السلام عليكم ، 

في هذا الفيديو اقدم لكم مجموعة من الاسالة المحاكية لأسالة امتحان الهيئة الطبية للتخصصات السعوديةsmle  ....واسالة في تخصص الجراحة surgery في كل سؤال اقوم بشرح لماذا تم اختيار الاجابة ....

كمثال

Question:
A 45-year-old man presents with sudden, severe epigastric pain that started a few hours ago. He has a history of chronic NSAID use for osteoarthritis. On examination, he appears distressed, with guarding and rebound tenderness in the upper abdomen. An upright chest X-ray reveals free air under the diaphragm. What is the most likely diagnosis, and what is the next step in management?

Answer:
The most likely diagnosis is perforated peptic ulcer. The next step in management is urgent surgical intervention, usually an exploratory laparotomy with ulcer repair. Initial resuscitation includes IV fluids, broad-spectrum antibiotics, and nasogastric tube placement.

Explanation:

• The patient has sudden, severe epigastric pain and a history of NSAID use, which increases the risk of peptic ulcer disease.
• Guarding and rebound tenderness suggest peritoneal irritation, likely due to gastric or duodenal perforation.
• The presence of free air under the diaphragm on an X-ray is a hallmark of perforation.
• Management includes immediate fluid resuscitation, IV antibiotics (covering Gram-negative and anaerobic bacteria), proton pump inhibitors, and early surgical repair