د.مؤمّــل رَحيـم

📌وزاري A couple with primary infertility for 10 years attended to the clinic. Male semen analysis showed a count of 1 million/ml with non-progressive motility. Female partner is 37 years old with normal hormone profile and free hysterosalpingography. What is the most suitable line of treatment? A) IUI for 6 cycles. B) Treat the husband and re-do semen analysis after 6 months. C) Intracytoplasmic sperm injection (ICSI) & IVF. D) Laparoscopy to confirm tubal patency. E) Induce ovulation with timed intercourse for 6 months.

Sign ?

📌وزاري A 5-year-old child presents after a fall off a second-storey apartment building. The patient is hypotensive and the trauma team is experiencing difficulty in obtaining a peripheral venous access. What is the most appropriate next step? A) Tibial intraosseous catheter placement B) Place a femoral central venous catheter C) Continue attempts at peripheral access D) Umbilical vascular access E) Venous surgical cut down of the saphenous vein

📌وزاري A 40-year-old chronic smoker male presents with ulceration of the tip of the right second, third, and fourth toes. He gives a history of recurrent migratory superficial phlebitis of the feet occurring a few years ago. Physical examination findings are remarkable for absent bilateral posterior tibial and dorsalis pedis pulses with palpable popliteal pulses. What is the most important step in management? A) Long term anticoagulant therapy B) Multiple toe amputations C) Immediate operative intervention D) Cessation of smoking E) Angiography followed by bypass surgery

📌 KAWASAKI DISEASE :- • Acute, self-limited vasculitis of medium-sized arteries, especially coronary arteries ❤️ 👶 Epidemiology • 🧒 Age: Mostly < 5 years (peak 1–2 years) • 👦 Slight male predominance (M > F ≈ 1.5 : 1) • 🌏 Common in Asian (Japanese) populations • ❄️ Peaks in winter → early spring …………………………………………………………………………………….. • Cause: Unknown — likely immune response to infection in genetically susceptible child. 🩸 Mechanism: Endothelial injury → inflammation → coronary aneurysm risk. …………………………………………………………………………………….. ⚠️ Diagnostic Criteria (Classic KD) Fever ≥ 5 days + ≥ 4 of 5 principal features 🔥 1. 👀 Conjunctivitis Bilateral, non-exudative, limbic sparing 2. 👄 Oral changes Cracked lips, strawberry tongue, red mucosa 3. 🌸 Rash Polymorphous, non-vesicular 4. ✋ Extremity changes Erythema, edema → later desquamation 5. 🤕 Lymphadenopathy Cervical, usually unilateral, ≥ 1.5 cm 🧩 Incomplete (Atypical) KD • Fever ≥ 5 days + only 2–3 criteria, but labs or echo suggest KD • 🍼 Common in < 6 months infants or older children • Labs: ↑ CRP, ↑ ESR, anemia, thrombocytosis (after week 1), ↑ ALT/AST, ↓ albumin, sterile pyuria. …………………………………………………………………………………….. 🕒 Phases of the Disease 1. Acute febrile (1–2 wks) → Fever, mucocutaneous signs 2. Subacute (2–4 wks) → Peeling of digits, thrombocytosis, aneurysm risk 3. Convalescent (≥ 6 wks) → Recovery, labs normalize. …………………………………………………………………………………….. ❤️ Major Complications • 🫀 Coronary artery aneurysm (most serious and most common )وزاري 2025 • 🧩 Thrombosis → MI • 💔 Myocarditis, pericarditis, valvular regurgitation • ⚠️ Long-term: premature atherosclerosis risk …………………………………………………………………………………….. 💊 Treatment (Start Aspirin — within 10 days!) 💉 IVIG : 2 g/kg single infusion Mainstay — ↓ aneurysm risk 💊 Aspirin (ASA) High → 80–100 mg/kg/day (acute) → Low 3–5 mg/kg/day (6–8 wks) Anti-inflammatory → antiplatelet 💉 Steroids With IVIG in high-risk or refractory cases Reduces coronary involvement 🧬 Infliximab / Cyclosporine If IVIG-resistant Rescue therapy …………………………………………………………………………………….. 🩺 Monitoring • 🫀 Echocardiography: • At diagnosis • Repeat at 1–2 weeks & 4–8 weeks • Long-term cardiology follow-up if any coronary involvement. 👉 @medspace22

A 5 -year- old boy present to the emergency department with 5 days of fever , most likely diagnosis ?

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OSCE question :

“In a 62-year-old man presenting with dyspnea, how would you differentiate between cardiac and respiratory causes using a single lab test ?”

🔹1. Swan Neck Deformity 🦢 Hyperextension of the PIP (proximal interphalangeal) joint and flexion of the DIP (distal interphalangeal) joint. 🔹2. Boutonniere Deformity (Buttonhole Deformity) 🔘 Flexion of the PIP joint and hyperextension of the DIP joint. 🔹3. Mallet Finger (Baseball Finger) ⚾ Flexion deformity of the DIP joint due to loss of active extension. 👉 @medspace22

اللي عدهم روته نسائية و توليد "مرحلة سادسة "راح انزل بالتعليقات اسئلة MCQs مهمة بالامتحانات النظرية اللي تمتحنوها ، الرابع و الخامس كذلك تستفادون منها .

📌وزاري 2025 Which one of the following is least complication to occur in turner syndrome: A) Osteoporosis B) Hyperthyroidism C) Diabetes D) Hypertension E) Coarctation of aorta

A 2-year-old African-American child presents with painful swelling of the hands and feet. Lab tests show hemoglobin of 9 g/dL, white blood cell count of 11,500, and platelet count of 250,000. Which additional test will confirm your diagnosis? A) serum calcium measurement B) skeletal survey C) hemoglobin electrophoresis D) bone marrow aspiration E) VDRL testing