Repeat US
D. Colonoscopy
…..
Case of established diagnosis of biliary sludge of postoperative sleeve pt with jaundice and US report of biliary sludge. What is
the management?
A. Expectant.
B. Endoscopic sphincterotomy
C. Cholecystectomy✅
….
What is the Pathophysiology of bacterial peritonitis due to E. Coli
A. translocation of bacteria
B. bowel Perforation✅
….
young male k/c of ulcerative colitis c/o bloody diarrhea, abd pain and S/s
of intestinal obstruction X-ray shows: megacolon What is appropriate management:
A. CT abdomen
B. Ileocolectomy with.
Answer is : IV steroids
….
65 male patient present with SOB and generalized fatiguability, On Ex: non tender mass in right iliac fossa, Hemoglobin: low
What the most important step in Mx:
A. colonoscopy ‫✅اشتباه ب ورم في القولون‬
B. Percutaneous biopsy
C. Abdominal CT
D. Ultrasound
…..
Surgeon at elective laparoscopic cholecystectomy find large mass in
Stomach=
A. stop oper
B. cholecystectomy only ✅
C. chlesrecomy and resection mass
….
Patient underwent esophageal dilation. After 12h patient had symptoms and they did gastrografin which showed leak.
Temperature is 39. BP 100/50*=
A. Stent
B. Esophagectomy
C. Surgical drainage✅
(esophageal rupture treat by Tube thoracostomy (drainage with a chest tube or operative drainage alone)
…
● neck mass LN FBA normal thyroid cell dx A. Follicular ca C. Papillary ca D. Ectopic✅
…
● *Sacral ulcer, skin necrosis and exposed subcutaneous fat manage?*
A. Debridement with dressing
B. Debridement with primary closure
C. Debridement with secondary closure graft✅
…
*Penetrating stab wound. Patient is stable. What is the next step*
A. US. B. CT✅
….
● Case of cystic fibrosis Wit abd pain , bloating , pale stool Abd scraled or curve
A. Chronic pancreatitis ✅
B. Acute pancreatitis
C. Pseudocyst
…
Patient claudication long case, then after full treatment with thrombolysis, patient is risk for what while staying in hospital?
A. Stroke B. PE✅ C. MI
…
Scenario Liver mass 3 cm next with splenomegaly
A. AFP
B. triphasic CT ✅
C. Biopsy
..
Epilepsy pt posterior dislocation, which joint? A. Subacromial
…
Tamoxifen for breast ca the came with abnormal uterine bleeding or something
like that??
A. Endometrial ca ✅
B. Endometriosis
…
Patient has crushed by a car came with 10cm deep laceration of his thigh with continues bleeding what you will do
A. tourniquet
B. compress at the site of the injury✅
C. compress the femoral area
….
Same scenario but with out mentioning of the depth and the patient were Hypotensive
A. normal saline
B. compress the site of the laceration ✅
.......
Meigs syndrome How to confirm the Dx?
A. Tissue histopathology ✅
B. Tumor marker
‫ = هستوا = قستوا‬megis= ‫مقاس‬
…
Old pt after hysterectomy what may cause her to stay more in the hospital? Her
UO is 35ml per hr =
A. Decrease oral fluid intake
B. Decrease urine output✅
N.B :35ml/h = more than 800 per days Oligouria < 500m
…
Patient has hx of rta since 2 weeks came today with sob the chest x ray has
shown haemothorax you have put him on chest tube and want to transfer him to higher center while he was in the ambulance the
pulse oximetry drop suddenly what to do
A. continue the journey to the higher center
B. check the potency of the chest tube✅
C. triphasic chest intubation
…..
Sigmoid volvulus case (s&s), ttt:
A. total colectomy with ileostomy
B. sigmoidoscopy detorsion if stable✅
….
Hepatitis B and lesion 6 cm what to do next?
A. TACE Transcatheter arterial chemoembolization) ✅more than 5
B. Excision
C. systemic chemo therapy
…
24 years old with history of appendectomy 5 years ago present with abdominal pain , distintion , vomitting for 3 days Ct scan
show obstruction signs And peritonitis , Whats contraindicated in this patient ?
A. Propofol.
B. Ketamine.
C. Sevoflorane.
D. Nitros Oxide✅
….
🌹 patient with s&s of bowel obstructions, investigations shows air fluid level and
dilated loop and colon collapse , asking about what drug is C/I?
A. Propofol
B. drug started by *sul* I think.
C. nitric oxide✅
…
🌹A baby boy came for circumcision in the clinic. The urine was coming from the mid shaft (I think hypospedias) what to do
next?
A. open circumcisio
B. plastibell circumcision
C. circumcision with gomco
D. refer to pediatric surgery✅
…
🌹What is associated with Biliary colic?
A. Bilirubin
B. Amylase
C. Alkaline phosphatase.
D*cholecystokinin*✅
…
🌹 pt. k/c of crohn's after colon surgery developed severe diarrhea what you will give ?
A. mesalamine. B. cholystaimne✅
…
Patient post-surgery came for follow up develop seroma near the wound or superficial can't remember ( no pain, no erythema, no
any sign of inflammation) what your management is:
A. percutaneous drainage.
B. daily dressing✅
…
🌹55 year old with constipation and distention, on examination there is , CXR pic with coffee bean appearance, where is the site
of obstruction?
A. Ceccal B. Sigmoid✅
…
🌹Euvolemic hyponatremia fluid replacement:
A. Normal saline
B. Half normal saline
C. Hypertonic saline
D- Water Restriction✅
…
🌹Post colectomy for colon cancer she is Diabetic, received dextrose and
Insulin for 2 days, then she developed confusion and agitation. Lab :
hypoNA hypoK, urine osmolality normal, serum 270. Most likely cause?
A-Water overload.✅
B-Addison disease.
C-SIADH
…
🌹What of the following pass through deep inguinal ring:
A- Round ligament✅
B- illo-inguinal nerve
….
🌹burn patient and resuscitation done, which of the following reflect a good
resuscitation has been achieved?
A-normalization of heart rate B-normalization of blood pressure
C-Urine out of 0.6ml/kg/h ✅
D-central venous pressure 12
…
🌹Birad 3 =Follow up for short time. F = 3
🌹Birard 4 = core biopsy 🌹 core ‫اربع حروف‬

Core needle biopsy showed atypical ductal hyperplasia.=wire surgical excision.

