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    Crohn’s + Ulcerative Colitis Summary

1) patient  with a history of recurrent anal fissures, canker sores, and abdominal pain presents with weight loss, foul-smelling anal discharge, and perianal discomfort. He smokes daily. Exam shows fever, right lower quadrant tenderness, a perianal skin tag, and a draining fistula. A biopsy reveals non-caseating granulomas = Crohn’s disease.

📌 نوت:  اذا شوفتوا بالسؤال فقط  هذه الجملة  non-caseating granulomas  فكروا مباشرة فCrohn’s disease.

 

2) Patient with  6-month history of non-bloody diarrhoea, recurrent abdominal cramps, and weight loss. He appears pale and has oral ulcers. On examination, he has tenderness in the right lower quadrant. temperature 38.1°C. diagnosis is:  Crohn’s disease.

📌 نوت:  مرضCrohn’s disease يؤثر على أي جزء من الجهاز الهضمي بداية من فتحة الفم يسبب فيها تقرحات الى فتحة الشرج يسبب فيها يسبب تشققات، وخراجات، وتضيق لكن اشهر مكان يأثر فيه هو Ilium  . 

3) most common location of Crohn’s disease = Ileocolonic (ileum)

 

4) extra-intestinal manifestants of Crohn’s disease = Erythema nodosum

 

5) An 18-year-old girl with chronic diarrhea, intermittent abdominal pain, and no gastrointestinal bleeding is slim and pale on examination. Lab results indicate anemia  , elevated MCV,  thrombocytosis , low vitamin B12 and low folic aciddiagnosis is : Crohn’s disease.

 

6) In Crohn’s disease, which factor is most strongly associated with increased osteoporosis risk= Long steroid use

📌 نوت:  استعمال الستيرويد لفترة طويلة تسبب هشاشة في العظام

 

7) Patient a smoker for 5 years, who had an appendectomy 2 years ago, visits the clinic concerned about his risk of developing Crohn’s disease due to his brother’s difficult-to-control Crohn’s disease. factor increases his risk of developing Crohn’s disease = smoking

 

8) most common location of Crohn’s disease = Ileocolonic (ileum)

 

9)  patient with abdominal  pain, fever, endoscopy showed ulceration transmural but in patches (not continuous), the lesion most likely affecting which part of GI = ileum 

 

10)                   patient with  abdominal pain and diarrhea colonoscopy showed non contagious patches in the terminal ileum and colon Pathology shows transmural inflammation whats is the Diagnosis = Crohn’s

 

11)  patient with ileocolonic Crohn’s disease who presents with perianal fistulas the best next step in management = Infliximab.

 

12)  case of Crohn’s disease, asking which of the  followings came with it =  Perianal disease  

 

13)   patient with only of perianal discharge  on examination three sinuses were noted at the 3 5 7 o’clock positions  next step=  Colonoscopy

 

14)   patient with ileocolonic Crohn’s disease and currently on infliximab and azathioprine, visited the clinic with complaints of perianal pain, purulent discharge, low-grade fever persisting for 3 weeks, and having 3-4 non-bloody bowel movements per day. He presents with perianal induration and purulent discharge on pressure ,  next step = Order MRI pelvis

 

15)  patient with Crohn’s disease, post-terminal ileum resection, and on azathioprine presents with forgetfulness, fatigue, + lower limb numbness. Lab results show low hemoglobin  , elevated MCV  , and elevated MCH The deficiency responsible for her symptoms is = Vitamin B12 deficiency.

 

16)   patient with terminal Ileum resection due to Crohn’s disease She presents this time with difficulty in walking. She is anaemic and has lost position sense bilaterallydiagnosis = Vitamin B12 deficiency.

 

17)   The most appropriate treatment for man with watery diarrhea following ileocecal resection for fibrostenotic ileal Crohn’s disease is = cholestyramine.

 

18)  patient with inflammatory bowel disease   presents with a  single stricture at the terminal ileum  1 cm from the ileocecal valve  management = Segmental resection with ileostomy

 

19)  Patient with  reports a 3-month history of frequent bloody bowel movements with mucus and occasional right hip pain. There is  gross blood on rectal examination and knee pain and Low Hb Stool analysis: Shows many RBCs and few WBCs diagnosis = Ulcerative colitis

 

20)   Patient  with a 3-week history of bloody diarrhoea. He reported frequent urges to defecate, associated with mild lower abdominal cramps. He had experienced similar attacks in the past, but milder, associated with bloating and loose stool, which was mucus with a few blood drops. Abdominal examination was soft with mild tenderness at the left lower quadrant but no guarding. Temperature: 36.6 °C diagnosis = Ulcerative colitis

📌 نوت:   اسهال دموي و الم في البطن اهم اعراض Ulcerative colitis

21)  patient with recurrent epigastric pain with occasional vomiting since 1 year otherwise, normal stool analysis is positive for blood and mucus and positive blood occult test what is dx?= Inflammatory bowel disease  

📌 نوت:  : كلمة Inflammatory bowel disease   يشمل مرض كرون و ulcerative . 

22)  A 35-year-old man with a 7-year history of ulcerative colitis presented with an insidious onset of progressive fatigue, pruritus, and jaundice. He underwent MRCP, which demonstrates multiple short strictures of the biliary tree at both intrahepatic and extrahepatic ducts diagnosis= Primary sclerosing cholangitis.

 

📌 نوت:   من احد مضاعفات الإصابة ب ulcerative colitis يحصل للمريض Primary sclerosing cholangitis

 

23)  In a patient with ulcerative colitis, which of the following is associated with an increased risk of colorectal cancer = Primary sclerosing cholangitis

📌 Note : ulcerative colitis = Primary sclerosing cholangitis = colorectal cancer

 

24)   women diagnosed with ulcerative colitis They ask about need of colonoscopy  = Do it after 10 years from diagnosis 

📌 نوت:   مرضى ulcerative colitis لازم يسو colonoscopy  بعد عشر سنوات من الإصابة لان مشكلة هذا المرض بسبب الالتهاب المتكرر ممكن يسبب سرطان   لذلك المنظار مهم علشان نكتشفه بدري 

 

25)  common site of ulcerative colitis = Rectum common site of Crohn = ilium.

 

26)   lead pip point on X.ray = ulcerative colitis

نوت: فيه كذا علامة تظهر على اشعة x-ray يدل على إصابة الشخص ب ulcerative colitis من ضمن هذه العلاماتlead pip

ربط Pip من كلمة Pain  و ulcerative  من كلمة ulcer ، الجملة :  القرحة دائما مؤلمة 

 

27)   Case of schizophrenia patient with recurrent vomiting and constipation episodes, presents with severe abdominal pain and distention ct was colon dilated more than 10 cm, conservative therapy was done with IV fluids, PO, and antibiotics what appropriate management = –Surgical intervention

نوت :هذا المريض عنده توسع كبييير في القولون  نسميها  (Toxic Megacolon) يكون التوسع اكثر من ١٠ سم  ، مشكلة هذا التوسع ممكن يخلي القولون ينفجر و بالتالي لازم نلحقه بعملية جراحية.

