Hamoud’s Approach
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A textbook based approach to high yield topics in the SMLE. Family Medicine channel: https://t.me/Hamoud_Almubki Twitter: Halmubki
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Channel Hamoud’s Approach (@surgerybyhamoud) is an active participant. Currently, the community unites 12 264 subscribers, ranking 1 976 in the Medicine category and 7 002 in the Saudi Arabia region.
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The author describes the resource as a platform for expressing subjective opinions:
“A textbook based approach to high yield topics in the SMLE.
Family Medicine channel: https://t.me/Hamoud_Almubki
Twitter: Halmubki”
Thanks to the high frequency of updates (latest data received on 29 April, 2025), the channel maintains relevance and a high level of publication reach. Analytics show that the audience actively interacts with content, making it an important point of influence in the Medicine category.
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Be sure to join Abdulaziz’s channel for Internal Medicine: https://t.me/Dalaanmedicine
He corrects from similar references, including Harrison’s which as I’ve said before is the best for IM.
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Here’s an interesting OBGYN question from last year that I felt like posting and sharing my point of view.
Full recall
Primigravida , delivers healthy baby with uneventful vaginal delivery. After delivery of the placenta, she’s found to have lost 1000 cc of blood. She looks well, stable and her uterus is firm. What is the most likely cause for bleeding?
A- uterine atony
B- coaglopathy
C- retained products of conception
D- genital tract laceration ✅
A -> Atony is the most common cause, but considering the uterus is firm it’s automatically excluded.
B -> It’s incredibly rare, and there are no risk factors in the question.
C -> The presentation tends to be late.
Take a look at these screenshots from Hacker and Current OBGYN:
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As mentioned previously, I’m done with solving SMLE questions considering I’ll be starting my FM residency very soon and I’ll be focusing on it completely. From time to time, I may post a high yield approach or two for IM similar to the COPD approach here considering the overlap in knowledge. Naturally, I’d be focusing on the most important concepts.
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Pregnancy typical DVT symptoms then developed PE, how to dx?
A- Ct
B- D dimer
C- V/Q ✅
D- Us for lower limbs
patient with recent rectal surgery comes to you with absent pulses up to the femoral area.
How will you manage such a case?
a. Unfractionated heparin
b. Enoxaparin
c. IVC filter
d. Thrombolysis
Depends on the full recall. If recent surgery <14 days, A. If past it, D. If it came exactly like this? Most likely A.
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A 57 year old man presents with 2 days of abdominal pain, nausea and vomiting.
Examination revealed a distended, tympanic and mildly tender abdomen without rebound or
guarding (see lab results and reports) Hb 153 (normal value 130-170 g/L)
WBC 12.6 (high) Plain abdominal x-ray: multiple air-fluid levels CT scan: multiple dilated
loops of small bowel with a transition point in the distal small bowel, with some adjacent fat
stranding. Which of the following is the most appropriate next step in management?
1. Observation
2. Colonoscopy
3. Diagnostic laparoscopy
4. Exploratory laparotomy ✅
Due to the CT findings. Take a look at this excellent algorithm from Washington.
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A 42-year-old woman underwent an uneventful laparoscopic cholecystectomy, 2 weeks later, she present to the Emergency Department with vague abdominal pain. CT scan: Large collection in the subhepatic area. Which of the following is most
appropriate next step?
A. Operative drainage
B. CT-guided drainage
C. Laparoscopic drainage
D. ERCP with biliary stent placement ✅
Then go for drainage.
The reference is Bailey & Love.
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A 41 years old man underwent a laparoscopic cholecystectomy, 5 days back started to
experience severe abdominal pain and distension. Examination revealed a tender and
distended abdomen. Bp: 100\55 HR: 103 Temp:37.9 ,,revealed the presence of ascites. which of
the following is the most appropriate management :
A) ERCP
B) percutaneous drainage ✅
C) Exploratory laparotomy
D) diagnostic laparoscopy
This is postoperative collection, not ascites. When would we choose laparotomy? If the patient had peritonitis. His BP is irrelevant in our scenario.
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65 YO male presented to ER with severe right leg pain and absent pedal pulse.
Which of the following is the most diagnostic investigation?
A. СТА ✅
B. MRA
C. Conventional angiography
D. Ultrasound doppler
Multiple references (except Schwartz) are going with CT-A, so I’m changing my answer.
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Men had multiple gun shots bleeding from
everywhere He is oriented opening his eye spontaneously
obey command Vitals
80/60
Pules 133
RR 25
O2 88%
How to manage him?
1- inserting 2 iv line ✅
2- laparotomy
3- oxygen mask
4- CT
No indications whatsoever for oxygen mask (B) since the patient is conscious and breathing normally, so go for (C) and fix the circulation.
