Abdominal 🥁

Question 1

Better recall:
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

Answer 1

D. Nitros Oxide ✅💛

Question 2

24 YO case of SBO. Imaging shows small bowel intussesception.
Appropriate management?
1. A- Barium enema
2. B- Surgery

Answer 2

2. B- Surgery ✅💛
   Note :
   Adult > intusseception

Question 3

Best IV fluid for IO with persistent vomiting 2 days:
RI
NS
Albumin

Answer 3

NS ✅💛

General rule, Ringers (LR) is the best fluid for GI loss expect in case of stomach loss → choose NS

لو جاكم كيس واحد عنده pyloric stenosis

كمان تختارون له NS

Question 4

A 45 years old male patient underwent appendectomy after signs and symptoms of appendicitis. Histopathology report : tip of appendix carcinoma. What is the most appropriate management

A- Observation
B- Chemotherapy
C- Radiotherapy
D- Right hemicolectomy

Answer 4

Observation ✅💛

Note :
Tip is cured by appendectomy

Question 5

Pt did splenectomy or any spleen surgery, then after 1 week i think, had left upper quadrant pain, lungs exam on lower left area: dullness, decreased or absent lung sound. I think fever, forget if theres cough or not, dx?
1. Subphrenic absess
2. lower left lobe pneumonea

Answer 5

Subphrenic absess ✅💛

Question 6

Mva with splenic tear
Done splenectomy
What is goona decrease in his blood after surger ?
A.Insulin
B.Glucagon
C.Tg
D.Glucose

Answer 6

Insulin ✅💛.

Question 7

🟡 when to give the Ab of appendicitis ?

Answer 7

60min pre op (U).

Question 8

🟡 acute 🐡 , after labs , next ?

Answer 8

US ✅💛

Question 9

🟡 Angiodysplasia ttt ?

Answer 9

embolisation ✅💛

Question 10

Patient with typical picture of appendicitis
, 6 days later he developed appendical abssess “ 10 cm “ , how would you manage?
A) laparoscopic appendectomy
B) Percutaneous drainage
C) open appendectomy

Answer 10

B) Percutaneous drainage ✅💛

Note :
<4 cm Abx
>4cm p/c drainage

Question 11

Appendicitis completed by abscess, asking about Abx what should cover ?
- gram positive & something
- Gram positive & something
- gram negative & arobes
- gram negative & anaerobes

Answer 11

gram negative & anaerobes ✅💛

Question 12

A 38 year female presented to the ER complaining of epigastric pain for 6 days, radiating to the back and it associated with multiple episodes of vomiting. She’s known to have multiple small gallstones. On examination there’s diffuse abdominal distention, epigastric tenderness and sluggish bowel sounds
Labs:ALP, amylase total and direct bilirubin all within the normal range
What’s the most appropriate next investigation ?
1. A-Trans abdominal ultrasound
2. B-Abdominal CT
3. C-Urine amylase
4. D-Abdominal/smth fluid analysis

Answer 12

B-Abdominal CT ✅ 💛

Note :
Abdominal CT with contrast is the imaging modality of choice for gallstone ileus

Question 13

🟡 Dx modality for
• Diverticulosis: …
• Diverticulitis: …

Answer 13

🟡 Dx modality for
• Diverticulosis: Colonoscopy
• Diverticulitis: CT with IV contrast

Question 14

Young Pt did surgery (I think appendectomy or something like that ) he have recurrent adhesion and now come with symptom of obstruction on physical ex there is guarding and tenderness all over abd what is ur mx:
1. A- NPO and rest bowel and hydration
2. B- exp. laparotomy
3. C- not remembered

Answer 14

exp. laparotomy ✅💛

Question 15

Q: Patient With presentation of pancreatitis (epigastric pain + high amylase) and history of gall bladder stone. What is the next important initial step?
A:
1. Crystalloid fluid IV
2. ERCP
3. US

Answer 15

Crystalloid fluid IV ✅💛

Question 16

65 years old man admitted for elective ventral hernia repair, K/C of
hypertension and BA, upon examination bilateral crepitation, ascites and
bilateral edema, what to do?
A) Proceed with hernia repair.
B) Don’t repair unless obstruction has occurred.
C) Delay until situation is controlled.