 

28)  Ulcerative colitis  patient  with y shape  with very enlarged transverse colon and no haustrea ( Scenario of Toxic Megacolon )  Colon dilation on imaging 15 cm best next step I.V steroid

نوت :نفس السيناريو الي قبل لكن هنا طلب next step لذلك الجواب ستيرويد ، بينما السيناريو الي قبل كان طالب proper

28)   patient presenting with chronic watery diarrhea mixed with blood and mucus, along with weight loss, anemia , and on/off joint pain initial step = Corticosteroids

نوت: الإسهال المزمن المصحوب بالدم والمخاط، وفقدان الوزن، وفقر الدم، وآلام المفاصل عادة يدل على إصابة ب Ulcerative ، لذلك نعطيهم كورتيزون حتى يخفف الالتهاب و الألم و الاسهال الدموي 

 

 

 

29)  Patient planning to get pregnant; she has distal ulcerative colitis most appropriate advice She can get pregnant as her disease is controlled

نوت : عادي لو مريضة مصابة بمرض ال ulcerative colitis و تبغى تكون حامل نخليها تحمل ولا نعاقبها بعدم الحمل علشان مرضها ؟ عادي عادي ان شاء الله مافيها ضرر . 

30)  A young woman who is known to have pan ulcerative colitis is admitted for a severe relapse Since there was no response to medical treatment, surgery is decided The patient is very sceptical about surgery and requested more information. appropriate way to address her concern =  Agree on another meeting with the surgeon and the gastroenterologist 

 

نوت : مريضة ياعمري عليها سار لها انتكاسة شديدة للمرض (Ulcerative colitis ) و كل الادوية خلاص ما عاد سارينفع معها حتى الستيرويد ما ينفع معها و الاطباء قالوا لها علاجك في الجراحة لكن المريضة مترددة جدا بشأن الجراحةوطلبت معلومات اكثر عن الجراحة ايش الطريقة الي نقدر نساعدها فيها علشان تعرف تاخذ قرار صح ؟ نسوي اجتماع  معجراح أخصائي أمراض الجهاز الهضمي علشان يشرح للمريضة اكثر عن العملية و فوائدها و اسباب حاجتها للعملية ولوعندها اي سؤال مو واضح لها نفهمها

 

31)  A 30-year-old woman with left-sided ulcerative colitis presented to the Emergency Room with 7-8 episodes of bloody diarrhoea per day associated with low-grade fever, abdominal pain, and joint pain at her knees. On examination, she looks ill and is in pain. All stool cultures were negative. After fluid resuscitation, best next step = IV methylprednisolone

 

نوت : هذه مريضة مسكينة كل شوي يجيها التهاب و اسهال مع دم ٦ مرات و غير الم المفاصل و الم البطن ، طيب مافي دواء يهدي البهدلة هذه كلها ؟ اعطيها ستيرويد مثل ( methylprednisolone ) هذا راح يهدي الالتهاب و بالتالي يهدي نوبات الألم و الاسهال الدموي. 

Colon Cancer Summary

 

32)   Cancer Screening test modality = Annual Fecal Occult Blood

 

33)   Q- 45-year-old women when to to start colon cancer screening =  Strat at 50 with annual Fecal occult blood

 

34)   recommended age for screening colonoscopy for average-risk patient  45

 

35)     recommended age in years for a low-Risk  adult man to start screening for colon cancer = 50

 

36)    A 35-year-old man There is no family history of colorectal cancer, although his mother did have two documented sessile polyps (one ≥ 1cm) at age 55. When should he undergo his first screening colonoscopy = Age 40 years

 

37)    51y woman presents to  colon screening,  her mother developed colon cancer at age 85. She underwent colonoscopy during which 2 small (8mm) hyper plastic polyps were removed, which of the following is the next step in management = Colonoscopy every 10 years

 

38)     Patient presented with infrequent anal bleeding did a colonoscopy that revealed one polyp size 1.5cm and a biopsy showed tubular adenoma 1.2 cm. Interval of screening = 3 years

 

39)   about the interval of colonoscopy for a polyp size of 0.9 cm and results of histopathology is adenoma = 10 years

 

40)    A national screening program is going to establish which cancer according to priority and impact = Colorectal Cancer

 

41)        Colon cancer common metastasis to = Liver

ربط = القولون والكبد = كلهم من اجزاء الجهاز الهضمي مسؤولين عن GIT

 

42)     cancers is recommended to  screened for in asymptomatic adults= Colorectal Cancer

 

43)   Proctoscope was done and showed numerous polyps covered the linings and multiple biopsies taken. diagnosis = Familial adenomatous polyposis.

نوت سهل من السيناريو  مغششنا انه polyposis لكن Famil

44)    man presents to the clinic for advice. He has a positive family history of familial polyposis syndrome the best advice at this stage= Order colonoscopy

 

45)    A 55-year-old man presented to the Colonoscopy Unit to perform screening colonoscopy. The consent was taken, and the procedure started. During colonoscopy, a large 4 cm polyp was seen, which needs to be removed by snare polypectomy. Snare polypectomy carries a higher risk of bleeding and perforation than the screening colonoscopy. the best action = Repeat the procedure with a high-risk consent

نوت اي مريض كبير بالعمر وعنده haemorrhoid لاااازم  نعمل له منظار للقولون ، حتى نستبعد وجود سرطان فيالقولون او سرطان  المستقيم Colorectal Cancer.

46)   Elderly patient present with History of bleeding on defecation there is anal haemorrhoid stage 3 next step = Colonoscopy

47)   male smoker has an adenoma removed from his colon. Pathology report shows a benign lesion. What advice should you give this patient to prevent him from getting colon cancer  and start exercising = Lifestyle modification  and Stop smoking (healthy diet and exercise)

 

48)    A 60-year-old woman with a recent history of feeling tired, fatigue, and weight loss has also noticed a worsening of her chronic constipation. A stool test for occult blood was positive   best next step = Colonoscopy

نوت: امساك مزمن + كبير بالعمر + وزنه نزل + دم في البراز كلها تيبيكال اعراض سرطان القولون لذلك نعمل منظار للقولوننتأكد هل فيه سرطان في  colon and rectum ، و نعرف مصدر الدم مع البراز . 

49)   Q- 63 years came with rectal bleeding with unintentional weight loss, he was pale, on PE empty rectum and no masses were identified but bleeding with fresh blood was noted. next step =Colonoscopy

Note : In the elderly (age ≥65 years), hemorrhoids and colorectal cancer are the most common causes of  minor bleeding.

 

50)    A 73-  with new onset jaundice, generalised fatiguability, weight loss and loss of appetite CT scan Multiple lesions replacing approximately 70% of the liver parenchyma   the most appropriate management =  Colonoscopy

نوت نتيجة الاشعة تظهر كتل كثيرة في الكبد و هذا غالبا يدل على سرطان الكبد ، و لكن منطقة الكبد لما يحصل فيها ورم غالبا يكون الورم جاء من مكان ثاني ، يعني يكون حصل للمريض انتشار للورم ، و غالبا يكون جاي من القولون ، يعني الورم اصلا ظهر في القولون و لكن المريض لم ينتبه له و ما شعر ب اعراض ملحوظة و لم يتعالج و بالتالي الورم انتشر و ذهب للكبد ، لذلك لازم نعمل منظار للقولون نستبعد وجود سرطان في القولون 

 

51)   types of polyps is associated with the greatest risk of malignant transformation = Villous Adenoma 

 

52)    Pt underwent colonoscopy and a mass was seen and biopsy showed adenocarcinoma. What is the next step =   CT chest, abdomen, and pelvis

نوت حتى نتاكد هل الورم انتشر ؟

 

53)   A 55-year-old man presented to the Colonoscopy Unit to perform a screening colonoscopy. The consent was taken, and the procedure started. During the colonoscopy, a large 4 cm polyp was seen, which needs to be removed by snare polypectomy. This carries a high risk of bleeding and perforation compared to the screening colonoscopy. Which of the following is the best action = Repeat the procedure with high-risk consent

نوت : مريض  عمره 55 سنة  ذهب لوحدة المنظار  علشان يعمل منظار للقولون  (Screening Colonoscopy). ثم تم أخذموافقته وبدأت الإجراءأثناء الفحص ، تم اكتشاف وجود (polypكبير بحجم 4 سم، والذي يتطلب إزالته باستخدام تقنية الـsnare polypectomy وهذه التقنية تحمل مخاطر عالية من النزيف والثقب مقارنة ب Screening Colonoscopyالعاديالسؤال هوما هو أفضل إجراء يجب اتخاذه في هذا السياق؟ يجب اعادة أخذ موافقة خاصة للإجراء عالي المخاطر . 

