Corrections logسجل التصحيحات
We publish what we correct. Each entry names the chapter and item and what changed. To report a possible error, use the support form.ننشر ما نصحّحه، ويذكر كل إدخال الفصل والعنصر وما تغيّر. وللإبلاغ عن أي خطأ محتمل يُرجى استخدام نموذج الدعم.
Content audit — October 2026تدقيق المحتوى — أكتوبر ٢٠٢٦
Every chapter, flashcard, case and question was reviewed line by line for medical accuracy and English–Arabic fidelity (AI-assisted review). Below are the medical and answer-key corrections (933). Translation and wording corrections (16391) are recorded in the full ledger.رُوجع كل فصل وبطاقة وحالة وسؤال سطراً سطراً من حيث الدقة الطبية ومطابقة العربية للإنجليزية (مراجعة مدعومة بالذكاء الاصطناعي)، وفيما يلي التصحيحات الطبية وتصحيحات مفاتيح الإجابة.
Ethics, Legal & Patient Rights الأخلاقيات والقانون وحقوق المريض — 15 correction(s)
SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s15— Ambiguous wording: "no effect is compatible with the data" can be read as "NO effect (of any size) is compatible", the opposite of the intended point that the NULL value (1.0) lies inside the interval and so cannot be excluded.SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s22— Unsupported penalty claim: "a fine, suspension from practice, or both" does not correspond to the Saudi texts. Failing to report an injury suspected to be criminal is penalised under art. 28 of the Law of Practicing Healthcare Professions (breach of art. 11: imprisonment up to 6 months and/or a fine up to SAR 100,000); disciplinary sanctions in art. 32 are warning, fine up to SAR 10,000 and cancellation of licence; tSNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-fc040— The definition of confounding is wrong as a general definition. It describes only one scenario (a co-intervention introduced at the same time) and omits the defining feature: a third factor associated with both the exposure and the outcome. Students would miss standard items (e.g. smoking confounding a coffee–lung cancer association). The fix keeps the author's example.SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-cs012— The vignette calls the transplant surgeon 'the most experienced neurologist on site'. A surgeon is not a neurologist, so the vignette contradicts itself. The Arabic 'لأنه أخبر أطبّاء الأعصاب الموجودين' also reads as 'because he informed the neurologists present' (أخبرَ = told), which is a mistranslation.SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-q071— The stem calls the transplant surgeon 'the most experienced neurologist available'. A transplant surgeon is not a neurologist, so the stem contradicts itself. The AR 'لأنه أخبر أطبّاء الأعصاب المتاحين' also reads most naturally as 'because he informed the available neurologists'. The key (D) is unaffected.SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-fc060— The stated sanction for failing to report suspected child abuse ('a fine, suspension, or both') has no basis in the Saudi reporting provisions: the Law of Protection from Abuse (Arts. 3, 5) and the Child Protection Law set a duty to report with disciplinary accountability for employees who breach it but no fixed fine or suspension, and the Health Practice Law penalties are different (Art. 32 warning, fine up to SAR 1SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-q062— Art. 32 of the Law of Practicing Healthcare Professions lists only three disciplinary penalties (warning; fine up to SAR 10,000; licence cancellation with removal from the register). Suspension is an interim ministerial measure under Art. 39 while a violation punishable by cancellation is examined, not a graded sanction. Corrected here and in the s20 ladder and paragraph that teach the same sequence.SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s20— Art. 32 of the Law of Practicing Healthcare Professions lists only three disciplinary penalties (warning; fine up to SAR 10,000; licence cancellation with removal from the register). Suspension is an interim ministerial measure under Art. 39 while a violation punishable by cancellation is examined, not a graded sanction. Corrected here and in the s20 ladder and paragraph that teach the same sequence. (ladder step 6)SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s20— Art. 32 of the Law of Practicing Healthcare Professions lists only three disciplinary penalties (warning; fine up to SAR 10,000; licence cancellation with removal from the register). Suspension is an interim ministerial measure under Art. 39 while a violation punishable by cancellation is examined, not a graded sanction. Corrected here and in the s20 ladder and paragraph that teach the same sequence. (summary paragraSNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-q069— The stated sanction for failing to report suspected child abuse ('a fine, suspension, or both') has no basis in the Saudi reporting provisions: the Law of Protection from Abuse (Arts. 3, 5) and the Child Protection Law set a duty to report with disciplinary accountability for employees who breach it but no fixed fine or suspension, and the Health Practice Law penalties are different (Art. 32 warning, fine up to SAR 1SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-q070— The stated sanction for failing to report suspected child abuse ('a fine, suspension, or both') has no basis in the Saudi reporting provisions: the Law of Protection from Abuse (Arts. 3, 5) and the Child Protection Law set a duty to report with disciplinary accountability for employees who breach it but no fixed fine or suspension, and the Health Practice Law penalties are different (Art. 32 warning, fine up to SAR 1SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights-q070— The stated sanction for failing to report suspected child abuse ('a fine, suspension, or both') has no basis in the Saudi reporting provisions: the Law of Protection from Abuse (Arts. 3, 5) and the Child Protection Law set a duty to report with disciplinary accountability for employees who breach it but no fixed fine or suspension, and the Health Practice Law penalties are different (Art. 32 warning, fine up to SAR 1SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s02— Memory aid said 'Forcing or persuading breaks autonomy'. Rational persuasion (information and reasoned argument) respects autonomy; coercion, manipulation and undue pressure breach voluntariness. Reworded to 'pressuring' (EN) / 'الضغط' (AR).SNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s22— The legal basis was stated loosely ('the law governing health practice'). The general duty to report suspected abuse sits in the Child Protection Law and the Law of Protection from Abuse (Art. 3: anyone who learns of abuse must report; employees through the employer), and the Health Practice Law (Art. 11) separately requires practitioners to notify the authorities of suspected criminal injury. Named the laws in EN anSNLE_Part01_Ch01_Ethics_Legal_Patient_Rights::s23— 1982 is the date of the Council of Senior Scholars decision (No. 99) permitting organ transplantation; it did not address brain death. Acceptance of brain-death criteria by Islamic jurisprudence councils is dated later (1985-1988). Date removed from brain death and attached to transplantation only.
The Nursing Process, Prioritisation & Documentation العملية التمريضية وترتيب الأولويات والتوثيق — 24 correction(s)
SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s01— Incomplete list: objective 11 names only five of the six clinical-judgment steps and leaves out 'generate solutions' (section 2.16 and flashcard fc041 list all six). The AR has the same omission.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s03— Unsupported superlative presented as fact: a wrong cuff size is a recognised, common source of false blood-pressure readings, but the sources do not rank it as 'the commonest reason'. The AR also omits 'or makes a call' and the whole cuff-size clause.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-cs005— 'The three symptoms of hypoglycaemia' implies a fixed, canonical triad. Hypoglycaemia has many recognised symptoms (autonomic: sweating, tremor, palpitations, hunger; neuroglycopenic: confusion, drowsiness, irritability), so the measurable outcome should ask the patient to name three of them.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-cs012— Rash after an IV antibiotic given despite an overridden allergy alert, yet the post-event actions omit the first step for any suspected drug reaction: stop the drug (then assess ABC and treat). Step added. The AR replacement also rewrites the feminine imperatives (قيّمي، عالجيه، أبلغي، وثّقي، قدّمي) impersonally.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-cs013— Mislabelled event. A wrong-patient dose that reached the patient without harm is not an 'adverse event': this chapter's own fc063 defines an adverse event as one that caused harm, and the AR 'حدث ضارّ لم يُحدث ضرراً' is self-contradictory (a harmful event that caused no harm). By the WHO ICPS this is a no-harm incident (not a near miss, because it reached the patient). The rest of the answer is unaffected.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q012— Two defensible answers. The quoted diagnosis has no 'evidenced by' part, and this chapter teaches that an actual diagnosis has three parts (q007 explanation; cs002 says only a risk diagnosis has two), so option B ('missing its evidence-based third component') is also a true error besides the intended D (related factor names a nursing action - circular). Adding an evidence phrase to the quoted statement leaves D as thSNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q048— Key wording is literally inaccurate: RR, temperature and HR rose while BP fell, so the four parameters did not move 'in the same direction'. They all moved towards deterioration. As written, a careful student may reject the key and choose C (SBP < 100).SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q057— Inaccurate: decompression of a tension pneumothorax is fast and life-saving but NOT definitive. Needle decompression is a temporising measure, and tube thoracostomy (chest drain) is the definitive treatment and is required after it. The key (Red/immediate) is unaffected.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q071— Unsupported superlative presented as fact: no cited evidence ranks under-reporting of near misses as 'the commonest reason' an error recurs with harm. The fix keeps the point (unreported near misses leave the fault in place) without the invented ranking.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-cs008— Late mealtime insulin mainly causes post-meal hyperglycaemia / poor control; hypoglycaemia is the risk when insulin is given and the meal is then delayed. Reworded to state both halves correctly (late dose -> post-meal hyperglycaemia; delayed meal after the dose -> hypoglycaemia).SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q033— Late mealtime insulin mainly causes post-meal hyperglycaemia / poor control; hypoglycaemia is the risk when insulin is given and the meal is then delayed. Reworded to state both halves correctly; the key (C) is unchanged.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-fc024— Interdependent (collaborative) interventions are those coordinated with other members of the healthcare team; actions under a protocol or standing order are carried out under a provider's order or direction and belong with the dependent type. Removed 'or under a protocol' (also matches section 2.9, 'carried out WITH other disciplines').SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-fc028— 'Within the drug's expected onset time' can mean reassessing before the drug has had time to act. Reassessment is timed for when the drug should be working, around its expected peak effect, and not left to the end of the shift.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s04— Unsourced superlative ('the commonest ... and the first thing a reviewer will challenge'). Softened to a defensible statement; the teaching point (chart the observation, not the conclusion) is unchanged.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s11— Timing rule 'within the analgesic's ONSET time' (first note): reassessing within the onset time can mean reassessing before the drug has had time to act. Reworded to 'when the analgesic should be working, around its expected PEAK effect'.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s11— Same timing rule in the second note ('within the analgesic's onset time'): reworded in the same way so the section agrees with itself and with flashcard fc028.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q025— Same imprecise timing rule as section 2.10 and flashcard fc028 ('within the drug's expected onset time'); the stem gives an oral analgesic with onset about 30 minutes, so the correct option now states when to reassess (30-60 minutes after the dose). The key (D) is unchanged.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation-q025— Same imprecise timing rule ('at the drug's expected onset'); the explanation now says the reassessment is made when the drug should be working. Key unchanged.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s16— Unsourced superlative ('the two entries most likely to be used against a nurse in a review'). Softened; the warning (do not chart a label instead of a behaviour, do not chart in advance) is unchanged.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s20— Unverifiable claim about exam frequency ('the hardest part ... and the part most often tested'). Removed; the clinical content (a patient in cardiac arrest is not the first priority in a mass-casualty incident) is unchanged and correct.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s20— Unverifiable claim about what is examined ('This inversion is the examined point'). Replaced by a neutral study cue.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s21— Unverifiable exam-frequency claim ('the most reliably tested part') for teach-back. Replaced by a statement of what teach-back does; the practice itself is correct.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s21— Same unverifiable exam-frequency claim ('most reliably tested') in the summary note.SNLE_Part01_Ch02_Nursing_Process_Prioritisation_Documentation::s23— Unverifiable exam-frequency claim 'asked directly, every sitting' replaced by a neutral statement ('a classic exam point'); the identifier rule itself is correct (Joint Commission NPSG.01.01.01).
Communication, Patient-Centred Care & Health Education التواصل والرعاية المتمحورة حول المريض والتثقيف الصحّي — 25 correction(s)
SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s13— Imprecise rationale: in expressive (Broca) aphasia the patient's own WRITING is usually limited as well; what is relatively preserved is comprehension/reading of simple material. "Write instructions down" is good advice, but "written language is often less affected" is not reliably true. Also feminine imperative (واكتبي).SNLE_Part01_Ch03_Communication_Patient_Centred_Care-fc020— Safe distance from an escalating patient is stated as 'an arm's length', i.e. within striking reach. De-escalation guidance recommends keeping at least two arm's lengths away (and standing at an angle). Also feminine second-person imperative 'احتفظي' in AR.SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s24— Premarital screening was listed as an example of SECONDARY prevention, but the section's own rule is screening people who may already have the disease; the Saudi premarital programme detects carriers to prevent affected births and is classed in the literature as primary prevention. Replaced by an unambiguous secondary-prevention screening example (cervical screening). Note: Ch17 s02 also lists 'premarital carrier tesSNLE_Part01_Ch03_Communication_Patient_Centred_Care-cs014— Terminology qualifier: the case uses the public-health levels-of-prevention classification, in which rehabilitation of established disease is tertiary; cardiology guidance files post-MI cardiac rehabilitation under secondary prevention. The qualifier states which classification is meant.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-cs014— Terminology qualifier (second part): cardiology guidelines use 'secondary prevention' for the same programme.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-fc055— Terminology qualifier: tertiary in the public-health classification used in this chapter; cardiology guidance (NICE QS99) calls post-MI cardiac rehabilitation secondary prevention.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-fc002— Model qualifier: the card teaches the three-phase model; many textbooks add a pre-interaction phase (four phases in total). The three-phase answer is kept and the variant is named so that students who meet the four-phase version are not misled.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-fc075— Absolute 'Never' for telephone death notification softened: in-person notification is the standard, telephone notification is accepted only when unavoidable and a direct question is answered honestly.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-fc075— Adds the honesty rule for a direct question (consistent with case cs017).SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q011— Unsourceable ranking claim ('most frequently tested') replaced by a neutral descriptor.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q088— Over-generalisation ('usually the frustration'): agitation in an awake ventilated patient has several causes; physiological causes (pain, hypoxia, tube/ventilator problem, delirium) must be considered alongside setting up a yes/no signal. Key B unchanged.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q088— Completes the qualifier: sedating before communication is established and physical causes are checked treats the signal, not the cause.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q090— Absolute wording softened: telephone notification of a death is avoided as a rule (key D remains the best option); a direct question is answered honestly, as in case cs017.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q090— Adds the honesty rule for a direct question.SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q097— The explanation listed 'who delivers the message' among the usual barriers beside clinic timing, transport, cost and childcare. Messenger/recommendation is a social-process driver, not a practical barrier, and its inclusion made distractor D (a more senior health official) look partly supported, weakening the single-best-answer design (key B: a practical barrier remains).SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s03— The chapter teaches three phases (orientation, working, termination). Peplau's original model has four phases and many nursing/psychiatric-nursing texts add a pre-interaction phase before orientation, so a student may meet that term on the exam. A one-line note was added; the three-phase teaching is unchanged.SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s09— Step 2 'Move somewhere PRIVATE' had no safety qualifier. Separating an angry person from an audience is recommended, but staff must not become isolated; a short qualifier keeps the step consistent with the safety paragraph that follows (exit behind you, call for help early).SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s11— 'News of a death is not given by telephone' is stated without qualification, which could be read as permitting the nurse to deny the death if a relative asks directly. This chapter's own open case (cs017) already teaches the exception: do not lie, say it cannot be discussed properly by telephone and that someone will meet them, and if pressed answer plainly and stay on the line. The same qualifier was added to the exSNLE_Part01_Ch03_Communication_Patient_Centred_Care::s11— The 'Watch out' card said 'Never confirm a death over the telephone', which as written contradicts the rule that a direct question is not answered with a lie. Reworded to 'break the news' (initiating disclosure), matching the chapter's flashcard fc075 ('Breaking news of a death by telephone: Never').SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s24— The diabetic foot check was listed under SECONDARY prevention, whose definition here is 'someone who HAS the disease but does not know'. A foot check is done in people who already know they have diabetes, to prevent complications, which this chapter's own tertiary tile lists, and flashcard fc053 already gives 'diabetic foot care' as tertiary. The example was replaced in the secondary tile with screening for undiagnosSNLE_Part01_Ch03_Communication_Patient_Centred_Care::s24— Companion change: diabetic foot care added as an example under TERTIARY prevention ('preventing complications'), consistent with flashcard fc053.SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s24— Terminology collision: the TERTIARY tile ended with 'secondary prevention of another stroke'. Stroke guidelines use 'secondary prevention' for preventing recurrence, but inside the three-level model that is tertiary, and the phrase inside the tertiary definition confuses students. Reworded to 'preventing another stroke'. The Arabic already avoids the phrase and needs no change.SNLE_Part01_Ch03_Communication_Patient_Centred_Care::s19— Low health literacy was described as 'independent of (general) education', which overstates the evidence: education is associated with health literacy but does not reliably identify who has low health literacy. Reworded to 'not reliably predicted by education (level)' in every place in the chapter (s19, q058 explanation, fc040).SNLE_Part01_Ch03_Communication_Patient_Centred_Care-q058— Low health literacy was described as 'independent of (general) education', which overstates the evidence: education is associated with health literacy but does not reliably identify who has low health literacy. Reworded to 'not reliably predicted by education (level)' in every place in the chapter (s19, q058 explanation, fc040).SNLE_Part01_Ch03_Communication_Patient_Centred_Care-fc040— Low health literacy was described as 'independent of (general) education', which overstates the evidence: education is associated with health literacy but does not reliably identify who has low health literacy. Reworded to 'not reliably predicted by education (level)' in every place in the chapter (s19, q058 explanation, fc040).