Patient with stab wound in anterior neck, he is Alert but in labs oxygen sat 82%. What to
do?
A. Oxygen mask
B. Cricothyroidotomy
C. Endotracheal intubation ✅
D. Tracheostomy
As mentioned above, oxygen mask is for Breathing (B). It doesn’t secure the airway, and they simply want you to follow ABCDE.
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36 old male at ER C/O Right abdominal Pain, O/E: fever, anorexia, weight loss,
tenderness in RQ and Lower intercostal margines also patient is toxic
Temp. 37.9 (I think but it was elevated) wbc high, bilirubin high US: cystic lesion without
septates CT : homogenous (not sure) and "THICK WALL with
Peripheral enhancement
- What's most appropriate
A. Ceftriaxone
B. Metronidazole
C. Surgical drainage
D. Percutaneous drainage ✅
Same answer as last time, but I want to clarify something.
According to Current: we would initiate management with fluoroquinolone monotherapy or a third-generation cephalosporin (Ceftriaxone) + Metronidazole.
Considering they are separated, the answer is D for sure even if asked for an initial management.
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A patient with Crohn’s disease treated with azathioprine and infixmab and other
medication presented complaining of pus out from anal. Vital signs stable also no fever.
what is the next step?
A- Pelvic MRI ✅
B- BroadIVAntiBiotic
C- Swabandculture
D- increse inflixmal dose
I would only choose B if they were telling me that the patient is febrile. I don’t think the medications used are relevant considering the abysmal quality of these superficial SMLE questions.
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Case of diverticulosis pt came with severe left iliac fossa pain and constipation,
tenderness upon palpation
Bp was normal temp was 37.6
Radiology image
Collection of fluid 9x10 cm with inflammation of the sigmoid
How would you manage
A-Exploratory laparotomy
B-Sigmoidectomy and anastomosis
C-Percutanous drainage ✅
Same answer as last time, but I need to point out that it could change to A if there are signs of perforation (free air). This question could be incomplete.
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16 YO came to ER after vomiting once with blood , she had recurrent N/V before
her period in the last time there was slight blood with vomiting , after 4-6 hours they
mention also ,all labs and exams are normal what you should so?(came in nov and dec)
A— admit her for observation
B— reassure and ask to come if it recur again
C— prepare for urgent EGD
D— Discharge
Better recall: young man with multiple episodes of vomiting, last one was bloody small amount , vitally
stable, No more vomiting or pain, what's the most appropriate treatment?
A. Conservative management ✅
B. Urgent Upper GI endoscopy
C. Discharge and tell her to come back if symptoms recurred
This recall has the missing correct option. I’ve checked a ton of references and the answer remains the same. Mallory-Weiss is always managed conservatively unless the patient has continuous bleeding -> endoscopy. The other options don’t make sense.
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A 44 year old lady was hit by a vehicle, and brought to the emergency room conscious, on
100% 02, received 2 liters of normal saline and 2 liters of blood. Blood pressure 60/40 mmHg
Examination confirmed abdominal rigidity. 145 beat /Heart rate min CXR and pelvic x-ray were
normal. Which of the following is the most appropriate step?
A) DPL
B ) FAST ✅
C) CT scan abdomen
D) surgical exploration
I chose D last time. The only clue for peritonitis is rigidity and nothing else, so I think they simply want us to follow the trauma protocol.
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60 years old female came with bloody nipple discharge
Most appropriate steps to her management:
A- mammogram annually
B- start ultrasound
C- MRI
Better recall: 61 year female patient complaining of left breast pain and nipple bloody
discharge , the examination revealed normal left breast and axilla .
What is the appropriate initial test to do ?
A- MRI
B- CT
C- US
D- Mamo ✅
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COPD approach
Maintenance
1) LAMA
2) LAMA + LABA
3) Both + ICS
Smoking cessation is the most important and initial preventive measurement, and oxygen therapy is the best way to achieve patient survival if at 88% sat or less (89% if corpulmonale). Venturi mask is preferred. Pulmonary rehabilitation reduces hospitalization.
Exacerbation
1) SAMA + SABA
2) Antibiotics (infections often trigger COPD exacerbations)
3) Systemic steroid
4) Supplemental O2 to maintain at 90%
5) Intubation indications:
Non invasive ventilation
- PaCO2 >45
- Alert aware and cooperative patient with no contraindication for NIV
Mechanical ventilation
- Impaired mental status, copious secretions or inability to clear them, facial trauma, hemodynamic instability, severe acidosis
اهم توبيك مدسن في SMLE 👆🏻
Reference: Harrison’s Principles of Internal Medicine