Zollinger Ellison syndrome

54)   Epigastric pain, diarrhea, started 8 months prior and only partially improved with eating and use of omeprazole, his hx  recurrent Nephrolithiasis, EGD shows multiple ulcers throughout the transverse portion of the duodenum and jejunum,  diagnosis = Gastrinomas

 

55)   -Epigastric pain , diarrhoea and recurrent peptic ulcer with increase secretin of acid Gastrinomas

 

56)   Pt with recurrent esophagitis with multiple gastric ulcers What is the best diagnostic value  = Fasting serum gastrin

 

Diabetes mellitus

57)  Patient with polyuria and polydipsia with strong family history of type 2 diabetes mellitus first-line treatment = Dietary advice, exercise and metformin

 

58)   Patient with  diagnosed with pre-diabetes.  HbA1C : 6.1   In helping this individual to achieve and maintain his target weight loss  best advice= Exercise for at least 30 minutes most days of the week and low carbohydrate diet  

 

59)   Patient  recently diagnosed with type 2 diabetes and has been following a plan of lifestyle measures to improve his diet and increase his level of exercise HbA1C: 6.9 the appropriate treatment option now = Metformin

 

60)    – Female just gave birth 2 weeks ago and was having GDM  and HBA1C was 5.5 Fasting was normal And she is obese drug to give= Metformin

 

61)   Q5-  pregnant  diagnosed to have gestational diabetes meintus (GDM) at week 24. she asks about any safe oral medication to be used in pregnancy. What oral hypoglycaemic agents has safety data and recommended to be used in pregnancy = Glyburide

 

62)   A 19 -year- old  with   Diabetic ketoacidosis . Her hemoglobin 14.5%. She was discharged from the hospital on a basal and prandial insulin regimen with minor adjustments required as an outpatient. Recently she started to have episodes of both fasting and postprandial hypoglycemia. Medications are insulin glargme and insulin aspart.     HbA1C 6.0    Random Glucose 4  mmol/L ,  most appropriate management for her hypoglycemia= Decrease insulin glargine. decrease insulin apart 

 

 

 

63)    A 20-year-old woman is diagnosed of type 1 diabetes mellitus after presenting with diabetic ketoacidosis. Her blood sugars are now stable and she is ready for discharge the best insulin regime as outpatient= Basal-bolus insulin regimen with once-daily insulin glargine 

 

64)   Q- A 20-year-old man with type 1 diabetes presents to the Emergency Department with vomiting and abdominal pain. He has been suffering from …. for 2 days   then became severely dehydrated and started to vomit. He has not had his insulin for the last 24 hours. Normally, he has a basal bolus regime with Giargine as a long-acting insulin, and Humalog as short-acting On admission, he Is found to have acidosis, elevated serum ketones and elevated blood glucose, and was diagnosed with diabetic ketoacidosis. He is started on IV fluid  What insult should he be prescribed now = Fixed rate IV insulin as well as long-acting insulin

 

65)   Q9- man with type 1 diabetes mellitus presents  with history of prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. He Is using insulin glargine and insulin aspart with meals  HbAIC 7.0   most appropriate management of this patient’s hypoglycemia on the days that he exercises = Decrease meal-time insulin aspart dose prior  to exercise, continue insulin glargine dose.

 

66)   – man is admitted to the hospital for evaluation of chest pain.   medical history is significant for type 2 diabetes mellitus. coronary artery disease, hypertension, and hypeflipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin His other medications are aspirin, metoprolol, atorvastatin. and sublingual nitroglycerin as HbAIC 8.5       most appropriate diabetes treatment for this patient while hospitalized= Basal and prandial insulin

 

67)   A 70-year-old woman known to have type 2 diabetes mellitus. She is currently taking metformin 1g bid physical Glucose, fasting 6  Random Glucose 7.5 HbA1C: 6.9      next step in management plan = No changes

 

68)   What advice should be given to reduce her risk of developing diabetes, in addition to increasing her physical activity to >150 minutes per week = Low glycemic index diet to produce 5-10 % weight loss

69)   – A new screening test for Diabetes has a sensitivity of 90% and specificity of 80% Which is best interpretation=  The test was positive for 90% of diabetic patients

 

70)   – the treatment goal for diabetic patients with coronary artery disease = low density lipoprotein < 70

 

71)    Target of HA1C in diabetic patient  =  less than 7 

 

72)    78-year-old man Creatnine was  196 (high)  +  Urinary protein: creatinine ratio 154 (normal <30) so high  diagnosis = Diabetic nephropathy

 

73)    58-year-old man with diabetes mellitus came for follow-up He is on metformin (Glucophage), 1000 mg/day, as well as Atorvastatin (Lipitor), 40 mg dally for hyperlipidaemia . There Is no diagnosis of hypertension His urine albumin/creatinine ratio is in the microalbuminuria range for the first time HbA1C 6.3 = Repeat urine albumin/creatinine ratio

 

74)  Patient  with diabetes and hypertension complains of pain in the right eye and double vision when looking to the left , there is ptosis, limited adduction, elevation, and depression of the right eye The pupils are equal and reactive in both sides cause = Diabetic third nerve neuropathy

 

 

75)    A 61-year-old man with a 20-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 8 months, which worsens at night His Haemoglobin A1c levels have remained less than 7 0% for the last 1 years but were between 9 0% and 10.0% before adding insulin therapy to metformin 1 years ago His medical history includes coronary artery disease. non-proliferative diabetic retinopathy, hypertension, and hyperlipidemia Medications are aspart insulin, glargine. Aspirin . metoprolol, atorvastatin, and lisinopril. On physical examination, findings are compatible with distal symmetrical polyneuropathy.  Which of the following is the most appropriate management of this patient’s neuropathy  = Amitriptyline

 

76)    The child has a recent onset of symptoms including polydipsia (excessive thirst), polyuria (frequent urination), and weight loss over the past 3 weeks, suggestive of uncontrolled diabetes mellitus.

Presenting Symptoms: Vomiting and abdominal pain for 1 day, along with signs of dehydration (low blood pressure, tachycardia, hypoactivity). 

 

Test Result            Normal Values

ABG HCO3- 5       13-22 mmol’L 

ABG PCO2 22         27-40 mmHg 

ABG PO2 100          8^24 mmHg (Newborn) 55-80 mmHg (Child)

Base access -17 -2 to 2 mmol/L  Laboratory Findings: ABG (Arterial Blood Gas) shows metabolic acidosis with a low bicarbonate (HCO3-)    Elevated blood glucose  ).Presence of ketones in the urine diagnosis= ،   Diabetic ketoacidosis

77)   Q22-case with Diabetic ketoacidosis and high potassium (Potassium 2.8   normal   3.5-5.1 mmol/L ) next step = Initiate intravenous insulin therapy

 

78)    What should be the aim in managing hyperglycemia in a diabetic ketoacidosis patient = Reduce blood glucose by 3  mmol /l per hour

 

79)   At which estimated GFR level, metformin should be stopped in diabetic patients = GFR less than 30

 

80)    What is the best advice at this moment to control her blood sugar and prevent congenital malformation= Delay conception until her HBA1c is as close to normal as possible, if this can De safely achieved

 