Answer 16

Delay until situation is controlled ✅💛

Question 17

Pancreatic pseudocyst Tx:
1. A. Drainage pi cutaneous
2. B. Drainage Internally

Answer 17

Drainage Internally ✅💛

Question 18

Patient post hernia repair, when can she get pregnant:-
A-3 m
B-6 m
C-9 m
D-12 m

Answer 18

12m ✅💛

Question 19

198.Hematemiss splenomegaly, portal venous thrombosis :
A. splenectomy
B. portalcavoshunt
C. portorenal shunt

Answer 19

splenectomy ✅💛

Note :
Bec. portal venous thrombosis :

Question 20

5. You are consulted by the emergency department to evaluate a
   19-year-old man with acute abdominal pain. The patient reports
   the pain started around his umbilicus approximately 12 hours
   ago and is now most severe in the RLQ. You have a high
   suspicion for acute appendicitis and elect to take this patient to
   the operating room for laparoscopic appendectomy, foregoing
   diagnostic imaging. Upon entry into the abdomen, you note the
   appendix appears grossly normal. However, the cecum and
   terminal ileum are severely inflamed. The abdomen otherwise
   looks normal. What is the most appropriate next step?

a. Continue with appendectomy and refer the patient to a
gastroenterologist
b. Leave the appendix, close the abdomen, and refer the patient to a
gastroenterologist
C. Resect cecum, appendix, and terminal ileum en bloc
d. Biopsy an area of inflammation and send for frozen section to

Answer 20

Leave the appendix, close the abdomen, and refer the patient to a
gastroenterologist ✅💛

Note :

must use his or her clinical judgment to determine the next step. In
this scenario, severe inflammation of the cecum and terminal ileum
suggest this patient may have a new diagnosis of Crohn disease.
Given that the cecum is inflamed, appendectomy is ⚠️
as it has a high risk of leak.

Question 21

T stage in gastric adenocarcinoma
A- PET
B- MRI
C- Endocopic U/s
D- Abdominal U/s

Answer 21

Endocopic U/s ✅💛

Question 22

5.Patient “45 years old, came with history reducible hernia in inguinal area it pop out every two days”interval” with mild pain and and he Manuel reducible it by his finger, then he suddenly developed severe “constant ” pain in early morning in that area and came to hospital, on examination of the inguinal area and scrotum examination and he is free from both them and pain is disappear Now just with persistent nausea and vomiting next step ?
A- Pelvic and Abdomen CT
B-hernia repair today after 2 hour i think
C reasurance and discharger
D hernia repair after 2 days.

Answer 22

Pelvic and Abdomen CT ✅💛

Question 23

Patient post appendectomy, came for regular follow up post-surgery, no active complaints, on exam he has seroma which drains freely from the opening of the wound, no erythema no pain no fever, what is the appropriate management?
A. Observation
B. Open wound exploration
C. Regular wound dressing
D. US guided drainage

Answer 23

Regular wound dressing ✅💛

Question 24

Old patient in Intensive Care Unit (ICU) with acalculous cholecystitis, what is the best management for him?
A. Cholecystectomy tube
B. Lap chole
C. Open chole

Answer 24

Cholecystectomy tube ✅💛

Question 25

46 YO male came with RUQ pain, fever, chills and rigors and SOB. He has previous hx of duodenal ulcer perforation repair 3 weeks ago. O/E there is tenderness in the right hypochondrium.
Vitals:
High Temprature
Low Hb
CXR:Right atelectasis with right lower lung pleural effusion
What is the most appropriate next step?
A- CT chest
B- Abdominal Ultrasound
C- Explaratory laparotomy

Answer 25

Abdominal Ultrasound ✅💛

Note :
This pt might have bleeding etc start simple
C is too invasive and A don’t make sense

Question 26

A patient is undergoing surgery ( i think appendicitis but not sure ) ,for how long he should take the prophylactic antibiotics :
A - only the preoperative dose ( single dose )
B- 3 days
C - 5 days

Answer 26

only the preoperative dose ( single dose ) ✅💛

Question 27

Patient has appenicular abcess large 10*15 reaching the right flank there is also fecolith on the US what should u do
A- Laproscopic appendectomy
B- Open appendectomy
C- perecounous drainage

Answer 27

perecounous drainage 💛✅

Question 28

Q- A 56-year-old patient presents with left lower quadrant pain and a change in bowel
motion. Upon examination, the patient has a fever and left lower quadrant tenderness.
Imaging showed thickened bowel. What is the Treatment?
A. Conservative Oral antibiotics.
B. Colonoscopy.
C. Admission with IV antibiotics.
D. Laparoscopic Colectomy.

Answer 28

Oral Ab 💛✅

Question 29

Q- 28 years old patient medically free presented to the ER with hx of abdominal pain
nausea anorexia and lower quadrant abdominal pain vitally stable. CT shows diverticulitis
with 20 ml fluid 2x2 cm. What is the most appropriate management?
A. exploration laparoscopic with sigmoidectomy
B. exploration laparoscopic with easy content content
C. conservative IV antibiotics
D. diagnostic laparoscopic

Answer 29

IV Ab 💛✅

Question 30

1- You are in the OR and want to do appendectomy. How to know appendix location?
A- Follow terminal ileum
B- Follow ileucecal valve
“There is no taenia coli in choices”

Answer 30

Follow ileucecal valve ✅💛

Question 31

2- 60 years old patient with chronic liver disease and acitest came complaining with umbilical hernia How to treat it ?
A -Laprscopic hernial repair
B -Repair with waterproof mesh
C -Wait till acietest treated first
D -Do paracentesis and repair after 2 days

Answer 31

Wait till acietest treated first ✅💛

Question 32

63 years old male patient came with massive lower GI bleeding
What is the most common cause?