Health Assessment & Vital Signs التقييم الصحّي والعلامات الحيوية — 21 correction(s)
SNLE_Part01_Ch04_Health_Assessment_Vital_Signs::s07— Apical pulse landmark: the text gives the fifth intercostal space as the apical site and says this site is used in infants. In infants and young children the apex is at the FOURTH intercostal space (left midclavicular line); the fifth is the adult landmark.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs::s07— Same landmark statement in the summary paragraph: fifth intercostal space is given without the infant/young-child qualifier (fourth intercostal space), although the next sentence says the site is used in infants.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs::s13— Overstatement: 'chronic pain simply does not produce a sympathetic response'. In chronic pain the vital-sign (sympathetic) changes are typically not evident because the body adapts, but they are not absent in every case (e.g. acute-on-chronic flares). The sentence is softened to match the preceding statement ('typically normal in chronic pain - because the body adapts').SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-fc014— The card is unqualified, but the fifth intercostal space applies to adults and older children only; in infants and young children the apical impulse is at the FOURTH intercostal space (left midclavicular line). The neighbouring card (fc013) tells students to take the apical pulse in infants, so the unqualified answer could be misapplied.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-cs002— 'Everything is still nearly normal' is not accurate for these observations: a respiratory rate of 28 is a red (3-point) NEWS2 parameter and new vagueness/confusion also scores 3, so the set is not 'nearly normal'. The wording is softened to match the corrected model answer (apart from the respiratory rate, no single value is dramatically abnormal).SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-cs002— Internal inconsistency with the chapter's own early-warning teaching: a respiratory rate of 28 is not 'nearly normal' - it is a red (3-point) NEWS2 parameter that prompts urgent review on its own (the chapter says the same in s24 and cs012). The five parameters also did not move 'in the same direction' numerically (temperature, pulse and respiratory rate rose; blood pressure and saturation fell); they moved towards dSNLE_Part01_Ch04_Health_Assessment_Vital_Signs-cs003— Over-statement: pain treatment can substantially reduce agitation in dementia, but it does not 'often resolve it entirely' (in the trial of stepwise pain treatment roughly one in five residents became significantly less agitated, and behaviour worsened again after analgesia was tapered). The wording is softened.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-cs008— Faulty reasoning: unmeasured (missed) OUTPUT would make the true balance more negative than the chart, i.e. it cannot explain a chart that looks balanced while the patient has GAINED 2.4 kg. Only missed intake (flushes, drug volumes, fluids from family) or over-recorded output explain the gap. 'Unmeasured output' is removed from the list of usual culprits (the AR list is corrected in the same way, and the non-human sSNLE_Part01_Ch04_Health_Assessment_Vital_Signs-cs012— Over-generalisation: a respiratory rate of 28 does not cross the escalation threshold in 'any' early warning system (e.g. original MEWS scores 21-29 as 2 points), and 28 + pulse 118 is not 'well above' the trigger in NEWS2 (3 + 2 = 5, i.e. at the urgent-response threshold). The chapter's own EWS (s24) uses the seven NEWS2 parameters, so the statement is made NEWS2-specific.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q019— 'It is the site used in infants' is misleading: the fifth intercostal space applies to adults and older children. In infants and young children the apical impulse lies at the FOURTH intercostal space (left midclavicular line). What is used in infants is the apical method, not this site.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q023— MCQ validity: two options are defensible for "What must she avoid?": D (palpating both carotids together, which can reduce cerebral perfusion and stimulate the carotid sinus) AND A (using the thumb, which has its own pulse, is also something that must be avoided when palpating any pulse including the carotid). Narrowing the stem to patient harm leaves D as the only correct answer; the KEY itself is unchanged.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q090— The example says every individual value "could be called acceptable", but a pulse of 110 is above the normal adult resting range (60-100 bpm), i.e. tachycardia. Using 100 as the end point keeps the teaching point (a steady trend within "normal" values) accurate.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q104— Overstatement: "It is never acute." Clubbing usually develops slowly, but onset over about two weeks is described (and it can regress quickly once the cause is treated). Softened to "rarely". The Arabic also omits this last sentence, so the matching Arabic is added.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q016— Borderline stem value: the chapter defines hyperpyrexia as above 41 °C, but some reputable sources use above 41.5 °C, so 41.4 °C is classed differently depending on the source. The stem temperature is raised to a value that is hyperpyrexia under every common definition (key C unchanged).SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q132— Two defensible answers: option B 'It is scored highest' is literally true (motor is scored 1-6, the widest range) and the stem said 'carry most weight'. The stem is reworded to ask for the most informative component, so B no longer answers it; key C unchanged.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q143— Mechanism mis-attributed: S3 is rapid early-diastolic filling of a dilated or volume-overloaded (failing) ventricle; a stiff, non-compliant or hypertrophied ventricle is the classic S4 mechanism (as q110 in this chapter states). 'Stiff or overloaded' is corrected to 'dilated or volume-overloaded'.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q147— Two defensible answers: option B 'Frequent small voids only' is described in the explanation as a classic disguise for retention (overflow incontinence). The stem now asks which finding MOST STRONGLY suggests retention, making the direct sign (A) the single best answer.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q147— Explanation now states why A is the most direct sign and that frequent small voids alone are only an indirect clue, consistent with the reworded stem.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs::s10— Pulse pressure was given as normally 30-40 mmHg. Agreed wording: 'normally about 40 mmHg (roughly 30-50 mmHg)'. Aligned in s10 (cell), q033 explanation and fc024 back (EN and AR). q033 key (64 mmHg, widened) is unchanged; no option becomes wrong.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-q033— Pulse pressure was given as normally 30-40 mmHg. Agreed wording: 'normally about 40 mmHg (roughly 30-50 mmHg)'. Aligned in s10 (cell), q033 explanation and fc024 back (EN and AR). q033 key (64 mmHg, widened) is unchanged; no option becomes wrong.SNLE_Part01_Ch04_Health_Assessment_Vital_Signs-fc024— Pulse pressure was given as normally 30-40 mmHg. Agreed wording: 'normally about 40 mmHg (roughly 30-50 mmHg)'. Aligned in s10 (cell), q033 explanation and fc024 back (EN and AR). q033 key (64 mmHg, widened) is unchanged; no option becomes wrong.
Infection Control, Safety & Medication Administration مكافحة العدوى والسلامة وإعطاء الدواء — 21 correction(s)
SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s13— Logically wrong: recapping cannot be 'the ONLY cause that can be entirely avoided' - every needlestick mechanism (hand-to-hand passing, overfull containers, careless disposal) is preventable. Recapping is a well-known avoidable cause. (Arabic-only callout; align the EN counterpart if one exists.)SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s32— Unsupported/misleading mechanism in an Arabic-only callout: the stated reason for never adding concentrated potassium chloride to a bag that is already hanging is that 'mixing at the bedside gives an unknown concentration in the TOP of the bag'. The authoritative statement is that adequate mixing of a concentrate added to a hanging bag is unlikely and a potassium BOLUS may result; no source places the concentrate 'atSNLE_Part01_Ch05_Infection_Control_Safety_Medication-fc022— 'Recapping is the commonest cause of needlestick injury' is not supported by current surveillance (US EPINet 2023: only 1.7% of injuries occurred while recapping a used needle; 50.4% occurred during use of the item). Recapping remains a prohibited, entirely avoidable cause; soften the superlative.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-cs003— 'Recapping is the commonest cause of needlestick injury' is not supported by current surveillance (US EPINet 2023: only 1.7% of injuries occurred while recapping a used needle; 50.4% occurred during use of the item). The teaching point (recapping is prohibited and avoidable) stands; soften the superlative.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q018— Explanation refers to the option groups by position ('the first group is airborne, the second contact, the third blood-borne'). Read against the displayed order, the first group (option A, the KEY) is the droplet group, so 'the first group is airborne' appears to contradict the key (influenza/pertussis are not airborne); it only works for the three distractors in B-D order and breaks if options are shuffled. Name theSNLE_Part01_Ch05_Infection_Control_Safety_Medication-q041— Keyed option says a drainage bag resting on the floor risks 'back-flow into the bladder'. Back-flow occurs when the bag or tubing is raised ABOVE bladder level; a bag on the floor is below the bladder, which is the correct position. The floor-related risk is contamination of the drainage port / closed system - exactly as the item's own explanation states ('kept below bladder level to prevent back-flow but off the floSNLE_Part01_Ch05_Infection_Control_Safety_Medication-cs001— Escort PPE stated as an absolute (escorts wear fit-tested N95). CDC does not require transporting staff to wear a mask or respirator when the patient wears a surgical mask and any infectious skin lesions are covered, although many TB policies still require an N95; the sentence now states both and defers to local policy.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q015— The rule for what is removed outside the room was worded as "respiratory protection", while q027 said "the mask or respirator last and outside the room". The wording now says specifically that only a respirator is removed outside, after leaving and closing the door, consistent with CDC and with the revised q027.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q027— Inconsistent with q015 and with CDC: the explanation placed any mask (including a surgical mask, as under contact + droplet precautions) outside the room; CDC removes all PPE before exiting except a respirator, which is removed outside after closing the door. The mask is now taken off last at the doorway and the respirator exception is stated. The key (A) is unchanged.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q038— The stem asked for the mechanism "responsible for most" of four injuries but gave no data, and current surveillance does not show recapping as the commonest circumstance (EPINet 2023: during use 50.4%, recapping 1.7%), so the item was answerable only from an outdated generalisation. The stem now states the incident-report findings (three of four from re-sheathing), making recapping the unambiguous answer; the key (B)SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q038— Over-statement: "Recapping is the commonest cause" is not supported by current surveillance (EPINet 2023: during use 50.4%, recapping 1.7%). The explanation now rests on the data in the revised stem and calls recapping a well-recognised, entirely avoidable cause (wording already used elsewhere in this chapter).SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q066— Two defensible answers: bending forward from the waist under load (option A) is as recognised a risk as twisting, and no source attributes "most" back injuries to one movement. The stem now asks which loaded movement is avoided by turning with the feet instead of the trunk, which only option B satisfies; the key (B) is unchanged.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-q066— Unsupported claim that twisting "causes most nursing back injuries". NIOSH lists twisting and bending as awkward postures that are risk factors, and advises turning with the feet. The explanation now says so.SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s08— Over-generalisation: "anything not on it is not airborne". The three-organism list is the classic exam list, but CDC also lists smallpox and SARS under Airborne Precautions. The line now frames the list as the classic exam list and names these exceptions.SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s13— Overstatement: "too late" after one day. PEP should be started as soon as possible and up to 72 hours (less effective at 48-72 h), so a next-day report is late, not too late; a student could wrongly conclude PEP is pointless after 24 hours.SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s13— Superlative not supported by current surveillance (EPINet 2023: recapping 1.7% of injuries; during use 50.4%). The callout now calls recapping a well-recognised, entirely avoidable cause (wording already used in flashcard fc022 and the case on delayed reporting).SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s15— Overstatement: 'Most healthcare-associated infection follows a device.' In the CDC multistate point-prevalence survey device-associated infections (CLABSI, CAUTI, VAP) were about a quarter (25.6%) of all HAIs, while pneumonia, surgical-site and gastrointestinal/C. difficile infections made up the biggest shares. Changed 'Most' to 'Many'.SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s15— Guideline update: 'regular oral care with an antiseptic' reflects older VAP bundles (chlorhexidine oral care). The 2022 SHEA/IDSA/APIC compendium recommends daily toothbrushing without chlorhexidine and lists routine chlorhexidine oral care among approaches not to be used routinely. Reworded to toothbrushing, with a local-policy qualifier because some local bundles still include chlorhexidine.SNLE_Part01_Ch05_Infection_Control_Safety_Medication-fc026— Same VAP-bundle statement on the flashcard ('oral care with antiseptic'); aligned with the corrected section 5.14 and the 2022 SHEA/IDSA/APIC compendium.SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s24— Unsupported superlative: twisting while carrying a load is a recognised risk posture, but occupational guidance attributes nursing back injury mainly to manual patient handling (lifting, transferring, repositioning) with awkward postures contributing; no source supports 'the movement that causes most' injuries. Hedged in English and Arabic.SNLE_Part01_Ch05_Infection_Control_Safety_Medication::s24— The unsupported claim that twisting is 'the movement that causes most nursing back injuries' had been corrected in q066 (twisting is an awkward posture that NIOSH lists, together with bending, as a risk factor for back injury). The clin2-snle-007 softening of the s24 callout still ranked twisting among the movements 'most associated' with nursing back injuries, so it is now aligned with the q066 wording.
Pain Management, Palliative & End-of-Life Care إدارة الألم والرعاية التلطيفية ورعاية نهاية الحياة — 17 correction(s)
SNLE_Part01_Ch06_Pain_Palliative_End_of_Life::s11— Generalisation not correct for all listed antidepressants: 'The antidepressant is prescribed for the pain, at a lower dose than for depression' is true for tricyclics (e.g. amitriptyline) but not for duloxetine, whose analgesic dose for diabetic neuropathic pain (60 mg once daily) equals its antidepressant maintenance dose. Qualify as tricyclics. The Arabic card text is also duplicated and incomplete (omits the drugSNLE_Part01_Ch06_Pain_Palliative_End_of_Life::s23— Unsupported superlative: 'A full bladder is the commonest of them'. Urinary retention is a well-recognised reversible cause of terminal agitation, but no authoritative source ranks it as the commonest; the section's own Arabic key point says «من أشيع أسباب الهياج النهائي» ('one of the commonest causes'). Soften the English to match.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q056— Context inconsistency for a Saudi exam: the Saudi weekend is Friday-Saturday (since 2013), so a patient recognised as dying on a Friday afternoon is already in the weekend; 'before the weekend begins' fits Thursday afternoon. Key and explanation unaffected.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q075— Stem allows more than one defensible answer: options B (single quiet room, low light/noise) and C (family staying with him) are also good non-drug delirium measures and would also be done 'before sedation'. The key (A, look for reversible causes) is the correct FIRST step, as the explanation says; adding 'first' makes it unambiguous (q059 in the same packet already uses 'first').SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q078— Wrong count: the stem asks for 'four symptoms', but anticipatory prescribing routinely covers five (pain, breathlessness, nausea/vomiting, agitation and respiratory secretions). The item's own explanation, flashcard fc050 and the chapter's anticipatory-prescribing section all list five including secretions. Key B remains the best option; remove the number.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q078— Incomplete keyed option: the standard routine set also includes respiratory secretions (the item's explanation lists five). Add it so the key matches the explanation.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q092— Stem allows more than one defensible answer: option A (cancer patients who have stopped active treatment) and option C (patients expected to die within six months) are each themselves appropriate groups for palliative care referral; the explanation treats them as too narrow ('not only cancer and not only at the end'). Asking which description 'most accurately defines' who is appropriate makes B (any serious illness wSNLE_Part01_Ch06_Pain_Palliative_End_of_Life-fc009— Unsupported ranking: 'the commonest professional barrier' = disbelieving the patient; no source ranks it first. Softened to 'a common' professional barrier; the answer on the back is unchanged.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q010— Same unsupported ranking in the stem ('Which is the commonest professional barrier?'). Reworded to ask for the attitude-related professional barrier, which keeps option B the only defensible answer (A and C are system barriers, D is a knowledge barrier).SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q010— Same unsupported ranking in the explanation ('is the commonest professional barrier'); softened to match the reworded stem.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-fc018— Breakthrough-dose size given as a single figure ('around a tenth'); sources differ (UK: one-tenth to one-sixth of the 24-hour dose; US/ONS: about 5-20%). Replaced by the overlapping range one-tenth to one-sixth, so the card is correct under either convention.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q005— Breakthrough dose given as 'around a tenth' of the total daily dose - the lower end of the accepted range (UK one-tenth to one-sixth; ONS 5-20%). Qualifier added, consistent with flashcard fc018; the key (D) is unchanged.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q008— Option B ('Pain has a genuine circadian pattern of severity') is not false - pain sensitivity does vary with time of day - so with keyed D the item had two defensible answers. B reworded into a clearly incorrect statement (pain determined by tissue damage alone); key D unchanged.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q018— Option A ('It may reduce the effectiveness of his heart failure treatment') was also defensible: NSAIDs can blunt ACE inhibitors and diuretics, the core heart-failure drugs. The key (B: bleeding, renal and fluid-retention risks) is the most complete answer and the one the explanation teaches, so the distractor is reworded to a statement that is plainly incorrect: NSAIDs add to the bleeding risk of an anticoagulant, tSNLE_Part01_Ch06_Pain_Palliative_End_of_Life::s04— The 'Watch out' box (English and Arabic) ranked disbelieving the patient as THE commonest professional barrier. No authoritative source ranks it first (inadequate assessment, knowledge deficits and fear of addiction or respiratory depression are also commonly reported), so the ranking is softened to 'a major professional barrier'.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life::s07— Breakthrough-dose size was given as 'around a tenth' of the total daily dose. Guidance varies: UK palliative guidance gives up to one-sixth of the 24-hour dose (one-tenth to one-sixth), US sources about 5-20%. A one-tenth to one-sixth range covers both without conflicting with UK-style exam questions.SNLE_Part01_Ch06_Pain_Palliative_End_of_Life-q005— Same breakthrough-dose figure as s07; widened to the one-tenth to one-sixth range for consistency.