🌹 Intraductal hyperplasia in patients with breast cancer family history=wire excision = ‫قناة نجيب لها وير‬

🌷 ULQ lump increasing with time, size 15x15 cm, us show solid mass
with multiple cystic spaces with posterior costic enhancement== (PHYLLOID TUMOR) == simple mastectomy🌹

radical mastectomy complaining of loss of sensation in inner side of right arm= Inter-Costo-Bracial nerve ✅
Inter = inner Costo = mastect Bracial = arm
‫ربط= رايت =براكيال‬

🌷lactating came with mastitis with abcsess 5 cm tx?

A. I&D ( for abcsess)✅

🌹Acute mastitis organism =staph aureus🌹= ‫ماستيتس = ماستيكا = تتعرض للستاف والهواء كثير‬

🌷mastitis alone treat by = Antibiotic🌷

🌹Lactaional mastitis case = oxacillin with continu breast feeding 🌹

‫ =ربط‬O ‫ = بريست‬x

🌹showed BIRADS IV, your next step == Core biopsy

…….
🌹Breast mass 2*2 describe as Oval shape painful:= . breast cyst

🌹Oval with smooth surface 2*2cm not painful = fibroadenoma

🌹recent mass in right breast which is mobile = fibroadenoma

‫ له ثالث عالمات مهمة أوال ترتبط بالهرمون وخاصة باالستروجين يعني كل مازاد‬fibroadenoma ‫ هو ان‬fibrocyst ‫ و‬fibroadenoma ‫الفرق بين‬
، menstrual cycle‫ او قبلها ب أسبوع وتختفي او يقل حجمها بعد‬menstrual cycle ‫ لذلك غالبا يجي في وقت‬، ‫االستروجين يزيد حجمها وكلما قل يقل حجمه‬
‫ من اسمها‬mobile ‫ اذا ضغطت عليها تحس بالم وماله أي عالقة بالهرمونات ثالثا‬cyst ‫ مافي أي الم لما تضغط عليها عكس‬painless ‫ثاني شيء انها‬
firm or smooth‫يكون سطحها‬adenoma ‫ ال‬. ‫ ثابت من اسمها كيس = تابت ما تتحرك‬cyst ‫الكتلة تتحرك لكن‬adenoma

🌹 no family Hx of breast ca , mammogram normal When to do next mammogram = 2year = ‫ حرفين‬mm= 2

🌹 left breast mass with bloody discharge most important next step? Bilateral Mammo
🌹pregnant came with bilateral breast tenderness and mass what
investigation you’ll do? A. US ‫هنا حامل المامو ممنوع‬

🌹breast mass behind nipple, on US there is hypoecoich lesion, what next :

A- FNA ✅✅ B- core biopsy C- exicional biopsy D- reassess after ...
‫نبدء باالسهل‬

🌹increasing breast mass 3 to 4 cm =Bilateral ultrasound🌹 ‫حامل‬

🌹breast mass, periareolar, nipple pulled inside, unilateral what next step:
first breast imaging, then biopsy, then staging 🌹

🌹37 y/o Female with family hx of breast cancer complain of breast mass , She was concern of breast cancer by ex of there was a
breast mass with skin tethering Which of the following is the most important next step ? D.US ✅✅ ‫اقل من اربعين‬

🌹for breast examination but she wants female doctor to examine her what you will do: A. refuse B. respect ✅

🍓breast pain pre menses by 3 day Px no rmal next = reassurance.

🌹strongest risk factor of breast ca in female : age

🍓strong family hx of breast come with identified breast mass what next
mamogram

🌹young woman has painful breast lump with redness and tenderness. Vitals are given and show T 38.9. What will u do?
a. incision and drainage✅

🌹 invasive intraductal papilloma. The most appropriate management is= Wide local incistion.

🌹Patient with bloody stained nipple discharge, you’re suspecting intraductal papilloma. What’s the next step? Excision ✅ ‫نشيل‬
‫فقط القناة الي فيها ورم‬

🌹Color of discharge in intraductal papilloma ? A. Red

🌹duct ectasia, color of discharge=Green 💚

Ductal papilloma : red ❤️

🌷 breast biopsy shows intraductal papilloma what will u do

a. breast preserving✅ (Surgical excision of involved duct to ensure no atypia with breast preserving)

🌹Management of atypical ductal hyperplasia?

A. Wide local excision
‫ الي فيها سرطان واالنسجة الي حولها السليمة‬Duct ‫ فالغالج نشيل هذه‬Duct ‫قالك ورم في‬

🌹 32 yo I think female concerned about breast cancer, because her mother

have it and her sister has ovarian cancer. What to do?
BRACA

1 phylloid tumor: Phelloid Tx:

If he say in the case Benign > WLE
If he say in the Case milgnancy>Simple mastectomy
If he say Suspescion > You should start Mx as it Benign By WLE ‫اهم كلمة في المرض هذا لما يقولك‬

mass that has been increasing in size

🍒Benign breast phyllodes tumor = Wide local excision🍒‫فيل رجله واسعه‬

🌹4-5 cm malignant phyllodes mx? A.simple mastectomy B. wide local excision 🌹✅

🍒Malignancy phyllodes tumor = Simple mastectomy 🍒‫الن خبيث الزم استئصال‬

🌹years lady with breast lump 2*2 i think for year suddenly the mass increased in size? phylloids