81)  Old patient with type 1 DM was sitting in the waiting area of outpatient clinic, after a while patient developed symptoms of hypoglycemia, they checked blood sugar it was low. the next appropriate step= Give him juic

 

82)  Target of HA1C in diabetic patient = less than 7 

 

83)  -pt with non insulin dependent DM Come with upper back swelling lesion + multiple opening discharge What is the diagnosis =Carbuncle

 

84)   most appropriate intervention for primary prevention of type diabetes= Physical activity

 

85)   Elderly K/c case of long time poorly controlled DM2 and hypertension she is on aspirin atenolol metformin ,insulin, multivitamin She complains of dizziness when she stands what is the cause In examination There is decreasing of BP when standing but the HR *didn’t change* = Autonomic neuropathies

 

86)   Q32-  the best screening test to detect diabetic nephropathy = urine albumin to creatinine ratio

 

87)   Long scenario of diabetic patient and some renal problems when to stop metformin regarding the GFR =GFR below 30

 

88)   12 years old boy diagnosed with type 1 diabetes, he has been compliant with insulin since the diagnosis 2 months ago,.. (but still hasn’t reach perfect control yet) = What is this called= Brittle disease Phenomenon

 

89)   Pregnant with high random blood sugar reading and fasting sugar. She’s at risk of what vaginal Infection= Candida

نوت ارتفاع السكر في الدم يعطي الفطريات Candida بيئة للنمو و التكاثر ، ف المريضة هذه عندها مرض السكر ، و هذا معناه ان السكر يكونمرتفع في الغدد العرقية و البول و saliva و الفم و genitals ، لذلك ارتفاع السكر مرتبط ب الاصابة بالفطريات خاصة الفم و منطقة الgenitals

Oesophageal varices

90)  Patient  with several episodes of hematemesis for the first time. Endoscopy show  dilated esophageal blood vessels with some adherent clots. diagnosis = Esophageal varices 

91)  Q   patient  with hematemesis , splenomegaly and ascites , epigastric tenderness. He is a heavy alcohol drinker and has history of previous admission due to peptic Ulcer =  Esophageal varices 

 

92)  Q- Patient with esophageal bleeding, How to prevent future recurrence/bleeding =   Beta block ( Nadolol) 

نوتاذا السؤال قالكم واحد عنده Esophageal bleeding و خلاص تعالج في الطورئ ايش الدواء الي ياخذهعلشان يحميه انه يسير له نزيف  في المستقبل مرة ثانية

93)   What is a long term treatment for Esophageal varices = Beta block

نوت دواء بيتا بلوك  يقلل من تكرار حدوث النزيف من الدوالي مرة ثانية عن طريق تخفيف الضغط فيالوريد portal ف يستخدم البيتا بلوك ك ( وقاية ) من حدوث نزيف اخر

 

 

94)  Q-alcoholic patient with vomiting large amount of bright red blood. On Ex : splenomegaly and ascites. after initial ER management, what to give before endoscopy = octreotide

نوتاذا السؤال قالكم واحد عنده Oesophageal varices قبل ما نسوي له منظار before endoscopy  ايشالدواء الي يأخذه يكون الجواب : octreotide

 

95)  patient with  oesophageal varices what drug given to reduce mortality = Ceftriaxone  

نوت المضاد الحيوي Ceftriaxone  يقلل من نسبة الوفاة في حالة oesophageal varices عن طريق التقليل من حدوثتلوث الدم بالبكتريا (bacteraemia.  )  .  

 

96)  Q-Case With Coffee floor emesis = Esophageal varices 

 

97)  Q-patient  with liver cirrhosis presents with several episodes of vomiting of blood and black tarry stool best next step = Resuscitation with adequate IV fluids    الاصح بين الاختيارات الاخرى

GERD

 

98)     Q- woman with chronic GERD symptoms. Her body mass index (BMI) of 28 kg/m2. . The patient taking omeprazole 20 mg daily. An upper endoscopic examination is performed, and the appearance of distal esophagitis the best next stepAdvise her to lose weight الاصح بين الاختيارات الاخرى

نوتأول و اهم خطوة في علاج GEDR ( ليس الادوية ) لان السبب الرئيسي هو السمنة و سوء العادات الغذائية لازمينزل من وزنه لان الادوية لوحدها ممكن لا تجيب فايدة الا فائدة بسيطة و مع استمرار السمنة و العادات السيئة ،الادوية راح تبطل تجيب مفعول يرضي المريض ، لذلك اهم خطوة انه ينزل من وزنه مع العلم ان  ال normal BMI range من   18.5 الى  24.9

 

 

99)     Q- patient  was diagnosed with GERD for 4 years on daily dose of PPI with a good control of her symptoms However, she reported occasionally heartburn Gastric biopsy revealed Helicobacter pylori. She gave history of smoking 20 pack-year but she quit 3 years ago. but she gave history of alcohol drink. On examination, she is obese otherwise normal. Which of the following Risk factors is mostly contribute to worsening of her GERD and she should control it= Obesity

 

100) Q- man presents to the clinic with symptoms of gastroesophageal reflux disease that not responding well to esomeprazole 20 mg once a day. Despite mild improvement in his symptoms, he continues to wake up with an acid taste in the middle of the night.  most appropriate management for this patient=  Increase the dose of esomeprazole

نوتأول شيء نبدء بجرعة 20 ملغ ، اذا الاعراض مستمرة او التحسن كان بسيط نزود الجرعة الى 40 ملغ . 

101) Q- female with heartburn, which mainly at pregnant women was night started after the on dinner when she lying on the bed. she antacid Syrup with some what response to that. best next step in the management= Increase the dose of esomeprazole

 

102) Q- female with heartburn, which mainly at pregnant women was night started after the on dinner when she lying on the bed. she antacid Syrup with some what response to that. best next step =  lifestyle modifications.

نوت:  تكرر نفس السؤال بالاختبار لكن الهيئة وضعت اربع اختيارات مختلفة لكل سؤال ، نفس السؤال الي قبل لكن الاختياراتكانت مختلفة راجعوا اصل السؤال من المذكرات الاصلية اذا تحتاج تشوفوا الاختيارات كاملة . 

103) Q-  man with heartburn and food regurgitation, he was taking 40 mg of pantoprazole daily with good response. He stopped it 4 months ago and started to have recurrence of his symptoms and becoming worse No dysphagia or weight loss. All routine laboratory workup was normal.  the best next step in his management= Prescribe same dose of PPI 40 mg 

نوت: لان الجرعة السابقة جابت معه فايدة و الاعراض خفت و بعد اربع اشهر رجع له الارتجاع مرة ثانية ، لذلك بما انه الجرعة السابقة جابت معهفايدة فيكون الجواب ياخذ نفس الجرعة .

 

 

104)Q-  patients with gastroesophageal reflux disease who is taking a maximum dose of pantoprazole for several weeks presents to the clinic with heartburn that is minimal  Improved with treatment The patient verified that he is taking the medication 30 minutes before meals. Upper endoscopy are normal most appropriate next step=  24-hour pH monitoring جواب استشاري جراحة

 

105) patients with a history of GERD for 10 years presenting with dysphagia for solids for 4 months. His BMI = 15.4 kg. What’s the next step= Endoscopy

نوت: نسوي له منظار علشان نستبعد لو قدر الله فيه سرطان بالمريء او المعدة بسبب الارتجاع المزمن لسنوات كثيرة. 

 

106)Q- A 62-year  man presents with a 3-month History  of epigastric pain after eating and intermittent heartburn between meals. He has lost weight but does not have any nausea or vomiting. He has not noticed any change in bowel habit and has not passed any blood or melena stools. He has no past medical history. He quit smoking 2 years ago most appropriate management strategy=  Urgent referral for upper Gl endoscopy

نوت: – لان كبير بالعمر و الان يشتكي من فقدان الوزن مهم جدا نسوي منظار علوي   حتى نستبعد اصابة المريض بسرطان او قرحة . 