Basic Clinical Skills & Physiological Needs المهارات السريرية الأساسية والحاجات الفيزيولوجية — 22 correction(s)
SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s12— Wording: "a patient who does NOT cough has NOT passed the swallow screen" can be read as "no cough = fail"; the intended (and correct) teaching is that the absence of a cough is NOT proof of a safe swallow. Also the Arabic line is duplicated and omits "aspirating WITHOUT any cough at all", "the absence of a cough is not reassurance" and "commonest in exactly the patients most at risk".SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-cs003— Sequencing error that contradicts the same answer and q022: the first-line instruction says to stop the infusion, REMOVE the cannula and elevate, and only afterwards asks what was infusing and says that for a vesicant the cannula should not be removed straight away (it is needed to aspirate the drug). The identity of the infusate must be checked before the cannula is removed. (AR rewritten impersonally at the same tiSNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-q030— Overstatement: X-ray is the gold standard/reference method, but it is not "the only method that reliably distinguishes the stomach from the lung" - a gastric-range pH (<=5.5) of aspirate is itself an accepted way to confirm gastric placement (the chapter says so in fc030/cs006/q032), and NHS England lists "pH 1 to 5.5 or an X-ray" as acceptable for initial placement.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-q061— Overstated absolute: 'never place fingers OR OBJECTS between the teeth'. Standard nursing-skills teaching is never to use fingers (bite reflex), but a padded tongue blade (or bite block) is used to open the mouth of an unconscious patient. The chapter's own teaching text says only 'never place fingers between the teeth'. Remove the unsupported 'or objects' (AR also fixes register: feminine imperative 'تضعي').SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16. (English description of the same card; the Arabic line is changed in the prevSNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16. (English description; Arabic changed in the previous finding.)SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16. (English description; Arabic changed in the previous finding.)SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s09— Urinary-catheter content (bag below bladder level, bag off the floor, meatal hygiene, drainage-bag sampling) sat inside 7.8 Peripheral Intravenous Therapy, where it is misleading (an IV bag is hung ABOVE the patient) and duplicates 7.16. The card is rewritten as peripheral-IV care from the CDC guideline; the catheter teaching stays in 7.16.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-q030— 'Required before first use' states the US convention (radiographic confirmation before first use of a blindly placed tube) as if universal; the NHS England alert (2016) checks placement by aspirate pH testing and, when necessary, X-ray. Qualified as 'under most policies', which agrees with cs006 and s13. The key (X-ray as the gold standard) is unchanged and no other option is acceptable.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-fc030— Same unqualified 'required before first use' as q030 (named in the finding); qualified to agree with q030, cs006 and s13.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-q038— The stem had no cue separating retention with overflow from a UTI causing frequency (option A), so two answers were defensible. A discriminating finding is added (a firm swelling palpable above the pubis, i.e. a distended bladder); the key (D) is unchanged.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-q038— Explanation updated to refer to the new stem finding so the reasoning matches the question.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs-q061— Distractor C (a padded tongue depressor between the teeth) is taught in some nursing-skills texts as a way to open the mouth, so it was not clearly wrong for 'which precaution is essential'. Replaced by a plainly unsafe act that matches the explanation ('never place fingers between the teeth'); the key (side-lying with suction ready) is unchanged.SNLE_Part01_Ch07_Basic_Clinical_Skills_Physiological_Needs::s23— The numbered card said to position the patient supine with the knees slightly bent, whereas the paragraph and the Watch-out box of the same section say low Fowler's with the knees bent. Both aim to relax the abdominal wall; the card now uses the same position as the rest of the section (low Fowler's, knees bent) so that one instruction is learned.
Basic Sciences for Nursing العلوم الأساسية للتمريض — 9 correction(s)
SNLE_Part01_Ch08_Basic_Sciences_for_Nursing-fc042— Unsupported superlative: reduced clearance plus polypharmacy was called "the commonest explanation" for a new symptom in an older patient. Adverse drug effects are a frequent and under-recognised cause (think drugs first), but no source ranks them as the commonest, so the claim is softened in both languages.SNLE_Part01_Ch08_Basic_Sciences_for_Nursing::s06— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing::s06— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing::s06— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing::s06— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing-fc013— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing-fc014— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing-q014— Over-generalisation: low albumin from nephrotic syndrome was listed among the causes in which "the circulation is UNDERFILLED". In nephrotic syndrome the effective blood volume is often normal or expanded (primary renal sodium retention), and underfilling applies mainly to some children with minimal-change disease. The list now says "in some patients" for nephrotic syndrome and the statement about the circulation isSNLE_Part01_Ch08_Basic_Sciences_for_Nursing::s10— The sepsis definition in s10 (8.9) was 'a dysregulated systemic response to infection causing organ dysfunction', omitting 'life-threatening' from the Sepsis-3 wording; added in EN and AR. It is the only definition of sepsis in the chapter.
Cardiovascular Nursing & Acute Coronary Syndrome التمريض القلبي الوعائي والمتلازمة التاجية الحادّة — 58 correction(s)
SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s06— Wrong reasoning in the troponin card: 'Because it stays raised for up to two weeks, a single normal result taken TOO EARLY does not exclude infarction'. A single early normal troponin does not exclude infarction because troponin takes about 3–4 hours to start rising; long persistence is why troponin is useful for late presenters (and why it cannot detect a re-infarct), not a reason why an early sample can be normal.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s09— Teaches the shellfish/iodine contrast-allergy myth. Shellfish allergy and so-called 'iodine allergy' do not predict a reaction to iodinated contrast (shellfish allergens are proteins; iodine is not an allergen); the strongest risk factor is a previous reaction to contrast media. The check should be for a previous contrast reaction. The Arabic clause is rewritten at the same time to remove the feminine imperative (تحقSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s15— Heading says 'Two mechanical supports worth knowing' but the second item, catheter ablation, is a procedure that destroys an arrhythmia focus, not a mechanical support (only the intra-aortic balloon pump is). Reword so the heading is accurate.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s23— Out-of-date post-arrest temperature control: the text gives the AHA 2020 values (32–36 °C for at least 24 hours). The AHA 2025 post-cardiac-arrest guideline recommends maintaining a temperature between 32 and 37.5 °C in adults who remain unresponsive after ROSC (Class 1) and that temperature control reasonably be maintained for at least 36 hours (Class 2a); fever prevention remains part of care. The Arabic also omitsSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s32— Infographic panel 3 (distributive shock): 'Needs fluid FIRST, then vasopressors' is applied to all distributive shock, but the first-line treatment of anaphylactic shock is intramuscular adrenaline (fluid is adjunctive). Add a short qualifier. The Arabic also omits the whole sentence about treatment; the fix adds it with the qualifier.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s32— Key point says 'every other shock makes the patient tachycardic and cold' (Arabic only; no English counterpart shown in the packet). This contradicts the same section, which teaches that early septic shock gives warm skin and a bounding pulse (and anaphylactic shock is also warm and flushed). 'Most' is accurate.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s38— Step 5: 'A tablet that does not tingle may be inactive' is an outdated myth. The Nitrostat label states that the ability to produce a burning or tingling sensation should not be considered a reliable method for determining the potency of the tablets; absence of tingling does not mean the tablet is inactive. (The Arabic omits the sentence; the replacement also fills the other omitted details of the step and removes thSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-fc050— 'Every other shock is tachycardic and cold' is an overstatement and contradicts the chapter's own teaching that early septic shock (and anaphylactic shock) gives warm skin and a bounding pulse. 'Most other shock' is accurate and keeps the card's point (neurogenic shock is the classic bradycardic exception).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s35— Andexanet alfa is licensed to reverse apixaban and rivaroxaban only; the label does not recommend it for edoxaban (lack of data). 'The factor Xa inhibitors' over-generalises. Name the two drugs.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-fc118— Andexanet alfa is licensed to reverse apixaban and rivaroxaban only (not recommended for edoxaban); 'the factor Xa inhibitors' over-generalises.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-cs001— 'Atypical presentation is the rule rather than the exception' overstates the evidence: about one-third of patients with MI present without chest pain (more often women, older adults and people with diabetes), so atypical presentation is common and commoner in these groups, not the rule. The teaching point (do not be reassured by absent chest pain; treat as possible ACS) is unchanged.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-cs012— Post-arrest temperature control is out of date: the text gives AHA 2020 values (32-36 °C for at least 24 h). The current AHA 2025 guideline recommends maintaining a temperature between 32 and 37.5 °C in adults who remain unresponsive after ROSC and (COR 2a) maintaining temperature control for at least 36 hours; ERC-ESICM gives no specific recommendation for or against 32-36 °C and advises active fever prevention forSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q014— Teaches the shellfish-contrast myth. Shellfish (and 'iodine') allergy does not predict a reaction to iodinated contrast; the strongest risk factor is a previous reaction to contrast media. Keep the key (contrast allergy) but remove 'shellfish'.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q014— Same myth in the explanation ('iodine or shellfish allergy must be identified'); replace with the evidence-based statement.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q033— Out-of-date target range. AHA 2025 post-cardiac-arrest guideline recommends maintaining a temperature between 32 and 37.5 °C in adults who remain unresponsive after ROSC (the 2020 range was 32-36 °C). Arabic also omits the unit («درجة» without «مئوية»). The option stays the correct (only) answer.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q033— Out-of-date range and duration: AHA 2025 recommends temperature control between 32 and 37.5 °C maintained for at least 36 hours (COR 2a) in adults who remain unresponsive after ROSC (the 2020 text said 32-36 °C for at least 24 h); ERC-ESICM advises active fever prevention for at least 72 h. Arabic also omits the unit («مئوية»).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q043— 'Every other shock is tachycardic and cold' is wrong and contradicts option D of the same item: early (warm) septic shock and other distributive shocks have warm, vasodilated skin with tachycardia. Bradycardia is the discriminator; coldness applies to hypovolaemic, cardiogenic and obstructive shock.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q055— After the first tablet, 'then repeat up to three doses' can be read as three further doses (four tablets in total). Guidance is a maximum of 3 tablets in total, 5 minutes apart, and the explanation already says 'up to three doses'. Make the key unambiguous.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q108— 'Up to a third of inferior infarcts involve the right ventricle' understates the usual figure: reputable sources give about 30 to 50% (up to 40% in StatPearls). Adjust the range in both languages; the key is unaffected.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q010— Keyed answer (CK-MB) reflects older teaching. The Fourth Universal Definition of MI (2018) diagnoses re-infarction by serial cardiac troponin (repeat sample 3-6 h later, >20% rise over an elevated but stable/falling first value); CK-MB mass is only the best alternative when troponin is unavailable. Option A ('Troponin T, repeated and compared with the earlier value') is therefore the best answer as written; the key, (answer key changed to A)SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q010— Keyed answer (CK-MB) reflects older teaching. The Fourth Universal Definition of MI (2018) diagnoses re-infarction by serial cardiac troponin (repeat sample 3-6 h later, >20% rise over an elevated but stable/falling first value); CK-MB mass is only the best alternative when troponin is unavailable. Option A ('Troponin T, repeated and compared with the earlier value') is therefore the best answer as written; the key,SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q010— Keyed answer (CK-MB) reflects older teaching. The Fourth Universal Definition of MI (2018) diagnoses re-infarction by serial cardiac troponin (repeat sample 3-6 h later, >20% rise over an elevated but stable/falling first value); CK-MB mass is only the best alternative when troponin is unavailable. Option A ('Troponin T, repeated and compared with the earlier value') is therefore the best answer as written; the key,SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q010— Keyed answer (CK-MB) reflects older teaching. The Fourth Universal Definition of MI (2018) diagnoses re-infarction by serial cardiac troponin (repeat sample 3-6 h later, >20% rise over an elevated but stable/falling first value); CK-MB mass is only the best alternative when troponin is unavailable. Option A ('Troponin T, repeated and compared with the earlier value') is therefore the best answer as written; the key,SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s06— Section teaches that CK-MB is the marker for re-infarction because troponin 'cannot show' a new event; current guidance uses serial troponin and keeps CK-MB as the alternative when troponin is unavailable (corrected with the key of q010).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s06— Section teaches that CK-MB is the marker for re-infarction because troponin 'cannot show' a new event; current guidance uses serial troponin and keeps CK-MB as the alternative when troponin is unavailable (corrected with the key of q010).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s06— Section teaches that CK-MB is the marker for re-infarction because troponin 'cannot show' a new event; current guidance uses serial troponin and keeps CK-MB as the alternative when troponin is unavailable (corrected with the key of q010).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s06— Section teaches that CK-MB is the marker for re-infarction because troponin 'cannot show' a new event; current guidance uses serial troponin and keeps CK-MB as the alternative when troponin is unavailable (corrected with the key of q010).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s06— Section teaches that CK-MB is the marker for re-infarction because troponin 'cannot show' a new event; current guidance uses serial troponin and keeps CK-MB as the alternative when troponin is unavailable (corrected with the key of q010).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-fc010— Section teaches that CK-MB is the marker for re-infarction because troponin 'cannot show' a new event; current guidance uses serial troponin and keeps CK-MB as the alternative when troponin is unavailable (corrected with the key of q010).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-fc036— The flashcard still gave the AHA 2020 values (32 to 36 °C for at least 24 hours) while section s23, question q033 and case cs012 of the same chapter were already updated to the AHA 2025 post-cardiac-arrest values (a constant temperature between 32 and 37.5 °C, maintained for at least 36 hours, with fever prevented). The card is aligned with them.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q058— Hypercalcaemia (option B) also increases sensitivity to digoxin, so with the original stem two options could be defended. The stem now asks for the disturbance caused by the loop diuretic the patient is taking (hypokalaemia; hypercalcaemia is not an effect of loop diuretics), which leaves hypokalaemia (D) as the only answer, and the explanation says why hypercalcaemia is not the answer. The key (D) and the options arSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q058— Hypercalcaemia (option B) also increases sensitivity to digoxin, so with the original stem two options could be defended. The stem now asks for the disturbance caused by the loop diuretic the patient is taking (hypokalaemia; hypercalcaemia is not an effect of loop diuretics), which leaves hypokalaemia (D) as the only answer, and the explanation says why hypercalcaemia is not the answer. The key (D) and the options arSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s05— A new left bundle branch block on its own was taught as indicating a STEMI. Current ACC guidance no longer treats a new LBBB alone as a STEMI equivalent; a left bundle branch block counts as one when it meets the (Smith-modified) Sgarbossa criteria. The sentence now names that pattern, using the same wording as section s12.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q064— The stem described a new LBBB and the key called it a STEMI equivalent. Current ACC guidance no longer treats a new LBBB alone as a STEMI equivalent; an LBBB that meets the Sgarbossa criteria is one. The stem now specifies the Sgarbossa-positive LBBB so that option B is the single correct answer under current guidance (and under the older teaching); options and key are unchanged.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q064— The explanation taught that a new LBBB with ischaemic symptoms is treated as a STEMI equivalent. It now states the current rule: an LBBB that meets the Sgarbossa criteria is the equivalent; a new LBBB alone is not, but still needs urgent medical assessment.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q084— "The single most important modifiable cardiovascular risk factor" over-states the evidence: in INTERHEART the lipid (ApoB/ApoA1) ratio carried a larger odds ratio and attributable risk than smoking. Smoking remains the leading modifiable lifestyle factor and the only modifiable factor among the options, so key D is unchanged; the stem, explanation and the repeated statements in s10 and fc071 are softened to match.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q084— "The single most important modifiable cardiovascular risk factor" over-states the evidence: in INTERHEART the lipid (ApoB/ApoA1) ratio carried a larger odds ratio and attributable risk than smoking. Smoking remains the leading modifiable lifestyle factor and the only modifiable factor among the options, so key D is unchanged; the stem, explanation and the repeated statements in s10 and fc071 are softened to match.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s10— "The single most important modifiable cardiovascular risk factor" over-states the evidence: in INTERHEART the lipid (ApoB/ApoA1) ratio carried a larger odds ratio and attributable risk than smoking. Smoking remains the leading modifiable lifestyle factor and the only modifiable factor among the options, so key D is unchanged; the stem, explanation and the repeated statements in s10 and fc071 are softened to match.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s10— "The single most important modifiable cardiovascular risk factor" over-states the evidence: in INTERHEART the lipid (ApoB/ApoA1) ratio carried a larger odds ratio and attributable risk than smoking. Smoking remains the leading modifiable lifestyle factor and the only modifiable factor among the options, so key D is unchanged; the stem, explanation and the repeated statements in s10 and fc071 are softened to match.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s01— "The single most important modifiable cardiovascular risk factor" over-states the evidence: in INTERHEART the lipid (ApoB/ApoA1) ratio carried a larger odds ratio and attributable risk than smoking. Smoking remains the leading modifiable lifestyle factor and the only modifiable factor among the options, so key D is unchanged; the stem, explanation and the repeated statements in s10 and fc071 are softened to match.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-fc071— "The single most important modifiable cardiovascular risk factor" over-states the evidence: in INTERHEART the lipid (ApoB/ApoA1) ratio carried a larger odds ratio and attributable risk than smoking. Smoking remains the leading modifiable lifestyle factor and the only modifiable factor among the options, so key D is unchanged; the stem, explanation and the repeated statements in s10 and fc071 are softened to match.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s12— A new left bundle branch block was taught as a STEMI criterion on its own. Current ACC guidance no longer treats a new LBBB alone as a STEMI equivalent and uses the Smith-modified Sgarbossa criteria in LBBB, so the definition now names an equivalent pattern (LBBB meeting the Sgarbossa criteria) rather than 'new LBBB'.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s15— Recent major surgery and severe uncontrolled hypertension were labelled 'relative rather than absolute'. Guidelines classify them differently (2013 ACCF/AHA lists hypertension unresponsive to emergency therapy as absolute; 2017 ESC lists major surgery or trauma in the previous month as absolute), so the step now says that timing and severity decide and that the risk is weighed against the benefit. The Arabic had omitSNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s23— Memory aid said 'four Hs' but listed five (hypoxia, hypovolaemia, hydrogen ion, hypo/hyperkalaemia, hypothermia) and 'four Ts' with a single thrombosis, whereas the main paragraph of the same section gives the AHA list of five Hs and five Ts (thrombosis coronary and pulmonary). Counts and the thrombosis item are aligned with the paragraph; the Arabic gets the same counts.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s23— Second part of the same correction: the Ts are five (tension pneumothorax, tamponade, toxins, thrombosis coronary, thrombosis pulmonary).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s25— Key point over-stated that infarct pain is never relieved by anything positional. Positional relief is typical of pericarditis but does not exclude ACS, so the wording is softened.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s25— 'That single question separates them' over-states what one bedside question can do; the ECG and troponin are still required.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s25— The paragraph says the positional character 'is what separates' pericarditis from infarction; softened to 'helps to separate' for consistency with the key point.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s38— 'Any man with chest pain' narrowed the PDE-5 inhibitor screening question to men. Sildenafil and tadalafil are also prescribed to women (for example for pulmonary arterial hypertension) and the nitrate interaction is the same, so the question is asked of every patient (men especially).SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s38— Pronoun made neutral after the change above ('he will not volunteer it' -> 'it will not be volunteered'). The Arabic 'ولن يتطوّع بذكره' already reads as generic and is unchanged.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s08— Right ventricular involvement was given as 'up to a third' of inferior infarcts (s08 list item and note, cs016; q108 said 'a third to a half'). Sources give about 40% (up to half), so all places now say 'about 40% of inferior infarcts (up to half)'.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s08— Right ventricular involvement was given as 'up to a third' of inferior infarcts (s08 list item and note, cs016; q108 said 'a third to a half'). Sources give about 40% (up to half), so all places now say 'about 40% of inferior infarcts (up to half)'.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q108— Right ventricular involvement was given as 'up to a third' of inferior infarcts (s08 list item and note, cs016; q108 said 'a third to a half'). Sources give about 40% (up to half), so all places now say 'about 40% of inferior infarcts (up to half)'.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-cs016— Right ventricular involvement was given as 'up to a third' of inferior infarcts (s08 list item and note, cs016; q108 said 'a third to a half'). Sources give about 40% (up to half), so all places now say 'about 40% of inferior infarcts (up to half)'.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s12— NSTEMI was defined as 'ST depression or T inversion with a raised troponin', implying these ECG changes are always present; the ECG in NSTEMI can be normal. Reworded in s12 (ladder step and note), q021 explanation and fc017 (EN+AR): NSTEMI = raised troponin without ST elevation; the ECG may show ST depression or T inversion, or be normal.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome::s12— NSTEMI was defined as 'ST depression or T inversion with a raised troponin', implying these ECG changes are always present; the ECG in NSTEMI can be normal. Reworded in s12 (ladder step and note), q021 explanation and fc017 (EN+AR): NSTEMI = raised troponin without ST elevation; the ECG may show ST depression or T inversion, or be normal.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-q021— NSTEMI was defined as 'ST depression or T inversion with a raised troponin', implying these ECG changes are always present; the ECG in NSTEMI can be normal. Reworded in s12 (ladder step and note), q021 explanation and fc017 (EN+AR): NSTEMI = raised troponin without ST elevation; the ECG may show ST depression or T inversion, or be normal.SNLE_Part02_Ch01_Cardiovascular_Acute_Coronary_Syndrome-fc017— NSTEMI was defined as 'ST depression or T inversion with a raised troponin', implying these ECG changes are always present; the ECG in NSTEMI can be normal. Reworded in s12 (ladder step and note), q021 explanation and fc017 (EN+AR): NSTEMI = raised troponin without ST elevation; the ECG may show ST depression or T inversion, or be normal.