🌹Case showed cystophylloides breast treatment=

a. wide local excision ‫الن قال كيس‬

🌹Lady breast mass 2 years ago but 6 month ago started to get bigger, mass well defined mobile not attached diagnosis =
phyllode✅

with painful breast mass since 6months. It get increased.it is in the outer upper surface (around 9 clock) Histopathology confirmed
a benign What is the best next step?
Wide local excision

hard, mobile, well-circumscribed painless left breast mass that has been increasing in size=Phylloid

🌹Pt with malignant phylloid tumor what is next? A.Contrast ct of chest B.pet scan

🌹women with 11*12 breast mass, examination showed no palpable LN. Core biopsy was taken and showed malignant phylloid
tumor, what’s the next appropriate step? A.WLE B.PET scan C.Chest CT witout contrast

pancreatitis:
🌹typical pancreatitis: epigastric pain, high amylase what is next step? A. US B. CT scan

🌹high amylase + k/c of gallstone what you will do next? A. US

🌹 signs and symptoms of cholangitis of biliary pancreatitis, q was "What is the most important initial mx"? D. IV fluids

🌹Scenario of abd pain post meal with a hx of pancreatitis month ago Fluid collection found what is it? Pseudo.Cyst

🌹 Pancreatitis 5 weeks ago. Now she has epigastric tenderness and cannot tolerate food with vomiting each time. By ultrasound
you found large about 12X10 mass With thick wall and fluid inside. Labs: 346 amylase, Wbc 15k. What is the diagnosis?*
A. Pseudocyst B. Abscess C. Walled off necrosis✅

🌹 chronic pancreatitis what you will find= increase lipolysis

🌹 Chronic pancreatitis what you will find? hyperglycemia, hypocalcemia+increase lipolysis

🌹40 years old woman with no pain but you noticed jaundice. She has high direct bilirubin and high ALT what is your diagnosis?
Carcinoma in head of pancreas ✅

Pt with pulsatile epigastric mass and ask about investigation:

Serum k, Serum amylase ✅.

Diffuse guarding and sluggish bowl sound amylase was hight what is the next step:
erect chest xray✅. abdominal xray CT abdomen
‫صوت االمعاء نسمعها بالصدر معناها حاصل ثقب‬

🌹 case of acute pancreatities : Iv fluids and analgesic Abx

🌹 Diagnosed case of acute pancreatitis. Received IVF + analgesic Next step?Urgent surgical consult'tion✅✅

🌹 30 y/o Cystic fibrosis with GI Symptoms? what complication he might have?

A- *Acute* pancreatitis ✅ ✔️ B-Chronic Pancreatitis

1 pancreatic pseudo cyst

Most pseudocysts resolve without interference and only require supportive care. For some, drainage is indicated.

best method for pancreatic pseudocyst drain =Endoscopic

🌹 Treatment of *Infected* pancreatic pseudo cyst: Percutaneous drainage ✅

endoscopic‫ وهي‬cyst ‫ غير كذا دايم اختاروا افضل طريقة نشيل فيها‬percutneus ‫ اختاروا‬cyst ‫اذا قالك انفكشن‬

🌹 Patient recovered from acute pancreatitis episode , presents 6weeks after with vomiting and epigastric fullness CT
done:showed cystic collection behind the pancreas what is the most likely dx:(no fever)
A-Pseudo cyst ✅ ✔️ B-Pancreatic abscess C-Pancreatic necrosis

🌹 pancreatic pseudocyst, one is 18 cm x 24 cm , how to manage ?

A- per cutaneous aspiration B- endoscopic drainage ✅

Pancreatic pseudocyst ttt:

- less than 6 cm and 6 week > observation
- more than 6 cm and 6 week > drainage

* Percutaneous catheter drainage for (( *infective* pseudocysts )) .

* Endoscopic drainage = ‫ ما عدا انفيكتف‬، ‫ هذا عادي نستعملها مع كل المرضى‬.

🌷 Pancreatic pseudocyst 5 week and 18 cm ? A. Medical B. Surgical ✅ ‫ سم‬٦ ‫اكثر من‬

🌷-Pancreatic pseudocyst if there is sign of infection as fever and leukocytosis do Percutaneous drainage

🌹 Alcoholic pt has severe abd pain radiate to back ?

A- stomach cancer B_ alcoholic pancreatitis✅

🌹 Gray turner sign= its sign of Necrotizin pancreatitis = causes of =abdominal hemorrhage (bleeding) 🌹 ‫جراي = اجري عشان تقوي‬
‫عضالت بطنك‬

🌷 Poor prognosis of pancreatitis:

A. Hematocrit ✅✅ B- Amylase above something
‫هي مات = مات = عالمة سيئة‬
🌹Epigastric pain radiate to the back x Ray normal, high amylase, ct showed pancreatic swelling, what is this complication?
pancreatic pseudocyst

🌹Old with painless jaundice . Us show dilated gall bladder,intra and extra hepatic bile duct . Ask about dx :- A. Klutskin Tumor
B.Pancreas Adenocarcinoma

🌹Pancreatitis first first step = IVF 🌹

🌹Case of pancreatitis Admitted, given ivf and pain killer Next to add in managment? A.Ppi B. Antibiotics C.Urgent
surgical consultation✅

🍓13X15 pseudo cyst of the pancreas in the lesser sac Patient vitals showed high temperature treatment: A. endoscopic. B. per
cutaneous✅ ‫الن انفكشن‬

🌹Pt. With pictures of pancreatitis ( epigastric pain + high amylase) hxof gall bladder stone ,Next important initial step ? A.
Crystalloid fluid iv ✅. B. ERCP. C. US

Pancreatic pseudocyst classical presentation. No signs of infection, there was 15×16 cm fluid collection in the lesser sac. What is
the management?
A. Imaging guided aspiration B. Surgical drainage C. Cyst excision D. Endoscopic fluid aspiration.✅

🌹 A 50 year old man presents with progressive jaundice, dark urine, and right upper quadrant pain and distention. On physical
examination he has a palpable gall bladder. Imaging shows an enlarged gall bladder and dilated Intrahepatic duct. Amylase = 481.
diagnosis is A. klatskin tumorn B. Pancreatic cancer ✅✅C. Cholecystitis D. Mirrizi’s syndrome

complication of pancreatitis after conservative treatment was done: : Pancreatic pseudocyst

🌹pt had pancreatitis and gall stone , had been managed with fluid and stable what to do :
A. Cholecystectomy at the same admission ✅✅B. Cholecystectomy after 4-6 weeks
N.B: Acute biliary pancreatitis: First resuscitation specially IVF.
Then : ERCP (stone extraction) followed by lap chole. Abx not indicated unless severe necrotizing pancreatitis. If it was mild,
moderate: lap chole in same admission.
Severe: lap chole in 4-6 weeks.