107)Q- A 70-year-man is mechanically ventilated in The  Intensive Care Unit  7 days later, he developed coffee ground vomitus. most likely the cause= Stress gastritis

 

108)Q- A 34-year woman presents with a 4-week history of retrosternal Heartburn The pain Is often worse following eating. past medical history depression and she is on escitalopram 10 mg OD.. diagnosis=  Gastro-oesophageal reflux disease (GERD).

 

H.pylori   

109)Q-woman presented with gastric pain. The pain is revealed by food. helicobacter pylori was positive. Upper endoscopy showed antral gastritis The patient was treated for H.pylon  whatis  the most appropriate test to ensure h pylori eradicationUrea breath test

نوتباختصار السؤال يقولك كيف نتأكد ان المريض تشافى تماما من جرثومة المعدة ؟ عن طريق اختبار التنفس باليوريا Urea breath test .

 

110)Q-Patient with history of peptic ulcer and +ve urea breath test. You started and finished the treatment course. When you can  re-examine the urea breath testat least 4 weeks 

ربط:  urea = فيها اربع حروف = اربع أسابيع

 

111)Q- Patient her father has gastric ulcer,  urea breath test done for her shows positive  result. What is the organism = H.pylori

نوتقلنا اشهر سبب يسبب قرحة للمعدة هو اكل المطاعم خاصة الغير نظيفة ،يسبب اصابة المعدة ب بكتريا اسمهاHelicobacter pylori  ، كأنها طيارة هليكوبتر ، الاسم المتداول بين الناس هو جرثومة المعدة ، مافي احد من المرضى راحيقولك عندي هيليكوبتر راح يقولك عندي جرثومة المعدة انت ك دكتور تفهم انه قصده عنده Helicobacter ، اختصار الطبي  لهذه الجرثومة  = H.pylori ،  المهم ان هذه البكتريا مشكلتها تسبب مع الوقت قرحة في المعدة ، و مع الوقت و استمرار القرحةتسبب ثقب في المعدة و بعدها نزيف ممكن يكون مميت ، او ممكن استمرار القرحة تسبب سرطان المعدة ، لذلك اول علاج لقرحةالمعدة اذا سببها هذه البكتريا هو نعطي مضاد حيوي يقضي عليها ، ثاني سبب لقرحة المعدة هو الادوية و اشهر الادويةمجموعة NSADI مثل  المسكنات القوية و  الاسبرينو الاختبار الي نسويه للكشف عن هذا جرثومة المعدة هو Urea Breath

 

 

MALT lymphoma 

112)patient with Upper Gl endoscopy : Showed multiple aniral superficial ulcers Revealed mucosa-associated lymphoid tissue (malt lymphoma ) with numerous H.pylori organism the best management option= H.pylori eradication

 

نوت : اولا MALT lymphoma باختصار شديد هو ورم غالبا يصيب جدار المعدة بالتحديد النسيج اللمفاوي. 

 

1)        السبب الاساسي و رقم واحد لهذا النوع من الورم هو جرثومة المعدة Helicobacter

2)        ف اول علاج اذا لم يتحول الورم الى نوع خبيث او اذا لم ينتشر ،  فيصبح العلاج الاولي له هو القضاء على جرثومة المعدة ، لانها المسبب الرئيسي له . 

 

لذلك اذا شوفنا حالة MALT lymphoma ابحثوا عن الجواب H.pylori eradication  او تلاقوا في الاختيارات اسماء علاجات كثيرة تختاروا منها المضاد الحيوية الذي يقضي على هذا النوع من الجرثومة ، راح تشوفوا لاسئلة و فيها اسماء الادوية الي تيجي في الاختبار  .

 

109)patient with Tissue lymphoma (MALToma). the next step = Eradication therapy for H Pylori.

 

110)Q- Patient after endoscopy found cancer in stomach, and he has h pylori +ve , what will do = refer for possible gastrectomy

نوت:هنا خلاص المريض جاه سرطان ما راح ينفع انه نستخدم مضاد حيوي لازم استئصال للورم الخبيث.

109) elderly patient  with epigastric discomfort and fullness , weight loss Decrease appetite What appropriate investigation= Gastroduodenoscopy

 

110) -patient  with symptom of Peptic Ulcer  with weight loss  = Urgent referral for upper endoscopy 

نوت:احتمال كبير يكون عنده سرطان المريء ، ف لازم في اقرب وقت يعمل منظار 

 

 

111) Esophageal carcinoma = Referral for possible esophageal resection  

 

112) man underwent Endoscopic Esophageal Dilatation and was cleared to go homepost operative  day 2. He returns post op day 8 with retrosternal pain and fever(39°)= Esophageal perforation

نوت من مضاعفاتendoscopic oesophageal  يحصل ثقب بالمريء = Oesophageal perforation

 

113) -Patient with Esophageal perforation post dilatation for achalasia = Surgical drainage and Anastomosis.

 

114) Forceful vomiting followed by severe central chest pain and nausea, Subcutaneous emphysema diagnosis = esophageal rupture يسبب الم شديد و مفاجئء في الصدر

115) patient with severe epigastric pain radiating to back  Chest X.Ray shows left air under diaphragm diagnosis = Perforated peptic ulcer  .

نوت : اي مرة تسمعوا كلمة Air under diaphegram في اشعة X.ray اعرفوا التشخيص فورا انه حصل  ( ثقب ) = perforated في احد الامعاء والاشهر الاماكن الي يحصل  فيها ثقب هم   stomach وال Dudenum  واشهر سببلحصول الثقب هو يكون فيه قرحة سابقة بالمعدة او Dudenum بسبب كثرة استخدام ادوية NSAID ، او اي سبب اخرادى لحصول قرحة بالمعدة ، و ولم تعالج ومع الزمن والوقت حصل ان القرحة اصبحت عميقة جدا حتى انه خرم الجدارالخرجي للمعدة وحصل مانسميه بالثقب وخرج الهواء الموجود في المعدة وبالتالي اصبح بالاكس راي نشوف هواءتحت الحجاب الحاجز والحالة خطرة جدا لان الثقب يعمل نزيف والنزيف قاتل ، من الاسباب الي تعمل قرح اشهرهمادوية ال NSAD بكل انواعها و الاسبرين و بكتريا المعدة H.pylori

 

116)  A male planned for exploratory laparotomy due to perforated peptic ulcer he is unstable, best next step= Crystalloid through peripheral line 

 

117) Patient with chronic use of NSAID for osteoarthritis, Present with sudden severe abdominal pain , guarding and tenderness, What most appropriate next step = Erect chest X-ray ( to exclude peptic ulcer perforated)

 

 

118) child with  Esophagitis what is important history clue for Eosinophilic Esophagitis =Chewing food excessively

Note: Esophagitis =Excessive chewing

119) Burning chest pain for 6 months increased at night and unpleasant taste when lifting heavy objects= Esophagitis

Note : metallic taste or unpleasant taste Think about Esophagitis or GERD.