Respiratory Nursing & Asthma التمريض التنفّسي والربو — 21 correction(s)
SNLE_Part02_Ch02_Respiratory_Asthma::s03— On the steep part of the curve a small further fall in saturation corresponds to a large fall in PaO2 (oxygen tension); arterial oxygen content/delivery does not fall disproportionately. 'Oxygen delivery' is imprecise. Arabic also omitted this clause, so it is supplied.SNLE_Part02_Ch02_Respiratory_Asthma::s18— Overstatement: smoking cessation has the greatest effect on the natural history of COPD, but it is not the ONLY intervention that changes the course - long-term oxygen therapy improves survival in severe chronic resting hypoxaemia (and, e.g., pulmonary rehabilitation/vaccination reduce exacerbations and admissions).SNLE_Part02_Ch02_Respiratory_Asthma-fc042— Overstated absolute: smoking cessation is the most important intervention, not the 'only' one that changes the course of COPD (long-term oxygen therapy improves survival in severe hypoxaemia)SNLE_Part02_Ch02_Respiratory_Asthma-fc042— 'Everything else treats symptoms' is inaccurate (long-term oxygen therapy and selected surgery improve survival)SNLE_Part02_Ch02_Respiratory_Asthma-fc054— Ethambutol is not a recognised hepatotoxic drug; only isoniazid, rifampicin and pyrazinamide areSNLE_Part02_Ch02_Respiratory_Asthma-cs004— Vignette makes the patient male ('his urine', 'he wears', takes the oral contraceptive pill) but the model answer (EN) and the Arabic vignette refer to a female patient; internally inconsistentSNLE_Part02_Ch02_Respiratory_Asthma-cs004— Ethambutol is not a recognised hepatotoxic drug; only isoniazid, rifampicin and pyrazinamide are ('all four' is wrong)SNLE_Part02_Ch02_Respiratory_Asthma-cs010— Ethambutol is not a recognised hepatotoxic drug; only isoniazid, rifampicin and pyrazinamide are ('All four are hepatotoxic' is wrong)SNLE_Part02_Ch02_Respiratory_Asthma-cs012— Overstated absolute: smoking cessation is the most important intervention, not the 'only' one that changes the course of COPD (long-term oxygen therapy improves survival in severe hypoxaemia)SNLE_Part02_Ch02_Respiratory_Asthma-q096— 'All four are hepatotoxic' is incorrect. Of the four first-line TB drugs, isoniazid, rifampicin and pyrazinamide are hepatotoxic; ethambutol is not considered hepatotoxic (its characteristic toxicity is optic neuritis). Key (C) stays correct; the statement is corrected to 'three of the four'.SNLE_Part02_Ch02_Respiratory_Asthma-q096— 'All four first-line drugs are hepatotoxic' is incorrect: ethambutol is not considered hepatotoxic; the hepatotoxic first-line drugs are isoniazid, rifampicin and pyrazinamide. Align with the corrected option C.SNLE_Part02_Ch02_Respiratory_Asthma::s10— Same VAP-bundle statement repeated in the ventilation section ('regular oral care with an antiseptic'); aligned with Part 01 Chapter 05 and the 2022 SHEA/IDSA/APIC compendium.SNLE_Part02_Ch02_Respiratory_Asthma::s15— 'It halves the delivery' is an unsupported quantitative claim: inhaler guidance only teaches that breathing out fully, away from the inhaler, allows a deeper breath in afterwards. Remove the '50%' figure.SNLE_Part02_Ch02_Respiratory_Asthma::s18— Key point overstates: smoking cessation is the intervention with the greatest effect on the course of COPD, but it is not 'the only thing' that alters it; the long-term-care note in the same section already says 'the intervention with the greatest effect'. Align the key point.SNLE_Part02_Ch02_Respiratory_Asthma::s18— Key point overstates: 'everything else treats symptoms' ignores treatments that reduce exacerbations (and, for long-term oxygen, mortality in selected patients). Say most other treatments relieve symptoms or reduce exacerbations.SNLE_Part02_Ch02_Respiratory_Asthma::s20— The sentence defines latent TB infection by an induration 'over 10 mm' for every patient, which contradicts the risk-stratified cut-offs (5, 10 and 15 mm or more) given in the previous sentences; the Saudi guideline itself uses the same risk-based cut-offs and requires active disease to be excluded (chest radiograph, symptoms).SNLE_Part02_Ch02_Respiratory_Asthma::s21— 'All four are hepatotoxic' is not the standard teaching: isoniazid, rifampicin and pyrazinamide are the hepatotoxic first-line drugs, while ethambutol's characteristic toxicity is optic neuritis. The flashcard, cases and quiz of this chapter already say 'three of the four'.SNLE_Part02_Ch02_Respiratory_Asthma::s21— Memory aid says all four drugs are hard on the liver; keep it consistent with the corrected note ('isoniazid, rifampicin and pyrazinamide').SNLE_Part02_Ch02_Respiratory_Asthma-q090— Option B (urinary tract infection) is itself a common cause of new confusion with low-grade fever in an 84-year-old, so it is defensible; it is wrong only because of its reasoning. Reword the distractor so that only option D is defensible: it now states the false inference that the absence of cough excludes pneumonia. Key (D) unchanged.SNLE_Part02_Ch02_Respiratory_Asthma::s20— The tuberculin skin test text said BCG complicates interpretation 'in a country that vaccinates at birth'. Saudi Arabia moved BCG from birth to 6 months of age in August 2019 (Part03 Ch10 now says so). Reworded to 'where BCG is given routinely in infancy' in s20 and q094 (EN and AR); the stem already says 'as an infant' and the key (D) is unchanged.SNLE_Part02_Ch02_Respiratory_Asthma-q094— The tuberculin skin test text said BCG complicates interpretation 'in a country that vaccinates at birth'. Saudi Arabia moved BCG from birth to 6 months of age in August 2019 (Part03 Ch10 now says so). Reworded to 'where BCG is given routinely in infancy' in s20 and q094 (EN and AR); the stem already says 'as an infant' and the key (D) is unchanged.
Diabetes & Endocrine Nursing السكّري والتمريض الغدّي — 57 correction(s)
SNLE_Part02_Ch03_Diabetes_Endocrine::s10— Management order in the paragraph (fluid, then insulin, then potassium) contradicts the step cards above and the safety rule in 3.10: potassium must be checked and replaced before or with insulin, and insulin is postponed if potassium is low (risk of fatal hypokalaemic arrhythmia)SNLE_Part02_Ch03_Diabetes_Endocrine::s10— Memory aid "fluids, then insulin, then potassium — in this order" teaches insulin before potassium, contradicting the step cards and the 3.10 rule (insulin withheld and potassium replaced first when potassium is low)SNLE_Part02_Ch03_Diabetes_Endocrine::s14— Ambiguous English: "annual influenza and pneumococcal vaccination" can be read as annual pneumococcal vaccination; only influenza vaccine is annual (pneumococcal vaccine follows a schedule, usually once). Arabic already conveys this; wording is made parallel to the corrected EnglishSNLE_Part02_Ch03_Diabetes_Endocrine::s23— Desmopressin is not a treatment for nephrogenic diabetes insipidus (a kidney that cannot respond to ADH); the paragraph defines DI as lack of ADH or a kidney that cannot respond, then says it is treated with desmopressin without qualification (the card correctly says "where indicated")SNLE_Part02_Ch03_Diabetes_Endocrine-q031— Under-states urgency: a patient on long-term steroids who is vomiting and cannot keep the tablets down is at risk of adrenal crisis and needs urgent medical attention (parenteral hydrocortisone), not merely help 'the same day'.SNLE_Part02_Ch03_Diabetes_Endocrine-q033— Over-general: the explanation includes the nephrogenic form ('a kidney that cannot respond') and then says 'It is treated with desmopressin'. Desmopressin treats central (cranial) DI only; it does not help nephrogenic DI.SNLE_Part02_Ch03_Diabetes_Endocrine-cs001— The potassium cut-off for withholding insulin in DKA was given as 'about 3.3'. The 2024 ADA/EASD/JBDS/AACE/DTS consensus report (opened) delays insulin until K+ is above 3.5 mmol/L; 3.3 is the older ADA 2009 figure. Updated to 3.5 with the older figure shown in brackets so both exam sources are covered; the action in this item (K+ 3.1) is unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine-fc028— The potassium cut-off for withholding insulin in DKA was given as 'about 3.3'. The 2024 ADA/EASD/JBDS/AACE/DTS consensus report (opened) delays insulin until K+ is above 3.5 mmol/L; 3.3 is the older ADA 2009 figure. Updated to 3.5 with the older figure shown in brackets so both exam sources are covered; the action in this item (K+ rule) is unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine-q016— The potassium cut-off for withholding insulin in DKA was given as 'about 3.3'. The 2024 ADA/EASD/JBDS/AACE/DTS consensus report (opened) delays insulin until K+ is above 3.5 mmol/L; 3.3 is the older ADA 2009 figure. Updated to 3.5 with the older figure shown in brackets so both exam sources are covered; the action in this item (K+ 3.0; key B stays correct) is unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine-fc005— 'The only insulin given intravenously' is a textbook over-simplification: rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision, while NPH, long-acting and premixed insulins are not given IV. Reworded to 'the standard insulin for intravenous use' (regular insulin), which keeps the exam point and the key.SNLE_Part02_Ch03_Diabetes_Endocrine-q003— 'The only insulin given intravenously' is a textbook over-simplification: rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision, while NPH, long-acting and premixed insulins are not given IV. Reworded to 'the standard insulin for intravenous use' (regular insulin), which keeps the exam point and the key. Key (D) unchanged: the other options are NPH, glargine and a pSNLE_Part02_Ch03_Diabetes_Endocrine::s04— 'The only insulin given intravenously' is a textbook over-simplification: rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision, while NPH, long-acting and premixed insulins are not given IV. Reworded to 'the standard insulin for intravenous use' (regular insulin), which keeps the exam point and the key. Section 3.3 tree branch.SNLE_Part02_Ch03_Diabetes_Endocrine::s04— 'The only insulin given intravenously' is a textbook over-simplification: rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision, while NPH, long-acting and premixed insulins are not given IV. Reworded to 'the standard insulin for intravenous use' (regular insulin), which keeps the exam point and the key. Same section, memory-aid card, kept consistent with the tree bSNLE_Part02_Ch03_Diabetes_Endocrine-q061— Guidelines differ on metformin before surgery: ADA says withhold on the day of surgery; UK CPOC 2021 and SAMBA allow it to be taken as usual (omit if eGFR <60 or <45 / contrast). The key (A) follows the ADA approach, but the explanation did not say so, leaving 'no change' (D) arguable under other protocols. The explanation now names the guideline and points to local policy; the key is unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine::s03— The glucose-testing figure said 'Discard the first drop'. After washing and drying the hands (as the figure itself says) the first drop is acceptable; discarding it is advised only when the hands cannot be washed, and firm squeezing is what affects the result. The contested instruction is replaced by the uncontroversial point already taught in the section text (avoid squeezing hard).SNLE_Part02_Ch03_Diabetes_Endocrine::s04— "Only insulin that can be given intravenously" over-simplifies: regular insulin is the standard IV insulin, but rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision. Reworded to "the standard insulin for intravenous use" in English and Arabic.SNLE_Part02_Ch03_Diabetes_Endocrine::s10— "Only insulin given intravenously" over-simplifies: regular insulin is the standard IV insulin, but rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision. Reworded to "the standard insulin for intravenous use" in English and Arabic. (ketoacidosis steps list).SNLE_Part02_Ch03_Diabetes_Endocrine::s10— "Only insulin given intravenously" over-simplifies: regular insulin is the standard IV insulin, but rapid-acting analogues (aspart, lispro, glulisine) are also labelled for IV use under medical supervision. Reworded to "the standard insulin for intravenous use" in English and Arabic. (ketoacidosis management note).SNLE_Part02_Ch03_Diabetes_Endocrine::s10— Potassium threshold for withholding insulin in ketoacidosis: the text gave about 3.3 mEq/L (ADA 2009 convention); the 2024 ADA/EASD/JBDS/AACE/DTS consensus uses 3.5 mmol/L (mEq/L). Now stated as about 3.5 with the older 3.3 acknowledged, in English and Arabic. (management note, 3.9).SNLE_Part02_Ch03_Diabetes_Endocrine::s11— Potassium threshold for withholding insulin in ketoacidosis: the text gave about 3.3 mEq/L (ADA 2009 convention); the 2024 ADA/EASD/JBDS/AACE/DTS consensus uses 3.5 mmol/L (mEq/L). Now stated as about 3.5 with the older 3.3 acknowledged, in English and Arabic. (rule card).SNLE_Part02_Ch03_Diabetes_Endocrine::s11— Potassium threshold for withholding insulin in ketoacidosis: the text gave about 3.3 mEq/L (ADA 2009 convention); the 2024 ADA/EASD/JBDS/AACE/DTS consensus uses 3.5 mmol/L (mEq/L). Now stated as about 3.5 with the older 3.3 acknowledged, in English and Arabic. (rule paragraph).SNLE_Part02_Ch03_Diabetes_Endocrine::s11— Potassium threshold for withholding insulin in ketoacidosis: the text gave about 3.3 mEq/L (ADA 2009 convention); the 2024 ADA/EASD/JBDS/AACE/DTS consensus uses 3.5 mmol/L (mEq/L). Now stated as about 3.5 with the older 3.3 acknowledged, in English and Arabic. (Watch out box).SNLE_Part02_Ch03_Diabetes_Endocrine-cs001— Potassium threshold for withholding insulin in ketoacidosis: the text gave about 3.3 mEq/L (ADA 2009 convention); the 2024 ADA/EASD/JBDS/AACE/DTS consensus uses 3.5 mmol/L (mEq/L). Now stated as about 3.5 with the older 3.3 acknowledged, in English and Arabic. (case answer; the case potassium is 3.1, so the action is unchanged).SNLE_Part02_Ch03_Diabetes_Endocrine::s28—SNLE_Part02_Ch03_Diabetes_Endocrine::s10— The potassium threshold for holding insulin was worded 'about 3.5 mEq/L; some protocols use 3.3' here but '3.5 (3.3 in some older protocols)' in q016 and fc028, and in mEq/L here but mmol/L in fc028. Aligned to one wording and one unit: below 3.5 mmol/L (3.3 in some older protocols). (s10 management paragraph)SNLE_Part02_Ch03_Diabetes_Endocrine::s11— The potassium threshold for holding insulin was worded 'about 3.5 mEq/L; some protocols use 3.3' here but '3.5 (3.3 in some older protocols)' in q016 and fc028, and in mEq/L here but mmol/L in fc028. Aligned to one wording and one unit: below 3.5 mmol/L (3.3 in some older protocols). (s11 ladder step 5, THE RULE)SNLE_Part02_Ch03_Diabetes_Endocrine::s11— The potassium threshold for holding insulin was worded 'about 3.5 mEq/L; some protocols use 3.3' here but '3.5 (3.3 in some older protocols)' in q016 and fc028, and in mEq/L here but mmol/L in fc028. Aligned to one wording and one unit: below 3.5 mmol/L (3.3 in some older protocols). (s11 note, the rule that follows)SNLE_Part02_Ch03_Diabetes_Endocrine::s11— The potassium threshold for holding insulin was worded 'about 3.5 mEq/L; some protocols use 3.3' here but '3.5 (3.3 in some older protocols)' in q016 and fc028, and in mEq/L here but mmol/L in fc028. Aligned to one wording and one unit: below 3.5 mmol/L (3.3 in some older protocols). (s11 Watch-out box)SNLE_Part02_Ch03_Diabetes_Endocrine-q016— Unit made consistent with the corrected explanation and the other potassium thresholds in the chapter (mmol/L); the value is numerically identical.SNLE_Part02_Ch03_Diabetes_Endocrine-q016— The potassium threshold for holding insulin was worded 'about 3.5 mEq/L; some protocols use 3.3' here but '3.5 (3.3 in some older protocols)' in q016 and fc028, and in mEq/L here but mmol/L in fc028. Aligned to one wording and one unit: below 3.5 mmol/L (3.3 in some older protocols). (unit only; the 3.3 clause was already correct)SNLE_Part02_Ch03_Diabetes_Endocrine-cs001— Unit made consistent with the potassium threshold (mmol/L) used in the answer, s10, s11, q016 and fc028; value unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine-cs001— The threshold sentence was garbled by two overlapping corrections ('below 3.5 mEq/L (3.5 (some protocols use 3.3) in some older protocols)' and the same in Arabic). Restored to the agreed wording: below 3.5 mmol/L (3.3 in some older protocols).SNLE_Part02_Ch03_Diabetes_Endocrine::s01— IV insulin wording: English already says 'the standard insulin for intravenous use' everywhere in the chapter, but the Arabic in s04 (note) and s10 used «المعتمد» (approved/adopted) where s04 (tree), q003 and fc005 use «القياسي» (standard). Aligned to «القياسي»; the objective in s01 ('name the one given intravenously') implied it is the only one and now says 'the standard insulin for intravenous use'. (objective 4)SNLE_Part02_Ch03_Diabetes_Endocrine::s06— Somogyi effect is presented as settled fact; it is a debated, uncommon exam entity, to be confirmed by 3 a.m. glucose or CGM and managed only once nocturnal hypoglycaemia is confirmed. (opening line of 3.5: 'has ONE OF TWO problems' -> 'may have', with the Somogyi caveat)SNLE_Part02_Ch03_Diabetes_Endocrine::s06— The opening line says the dawn/Somogyi distinction matters 'more than almost anything else' in the section, which overstates an uncommon, debated entity.SNLE_Part02_Ch03_Diabetes_Endocrine::s06— Somogyi effect is presented as settled fact; it is a debated, uncommon exam entity, to be confirmed by 3 