🌹Carpal tunnel syndrome

🌹Carpal Pain directly at the incision is typically only present for days or weeks after the surgery. Protecting the incision can help
alleviate pain, and it's important to avoid lifting or gripping for several weeks after carpal tunnel surgery. ... Treatments for pillar
pain may include rest, massage, and hand therapy
🌹Carpal tunnel syndrome still in pain after surgery?
A- Physiotherapy✅. B- Analgesia. C- Open again
‫هو انه االلم يستمر بعد العملية وممكن كمان اشد من االول‬...... pillar pain carbal tunnel =

🌹Patient has nerve radial injury , where level of injury ? spiral groove humerus 🌹
...............‫ = راديال ريدي = هل انت ريدي مستعد للهجووم ؟‬radial = ‫ = هيوميرال = هجوووم‬humeral = ‫ربط‬

🍓Patient had loss of sensation on the snuff box and dorsum of the medial hand, hehad wrist drop. At which level is the radial
nerve injured? A. Axilla. B. Humerus groove✅ C. Olecranon D. Carpal tunnel.
Snuff box> radial> spiral groove of humerus
humeral = humen .

🍓Paraesthesia and numbness with wrist drop (shows radial nerve injury) at which Part A. Groove of the humerus ✅. B. Carpal
tunnel. C. Olecranon
Wrist = Radial.

🍓Typist c/o tingling and pis in left thumb, index and middle & problem in dorsiflexion and fingers extending which nerve
affected ? A. Median. B. Radial ‫✅ي‬

Patient with pain when writing at keyboard, some test showed hypoperfusion
to superficial palmar arch, what’s the artery affected?‫يسال عن الشريان‬
A. ulnar.

🌹Thenar muscle atrophy ? Median nerve🌹

🌹Female complaining of tingling sensation in her ring finger increase when she raise
her hand , in the examination positive arm elevation test = A) carpel tunnel syndrome ✅
rise hand‫يرفع يده للسماء يدعي‬carp ‫ربط= كرب‬

🍒 Pt do surgery then Loss of sensation in ear pinna and upper neck what nerve is injured ? Great auricular nerve
:)‫ عشان المجوهرات‬pinna ‫ جزء الكبير والمهم في االذن هو‬great ‫ و‬، ‫ = معناها اذن‬aurical ‫ربط‬

🍒 Numbness on thumb and index finger what is the nerve affected? Radial nerve

🌹Male with left little finger and(( ring numbness)) or pain , rais stress test increases the symptoms, what’s dx: =. thoracic plexus

🌹Athlete with pain during standing PE: tenderness in medline planter sarface== plantar fasciitis.
 1Gallbladder

● Most common cause of biliary colic

A. cholydocolithaiasisis B. Gallstone✅

An elderly with IHD day 2 post cholecystectomy presented with sudden chest
pain SOB and vitally hypotension and tachycardia whats best ?
A. . CXR. B. ECG. C. CT angio✅✅ D. LL duplex US

Cause of biliary colic?

A. Choledocholithiasis B. Gallbladder stone C. Gallbladder sludge✅✅

● pt with typical cholecystitis Mx? A. immediate lap chole ✅B. wait

🍓what’s the common cause of cholesterol gallbladder stone : A. obesity B. rapid weight loss✅✅

🍒 Colicy abd pain with dilate CBD and intra hepatic duct causes of pain?Construcion of Sphincter of Oddi

Abdominal pain and US show stones in gall bladder with(( normal wall ))what is the management ? a) Lap chole b)
Ursodeoxycholic ✅

🌷Ursodeoxycholic Acid, is a naturally occurring bile acid and is used to dissolve gallstones that are rich in cholesterol. It is also
used to improve the flow of bile in primary biliary cirrhosis.

🌹Old man came with jaundice and dark urine , palpable gallbladder , lab shows direct belirubin =A) klatskin tumor. B) Perihailar
tumor. C) CBD stone✅✅

🌷30 y/o male patient presented with abdominal pain related to meals, radiated to the back, labs resulted high amylase, U/S
showed bile sludge with no gallbladder stones were notified, no CBD dilatation, what’s your management?
A.Labroscopic cholycystectomy . ✅✅ B. Endoscopic U/S C. Endoscopic sphenoidotomy

🌷Patient during complicated lap chole the surgeon accidentally transected the CBD (common bile duct( above the level of cystic
duct, what’s your management?
A.hepaticoduodenostomy. B. hepaticojejunostomy ✅ C. choledocho- duodenostomy.