 

121)  Q-   A patient presents with chronic dyspepsia and recurrent upper Gl bleeds. Urea breath test is positive. Which of the following regimen Is the best to treat the underlying cause=-  Esomeprazole, amoxicillin and clarithromycin for 14 days

 

122)  Q- Child diagnosed with peptic ulcer +ve H.pylori. He’s already on PPI. What medication to add= Clarithromycin

123)  patient on treatment  helicopter pylori eradication (PPI standard dose, clarithromycin 500mg, and amoxil 1g bid for 10 days) with  partial response  Endoscopy: Showed gastric erosions. Showed h pylori organism. the best treatment regimen= PPI. bismuth subcitrate 300mg  tetracycline 500mg+  metronidazole 500mg for 14 days

 

124)   patient had knee pain, no trauma no fever and also have epigastric pain.=  Paracetamol  

نوت: ممنوع ibuprofen لان عنده الم في المعدة ونخاف لو اخذ دواء NSAID يسبب له قرحة ف ننتبه جدا اي مريض في الحياة قالكم عندي الم في المعدة ويحتاج مسكن ابعدوا تماما عن اي ادوية من عائلة ال NSAID مثل دواء ibuprofen لان تسبب لهم قرحة والقرحة يعمل ثقب والثقب يسبب نزيف داخلي ومن ثم الوفاة ، ف اكثر دواء مسكن امن للمرضى ال عندهم مشاكل بالمعدة هو ال paracetamol  .

 

 

125)patient  with melena and hematemesis. He is a known case of diabetes mellitus, hyperlipidaemia, and he is on aspirin 81 mg, lipitor 20 mg, diamicron 80 mg and warfarin 3 mg a day. Underwent upper Gl endoscopy and showed multiple superficial ulcers at the antrum and duodenal bulb. medications is most strongly associated with his presentation= Aspirin

نوتمن اكثر الادوية المستخدمة هذه الايام و تسبب قرحة في المعدة هي مجموعة ( NSAIDs ) و من ضمن هذه المجموع  الأسبرين  لان الأسبرين  يؤثر سلبيًا على طبقة الحماية المخاطية في المعدة، مما يزيد من خطر تهيج وتلف هذه الأنسجة ويحصل  قرحة المعدة .

126)   elderly  with a history of diabetic  , hypertension and osteoarthritis presents with melena. He gave a history of NSAID use for knee pain. He underwent upper Gl endoscopy which showed 1 cm duodenal ulcer with bleeding vessel, hemostasis was applied with good hemostasis.  appropriate next step in the management =IV PPI Infusion for 72 hours then oral PPI

 

127)  Q -A 65-year-old man known case of diabetes mellitus and hypertension presents to Emergency Room with 1-day history of vomiting fresh blood and melena. He is taking aspirin 81 mg daily. After fluid resuscitation. he was started on IV PPI. He underwent upper Gl endoscopy, which revealed a 2 cm duodenal ulcer at the bulb with visible vessel seen, endoscopic hemostasis was done using endo dipthe recommended duration for IV PPI post endoscopic management =  72 hours

 

128)  Q-  46-year-old man came to the clinic  asking for advice about eradication of H.pylon. He is known to have GERD on daily dose of PPI for 8 years with good control. He developed new onset of epigastric pain and was found to have helicobacter pylori By ELISA testing.  What can happen post H.pylon eradication in such patient = Need to increase the PPI dose

 

129)   A 40-year-old man is evaluated in the Emergency Department for several episodes of hematemesis He has no previous similar episodes His history is unremarkable He takes no medications. There is no jaundice or other signs of chronic liver disease  all lap test was Normal  the most likely cause of his gastrointestinal bleeding = Peptic ulcer disease

 

130)    Patient complaining of epigastric pain, better with vomiting, worse with eating. He’s taking medications for her his joint pain diagnosis = Gastritis

 

131)man with chronic hepatitis C and liver cirrhosis presented to Emergency Room with perforated peptic ulcer that requires urgent laparotomy most appropriate next step in the management prior to the procedure= Fresh frozen plasma

132)–  patient  under treatment for a recurrent helicobacter-associated duodenal ulcer She noticed that her stool is turned non-tarry black What drug is likely to be the cause of the black stools = Bismuth subsalicylate

 نوت من الاعراض الجانبية لدواء Bismuth يجعل لون البراز اسود ، الحين نربطها علشان ما ننسى   ربط : كلمة bismuth = بيزماث = براز دواء  bismuth يخلي لون البراز اسود غامق

133)Q12-man presents to the dime complaining of severe epigastric pain that is worse after eating. He describes the pain  as burning in nature with mild Improvement  with antacid therapy. most appropriate test to establish the diagnosis = upper endoscopy

 

134)Q-Patient with Melanie and labs show anemia , Normal upper and lower endoscopy next step =  capsule Endoscopy 

 

135)Q- woman have epigastric pain and shortness of breath for many years . Relive  by vomit only What to do  =  upper endoscopy

 

136)  Q14-   man who has been medically treated as peptic ulcer tor a long time, underwent upper endoscopy, which showed a malignant ulcer. During the visit, he started Warning his primary physician and wanted to file a complaint. Which of the following is the most appropriate response= Agree that it is his right to do so

 

 

137)   Q- A 55-year-old woman has alcohol use disorder and presents with glossitis, diarrhea , progressive memory loss, and hyper-pigmented rash in sun-exposed areas. What deficiency is the  cause = Vitamin B3 (niacin)

Irritable bowel syndrome  القولون العصبي

138)   case of typical of a male with IBS presentation ( abdominal pain somewhat relieved with defecation, frequent loose stool, feeling of incomplete emptying, no loss of weights) on abdominal examination: normal  How to diagnosis=  diagnosed clinically

نوتالقولون العصبي مايحتاج فحوصات يكون واضح من الاعراض  

139)A 23-year-old woman complains of a 4-month history of abdominal discomfort with alternating bowel habits. She recently gave a history of bloating, passing mucus with stool, and noticed an increase in bowel motions (3-4 times a day). The abdominal pain is relieved by defecation  , no weight loss or fever. her uncle was diagnosed with colon cancer at the age of 60. (lab results All Normal  diagnosis=  Irritable bowel disease

 

 

140) What is   highly suggestive irritable bowel syndrome =  Diarrhoea that alternate with constipation

 

141) A 13-year  boy Is complaining of recurrent abdominal pain foe the last year. The pain takes about 5 to 7 days to Improve and It is usually associated Increased frequency of stooling In these occasions, his stool is watery. Irritable bowel syndrome is suspected  most appropriate in management= . Avoid lentil ingestion

نوت ال lentil هو العدس وهو نوع من البقوليات يفضل تجنبها لمرضى القولون العصبي لان العدس يهيج القولون . 

142) A 24-year-old woman presents with 9 months of intermittent abdominal pain and anxiety. Occasionally, the pain is associated with loose stools. She denies any alarming symptoms. All basic work-up  were normal. Stool cultures and fecal calprotectin were negative. the most appropriate treatment = Tricyclic antidepressants

نوت و مريض عنده متلازمة القلون العصبي يسير الدواء الذي يستخدم لعلاج الألم والقلق المرتبطين بـ متلازمة القولونالعصبي  هو Tricyclic antidepressants وهو عبارة عن مضادات الاكتئاب من فئة الثلاثي الحلقي .

 ربط :  من اسمها قولون عصبي = يعني شيء نفسي = تاخذ علاج نفسي يهدء النفسية و بالتالي القولون راح يهدء ان شاء الله

143)  – woman with Irritable  bowel syndrome most appropriate treatment=  Tricyclic antidepressant

144)  A 30-year. woman complains of epigastric pain, heartburn and bloating after meals for 3 months. No history of hematemesis or weight loss. A trial of esomeprazole 40mg for 8 weeks did not relief her  Gastroscopy Normal    Urea breath test: Negative  Ultrasound of abdomen:    Normal. best next step in management =  Tricyclic antidepressant

نوت في هذه الحالة، يُشتبه بأن الألم والأعراض التي تشتكي منها مثل حرقان في فوهة المعدة و الم و انتفاخ بعد الاكل و جربت ادويةمضاد لحموضة المعدة و لم يأتي ب اي فائدة هذه معناها ان هذه الاعراض تحصل بسبب اضطرابات نفسية مثل القلقنعطيها ادوية  نفسية من فئة (Tricyclic antidepressants)  مضادات الاكتئاب الثلاثي الحلقي . 