a.m. glucose or CGM and managed only once nocturnal hypoglycaemia is confirmed. (Somogyi comparison card heading)SNLE_Part02_Ch03_Diabetes_Endocrine::s06— The card gives 'decrease the evening insulin, or add a bedtime snack' as unconditional treatment; it applies only once nocturnal hypoglycaemia is confirmed, and the snack is adjusted rather than simply added.SNLE_Part02_Ch03_Diabetes_Endocrine::s06— The separating test should name CGM as well as the single 3 a.m. glucose.SNLE_Part02_Ch03_Diabetes_Endocrine::s06— Somogyi effect is presented as settled fact; it is a debated, uncommon exam entity, to be confirmed by 3 a.m. glucose or CGM and managed only once nocturnal hypoglycaemia is confirmed. (explanatory paragraph: add the caveat and the CGM route)SNLE_Part02_Ch03_Diabetes_Endocrine::s06— The paragraph states 'the answer is less evening insulin' unconditionally; it should be conditional on confirmed nocturnal hypoglycaemia and include the bedtime-snack option.SNLE_Part02_Ch03_Diabetes_Endocrine::s06— The distinguishing check should include CGM as well as the 2-3 a.m. fingerstick.SNLE_Part02_Ch03_Diabetes_Endocrine::s06— Watch-out box: the pre-adjustment check should include CGM.SNLE_Part02_Ch03_Diabetes_Endocrine::s06— Watch-out box treats a Somogyi rebound as the expected finding; it is uncommon and the harm applies when nocturnal hypoglycaemia is confirmed.SNLE_Part02_Ch03_Diabetes_Endocrine-q008— Quiz explanation states the Somogyi rebound as settled; it should acknowledge it is debated/uncommon while keeping the key (D) and give the confirmed-hypoglycaemia management. Key unchanged: the stem's 3 a.m. reading of 2.8 mmol/L is the confirmed nocturnal hypoglycaemia.SNLE_Part02_Ch03_Diabetes_Endocrine-q008— Add the agreed management (reduce evening/bedtime insulin or adjust the bedtime snack) once nocturnal hypoglycaemia is confirmed.SNLE_Part02_Ch03_Diabetes_Endocrine-fc013— Flashcard presents the Somogyi rebound as settled; add that it is debated and uncommon.SNLE_Part02_Ch03_Diabetes_Endocrine-fc013— Flashcard gives 'needs less evening insulin' unconditionally; make it conditional on confirmed nocturnal hypoglycaemia and add the bedtime-snack option.SNLE_Part02_Ch03_Diabetes_Endocrine-fc014— Flashcard on separating dawn from Somogyi should mention CGM as well as the 2-3 a.m. check.SNLE_Part02_Ch03_Diabetes_Endocrine-cs005— The case answer declares the Somogyi effect from the history alone ('points to the Somogyi effect'); it should be a possibility to be confirmed, with the debated/uncommon caveat.SNLE_Part02_Ch03_Diabetes_Endocrine-cs005— Overstated importance ('matters more than almost any other') for an uncommon, debated distinction.SNLE_Part02_Ch03_Diabetes_Endocrine-cs005— 'The answer is less evening insulin' is stated unconditionally; make it conditional on confirmed nocturnal hypoglycaemia and add the bedtime-snack option.SNLE_Part02_Ch03_Diabetes_Endocrine-cs005— 'Almost certainly driving deeper nocturnal hypoglycaemia' overstates the inference; most morning hyperglycaemia is not rebound.SNLE_Part02_Ch03_Diabetes_Endocrine-cs005— Add CGM as an alternative to repeated 2-3 a.m. fingersticks.SNLE_Part02_Ch03_Diabetes_Endocrine-cs005— A low night-time reading confirms nocturnal hypoglycaemia (and so supports Somogyi); it does not by itself 'confirm' the effect, nor does a normal reading 'confirm' dawn.SNLE_Part02_Ch03_Diabetes_Endocrine::s23— Osmotic demyelination syndrome was called 'permanent' / 'usually irreversible' here while Part02 Ch14 says 'often permanent' / «كثيراً ما يكون دائماً» (outcomes vary; some patients recover). Aligned to 'often permanent' in Ch03 s23 (ladder step and text), fc056, Ch09 q104 (option B and explanation) and mock snle-m03-q060; q104 key B unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine::s23— Osmotic demyelination syndrome was called 'permanent' / 'usually irreversible' here while Part02 Ch14 says 'often permanent' / «كثيراً ما يكون دائماً» (outcomes vary; some patients recover). Aligned to 'often permanent' in Ch03 s23 (ladder step and text), fc056, Ch09 q104 (option B and explanation) and mock snle-m03-q060; q104 key B unchanged.SNLE_Part02_Ch03_Diabetes_Endocrine-fc056— Osmotic demyelination syndrome was called 'permanent' / 'usually irreversible' here while Part02 Ch14 says 'often permanent' / «كثيراً ما يكون دائماً» (outcomes vary; some patients recover). Aligned to 'often permanent' in Ch03 s23 (ladder step and text), fc056, Ch09 q104 (option B and explanation) and mock snle-m03-q060; q104 key B unchanged.
Renal & Urinary Nursing التمريض الكلوي والبولي — 35 correction(s)
SNLE_Part02_Ch04_Renal_Urinary::s17— Pathophysiology error: loss of CLOTTING FACTORS would not raise thrombosis risk. The hypercoagulable state of nephrotic syndrome comes from urinary loss of natural anticoagulant proteins (antithrombin, protein S) with raised procoagulant factors; the same section's card already says "clotting inhibitors". Immunoglobulin loss explains the infection riskSNLE_Part02_Ch04_Renal_Urinary-fc001— Front says "five roles" (as do the chapter objectives) but the back lists six items; fluid/electrolyte and acid-base balance are one homeostatic role, so merging them makes five.SNLE_Part02_Ch04_Renal_Urinary-fc042— The tamsulosin label does not give a bedtime first-dose instruction: it says to take the capsule about 30 minutes after the same meal each day (orthostasis is most likely after the first dose, so patients are told to rise slowly). Bedtime first-dose advice is usually given for non-selective alpha-blockers (doxazosin, terazosin, prazosin). The Arabic is also written as masculine imperatives (خذ، انهض) and is rewrittenSNLE_Part02_Ch04_Renal_Urinary-q019— Claims that treating the streptococcal infection prevents post-streptococcal glomerulonephritis. Unlike rheumatic fever, antibiotic treatment is not shown to prevent PSGN (it limits spread of the nephritogenic strain to contacts).SNLE_Part02_Ch04_Renal_Urinary-q022— Says the first dose of tamsulosin is taken at bedtime. Bedtime first-dose advice belongs to non-selective alpha-blockers; the tamsulosin label/nursing references say to take it about 30 minutes after the same meal each day (and monitor BP after the first dose). This also contradicts distractor C (empty stomach).SNLE_Part02_Ch04_Renal_Urinary-q044— Illogical wording: restricting dietary calcium is the intuitive-but-wrong approach (it is NOT restricting that is counter-intuitive). The sentence says restriction is 'counter-intuitive but wrong', which muddles the teaching point (the key and the rest of the explanation are correct).SNLE_Part02_Ch04_Renal_Urinary-cs003— The answer placed the alert wristband on the arm opposite the fistula, which defeats its purpose (marking the restricted limb); the band belongs, loosely, on the fistula arm, and the rationale in the same sentence (the arm will otherwise be used by someone who does not know) only makes sense that way.SNLE_Part02_Ch04_Renal_Urinary-cs004— The comparison 'around 20% against 12 to 15% in North America' is not supported by recent Saudi community surveys (about 9-16%) or the usual North American range (7-13%); the unsupported figures are removed and the teaching point (high, heat-related risk) is kept.SNLE_Part02_Ch04_Renal_Urinary-cs009— The comparison 'around 20% against 12 to 15% in North America' is not supported by recent Saudi community surveys (about 9-16%) or the usual North American range (7-13%); the unsupported figures are removed and the teaching point (high, heat-related risk) is kept.SNLE_Part02_Ch04_Renal_Urinary-fc051— The flashcard's 'Risk is around 20%' is an unsupported single figure (Saudi community surveys report about 9-16%); replaced with the teaching point that risk is correspondingly high.SNLE_Part02_Ch04_Renal_Urinary-cs010— Relief of pain on scrotal elevation (Prehn sign) was given as a typical epididymitis feature without noting that it is unreliable and never rules torsion out; qualifier added (the case conclusion of torsion is unchanged).SNLE_Part02_Ch04_Renal_Urinary-fc058— The card contrasted epididymitis and torsion by relief on scrotal elevation and said torsion 'does not' ease, without noting that the sign is unreliable and never rules torsion out.SNLE_Part02_Ch04_Renal_Urinary-q056— The explanation presented relief on scrotal elevation as a clean discriminator and said torsion 'does not ease with elevation'; the sign is unreliable and never rules torsion out. Answer key C remains the best of the four options; qualifiers added.SNLE_Part02_Ch04_Renal_Urinary-q056— The explanation presented relief on scrotal elevation as a clean discriminator and said torsion 'does not ease with elevation'; the sign is unreliable and never rules torsion out. Answer key C remains the best of the four options; qualifiers added.SNLE_Part02_Ch04_Renal_Urinary-fc035— The card said urinary infection 'often presents as' confusion, falls or incontinence without urinary symptoms, which invites treating asymptomatic bacteriuria; a causal link with delirium is not established. Reworded as non-specific features that call for a search for other causes and no treatment of bacteriuria without symptoms or systemic signs.SNLE_Part02_Ch04_Renal_Urinary-q016— The explanation said urinary infection 'frequently presents' as confusion or falls without urinary symptoms; IDSA 2019 advises looking for other causes and not treating bacteriuria without urinary symptoms or systemic signs. Option A remains the best of the four options (the key is unchanged); qualifier added.SNLE_Part02_Ch04_Renal_Urinary-q027— 'Roughly a third of Saudi patients with type 2 diabetes have diabetic nephropathy' has no single national source: the Saudi National Diabetes Registry (Al-Rubeaan, PLoS One 2014) reports about 10.8% while hospital series report much higher figures depending on definition. The number is replaced by a statement that the proportion is substantial and estimates vary widely; the key (diabetes as leading cause of ESRD) isSNLE_Part02_Ch04_Renal_Urinary::s16— Relief of pain on scrotal elevation (Prehn sign) was presented as "the distinguishing point" between epididymitis and torsion. The sign is unreliable and must not be used to exclude torsion, so the sentence now gives it as a possible finding that is unreliable; the existing rule that an indistinguishable scrotum is treated as torsion is kept.SNLE_Part02_Ch04_Renal_Urinary::s16— Same point in the Watch-out box: "eases when the scrotum is elevated" was given as a discriminator. Reworded so that relief on elevation (Prehn sign) is stated to be unreliable and never to exclude torsion, in agreement with the corrected paragraph above it.SNLE_Part02_Ch04_Renal_Urinary::s23— The comparison "around 20% in the Kingdom against roughly 12 to 15% in North America" is not supported by recent surveys (Riyadh province 9.4%, Riyadh city 14.8%, another Saudi series 9.1%; US surveys 8.8% and 11%). The claim "markedly more common than in cooler countries" is also stronger than these figures allow. Reworded to "common ... where heat adds to the risk" with the surveyed ranges.SNLE_Part02_Ch04_Renal_Urinary::s23— Same note: the unsupported "around 20%" figure replaced by the range reported in recent Saudi community surveys (9.1% to 14.8% in the Riyadh studies).SNLE_Part02_Ch04_Renal_Urinary::s23— Same note: "roughly 12 to 15% in North America" replaced by the US survey figures (8.8% and 11%), and "the explanation is largely climate" softened to "a major factor is climate", since the Saudi and US ranges overlap.SNLE_Part02_Ch04_Renal_Urinary::s23— Key-point card of the same section repeated the unsupported "roughly 20% against 12 to 15% in cooler countries"; made consistent with the corrected note.SNLE_Part02_Ch04_Renal_Urinary::s23— "Roughly a third of Saudi patients with type 2 diabetes have diabetic nephropathy" is not supported as a single national figure (the Saudi National Diabetes Registry, 54,670 patients, reported about 11%; hospital series report higher figures depending on the definition). Replaced by a statement that a substantial proportion are affected and that estimates vary widely.SNLE_Part02_Ch04_Renal_Urinary-q026— q026 repeated the unsupported 'around 20% against 12 to 15% in North America' (already replaced by 'high' in cs004, cs009 and fc051). The explanation now says stone risk in the Kingdom is high.SNLE_Part02_Ch04_Renal_Urinary::s13— s13 said a urinary tract infection 'frequently presents as' new confusion, falls, reduced mobility or incontinence, which invites treating asymptomatic bacteriuria; q016 and fc035 already say it can present so, that the features are non-specific, that other causes must be sought and that bacteriuria without symptoms or systemic signs is not treated. s13 now says the same. (first sentence)SNLE_Part02_Ch04_Renal_Urinary::s13— s13 said a urinary tract infection 'frequently presents as' new confusion, falls, reduced mobility or incontinence, which invites treating asymptomatic bacteriuria; q016 and fc035 already say it can present so, that the features are non-specific, that other causes must be sought and that bacteriuria without symptoms or systemic signs is not treated. s13 now says the same. (second sentence)SNLE_Part02_Ch04_Renal_Urinary::s13— s13 said a urinary tract infection 'frequently presents as' new confusion, falls, reduced mobility or incontinence, which invites treating asymptomatic bacteriuria; q016 and fc035 already say it can present so, that the features are non-specific, that other causes must be sought and that bacteriuria without symptoms or systemic signs is not treated. s13 now says the same. (Key point box)SNLE_Part02_Ch04_Renal_Urinary::s07— 4.6 gives the 'evidence of kidney damage' proviso only for stage 1 (KDIGO applies it to G1 and G2: eGFR >=60 alone is not CKD) and does not split stage 3 into G3a (45-59) and G3b (30-44).SNLE_Part02_Ch04_Renal_Urinary::s12— Potassium-binding resins are named as the means of removing potassium; update to potassium binders (sodium zirconium cyclosilicate or patiromer; calcium resonium no longer routine). (4.11 treatment note)SNLE_Part02_Ch04_Renal_Urinary::s12— Potassium-binding resins are named as the means of removing potassium; update to potassium binders (sodium zirconium cyclosilicate or patiromer; calcium resonium no longer routine). (4.11 memory aid)SNLE_Part02_Ch04_Renal_Urinary-q015— Potassium-binding resins are named as the means of removing potassium; update to potassium binders (sodium zirconium cyclosilicate or patiromer; calcium resonium no longer routine). (q015 explanation; key B unchanged)SNLE_Part02_Ch04_Renal_Urinary-fc032— Potassium-binding resins are named as the means of removing potassium; update to potassium binders (sodium zirconium cyclosilicate or patiromer; calcium resonium no longer routine). (fc032)SNLE_Part02_Ch04_Renal_Urinary-cs001— Potassium-binding resins are named as the means of removing potassium; update to potassium binders (sodium zirconium cyclosilicate or patiromer; calcium resonium no longer routine). (cs001 answer)SNLE_Part02_Ch04_Renal_Urinary-cs007— Potassium-binding resins are named as the means of removing potassium; update to potassium binders (sodium zirconium cyclosilicate or patiromer; calcium resonium no longer routine). (cs007 answer)
Gastrointestinal & Liver Nursing التمريض الهضمي والكبدي — 35 correction(s)