Colon cancer
Agiodysplasia
Diverticulosis

Answer 32

Diverticulosis ✅💛

Question 33

Patient presented with appendicitis
The doctor palpated the left lower quadrant and was tender. Name of this sign:
Psoas sign
Blomberg
Rovsin sign
Mcburney’s Sign

Answer 33

Rovsin sign 💛✅

Question 34

60 years old male Patient came to ER complaining of severe epigastric pain radiates to the back ass/w nausea, vomiting and constipation. On examination distended ando was noted with tenderness over the epigatric area. X-rays revealed left pleural effusion. All labs were normal (LFTs, amylase, ALP).
Which of the following will confirm the diagnosis?
- urine amylase
- Pleural fluid analysis/ or amaylase
- Stool amylase

No imaging modalities were in the options

Answer 34

Pleural fluid analysis/ or amaylase ✅💛

This pt had 🐡 complicated with pleural effusion
And it had high amylase in it

Question 35

(Pic of air ender diaphragms)
Pt use ibuprofen and then complain of epigastric pain during examination generalized abdominal tenderness
Bp low
HR high
What’s the most appropriate step?
-CT
-ex lap
-endoscopy

Answer 35

ex lap ✅💛

Question 36

Patient after appendectomy, he has redness hotness, tenderness in the surgical site , what is the appropriate next step ?
1- open the wound
2- iv antibiotics
3- aspiration the surgical site

Answer 36

open the wound ✅💛

Question 37

Ederly man presented to the ER with rigid distended abdomen prepared for laparotomy with hypotension and fever (38) X ray showed free air under diaphragm What is the best initial resuscitation option ?

• intubation and ionotropes
  -Broad spectrum Abx
  -Colloid via central line
  -Crystalloid fluid via peripheral line

Answer 37

Crystalloid fluid via peripheral line 💛✅

Question 38

Female with lower abdominal pain for 6 hours with N/V, on exam there is suprapubic tenderness and left lower Quadrant, pregnancy and Urinalysis are normal:
A. US abdomen
B. Abdominal x ray
C. Laparoscopic exploration
D. Discharge with analgesia

Answer 38

US abdomen 💛✅

If not there go with CT

Question 39

25 sep

Female going for appendectomy
She asking you about the antibiotics

A- only 1 pre op then stop
B- pre op and 3 days post op
C- pre op and 5 days post op
D- pre op and 7 days post op

Answer 39

only 1 pre op then stop 💛✅

Question 40

Pt known case of dm , discharged after inguanal hernia repair, what it is your advise to him ?

A) Abdominal plinder
B ) avoid lifting heavy objects for 6 months
C) laxitive or frusimode i cant remember
D) …..

Answer 40

avoid lifting heavy objects for 6 months 💛✅

Question 41

Long case of severely ill pt , admitted to icu and done many surgeries for necrotizing panceritis 4 months ago what well the most imp metabolic response ?

1- decrease insulin resistance
2-hypoglycemia
3- decrease gluconeogynesis
4- increase lipolysis

Answer 41

increase lipolysis ✅💛

Question 42

Pt came 4 days after hernia repair, with mild swelling and tenderness in the wound, with no more Sx or labs DX?

A- Seroma
B- Hematoma
C- recurrent
D- Wound infection

Answer 42

Seroma ✅💛

Question 43

Pt after splenectomy surgery presented with with multiple episodes of intestinal obstruction

Now complianing of abdominal destination pain rigidity sluggish bowel sounds

Vitality stable

X ray air fluid level

What is the intial management?
A- Paracentesis
B- gastrografin enema
C- expl laparotomy
D- NGT , analgesic, bowel rest

Answer 43

NGT , analgesic, bowel rest ✅💛

Question 44

strangulated hernia ask about mx
A. Diagnostic lap
B. Expl laparotomy

Answer 44

Open with mesh ( hernioplasty ) ✅💛

Question 45

36 Years old female came with sudden pain for 12 in right iliac fossa and periumbilical , there’s tenderness over right iliac fossa and suprapubic no rebound tenderness. In the lab there’s High WBCs what you will do?
A. Transvaginal US.
B. CT abdomen
C. emergent appendectomy

Answer 45

CT abdomen ✅💛