🌷Lowest risk for cholesterol gallstones

○ Nulliparity ✅

🌷pt. With RUQ pain, US showed fluid around gallbladder, management:

A- US guided aspiration ✅ B- lap choly

🌹Recurrent RUQ pain aggregation with morphine, temperature 36.5 ?

a) Biliary colic ✅ ‫ نستخدم بديل له ميبرادين‬، ‫دواء المورفين يزود جدا االلم وال يخففه‬

🌹Pt came to ER with ruq pain and jaundice, with fever i think, 2 h later patient improved, us showed multiple gallstones within
normal walled gallbladder, management: A. lap choly✅ B.follow up C.ursodeoxycholic
🌹Pt post PTC has fever, on PR exam ant. Boggy mx ? A. Percut. Drainage ✅B. IV Abx (if small)

🌹 RUQ pain on US Dilated common bile duct with intrahepatic biliary dilatation , what is the cause ? A. cholelithiasis(gallstone

🌹 Patient with jaundice, abd pain and on US u see stones and dilated CBD vitals show fever only asking about diagnosis...
a. ascending cholangitis✅ b. choledocholithiasis c. cholecystitis
Cholangitis is an inflammation of the bile duct system ( dilated CBD so inflammantion on bile duct).

🌹Pt with DM and HTN and SCA , type of gallbladder stones will form?
A. Mixed B. Cholesterol stone C. Pigmented >> IF SICKLER✅

🌹Diabetic obese elderly female with sickle cell trait has Lithiasis what kind of stone she has:? A. Mixed ‫ترايات = ثالثة = ميكس = كذا‬
‫رقم‬

Patient with history of lap chole few weeks ago presenting with right upper abdominal pain , respiratory symptoms , US done and
show pus collection at site of gallbladder 12*6 cm What is the most appropriate in management?
A. antibiotic B. precautions guide drainage✅

🌹Patient post bariatric surgery complains of on and off fever for one week On
examination chest, abdomen and wound were normal How are you going tomanage:
A. Reassure B. CT abdomen✅ C. Chest x-ray
N.B : Spiking fever > deep collections

🍓female pt present with right upper Q pain , )))febrile((( Lab test show: increased WBCs increase ALP increase Direct bilirubin
US Show : fluid around gallbladder , multiple stone What the most appropriate management ?
A. Lap chole B. laparotomy C. precautions guide dringe D. antibiotic✅

🌹 Elderly pt admitted to Icu with acute MI , and developed pneumonia on tazocin , he also have RUQ pain and tenderness.
Management ?
A. ercp drainage B. emergency cholecystectomy
C. convert from tazocin to meropenem D. us guided cholecystostomy drainage✅✅

🍓 post cholecystectomy came with perihepatic collection, what will you do? B- Percutanous driange✅✅

🍓 patient with diverticultits did sigemoidectomy , 5 or 7 days after had fever on per rectal exam there is bogginess anteriorly
what to do : A-drainage ✅ b-reassure

🌹 Post colectomy paracolic collection:management?

-Ultrasound guided drainage ✅ -open drainage

🌹UC pt with y shape something with very enlarged transverse colon and no haustrea what is Rx
A.proctocolectomy with ileal pouch B. pan colectomy with ileostomy✅
 ERCP
🌹 -Obstrictive jaundice pic and cholangitis on IV abx ,US (dilated ducts, gallbladder has stones) what else in the mx? -
ERCP✅ -cholecystectomy

🌹Typical pic of acute cholangitis, next investigation? A. US B. MRCP C. ERCP✅✅

Cholangitis is an inflammation of the bile duct system it happened bez there is stone on bile duct and any stone on bile duct best
manag with ERCP
‫ اختاروا دائما‬common bile duct dialated ‫ مثل ما يقولكم‬dialated ‫ سواء كانت‬bile duct ‫ او جابوا سيرة‬bile duct ‫ في‬stone ‫أي مرة نشوف‬
ERCP

🌹Pt with fever, jaundice and RUQ pain,initial management= A. abd US B. ERCP✅✅ C. MRCP
‫ هنا تشخيص الحالة‬cholangitis

🌹Pt with history of Cholelithiasis, today present with abdominal pain after fatty
meal, on US : multiple gallbladder stones, thick wall , ))CBD 12(( mm , what’s next:
A. ERCP✅

Pt with calculous cholecystitis come with acute attack, When to do operation to Her = A. Lapcholy as soon as possible ✅ B. Wait
2 or 3months
\
🌹 patient presented with signs and symptoms of cholecystitis, days after hospitalization the patient recovered clinically and her
labs returned back to normal except for AMYLASE, what is your management: ‫معناها حصل التهب في البنكرياس بسبب حصوة‬
A. ERCP ✅.

Post lap chole presented after few days with abd distension and ascites and abd pain what will u do? a. open b. lap c. tapping D .
ERCP✅✅

After long ERCP, patient hypotensive with pain ..Most common site injured:
A. Esophagus B. Duodenal ✅✅C. Gastric

🍓 Patient post cholecystectomy day 8or 9 develops right mouth corner pain and fever 38.5 what is your mx:
Paracetamol. Antibiotic✅✅.

🌹 Patient came with RUQ pain , ultrasound findings : thickining gallbladder wall , pericystic fluid and stones . What's best
intervention :
A) percutaneous drainage B) Laparoscopic cholecystectomy ✅

🌹 6 weeks Post MI patient, planned to do cholecystectomy:

A.Do Lap cholecystectomy now ✅🌹
B.Do Open cholecystectomy now
C.Do lap cholecystectomy after 6 months
🌹 Gallbladder polyp *less than 10cm* :-
*if elderly or with stone* > cholecystectomy
*if less than 50y >* follow up with us every 6m

🌹 Pt did abdominal US as htn screen and the results show gallstone polyp what to do?
A.Follow up in 6 month ✅

🌹 Patient with biliary polyp, 0.6cm. Management:

A. reassure. B. follow up✅

🌹Cholecystectomy 6 years back, presented with vomiting and increased bowel sound movement (exaggerated) A. Adhesion ✅✅

🌹Kc of small gallstones presented with jaundice, Labs show high alk phos, high cong bilirubin, Next? A. Ercp B. Abd us ✅✅
N.B You have to start by US first If revealed dilated CBD go for ERCP

🍓Acute cholecystitis presents with right upper quadrant pain, fever, and leukocytosis. Patients with acute cholecystitis should be
treated with laparoscopic cholecystectomy within 72 hours