SNLE_Part02_Ch05_Gastrointestinal_Liver::s19— Outdated/unsafe teaching: «aggressive» IV fluid resuscitation is presented as the single most important early intervention. The WATERFALL RCT found aggressive resuscitation caused significantly more fluid overload (20.5% vs 6.3%) with no reduction in moderately severe/severe pancreatitis, and was stopped early; current practice is early, goal-directed (moderate) resuscitation with frequent reassessment (boluses onlySNLE_Part02_Ch05_Gastrointestinal_Liver::s19— Key-point box repeats the outdated «Aggressive fluid resuscitation» wording (see the Management paragraph); align with goal-directed resuscitation.SNLE_Part02_Ch05_Gastrointestinal_Liver::s27— "The only intervention with good evidence" is out of date: lifestyle/weight loss remains first-line, but resmetirom (March 2024) and semaglutide (August 2025) are now FDA-approved for MASH with moderate-to-advanced fibrosis. Softened to "first-line ... strongest evidence"; the AR also omitted this clause.SNLE_Part02_Ch05_Gastrointestinal_Liver-fc039— Incomplete list: hepatitis D also becomes chronic (always together with hepatitis B; superinfection of chronic HBV carriers is the severe form). Added as a short qualifier.SNLE_Part02_Ch05_Gastrointestinal_Liver-fc053— "Aggressive" fluid resuscitation is outdated wording: the WATERFALL RCT found more fluid overload with aggressive than moderate lactated Ringer's (20.5% vs 6.3%) and no outcome benefit, and the 2024 ACG guideline now suggests moderately aggressive, goal-directed resuscitation. Early fluids remain the key early treatment, so only a qualifier is added.SNLE_Part02_Ch05_Gastrointestinal_Liver-fc059— Over-broad: loperamide is contraindicated in invasive/bloody or febrile infective diarrhoea (dysentery, invasive bacterial enterocolitis incl. Salmonella, Shigella, Campylobacter), C. difficile/pseudomembranous colitis and acute colitis, but not in every infective diarrhoea (e.g. non-bloody, afebrile watery travellers' diarrhoea). Qualifier added.SNLE_Part02_Ch05_Gastrointestinal_Liver-cs008— Overstated: early mobilisation is sensible and low-risk, but it is not shown to be "the one intervention that consistently helps" or to do "more than anything else available" for postoperative ileus; the direct evidence is limited, and opioid-sparing multimodal analgesia (already mentioned) has more direct support. Softened.SNLE_Part02_Ch05_Gastrointestinal_Liver-cs008— Overstated claim ("does more ... than anything else available") softened. The Arabic also omitted the English statement that mobilisation addresses respiratory and thromboembolic risks, and the closing instruction to monitor for deterioration (fever, tachycardia, rising pain, peritonism, faeculent vomiting); both are added here.SNLE_Part02_Ch05_Gastrointestinal_Liver-q016— Incomplete: hepatitis D also becomes chronic (only together with hepatitis B), so «B and C can become chronic» implies D does not. Short qualifier added (same change as fc039).SNLE_Part02_Ch05_Gastrointestinal_Liver-cs006— "There is no tablet for it" was absolute. Lifestyle treatment remains the foundation for this patient, but since 2024 two drugs are approved for steatohepatitis with moderate-to-advanced fibrosis, so fibrosis staging decides whether a liver-directed drug is considered. Reworded to "no tablet that takes the place of lifestyle change".SNLE_Part02_Ch05_Gastrointestinal_Liver-cs006— Second sentence of the same answer: "The treatment is" changed to "The mainstay of treatment is" so the answer agrees with the qualified first statement.SNLE_Part02_Ch05_Gastrointestinal_Liver-cs006— Fibrosis assessment is where drug treatment enters, so the existing "assess for fibrosis" step now says why.SNLE_Part02_Ch05_Gastrointestinal_Liver-cs007— "Correct coagulopathy" was unqualified and the explanation implied that a prolonged INR and low platelets mean he "bleeds more". In cirrhosis the INR does not reliably predict bleeding, routine plasma to normalise it is not advised, and over-transfusion raises portal pressure; blood products are used selectively, as prescribed.SNLE_Part02_Ch05_Gastrointestinal_Liver-q024— "Not a drug" was absolute. Lifestyle change is still the first-line treatment and the correct answer here, but resmetirom (2024) and semaglutide (2025) are now approved for steatohepatitis with moderate-to-advanced fibrosis. Reworded to "mainstay ... rather than a drug", with a clause saying when a liver-directed drug is considered.SNLE_Part02_Ch05_Gastrointestinal_Liver::s05— "The single most effective piece of advice" ranks meal timing above weight loss and head-of-bed elevation, which the guideline does not do. Reworded to "one of the most effective", which is what the Arabic line already says.SNLE_Part02_Ch05_Gastrointestinal_Liver::s11— "Antibiotics given" presented antibiotics as routine in acute diverticulitis. Guidelines advise selective use in uncomplicated disease, with antibiotics for complicated disease, systemic illness or immunosuppression. Reworded to "given where indicated".SNLE_Part02_Ch05_Gastrointestinal_Liver::s16— The claim that fatty liver disease is «the dominant driver» of cirrhosis in the Kingdom is not supported: Saudi GBD-2019 data show MASLD is by far the most prevalent liver disease (about a third of adults) and rising, but liver-cancer/cirrhosis mortality in 2019 was still higher for hepatitis C and B than for MASLD. Softened to «the most common liver disease and a rapidly rising cause, alongside viral hepatitis».SNLE_Part02_Ch05_Gastrointestinal_Liver::s19— A routine low-fat diet is no longer advised in chronic pancreatitis: current guidance (ESPEN 2020) is an adequate-energy diet with pancreatic enzyme replacement, restricting dietary fat only when steatorrhoea persists despite adequate enzyme replacement (fat restriction risks worsening malnutrition). The wording keeps the low-fat idea as the conditional step rather than a blanket instruction.SNLE_Part02_Ch05_Gastrointestinal_Liver::s24— «Avoided in infective diarrhoea» is too broad: antimotility agents are avoided in bloody or febrile (invasive/inflammatory) infective diarrhoea, in suspected C. difficile infection and in active inflammatory colitis, whereas non-bloody afebrile watery diarrhoea is not an absolute contraindication in adults. Qualifier added.SNLE_Part02_Ch05_Gastrointestinal_Liver-q042— Same overly broad statement as in section 5.23: antidiarrhoeals are avoided in bloody or febrile infective diarrhoea (and in active colitis), not in all infective diarrhoea. Qualifier added for consistency with the corrected section.SNLE_Part02_Ch05_Gastrointestinal_Liver::s24— Watch-out box repeated the overly broad «Do not give loperamide for infective diarrhoea»; the qualifier (blood, fever, suspected C. difficile) is added to match the corrected paragraph.SNLE_Part02_Ch05_Gastrointestinal_Liver::s24— The INR is a marker of hepatic synthetic function and severity, not the earliest marker of liver injury: in paracetamol poisoning the transaminases are the first to rise (from about 24 h), and the INR rises in step with them, peaking at 72-96 h. Its established role is as the best early guide to the severity and prognosis of the liver injury (it is part of the King's College criteria). Consistent with the chapter's oSNLE_Part02_Ch05_Gastrointestinal_Liver::s27— «The treatment is NOT a drug» / «not a drug» is an absolute statement; lifestyle change is first-line for fatty liver disease, but drugs now exist for steatohepatitis with significant (F2-F3) fibrosis. Qualified as «first-line treatment» so the exam message (no tablet for simple fatty liver) stays and the statement stays true.SNLE_Part02_Ch05_Gastrointestinal_Liver::s27— Key point carried the same absolute wording; «first-line» added for consistency with the corrected sentence.SNLE_Part02_Ch05_Gastrointestinal_Liver-fc063— Flashcard carried the same absolute wording («not a drug»); «first-line» added for consistency.SNLE_Part02_Ch05_Gastrointestinal_Liver-cs006— Model answer said flatly «there is no tablet for it»; it now says there is no tablet that replaces lifestyle change and that a specialist may consider a drug only for steatohepatitis with significant fibrosis.SNLE_Part02_Ch05_Gastrointestinal_Liver-q024— Explanation carried the same absolute wording; «first-line» added for consistency.SNLE_Part02_Ch05_Gastrointestinal_Liver::s27— s27, fc063 and the key point still said the treatment of fatty liver 'is NOT a drug' / 'not a drug' (an absolute statement) while q024 and cs006 had been corrected to 'mainstay ... rather than a drug; liver-directed drug treatment is considered mainly for steatohepatitis with significant fibrosis'. (practical-consequence note)SNLE_Part02_Ch05_Gastrointestinal_Liver::s27— s27, fc063 and the key point still said the treatment of fatty liver 'is NOT a drug' / 'not a drug' (an absolute statement) while q024 and cs006 had been corrected to 'mainstay ... rather than a drug; liver-directed drug treatment is considered mainly for steatohepatitis with significant fibrosis'. (ladder step 1 called weight reduction "the treatment")SNLE_Part02_Ch05_Gastrointestinal_Liver::s27— s27, fc063 and the key point still said the treatment of fatty liver 'is NOT a drug' / 'not a drug' (an absolute statement) while q024 and cs006 had been corrected to 'mainstay ... rather than a drug; liver-directed drug treatment is considered mainly for steatohepatitis with significant fibrosis'. (Key point box)SNLE_Part02_Ch05_Gastrointestinal_Liver-fc063— s27, fc063 and the key point still said the treatment of fatty liver 'is NOT a drug' / 'not a drug' (an absolute statement) while q024 and cs006 had been corrected to 'mainstay ... rather than a drug; liver-directed drug treatment is considered mainly for steatohepatitis with significant fibrosis'.SNLE_Part02_Ch05_Gastrointestinal_Liver::s16— MASLD (the 2023 name for NAFLD) was added only in q024 option B; the name is now given alongside NAFLD where the disease is first named in the chapter's other places. (cirrhosis causes)SNLE_Part02_Ch05_Gastrointestinal_Liver::s27— MASLD (the 2023 name for NAFLD) was added only in q024 option B; the name is now given alongside NAFLD where the disease is first named in the chapter's other places. (first paragraph)SNLE_Part02_Ch05_Gastrointestinal_Liver-fc062— MASLD (the 2023 name for NAFLD) was added only in q024 option B; the name is now given alongside NAFLD where the disease is first named in the chapter's other places.SNLE_Part02_Ch05_Gastrointestinal_Liver-cs006— MASLD (the 2023 name for NAFLD) was added only in q024 option B; the name is now given alongside NAFLD where the disease is first named in the chapter's other places. (model answer, first sentence)
Musculoskeletal Nursing التمريض العضلي الهيكلي — 23 correction(s)
SNLE_Part02_Ch06_Musculoskeletal::s14— Callout says a prosthetic hip that is "shorter and EXTERNALLY rotated" is dislocated. After THR the usual dislocation is posterior, giving a shortened, ADDUCTED, INTERNALLY rotated leg (external rotation + abduction is the anterior pattern, and the classic hip-FRACTURE pattern). The EN teaching text says only "shortened and rotated"; direction should not be stated as external. Also "طعم" = graft, not prosthesisSNLE_Part02_Ch06_Musculoskeletal::s26— 'avoided in the elderly, in renal disease' overstates: NSAIDs are used with great caution in older adults (the Watch-out box of this section itself says use the lowest dose for the shortest time) and avoided in significant renal impairment and heart failure.SNLE_Part02_Ch06_Musculoskeletal-fc026— A dislocated hip prosthesis after the posterior-approach replacement taught in this chapter (precautions: no flexion >90 degrees, no adduction, no internal rotation) typically presents with the leg shortened, adducted and INTERNALLY rotated; the chapter's own case cs008 says 'SHORTENED and INTERNALLY ROTATED'. 'Externally rotated' is the picture of a femoral neck fracture (fc022) or an anterior dislocation, and contrSNLE_Part02_Ch06_Musculoskeletal-fc031— Front asks 'Osteoarthritis versus rheumatoid' but the back lists osteoarthritis features only (rheumatoid is on the next card, fc032), so the back does not answer the front. Minimal fix: make the front ask for the OA features. Arabic front also mixes three terms for OA (خشونة المفاصل / التهاب المفاصل التنكّسي / الفصال); use the standard 'الفصال العظمي'.SNLE_Part02_Ch06_Musculoskeletal-cs003— Dislocation of a hip replacement done by the posterior approach (the precautions taught here: no flexion >90, no adduction, no internal rotation) presents with the leg shortened and INTERNALLY rotated, not outward; contradicts the chapter's own cs008 ('SHORTENED and INTERNALLY ROTATED'). Outward rotation is the picture of a femoral neck fracture or anterior dislocation. Same error in fc026.SNLE_Part02_Ch06_Musculoskeletal-cs008— Ambiguous/misleading wording: 'keep the hip above 90 degrees' can be read as flexion above 90 degrees, which is exactly what the same answer says to avoid. Also the Arabic omits the rationale (push up from a high chair) and 'when lying and turning'; feminine imperative (صحّحي).SNLE_Part02_Ch06_Musculoskeletal::s14— The section teaches posterior-approach precautions, for which early post-operative positioning is on the back or the NON-operated side with a pillow between the legs; the operated side is avoided until the surgeon permits. 'Per instruction' is retained.SNLE_Part02_Ch06_Musculoskeletal::s14— Related error in the same section: the Watch-out says the dislocated prosthesis is 'externally rotated', but the posterior dislocation that these precautions guard against presents shortened, adducted and INTERNALLY rotated (the Arabic already says inward in a posterior dislocation). English aligned with the Arabic.SNLE_Part02_Ch06_Musculoskeletal-fc037— Flashcard states allopurinol is flatly 'not started during' an acute attack; ACR 2020 conditionally recommends starting urate-lowering therapy during a flare under anti-inflammatory cover. Qualifier added (exam convention kept).SNLE_Part02_Ch06_Musculoskeletal-q007— Shortened + externally rotated is the classic picture of femoral-neck fracture (q018) or anterior dislocation, not of the commoner posterior prosthesis dislocation (shortened, adducted, internally rotated). Wording changed to 'abnormally rotated', as in s14/q049; key unchanged.SNLE_Part02_Ch06_Musculoskeletal-q007— Same issue as the stem; explanation now says abnormally rotated, usually internally after the commoner posterior dislocation (consistent with section 6.13).SNLE_Part02_Ch06_Musculoskeletal-q012— Because ACR 2020 conditionally allows starting allopurinol during a flare, 'should not be started now' is guideline-contested; stem reworded so allopurinol (the only option that does not treat the attack) is the unambiguous key under both conventions. Key unchanged (A).SNLE_Part02_Ch06_Musculoskeletal-q012— Explanation stated as fact that allopurinol is not started during an attack; ACR 2020 conditionally recommends starting ULT during a flare with anti-inflammatory cover. Explanation now teaches the convention and states the current guideline.SNLE_Part02_Ch06_Musculoskeletal-q042— 'Paracetamol is first line' for osteoarthritis is contested (topical NSAIDs preferred first for knee/hand OA in current guidelines; paracetamol benefit small). Reworded to the safer options without changing the key (B).SNLE_Part02_Ch06_Musculoskeletal::s18— Text states flatly that allopurinol is not started during an acute attack; qualified as the traditional approach, with the ACR 2020 position added.SNLE_Part02_Ch06_Musculoskeletal::s18— Add the current ACR position and keep the continue-if-established teaching.SNLE_Part02_Ch06_Musculoskeletal::s18— 'Watch out' card in the same section gave the absolute rule; aligned with the qualified body text.SNLE_Part02_Ch06_Musculoskeletal::s26— 'PARACETAMOL - first line' for osteoarthritis presented as settled; current guidelines favour topical NSAIDs first for knee OA and paracetamol benefit is small. Heading softened and modest-benefit qualifier added (topical NSAIDs are already in step 3).SNLE_Part02_Ch06_Musculoskeletal::s26— Qualifier on the size of the benefit of paracetamol in osteoarthritis.SNLE_Part02_Ch06_Musculoskeletal::s26— Drug summary says allopurinol is 'not started in an acute gout attack'; ACR 2020 conditionally allows it under anti-inflammatory cover. Reworded as usually deferred, continued if already taken.SNLE_Part02_Ch06_Musculoskeletal::s28—SNLE_Part02_Ch06_Musculoskeletal::s29— Same unsupported absolute as the s24 callout / old q066: in the safe-lifting ladder the text said 'the twist is what causes the injury'. Twisting under load is a recognised risk factor (NIOSH), not the single cause; the instruction not to twist is kept.SNLE_Part02_Ch06_Musculoskeletal::s18— Section 6.17 presented exercise and posture as 'the treatment' of ankylosing spondylitis without saying that NSAIDs are the first-choice drug and that biologics follow failure of NSAIDs (the gout paragraph just above already carries the ACR 2020 nuance). Exercise and posture are now the mainstay of self-management, with the drug sequence stated. The AS wording occurs only in this paragraph (objective 19, q038 and fc0
Neurological & Stroke Nursing التمريض العصبي والسكتة — 17 correction(s)