Mallory Weiss tear

145)  QA 30-yearold woman presented with hematemesis after a bout of prolongedvomiting not on any medications. Diagnosis=  Mallory-Weiss tear

نوت أهم كلمة سرية لتشخيص Mallory-Weiss tear يقولك انا يا دكتور استفرغت كثير  و لكن اخر استفراغ ساريطلع دم ، يعني بعد نوبة استفراغ اكثر من مرة ، سار الاستفراغ مصحوب ب دم . 

hematemesis after a bout of prolonged vomiting = MalloryWeiss tear

 

 

146)  16 year old  came to ER after vomiting once with blood , she had recurrent nausea and vomiting. before her period in the last time there was slight blood with vomiting , after 4-6 hours  ,all labs and exams are normal what you should so = reassure and ask to come if it recur again

Guillain-Barré syndrome

147)  A child with a recent history of fever now presents with bilateral lower limb paralysis and tingling. The face, trunk, and upper limbs are not involved. On neurological examination, both lower limbs have a power of 3/5 and absent reflexes. Diagnosis =  Guillain-Barré syndrome.

 

148)  Q-Child post-GI infection a few weeks back develops ascending symmetrical muscle weakness associated with loss of reflexes. (It’s Guillain- Barré) how will you treat this child Intravenous immunoglobulin

نوت لأنه مرض مناعي ف افضل علاج لهم هو Intravenous immunoglobulin

149)  patient with ascending limb weakness with history of gastroenteritis 3 weeks back “ – Guillain-Barré syndrome “ what’s the prognosis of these diseases = full recovery  

نوت اغلب المرضى يتعافوا منها و يرجع صحتهم ١٠٠٪ حتى الشلل يروح منهم

Pheochromocytoma

Pheochromocytoma هو ورم يحصل في Adrenal Gland وكما هو معروف Adrenal تحتوي على medulla and cortex المرض هذا يكون تحديدا يقع في جزء ال medulla ، فيطلع بشكل مفرط epinephrine and norepinephrine الييلعبوا دور بشكل اساسي في:  heart rate, metabolism, and blood pressure لذلك لما يحصل ورم في medulla of Adrenal Gland يزيد norepinphron وبالتالي يرتفع نبضات القلب ويزيد ضغط الدم وتلاقي الشخص معرق كثير وعندهصداااع وتلاقيه يعصب بسرعة و اعصابه دايم متوترة ، بس تشوفوا الاعراض هذه كلها جات مع بعض لازم  تعملوا CT علىAbdomenحتى تستبعدوا هذا المرض اهم نقطة في علاج هذا المرض هو انكم لازم اول حاجة تعملوها تخفضوا ضغط الدمعن طريق دواء Alpha block 

 

150)   Patient with hypertension 220/110 not responding to home medications, abdominal CT show adrenal mass , catecholamine is very high , asking about management  = alpha blockers

 

151)  – patient with HTN that has been persistent despite antihypertensives. Several investigations= Urine catecholamine very high Which drug will you  use for management=  alpha blockers 

 

152)   – man with 5.5-cm left adrenal mass  on non-contrast CT of the abdomen. In view of the suspicious radiological features of the mass, the patient was referred to the endocrine surgical team for an elective adrenalectomy. investigations should be done prior to an elective adrenalectomy = 24-hour urinary fractionated metanephrines

 

Sjogren syndrome

 

📌 مرض Sjorgan syndrome = معناها حصل هجوم مناعي ، المناعة تهجم الغدد التي تفرز الدموع و ال saliva و بالتاليالمريض يكون عنده جفاف في العين و الفم بسبب قلة ال saliva ويسير عندهم تسوس بالاسنان ،  اي مكان يكون فيه سوائليحصل هجوم فيه و يقل السوائل حتى   بين المفاصل يكون عندهم التهاب متكرر في المفاصل بسبب ان السائل الي بين المفاصليحصل فيه جفاف   .

149)  Middle aged lady with dry mouth, unable to talk, itchy feeling in the eyes with bilateral parotid gland enlargement, which of the following is the most likely diagnosis=  Sjogren syndrome  

 

150)   female with Sjogren syndrome  ( dry mouth and dry eyes , Vaginal dryness , she  experienced severe hypokalemic episodes what type of tubular acidosis? Renal Tubular Acidosis type 1 

 

151)  type of Renal Tubular Acidosis comes with Hyperkalemia=Renal Tubular Acidosis type 4

📌 النوع الاول يكون عندهم  hypokalaemia

📌 النوع الرابع يكون عندهم Hyperkalaemia = ربط = هايبير = رابع

Thyroxine

149)  Q- A 49-year  woman is evaluated because of fatigue and weight gain although she follows a daily diet control and exercises 3 times per week for 45 minutes. She has hypercholesterolemia requiring statin therapy. On physical examination, she has dry skin, thyroid gland enlarged with a diffusely nodular texture. Laboratory studies are with similar results for TSH and T4 were obtained 4 months ago  BMI 29 kg/m2 Thyroid-Stimulating Hormone 7.0 (high) Thyroxine (T4 free serum) 9.5 (normal) Thyroid peroxidase antibody (TPOAb) 150 <35 IU/mL most appropriate next step in management = Start levothyroxine therapy

 

150)  Pregnant patient with Sx of hypothyroidism: cold intolerance, lethargy labs: high TSH low t4 what the most appropriate management  =Thyroxine

 

151)  -A 36-year woman is evaluated during her first prenatal visit for Medical history of hypothyroidism, for which she has taken levothyroxine 125 g/d. for the last 2 years. Thyrold-Stlmulatmg Hormone 4.4  Thyroxine (T4 free serum) 9.5 the most appropriate treatment of this patients hypothyroidism now = Increase levothyroxine dose

📌 معلومة : لو فيه سيدة كان عندها انخفاض في الغدة و تاخذ دواء levothyroxine و بعدها سارت حامل ( لازم ) نزود الجرعة  ، احفـظوها بالمنطق وحدة حامل الان عندها شخص ثاني في  بطنها ( الجنين ) ، طبيعي جسمها سوف يزداد احتياجه للهرمونات ،  إذا لم تكن هناك زيادة في جرعة levothyroxine، فقد يحدث نقص في الهرمونات الدرقية لدى الأم والجنين، مما قد يؤثر على صحة الحمل وتطور الجنين . 

149)  The case of a asymptomatic woman asks about management of hypothyroidism during pregnancy, the patient is not pregnant but wishes to become pregnant soon, she has a hx of hypothyroidism for several years and has been on a stable dose of levothyroxine, TSH checked 3 months ago was 2.0 uU/ml. , the most appropriate recommendation for this patient =  Increase the levothyroxine dose when the patient becomes pregnant.

 

150)  A 34-year-woman is evaluated for history of galactorrhea, worsening fatigue, malaise and irregular excessive menses for the last 5 months. She complains of headaches that occur about 2 to 3 times per week. Pregnancy test was negativeThyroid-Stimulating Hormone 16 (high) Prolactin 1000 (high) the most appropriate management=  Order pituitary MRI

 

151)    pregnant with Diagnosis of grave’s disease was confirmed but she is refusing to start any treatment while she is pregnant most appropriate action= Explain clearly the risk for her and the fetus and try to convince her to start the treatment immediately

 

152)   Female came with High TSH, and normal T4, she is planning to be pregnant, “she doesn’t take thyroxine”, what would you do to her = give thyroxine immediately

 

153)   patient with abnormal  thyroid function tests. Otherwise, she is asymptomatic(TSH): 15 (T4 free serum): 6.5   the most appropriate management plan = Start levothyroxine replacement

 

154)  Woman has controlled hypothyroidism on 175 mcg levothyroxine. In the last 3 months, the doctor raised the dose to 200 mcg. Labs: T4 (normal) T3 (normal)TSH= 17 (high) the best explanation lab findings = Poor compliance. 