🍓30y female patient, came to ER with abdominal pain... She has hx of elective cholecystectomy due to Gallstones. Now she has
high amylase, 9mm CBD and jaundiced diagnosis= missed stone in CBD

🌹Lady post cholecystectomy , due to cholothiasis. week later presented with jaundice , pain , U/S: showed dilated CBD. Dx: =
Retained stones

🍓70 years old patient with a history of Myocardial infarct that was 6 months ago, on this presentation he has cholecystitis and
requires cholecystectomy. when will
you operate? A. now✅✅ B. After 6 months

the surgeon accidentally cut off the Common bile duct at a level that is just above the cystic duct, how to repair?
hepaticojejunostomy

laparoscopic cholecystectomy come with discharge from middle management ‫يعني الججرح ينزل منه صديد‬
A.daily dressing B- wound inspect. C- exploration✅

🍓Middle discharge after cholecystectomy= A. Abs B. Exploration✅))No dressing or inspiction ((

🌹Patient on 3rd day post cholecystectomy develops fever, has no abdominal pain.What is the likely cause of fever: A.UTI✅✅
B.Wound infection C.Chest infection
3 day = UTI = ‫ثالث حروف‬

US showed collection 10x15cm in gall bladder fossa, ttt:

A. physiotherapy B. iv abx C. drainage✅

🌹PatiePT WITH post cholecystectomy, presented early (don't mention which day) with fever and lung consolidation (atelectasis),
and US showed 10*12 collection of fluid in lesser sac ,Mx?
A. Physiotherapy B. abx C. Precut drainage✅✅

🌹klatskin tumor= is cholangiocarcinoma located at bifurcation of common hepatic duct = CA 19-9.

🌹RUQ pain and dilated common bile duct, what is the diagnosis? Choledocholithiasis ✅
Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct (CBD) (thus
choledocho- + lithiasis)

🌹Choliduocholithisis managment?- ERCP ✅

 GIT
🌹Pt alcoholic ,smoker came with sever pain generalize in the abdomen In examination was tenderness and guarding= . Duodenal
perforation

🌹Elderly smoker with dysphagia , showed high grade dysplasia , management?

A. Add ranitidine B. Ask him to stop smoking C. CBT D_ endoscopic mucosal resection ✅✅

🌹best diagnostic test to detect ischemia :

A. stress Echo ( Approved

sign in radiology for duodenal ulcer ==clover leaf

= love = clove‫ = ودود‬doudenum = ‫ربط‬

🌹 Old man suddenly had vomited two episodes of bloody vomit, Physical Exam shows no Tenderness over his abdomen or
sternal area, he is stable, what is your diagnosis:Mallory weiss tear

🌹 24 hours vomiting after food poisoning develop hematemesis on endoscopy blood streak on stomach Dx? Mallory weiss

🌹 adult patient ( i forgot the age may be in 30 ) have repetitive vomiting come
with mild bleeding ( mallory weiss syndrome )what is the appropriate
management?
A. conservative management ✅B. laparotomy exploratory C. laparotomy with resection

🍓C/I to liver transplantation= Cirrhosis with active alcohol✅

patient with hepatitis B cirrhosis with ascites and have 6 cm lesion found in the with high vascularity = treatment? A. anti viral.
B. resection. C. chemo embolization✅✅

pt with Chronic hepatitis b then , then discover 70% of the liver was multiple lesions, next: Colonoscopy.
🍓Male Pt, smoker, have a history of appendectomy, his brother have crohn’s ,
what’s the risk factor to develop crohn’s : A. male B. smoking C. family history✅ D. history of appendectomy

🌹Healthy female with dysphagia diagnosed as achalasia, best treatment

A- pneumatic dilatation B- botulinum injection C- fundoplication

🌹Valvulas location: A.Cecum B.rectum C. sigmoid ✅

🍓Y shaped colon, Sigmoid volvulus what to do? Colonoscopy or sigmoidoscopy🍓

🍓Old patient history of vomiting with palpable mass imaging finding Y shape next app action? A. Fleet enema B. Ct C.
Sigmoidoscopy D. Colonoscopy

🍓Old male with generalized abdominal pain, ascites, constipation X-ray >> massively enlarge loop up to right part ? A. Sigmoid
volvulus ✅ B. Acute diverticulitis

🍓52-Patient came with abdominal diatention x ray showed y shaped colon what’s your management? A. Fleet enema B.
Sigmoidectomy with end colostomy C. colonoscopy✅✅(obstruction)

🌹 Pt with UC the most associated risk of Cancer is?

A. primary sclerosing cholangitis✅

🍒 Case of Sclerosing cholangitis, what you do for the patient? A- CT B- Colonoscopy ✅

🍒 Abdominal distended, vomiting, picture of obstruction. Dx? volvulus

🍒 Management of unstable patient with sigmoid volvulus?

A-Sigmoidectomy

🌹Most common site of sigmoid volvulus?

➔ Elderly > sigmoid ➔ Children > Ceacum

🌹Patient with basal ganglia disorder and absent gag reflex. How to provide nutrition?
A-Gastrostomy B-Jejunostomy✅

🌹Colorectal surgeon performing a low anterior resection for CRC and the pelvis won’t stop bleeding, so he consults a vascular
surgeon and he does:
A-Heavy packing of pelvis B-Arteriography intra operatively C-Infraceliac clamp !@

🍓bleeding aortic in OR and you did packing but he is still bleeding. Next?
A. clamping infrarenal B. clamping supraceliac C. cable CTA!@

🌹Patient had RTA with seat belt sign x ray of the spine showed chance fracture what most probably you will find in = Duodenal
perforation

🌹Rta patient his speed was 130 and he was on seat belt came with stable status no hypotension or change in consciousness what
you will do = A. CT B. us of abdomen. C. laparotomy