SNLE_Part02_Ch07_Neurological_Stroke::s02— Decerebrate posturing: the arms are adducted and INTERNALLY rotated with forearm pronation, not 'rotated outwards'. Arabic mirrors the error.SNLE_Part02_Ch07_Neurological_Stroke::s05— Heading contradicts its own body and current practice: the body says interventions are 'spaced, not batched', but the heading says 'CLUSTER care'. In raised ICP, nursing activities (suction, turning, painful procedures) are spaced with rest periods rather than clustered. AR heading («جمّعي الرعاية») has the same error, uses a feminine imperative, and omits the rationale and 'suction is brief and pre-oxygenated'.SNLE_Part02_Ch07_Neurological_Stroke::s05— Memory aid teaches «رعاية مجمّعة» (clustered care), contradicting the EN body ('spaced, not batched') and the correction above.SNLE_Part02_Ch07_Neurological_Stroke::s09— Logical error: 'a patient who does not cough has not passed the swallow test' is wrong as worded — silent aspiration means that absence of cough does NOT show a safe swallow (the patient has not necessarily passed). AR repeats the error («لم يجتز الاختبار») and the line is duplicated.SNLE_Part02_Ch07_Neurological_Stroke::s09— Watch-out box says nil by mouth «until the swallow screen is performed» (حتى يُجرى), whereas the rule (and the section text) is nil by mouth until the swallow screen is PASSED; a failed screen keeps the patient nil by mouth.SNLE_Part02_Ch07_Neurological_Stroke::s17— Wound-washing duration is left vague ('several minutes'); WHO specifies washing with soap and water for at least 15 minutes. AR is also duplicated and omits that rabies is almost universally fatal once symptoms appear, the vaccine and immunoglobulin, and that washing alone substantially reduces the risk.SNLE_Part02_Ch07_Neurological_Stroke::s21— Key point box tells the reader to check bath-water temperature "by hand" («باليد»). This contradicts the section's own teaching (use the ELBOW, not the foot) and is unsafe: in glove-and-stocking neuropathy the hands may themselves be insensate, so a scald can occur. The EN body of this Key point box is not shown in the packet; flashcard fc100 EN carries the same "by hand" wording and is corrected there - align the ENSNLE_Part02_Ch07_Neurological_Stroke-fc100— Teaches checking bath-water temperature "by hand" in peripheral neuropathy. Neuropathy is classically glove-and-stocking, so the hands may themselves be insensate and a scald can occur; recommended practice (and this chapter's own s21 step 4) is the elbow (or forearm/thermometer), never the foot or an affected hand.SNLE_Part02_Ch07_Neurological_Stroke-q007— Key is right, but the explanation omits the first nursing action when haemorrhage is suspected during thrombolysis: stop the alteplase infusion (and obtain emergent CT) while reportingSNLE_Part02_Ch07_Neurological_Stroke-q008— Overstated superlative: "the commonest preventable killer after stroke" is not supported (the chapter itself says "a leading cause of death after stroke" in cs008); soften to a leading causeSNLE_Part02_Ch07_Neurological_Stroke-q032— Oversimplification: bacterial meningitis frequently alters consciousness (altered mental state in about 69% of adults), so "largely preserves consciousness" can mislead; add a short qualifier (key remains correct)SNLE_Part02_Ch07_Neurological_Stroke-cs006— Vignette gives ward drug rounds at 08:00, 14:00 and 20:00, but the worked example says the 10:00 dose was given at 11:30 "with the rest of the round" - there is no round at 11:30.SNLE_Part02_Ch07_Neurological_Stroke-fc010— "Cluster care" for raised ICP contradicts the chapter (section 7.4: "Do NOT cluster care - space out interventions") and current nursing guidance to space nursing activities with rest between, because grouped suctioning/turning/washing produce a cumulative ICP rise. (Sources differ; the card is aligned to the chapter. The tetanus and subarachnoid-haemorrhage answers use clustered care to limit stimulation and are lefSNLE_Part02_Ch07_Neurological_Stroke::s05— Memory aid: English says "cluster care" while the Arabic says «رعاية متباعدة لا مجمّعة» (spaced, not clustered) and the same section's ladder says "Do NOT cluster care - space out interventions"; English corrected to match.SNLE_Part02_Ch07_Neurological_Stroke::s04— "Central, not peripheral" oversimplifies current GCS practice: begin with fingertip (peripheral) pressure and apply a central stimulus (trapezius squeeze or supraorbital pressure) if there is no response or to confirm localisation; a peripheral stimulus alone can elicit a spinal reflex withdrawal.SNLE_Part02_Ch07_Neurological_Stroke::s04— Second half of the same GCS correction: state when the central stimulus is applied and that a peripheral stimulus ALONE can give a spinal reflex.SNLE_Part02_Ch07_Neurological_Stroke::s07— Overstatement: eligibility for thrombolysis does not depend on the onset time "alone" - imaging, blood pressure, glucose, anticoagulant use and other exclusion criteria also apply (as the section itself lists). Same overstatement in the English of the key-point box.
Perioperative Care, Haematology & Transfusion الرعاية حول الجراحة وأمراض الدم ونقل الدم — 17 correction(s)
SNLE_Part02_Ch08_Perioperative_Haematology::s17— "Generous intravenous fluids" is not supported by guidelines and risks fluid overload, pulmonary oedema and acute chest syndrome in sickle cell crisis; the safe teaching is adequate hydration (oral if the patient can drink, intravenous if not) while avoiding over-hydration. The Arabic is changed to match and also restores the omitted rationale clause.SNLE_Part02_Ch08_Perioperative_Haematology::s22— Inaccurate epidemiology: it is NOT true that nearly every fatal transfusion reaction comes from the wrong unit given to the wrong patient. Transfusion deaths are mainly due to pulmonary complications (TACO, TRALI) and delays; ABO-incompatible transfusion (wrong blood) is rare as a cause of death although it is the most dangerous avoidable error. The chapter itself teaches TACO/TRALI as the other major reactions.SNLE_Part02_Ch08_Perioperative_Haematology::s26— Incorrect/misleading causal claim: consanguinity does not 'explain the high local prevalence' of G6PD deficiency, sickle cell disease and thalassaemia. G6PD deficiency is X-linked (not autosomal recessive), so consanguinity is not the explanation for it; the high carrier frequency of the sickle, thalassaemia and G6PD genes in the Arabian Peninsula reflects historical malaria selection. Consanguinity increases the chaSNLE_Part02_Ch08_Perioperative_Haematology-cs001— Inaccurate epidemiology (same overstatement as in s22): transfusion deaths are mainly pulmonary complications (TACO/TRALI) and delays; ABO-incompatible transfusion from wrong-unit/wrong-patient errors is the most dangerous AVOIDABLE error but not 'almost every' fatal reaction.SNLE_Part02_Ch08_Perioperative_Haematology-q084— Stem ambiguity: 'What must NOT happen to his insulin?' asks for something to be avoided, but the options are mixed statements. Option A ('He should take his usual full dose') is also something that should not happen (basal insulin is continued at a reduced dose, about 80%, on the day of surgery, which the explanation itself says), so two options are defensible. Re-phrase the stem so that only B is correct; key B unchSNLE_Part02_Ch08_Perioperative_Haematology-q019— The explanation put the onset of surgical site infection at day three to five, which conflicts with q077 (wound infection day 5 to 7) and with the usual onset; it is now 'from about day five', with the earlier onset of aggressive organisms stated so that the day-3 vignette (fever 38.8 °C, spreading redness, pus) stays consistent. Key unchanged.SNLE_Part02_Ch08_Perioperative_Haematology-fc019— Same SSI onset statement ('day three to five') repeated on the flashcard; aligned with the corrected q019 explanation and q077.SNLE_Part02_Ch08_Perioperative_Haematology::s10— Timeline tile gave surgical site infection as 'Day 3–5'; aligned with q019 / q077 (from about day five; classic 'Day 5 to 7').SNLE_Part02_Ch08_Perioperative_Haematology-q027— 'Generous fluids' is dated: current practice is adequate hydration (oral if possible), avoiding over-hydration, which risks pulmonary oedema and acute chest syndrome. Wording aligned with the chapter's own section 8.16 ('Adequate hydration ... avoiding over-hydration'). Key (hydration, oxygen, analgesia) unchanged.SNLE_Part02_Ch08_Perioperative_Haematology-q076— 'Atelectasis is the commonest cause of early post-operative fever' is a classic textbook teaching that clinical evidence does not support; reworded as the classic attribution. The key (deep breathing and spirometry prevent atelectasis and pneumonia) is unaffected.SNLE_Part02_Ch08_Perioperative_Haematology-q077— Atelectasis as the day 1 to 2 cause is the traditional exam answer but is not supported by clinical evidence (most early fever is the inflammatory response to surgery). Key kept (atelectasis is the best of the four options as taught); the explanation now says so, and the stem asks for the classic teaching so only one answer is defensible.SNLE_Part02_Ch08_Perioperative_Haematology-q077— Stem asserted atelectasis as the 'commonest cause'; it now asks for the classic teaching, consistent with the qualified explanation. Key (D, atelectasis) unchanged.SNLE_Part02_Ch08_Perioperative_Haematology-q080— 'Fever, neck stiffness or photophobia would suggest meningitis instead' over-simplifies: neck stiffness and photophobia can accompany post-dural puncture headache (ICHD-3 notes neck stiffness and/or hearing symptoms), so they do not separate it from meningitis. Fever, altered consciousness or loss of the postural pattern are the safer red flags; fever with neck stiffness still needs a meningitis work-up. Key (post-duSNLE_Part02_Ch08_Perioperative_Haematology::s15— 'Tea with tablets is the commonest reason iron does not work' is an unsupported superlative: tea reduces non-haem iron absorption, but non-adherence from GI side-effects, continuing blood loss and malabsorption are leading causes of oral iron failure. Changed to 'a common reason'.SNLE_Part02_Ch08_Perioperative_Haematology::s15— 'Oral B12 does not correct pernicious anaemia' is an over-absolute statement: standard-dose oral B12 is unreliable because intrinsic factor is absent and IM hydroxocobalamin remains the standard (especially with neurological involvement), but high-dose oral B12 can raise serum B12. Reworded to 'Standard-dose oral B12 is unreliable'; the Arabic is changed in the same card. The injection-for-life teaching is unchanged.SNLE_Part02_Ch08_Perioperative_Haematology-q074— q074 explanation still said 'position supine with knees flexed' for evisceration while s10, q020, fc020 of the same chapter (and Part02 Ch13) teach low Fowler's position with the knees bent. Aligned q074 (EN and AR); option A ('position knees flexed') is compatible and the key is unchanged.SNLE_Part02_Ch08_Perioperative_Haematology::s10— The s10 ladder step said 'lie him down with knees slightly bent' while the Watch-out in the same section, q020, fc020 and q074 teach low Fowler's with the knees bent; the step is aligned (EN and AR).
Oncology & Critical Care Nursing تمريض الأورام والعناية الحرجة — 27 correction(s)
SNLE_Part02_Ch09_Oncology_Critical_Care::s03— Overstatement and omission: a non-healing ulcer is not always basal/squamous cell carcinoma ('is' should be 'may be'); the Arabic omits this whole clause and that these are far commoner than melanoma.SNLE_Part02_Ch09_Oncology_Critical_Care::s14— WRONG ORDER of emergency steps: in the NTSP/Resuscitation Council UK algorithm the speaking valve/cap and the INNER TUBE are removed first, THEN a suction catheter is passed to test patency, and the cuff is deflated only if the catheter will not pass. Here suction comes first and inner-tube removal + cuff deflation second (and the 'Watch out' box itself says to remove and check the inner cannula first).SNLE_Part02_Ch09_Oncology_Critical_Care::s14— WRONG ORDER (continuation): step 4 must become the cuff-deflation step performed only when the suction catheter cannot be passed (see step 3).SNLE_Part02_Ch09_Oncology_Critical_Care::s23— Epidemiology error: breast cancer, not colorectal cancer, is the commonest cancer overall (both sexes) in Saudi Arabia; colorectal is second overall (first in men, third in women). Arabic line is also duplicated.SNLE_Part02_Ch09_Oncology_Critical_Care-fc049— Epidemiology error: colorectal cancer is the commonest cancer in Saudi MEN, but breast cancer is the commonest overall (both sexes); colorectal is second overall (breast 17.3% vs colorectal 13.2%, Saudi Health Council 2022).SNLE_Part02_Ch09_Oncology_Critical_Care-fc019— Overstatement: "function lost before treatment is not regained" is absolute. Neurological function lost before treatment is usually (not never) regained - in the randomised trial, 10/16 (62%) non-ambulant patients regained walking after surgery plus radiotherapy vs 3/16 (19%) after radiotherapy alone; the teaching point (treat before deficit; ambulatory status at treatment predicts outcome) stands. The case cs004 alrSNLE_Part02_Ch09_Oncology_Critical_Care-q093— 'Most transfer incidents are equipment failures' is an unsupported generalisation: studies of intrahospital transport report equipment- and organisation-related adverse events in anywhere from about 10% to about 72% of cases, and patient deterioration is the main cause of the serious events. Softened to 'Many ...' (the key - loss of monitoring, oxygen or infusion - is unaffected).SNLE_Part02_Ch09_Oncology_Critical_Care-q055— The explanation says the bundle works 'because each element reduces aspiration or shortens ventilation time' and then lists VTE and ulcer prophylaxis. Those two are components of the older IHI 'ventilator bundle' (general care of ventilated patients) but they neither reduce aspiration nor shorten ventilation: VTE prophylaxis prevents thrombosis, and stress-ulcer prophylaxis is explicitly 'not recommended' for VAP/VAESNLE_Part02_Ch09_Oncology_Critical_Care-cs006— Median age at breast cancer diagnosis in Saudi Arabia is 52 years in the Saudi Health Council 2022 report, not 49; the teaching point (about a decade younger than in the West) still stands.SNLE_Part02_Ch09_Oncology_Critical_Care-fc048— Median age at breast cancer diagnosis in Saudi Arabia is 52 years in the Saudi Health Council 2022 report, not 49; still younger than in the West. ('About a third of all cancers in women' matches the 31.3% reported.)SNLE_Part02_Ch09_Oncology_Critical_Care-fc050— 'About a third of cases present late' matches neither definition of late in the Saudi registry (23.6% distant; 29.3% regional); state the stage instead: just over half present at a regional or distant stage.SNLE_Part02_Ch09_Oncology_Critical_Care-q003— Distractor D (rich moisturising cream each night) is defensible under UK advice (fragrance-free moisturiser used frequently, just not within the hour before treatment). Reworded to an unambiguously wrong option (perfumed lotion just before treatment); key B unchanged.SNLE_Part02_Ch09_Oncology_Critical_Care-q039— The empirical superlative 'most often neglected' also fits hand hygiene (option B); stem reworded to ask which element shortens the time the line stays in, which only option A does. Key A unchanged.SNLE_Part02_Ch09_Oncology_Critical_Care-q039— Explanation repeated the unsupported 'most neglected element' claim; aligned with the reworded stem.SNLE_Part02_Ch09_Oncology_Critical_Care-q055— Routine chlorhexidine oral care is no longer recommended for adults in the 2022 SHEA/IDSA/APIC VAP compendium; daily toothbrushing without chlorhexidine is the essential practice. Key (oral care) unchanged.SNLE_Part02_Ch09_Oncology_Critical_Care::s13— Consistency with the corrected VAP explanation: step 2 of the VAP bundle ladder taught oral care with chlorhexidine; now oral care with toothbrushing (per protocol).SNLE_Part02_Ch09_Oncology_Critical_Care-q091— 'Regular chlorhexidine care ... reduce VAP measurably' conflicts with the 2022 SHEA/IDSA/APIC VAP compendium (chlorhexidine oral care not recommended; benefit only in unblinded trials); toothbrushing oral care and subglottic drainage are the supported measures. Key (oral care) unchanged.SNLE_Part02_Ch09_Oncology_Critical_Care-q108— 'The single most effective infection control measure' reads as a general claim that competes with hand hygiene; it is true only for device-related infection (CDC CAUTI guideline: minimise catheter use and duration; SHEA CLABSI 2022: daily review of need and prompt removal). Scoped to device-related infection.SNLE_Part02_Ch09_Oncology_Critical_Care-q117— 'Family presence reduces delirium' is overstated: the ICU Visits cluster-randomised trial (JAMA 2019) found no significant reduction in delirium (18.9% vs 20.1%, RR 0.91, 95% CI 0.73-1.15) and no patient-outcome differences, but lower family anxiety and depression and higher satisfaction. Option D reworded to what the evidence supports; key D unchanged.SNLE_Part02_Ch09_Oncology_Critical_Care::s12— Vasopressors were taught as given only once volume is adequate, 'not before'; the Surviving Sepsis Campaign applies them during or after fluid resuscitation when hypotension persists (and does not delay them for full fluid loading). Reworded to the guideline timing while keeping the teaching point that vasopressors never replace volume.SNLE_Part02_Ch09_Oncology_Critical_Care::s23— Median age at breast cancer diagnosis in Saudi Arabia was given as about 49, older registry data; the 2022 national report gives 52. Rounded to 'about 50', which covers the registry years and keeps the point that it is about a decade younger than in the West.SNLE_Part02_Ch09_Oncology_Critical_Care-q026— Same median-age figure repeated in the explanation; kept consistent with the section.SNLE_Part02_Ch09_Oncology_Critical_Care-q027— Same median-age figure repeated in the keyed option; kept consistent with the section (the key stays C: a lump at 42 is never dismissed as too young).SNLE_Part02_Ch09_Oncology_Critical_Care::s23— 'A third present late' for colorectal cancer matches neither the distant-stage (23.6%) nor the regional-plus-distant (52.9%) figure in the Saudi registry; replaced by a non-numeric statement that agrees with the section's stat ('a high proportion present at an advanced stage').SNLE_Part02_Ch09_Oncology_Critical_Care::s08— Rule 5 of section 9.7 said steroids are started for any new back pain in a patient with known cancer. NICE NG234 (2023) offers dexamethasone when neurological symptoms or signs are present and otherwise considers it only for severe pain or haematological malignancy. This is the only place in the chapter that states the blanket steroid rule (the 9.7 'Watch out' box, q005, fc019 and the s03 pointer do not mention steroSNLE_Part02_Ch09_Oncology_Critical_Care-q104— Osmotic demyelination syndrome was called 'permanent' / 'usually irreversible' here while Part02 Ch14 says 'often permanent' / «كثيراً ما يكون دائماً» (outcomes vary; some patients recover). Aligned to 'often permanent' in Ch03 s23 (ladder step and text), fc056, Ch09 q104 (option B and explanation) and mock snle-m03-q060; q104 key B unchanged.SNLE_Part02_Ch09_Oncology_Critical_Care-q104— Osmotic demyelination syndrome was called 'permanent' / 'usually irreversible' here while Part02 Ch14 says 'often permanent' / «كثيراً ما يكون دائماً» (outcomes vary; some patients recover). Aligned to 'often permanent' in Ch03 s23 (ladder step and text), fc056, Ch09 q104 (option B and explanation) and mock snle-m03-q060; q104 key B unchanged.