 

 

 

 

 

Dehydration

155)  Case of female her weight is 40 Kg calculate the maintenance = 1900

📌 طريقة الحساب مشروحة في المذكرات الأساسية .  

156)    A 6-year- presented to Emergency Department with  severe vomiting and diarrhoea the volume of maintenance fluid intake per hour she required = 56

 

157)  Calculate the maintenance I.V Fluid for paediatric weight 12 Kg = 1100

 

158)   Calculate fluid deficit of 5%. Dehydration Weight 10 keg = 1500

 

159)  -Dehydrated patient sunken eyes, decreased skin turgor, and a depressed fontanelle the percentage of dehydration = 10%

 

160)    A 5-year child presents to Emergency Room with vomiting and diarrhoea for 4 days. he looks dehydrated, hypoactive with sunken eyes and delayed skin lurger with dry mucous membrane and capillary refill is 4 seconds The child connected lo cardiopulmonary monitor and IV access attained, blood sample sent for electrolytes. next action = 20 ml per-kg normal saline bolus

 

161)    A 2-year  girl presents to the Emergency Room with fever, vomiting and diarrhea for the last 4 days On examination, she looks severely dehydrated, lethargic with altered conscious stat, with mild abdominal pain The family mentioned that they tried to use oral rehydration solution at home but she is noi drinking well. A rapid correction by intravenous normal saline fluid established lo manage her case. After 30 minutes, she starts to have abnormal movement and went in coma, which required resuscitation Intubation and admission to pediatric  Critical Care Unit ( Blood pressure 75/35 mmHg  Heart rate 110/min   Temperature 39 “C the most likely cause her deterioration = Rapid correction lead to cerebral edema

📌 نوت: فيه شيء اسمه Rapid correction to normal salin يعني نعطي محلول و نعالج الجفاف لكن بكمية اكبر و في وقت قليل ، المصيبة  الي سارت مع هذه الطفلة ، عندما يحدث تصحيح سريع لمستوى للجفاف ، هذا راح  يسبب تضخمًا في الدماغ (تصاعد الدماغ) كأنه غرقان وسط ماء كثير بسبب الزيادة السريعة في اعطاء المريض محلول عبر الوريد ، لذلك فيه حساب و قاعدة معينة بحيث يحدد لنا كل ساعة مفروض نعطي كم مل للمريض الي عنده جفاف، و ليس بشكل عشوائي لان الزيادة الكثيرة للسوائل يؤدي الى تضخم خلايا المخ ، و لذلك هذه الطفلة  ، تدهور صحتها بسرعة بعد التصحيح السريع بالسوائل الوريدية، و ظهر عليها  حركات غير طبيعية وفقدان الوعي و هذا بسبب تورم خلايا المخ بسبب كثرة الماء  لذلك ننتبه اثناء علاج الجفاف الشديد لا نسوي Rapid correction . 

 

163)  A 4-year-old gin 5 brought to the Paediatrics Emergency Department with vomiting and lethargy. The parents report a weight loss of 1 kg over the last 2 weeks. There has been Ittie appetite, but a lot of thirst and frequent urination. The child appeared sleepy and irritable. Physical examination confirmed dry mucous membranes and a generally reduced skin tone. After running several exams, the paediatrician started IV treatment with ringer lactate plus added electrolytes and a low-dose insulin infusion (see lab results).  pH 7.27.36-7.45  Glucose 20 3.5-5.5 mmol/l complications should be observed =  Cerebral oedema 

 

164)  A 2-year-old child presents to the Emergency Room with fever, vomiting and diarrhoea for the last 4 days. On examination, she looks severely dehydrated, lethargic with altered conscious stat, with mild abdominal pain. The family mentioned that they tried to use oral rehydration solution at home but she is not drinking well. A rapid correction by intravenous normal saline fluid established to manage her case. After 30 minutes, she starts to have abnormal movement and went in coma, which required resuscitation intubation and admission to Paediatric Critical Care Unit appropriate management= Fluid deficit should be replaced over 24 hours

📌 نوت نفس السؤال الي قبله ، لكن كأنه يعلمنا انه مفروض نستبدل السوائل الناقصة على مدار ال 24 ساعة  الطفليعاني من تورم في الدماغ نتيجة التصحيح السريع للجفاف التي كانت عن طريق  السوائل عبر الوريد، يجب أن يتم استبدالهذه السوائل ببطء خلال فترة زمنية تصل إلى 24 ساعةهذا يعني أن الكمية الكبيرة من السوائل التي يحتاجها الطفل يجبأن توزع على مدى يوم كامل بدلاً من اعطاء الكمية كاملة  في فترة زمنية قصيرةهذا النهج البطيء يساعد في تقليل مخاطرتورم الدماغ

165)   scenario baby with Signs and symptoms of sever dehydration. Asking about sodium serum= High

 

166)  child with DKA , PH 7.1 and glucose 20mmol,  Child with dehydration, depressed anterior fontanel, and decreased skin turgor.  What is the initial management step  = Iv fluids

 

167)  40s o lady diagnosed with breast cancer underwent neoadjuvant chemotherapy then mastectomy surgery, now started radiotherapy sessions, her labs  Potassium 6.7 Creatinine 730  Uric acid  high What’s the cause of her labs = radiotherapy induced tumour lysis 

Electrolyte disturbance

 

165)  Patient has frequent seizures and cognitive impairment. Diagnosed withglioblastoma multiforme. Labs : decreased Na, decreased K, decreased Cl cause of the electrolyte abnormalities=Cerebral salt wasting syndrome

 

166)  75-year-old type 2 diabetic undergoes a bowel resection for colon cancer. He [is well prior to the operation with well-controlled diabetes and no other underlying | condition. The operation is successful and the patient is given postoperative insulin and IV dextrose.2 days after the operation he becomes very agitated , Na = low,  K = low ,  Cr = low , Serum osmolality : low , Urine osmo: normal Which of the following is the most likely cause = Water overload

📌 ربط من اسمها جدا سهل مريض عنده اكتئاب + و عنده شعور بعطش كثير وكثرة تبول . = يسير التشخيصpsychogenic polydipsia

167)  Pt with multiple vomiting What do you expect of Na level = Low

📌 ربط : المريض استفرغ كثير  = يعني اكل كثير خرج منه = يعني الصوديوم سار قليل عنه = لان طلع كل شيء في المعدة فطبيعي يسير قليل الصوديوم

168)  – 5 years old with meningitis Labs hyponatremia, and low serum 

osmolality, High urine Na and high urine osmolality Diagnosis= SIADH

 

169)  Pt admitted to ICU then start to deteriorate and confuse Labs: hyponatremia, and low serum osmolality, High urine Na and high urine osmolality Diagnosis What’s the cause=SAIDH

 

170)  Pregnant c/o sever abdominal pain and uterine contractions she was given 6mg Mg sulfate and the e contractions become normal then decrease the dose to 4mg Then complained of shortness of breath What is next step= discontinue mgso4.

📌 نوتأول خطوة نوقف مغنيسيوم و بعدها نعطيها Ca gluconate.

 

171)   long history of pregnant lady received IV mgso4. What drug reverse the action = Calcium gluconate

 

172)  Patient post thyroidectomy had hypocalcemia didn’t improve even after iv and oral calcium. What is your management: =  Check magnesium level