🌹Pt elderly known to have IHD come with sever central abd.pain Amylase: slightly elevated = Mesentric emboli of occlusion
‫ا ي مرة تشوفوا مكتوب حصل له اسكيميا قبل كذا بالقلب وبعدها سار له الم بطنه اعرف انه جلطة حصلت ايضا باالمعاء خااااصة كبار بالعمر‬

🌹Patient known to have ischemic heart disease complain of abdominal pain (the only complain) with lab showing amylase of 600
and x-ray showing signs of obstruction ?
A.Acute appendicitis B. intestinal obstruction C. mesentric ischemia ✅✅
55 years old male presented with sudden abdominal pain radi ated to the back the patient has history of cardiomyopathy, the
patient mentioned that he passed small amount of loose stool, during the examination there is exaggerated bowel sound Labs:
Amylase = mildly elevated above normal What is the Diagnosis?
AAcute pancreatitis B. Mesenteric vascular ischemia✅

🌹seat belt sign = bowel/mesenteric injury like Duodenal perforation.

##multiple ulcers in the antrum = antrectomy ##heavy

● Multiple antrum ulcers , by Bx >H pylori what is the mx ?

A. start Abx ✅✅ B. Chemo C. Radiation

🌹 GIST , 5 cm in posterior wall, mx: A-Total gastrectomy. B. partial gastrectomy. C. WLE✅✅

🌹gastrointestinal stromal tumors with ((metastasis)) = treat by = tyrosine kinase inhibitors (imatinib)

🌹Giant gastrointestinal stromal tumor = wedge wide local exsion 🍬 == Dont choice (gastrectomy) 🌹

🌹stomach tumor with positive secretin stimulation test = gastrinoma

🌹pt with LLQ pain, and hx of constipation, on exam, bulky mass in LLQ, with wild discomfort, no worrying sings or old age,
dx: = constipation ✅

🌹50 yrs man diabetic, well controlled had colon cancer surgery ( coloectomy),, they kept him on insulin and dextrose, after
surgery by 2 days he became irritable, in shock, his electrolyte ( Na 129 ) ( K 3.2 ) urine and serum osmolality Normal, what's
the Dx: Fluid overload ✅ ✔️

🌹Patient while doing laparoscopy for esophageal perforation with Bp 80/50,,RR25 pulse 120 which type of shock?
A.Cardiogenic B.Hypovolemic ✅✅‫نزيف بسبب الثقب‬

🌹patient with GERD underwent endoscopy show multiple antral ulcer Ttt= Partial distal gastrectomy ✅ ‫= هي نفسها‬antrectomy

🌹 Succession splash -‫ هذا اسم صوت بالسيتيسكوب نسمعه في البطن عن الفحص‬symptoms of obstruction patient have?
A.met acidosis
B.Met alkalosis ✅
= alk ...........‫ =صوت = قلق‬succ = ‫ربط‬

🌹Symptoms of obstruction and X-ray done showed Dilated loops towards RUQ = Sigmoid megacolon ✅🌹

🌹 K/c of chrons with perianal mass , painful , there discharge when touch it , Mx= MRI pelvic

(Angiodysplasia is a small vascular malformation of the gut. It causes sever bleeding therfore must be treat )

*Treatment for angiodysplasia*=

🌹Angiodysplasia in 60 year patient, how to manage? argon plasma coagulation (APC) and bipolar electrocoagulation (BEC) =
Both are safe and effective ✅ ✔️

🌹Patient with rectal bleeding done technetium scan and Dx with angiodysplasia in left colon TTT = laser ablation

🌹Old p'tient >50 ye'rs old. Alternating diarrhea and constipation. Physic'l is normal. Underwent sigmoidoscopy, revealed
multiple lesions in the dist'l sigmoid. Biopsy = 'adenocarcinoma'. Next step in management? Colonoscopy

🌹Case of perianal swelling , perrectal bleeding , investigated : it is 1 cm from anal verge , biopsy: ((adenocarcinoma ))
(rectal) Mx
- abdomen perineal resection ✅.
🌹 20-year-old weight lifter developed abdominal hernia that is irreducible, tender. Imaging shows air-fluid levels in small bowel
and no free air in large bowel. Type?Incarcerated

Strangulated hernia: ischemic segment will cause symptoms such as erythema, leukocytosis and fever. (Toxic patient)

🍓Most common cause of Small bowel obstruction > adhesions✅ Large bowel > neoplasm✅

🌹4th day post OP (appendicitis) presented with diffuse abd pain, distension , vomiting and sluggish bowel sounds Abd
xray: Multiple air/fluid level
-ileus ✅ ‫ يكون معاها صوت االمعاء كسول او خاملة‬-adhesions and SBO ‫يزيد صوت االمعاء‬
(( sluggish‫ كسول او خامل‬bowel sound == ileus))
((Incresse bowel sound ==adhesions and SBO ))

-Pt 6 yrs post abd operation has bloating and signs of obstruction cause?
a. adhesions✅

🌹case scenario of intussusception what is the gold standard investigation= barium enema best intinal = us Gold stander =enema
‫منطقي الن الصبغة توضح كانك تشوفها بعينك انه حاصل تداخل باالمعاء‬

Patient with symptoms of intussusception what is true about it: = C/Recurrence is high after surgical treatment✅✅

What type of cancer that should be screened for with out symptoms :
Colon ✅

🌹 28 male healthy, hx 2 month of abd pain with 2 bloody stool, proctoscope done with numerous polyps covered the linings and
multiple biopsy taken , no details in hs of family hx or sexual.. Dx:
A. familial polypoid✅ B. UC C. diverticulosis coli D. human papillomavirus polyp

🍓Multiple polyps in colon and duodenal And bloody diarrhea=, Familial Colon Cancer Syndromes✅.

🌹Long case with Thumbprint sign on abdominal x-ray ? Pancritits or Ischemic colitis 🌹

🌷Thumbprint sign in abdomen = Pseudomembranous colitis AND ischemic colitis🌷

🌹Man with high grade dysplasia of the esophagus== Refer him for surgery

🌹Anterior duodenal perforation tratment = : Graham omental patch✅

🌹A young healthy man medically free came complaining of indigestion problem otherwise he is normal no vomiting no nausea
no bloody diarrhea you gonna do ?
functional dyspepsia
 Alaa Rashed:
Truma
🌹Patient post RTA with warm peripherals Which type of shock?. Neurogenic bez (warm peripheral)

🌹15year, fell and revived a supracondylar fracture above the elbow. Management?
If Brachial pulse present >> Reduction If Not present >> Surgical Exploration

loss of consciousness + loss of his conscious with dilated pupils = Epidural hematom✅

🍓What kind of shoulder dislocation.. difficulty in addiction and internal rotation=. posterior dislocation

🌹abdominal trauma (by wooden stick) with painful RLQ pain and grey discharge, pain increased by extending the leg. Next step?
Give antibiotics ✅

🌹Female had femoral fracture then after I think a week developed respiratory symptomes ? Fat embolism syndrome ✅

🌹Colles fracture in pedia what is the most important mangement ? closed reduction
‫من اسمها كوليس = كلوز‬Colles = Close

🌹 Picture of green stick and ask for treatment?

A. close reduction with cast

pulse increased =hypovolemic

🍒Patient 72 years old have DM,,,For 3 month cant be stand from the chair What can happen to him ? A-Fall ✅.

🍒Most common site of aortic injury ? Proximal to left brachiocephalic

🌹Blunt truma in chest or thoracic what to injured= left subclavian artery

🌹 Most common site of thoracic aortic blunt trauma= distal to left subclavian artery .

= ‫ = هللا يبعدكم عنه = يبعدكم‬subclavian = sub= ‫ صعب حادث باالورطى شريان مهم = صعب‬distal = ‫ربط = حادث في االورطى = بعيد الشر عليكم = بعيد‬
left .

🌹after RTA pt hospital is away 40km what would you do= call surgical oncall✅

🌹A traumatic pt lost 25% of his blood..which of the following is the most suspected to be effected first Pulse pressure ✅.

🌹male involved in RTA in ER he is fully conscious and no abnormality in vital signs admitted for observation and a FAST scan
done ,.what do you expect to find
= peritoneum free fluid✅✅

🌹Traum' patient. Intra abdominl hemorrhage and seen injury. Underwent laparotomy and splenectomy. Which of the following
will be low= Insulin✅.

🌹best method to clear cervical trauma in ICU patient after motor vehicle accident= CT

🌹after RTA pt hospital is away 40km what would you do? ABC .

pt with neck injury after RTA ?? O2 mask. ✅✅ ETT. Coricothyrdoctomy

Remember ABCDE of primary survey.. O2 mask > intubation > chest tube

🌹45 years old man had MVA presented with isolated head injury and coma for 5 days in ICU , the best way of feeding?
A- Nasogastric tube feedings ✅.

🌹Gastric cancer metastasizing to the liver= chemotherapy .🌹

● Pt e gastric cancer & gross ascites , next step in management Abdominal paracentesis

And have flat foot= spring ligament

pt fallen down from 3 meter height he felt severe pain and swelling at the lower Rt leg xray showed commonuted fracture of the
lower tibia what is the most accurate management= open reduction, internal fixation and elevation

Femoral fracture 30 d angulation child 4 years old = Traction

patient with mid shaft femoral fracture, 30% anterior angulation = Closed reduction with hip spica cast

🌹Most important thing to do before reduction of fracture))) ==== Check vascular status(pulse) ✅

🌹Head trauma post MVC at speed 130 km/hr. Tight seat belt. Patient is stable and alert. Most appropriate next step in
management?
○Abdominal US

vascular problems in lungs class/group of pulmonary HTN ?

3 = ‫ = ربط = ثالثة = وريد وشريان ورئة‬vascular + lung

Battle sign"= Basal skull fracture‫من اسمها‬

🌹 Ear secretion after trauma external ear was intact ? presented with ear bleeding, ruptured eardrum = Basal skull fracture

🌹RTA patient injures jugular foramen, what will happen?

. something happening to the vocal cord ✅✅
.‫ فالزم نلبس جاكيت‬vocal cord = ‫ جايكيت = نلبسه بالبرد = في البرد يسير لنا التهاب بال‬jugular = ‫ربط = جاكيوالر‬

🌹Pt had trauma cause base skull fracture .. jugular foramen:

A. ipsilateral vocal cords injury
🌹The most probable viral cause of repture of ear drum with abcess or pus ? RSV

🍒Case of alcoholic patients with epigastric pain radiating to the back with x ray showing air under diaphragm= duodenal
perforation✅

🌹Pt have RTA can ((shrug shoulder)) but can’t move elbow and lower limbs ? High spinal cord injury

🌹 Man who was in MVA, hypotensive with slow heart rate and can't move legs or
hands, what caused his shock? high spinal cord injury ===🌹What is the cause of this hypotension? : A-Upper spinal ingury ✅✅

🌹Young male, post MVA Opens eyes spontaneously Responds to verbal Commands Shrugs shoulders Shallow breathing Left
chest wall contusion Cannot flex elbows or move lower limbs Respiratory rate: ?BP: hypotensive Most likely diagnosis:=High
spinal injury

positive valgus test = .Medial collateral ligament sprain

🌹Football player received a trauma to lateral side of his left knee, the patient now is complaining of severe pain and swelling of
the medial side of his left knee, positive valgus and (-) anterior drawer and lachman, most likely diagnosis: Medial collateral
ligament sprain

🌹Player professional football with knee Injury in lateral side , medial knee swelling , lachman and MCmurray test ( negative) ?
Medial collateral ligament sprain

Pt came with instable knee. Ex femur come in front of tibia, which ligament injured ? A. anterior cruciate ligament (ACL)

Thank You wish you the Best