Mental Health Nursing تمريض الصحّة النفسية — 26 correction(s)
SNLE_Part02_Ch10_Mental_Health-cs001— Overstatement: the myth that asking about suicide plants the idea is a common barrier, but it is not "the single reason" risk goes unasked about (discomfort, lack of training and time are others).SNLE_Part02_Ch10_Mental_Health-q006— Hypersomnia (option D) is also a recognised depressive symptom (DSM-5 "insomnia or hypersomnia"; common in atypical depression), so "characteristic of depression" is not exclusive to early waking. The explanation calls early waking "the characteristic biological feature": say so in the stem.SNLE_Part02_Ch10_Mental_Health-fc128— Superlative is not supported: of the three Ds, delirium is the one most often missed (roughly 32-67% of delirium goes unrecognised), whereas the card's own answer concerns depression being mistaken for dementia (pseudodementia). Reworded so the question matches the back of the card.SNLE_Part02_Ch10_Mental_Health-fc047— 'Insomnia is a symptom of and a driver of nearly every psychiatric condition, so improving it improves everything else' is overstated: insomnia is a transdiagnostic symptom and perpetuating factor, and treating it often helps comorbid symptoms, but not 'everything'.SNLE_Part02_Ch10_Mental_Health-q001— 'Tearful' (a labile or dysphoric affect) and 'flat' (absent emotional expression) are different affects, yet the key says 'affect observed flat'. The stem now describes a flat affect (withdrawn, expressionless) so the stem and the key agree; mood-versus-affect remains the point.SNLE_Part02_Ch10_Mental_Health-q007— 'What is the risk?' did not say which risk, and an antidepressant-induced manic switch (option A) is also a recognised early-treatment risk. The stem now asks for the suicide-related risk, so only 'Energy may return before mood lifts' (D, unchanged key) fits.SNLE_Part02_Ch10_Mental_Health-q075— 'Prevent most absconsions' is an unsupported quantifier; the measures (engagement, honest explanation of status, negotiated leave) are standard practice but no source shows they prevent 'most' absconsions. Softened to 'help prevent many'.SNLE_Part02_Ch10_Mental_Health-q082— 'Deaths in restraint are almost always from this mechanism' overstates the literature: positional/restraint asphyxia is one proposed mechanism with several contributing risk factors, and the cause of death is often hard to assign. The key (prone restraint risks positional asphyxia) is unchanged.SNLE_Part02_Ch10_Mental_Health::s07— Onset/duration of the baby blues was given as 'day 3 to 10' and 'resolves within days'. Standard teaching: onset in the first few days after birth, peak around day 3-5, settling within about 2 weeks (this is also how Part 3 Ch 6 of this platform teaches it). Reworded; the Arabic follows.SNLE_Part02_Ch10_Mental_Health::s07— Duration: the blues settle within about 2 weeks, not 'within days'.SNLE_Part02_Ch10_Mental_Health-q041— Same 'day three to ten' onset appears in this explanation; aligned with the section.SNLE_Part02_Ch10_Mental_Health-fc065— Same 'day three to ten' onset appears on this flashcard; aligned with the section.SNLE_Part02_Ch10_Mental_Health::s10— The key-point callout over-generalised ('nearly every psychiatric condition', 'improving sleep improves everything else'). Insomnia is not otherwise covered in 10.9, but the callout is a chapter-level point and is kept with a calibrated claim.SNLE_Part02_Ch10_Mental_Health::s10— The key-point callout over-generalised ('nearly every psychiatric condition', 'improving sleep improves everything else'). Insomnia is not otherwise covered in 10.9, but the callout is a chapter-level point and is kept with a calibrated claim.SNLE_Part02_Ch10_Mental_Health::s21— 'Almost always' / 'are from positional asphyxia' overstate the evidence: positional asphyxia is the leading mechanism but restraint deaths are often multifactorial. Reworded to 'most often related to', with the contributors named.SNLE_Part02_Ch10_Mental_Health::s21— 'Almost always' / 'are from positional asphyxia' overstate the evidence: positional asphyxia is the leading mechanism but restraint deaths are often multifactorial. Reworded to 'most often related to', with the contributors named.SNLE_Part02_Ch10_Mental_Health-fc110— Flashcard 'How people die in restraint' implied positional asphyxia is the only mechanism; aligned with the section.SNLE_Part02_Ch10_Mental_Health::s21— Restraint deaths are said to be 'most often related to' positional asphyxia; the literature describes the cause as often unclear and multifactorial (positional/restraint asphyxia, cardiac arrhythmia, acute behavioural disturbance). (10.20 opening note)SNLE_Part02_Ch10_Mental_Health::s21— Connector sentence must now refer to positional asphyxia specifically, since the preceding clause lists several mechanisms.SNLE_Part02_Ch10_Mental_Health::s21— Restraint deaths are said to be 'most often related to' positional asphyxia; the literature describes the cause as often unclear and multifactorial (positional/restraint asphyxia, cardiac arrhythmia, acute behavioural disturbance). (10.20 watch-out box)SNLE_Part02_Ch10_Mental_Health-q082— Restraint deaths are said to be 'most often related to' positional asphyxia; the literature describes the cause as often unclear and multifactorial (positional/restraint asphyxia, cardiac arrhythmia, acute behavioural disturbance). (q082 explanation; key A unchanged: positional asphyxia is still the reason the prone position is avoided)SNLE_Part02_Ch10_Mental_Health-fc110— Restraint deaths are said to be 'most often related to' positional asphyxia; the literature describes the cause as often unclear and multifactorial (positional/restraint asphyxia, cardiac arrhythmia, acute behavioural disturbance). (fc110)SNLE_Part02_Ch10_Mental_Health-cs008— Restraint deaths are said to be 'most often related to' positional asphyxia; the literature describes the cause as often unclear and multifactorial (positional/restraint asphyxia, cardiac arrhythmia, acute behavioural disturbance). (cs008 answer)SNLE_Part02_Ch10_Mental_Health::s22— Hypoactive delirium is called 'the commonest and the most missed'; subtype frequency varies by setting (common; in many settings the commonest, especially in older and palliative patients) and it is the most often missed. (10.21 delirium card)SNLE_Part02_Ch10_Mental_Health::s22— 'the one that is not reported' is absolute; match the softened 'most often missed'.SNLE_Part02_Ch10_Mental_Health-q059— Hypoactive delirium is called 'the commonest and the most missed'; subtype frequency varies by setting (common; in many settings the commonest, especially in older and palliative patients) and it is the most often missed. (q059 explanation; no key)
Immunology, Allergy & Autoimmune Disease المناعة والحساسية وأمراض المناعة الذاتية — 31 correction(s)
SNLE_Part02_Ch11_Immunology_Allergy-cs005— In this patient the adrenal crisis is due to long-term prednisolone (secondary/tertiary adrenal suppression), where the renin-angiotensin-aldosterone axis is intact. Hyperkalaemia is characteristic of PRIMARY adrenal insufficiency (aldosterone deficiency) and is absent in secondary/tertiary insufficiency; hyponatraemia (and hypoglycaemia) are the typical findings. 'low sodium and raised potassium are characteristic'SNLE_Part02_Ch11_Immunology_Allergy-q013— 'Renal involvement is silent' is an overstatement (lupus nephritis is often, not always, silent) and the Arabic already says 'غالباً' (often); flashcard fc018 also says 'often silent'. Align the English with the Arabic and fc018 (no Arabic change needed).SNLE_Part02_Ch11_Immunology_Allergy-q046— Unsupported claim: a cold injection is NOT the commonest reason patients stop a biologic (lack of effectiveness is; injection discomfort is only one recognised reason).SNLE_Part02_Ch11_Immunology_Allergy::s05— The rule card said he must never be sat up 'not even ... to help him breathe', contradicting the position list ('BREATHING difficulty -> sit up') and the Watch-out ('unless breathing is the dominant problem'). The danger documented in guidelines is a SUDDEN change of posture (sitting or standing up suddenly), not gradual raising when breathing is the dominant problem. Rule limited accordingly.SNLE_Part02_Ch11_Immunology_Allergy::s05— The rule card said he must never be sat up 'not even ... to help him breathe', contradicting the position list ('BREATHING difficulty -> sit up') and the Watch-out ('unless breathing is the dominant problem'). The danger documented in guidelines is a SUDDEN change of posture (sitting or standing up suddenly), not gradual raising when breathing is the dominant problem. Rule limited accordingly. (companion bullet madeSNLE_Part02_Ch11_Immunology_Allergy-cs003— 'Non-adherence is the commonest cause of late graft loss' overstated, and does not fit a patient 3 months after transplant. Reworded to a leading preventable cause of rejection and graft loss, and missed doses as an early thing to exclude.SNLE_Part02_Ch11_Immunology_Allergy-fc031— 'Commonest cause of late graft loss' overstated; reworded to 'a leading preventable cause'.SNLE_Part02_Ch11_Immunology_Allergy-q020— 'Commonest cause of late graft loss' overstated. Stem reworded to 'a leading preventable cause'; key D (non-adherence) remains the single best answer among the options (hyperacute rejection and surgical complications are early events; donor organ quality is not a preventable late cause), so the key and explanation are unchanged.SNLE_Part02_Ch11_Immunology_Allergy-cs004— The confidentiality promise was unqualified. HIV is a notifiable infection and the premarital programme involves the prospective partner, so a legal-requirement exception is added. The other two Saudi-specific points ('Can he marry: yes', 'the decision is theirs') are left for human review (see note).SNLE_Part02_Ch11_Immunology_Allergy-cs008— Saying colchicine is taken only 'to prevent amyloidosis' is incomplete: daily colchicine also prevents attacks. Reworded to 'attacks and, above all, amyloidosis', keeping the point that it does not treat an attack under way.SNLE_Part02_Ch11_Immunology_Allergy-fc069— 'Main purpose is amyloid prevention, not aborting attacks' omits that daily colchicine also prevents attacks. Reworded; the Arabic 'إجهاض النوبات' (which also means miscarriage) is replaced by the clearer 'يوقف نوبة'.SNLE_Part02_Ch11_Immunology_Allergy::s05— Learning objective 9 promises the dose, route, site and repeat of adrenaline, but step 3 gave no dose. Adult dose and a pointer for children added (consistent with case cs001).SNLE_Part02_Ch11_Immunology_Allergy::s05— 'Second-line' is kept, but the step now says these drugs are adjuncts only and that steroids are no longer advised routinely, in line with current UK guidance; the safety message (adrenaline first) is unchanged.SNLE_Part02_Ch11_Immunology_Allergy::s11— 'Tenfold' is unsupported: the single-strength rule is correct, but mixing strengths (for example 2.5 mg and 10 mg tablets) gives a several-fold, not a specific tenfold, error. The figure is removed in both languages.SNLE_Part02_Ch11_Immunology_Allergy::s13— The ankylosing spondylitis card said morning stiffness over an hour, contradicting the Memory aid card, flashcard fc080 and quiz q045 (over half an hour). Inflammatory back pain is characterised by stiffness over 30 minutes; over an hour is the rheumatoid arthritis figure, which stays unchanged.SNLE_Part02_Ch11_Immunology_Allergy::s13— 'Is lupus until proved otherwise' is too absolute: neuropsychiatric lupus is a diagnosis of exclusion, and infection, metabolic, hypertensive and drug (steroid) causes must be actively excluded. Reworded to keep the teaching intent (do not dismiss as primary psychiatric illness; investigate urgently).SNLE_Part02_Ch11_Immunology_Allergy::s13— The Key point card had the same over-absolute wording ('not attributed to ... an infection or the medication'), which would tell the learner not to consider infection or drug effects. Reworded to match the body text.SNLE_Part02_Ch11_Immunology_Allergy::s14— The heading said 'Adherence is the commonest cause of LATE graft loss' (which also reads as if adherence caused the loss). Non-adherence is a leading, preventable cause of late rejection and graft loss, but not established as the single commonest cause (chronic allograft dysfunction and death with a functioning graft also account for much late loss). Reworded in both languages.SNLE_Part02_Ch11_Immunology_Allergy::s14— The Key point card repeated the overstatement 'Non-adherence is the commonest cause of late graft loss'. Reworded to 'a leading, preventable cause' in both languages.SNLE_Part02_Ch11_Immunology_Allergy::s16— The Key point card called a cold injection 'the commonest reason people stop taking it', which is unsupported and contradicts step 1 of the same section ('a common reason'). Aligned to 'a common reason' in both languages.SNLE_Part02_Ch11_Immunology_Allergy-q034—SNLE_Part02_Ch11_Immunology_Allergy::s06— ACE-inhibitor angioedema 'does NOT respond' to adrenaline/antihistamines/steroids is stated as an absolute; sources say generally ineffective (bradykinin-mediated), with adrenaline still given when anaphylaxis cannot be excluded or the airway is threatened. (comparison card)SNLE_Part02_Ch11_Immunology_Allergy::s06— Management line: make explicit when adrenaline is still given.SNLE_Part02_Ch11_Immunology_Allergy::s06— ACE-inhibitor angioedema 'does NOT respond' to adrenaline/antihistamines/steroids is stated as an absolute; sources say generally ineffective (bradykinin-mediated), with adrenaline still given when anaphylaxis cannot be excluded or the airway is threatened. (watch-out box)SNLE_Part02_Ch11_Immunology_Allergy::s06— Watch-out box should carry the action: airway first, adrenaline if anaphylaxis cannot be excluded or the airway is threatened, stop the ACE inhibitor.SNLE_Part02_Ch11_Immunology_Allergy-q027— ACE-inhibitor angioedema 'does NOT respond' to adrenaline/antihistamines/steroids is stated as an absolute; sources say generally ineffective (bradykinin-mediated), with adrenaline still given when anaphylaxis cannot be excluded or the airway is threatened. (q027 explanation; key D unchanged)SNLE_Part02_Ch11_Immunology_Allergy-q027— Add the action: airway first, adrenaline still given if anaphylaxis cannot be excluded or the airway is threatened.SNLE_Part02_Ch11_Immunology_Allergy-fc041— ACE-inhibitor angioedema 'does NOT respond' to adrenaline/antihistamines/steroids is stated as an absolute; sources say generally ineffective (bradykinin-mediated), with adrenaline still given when anaphylaxis cannot be excluded or the airway is threatened. (fc041)SNLE_Part02_Ch11_Immunology_Allergy-cs006— ACE-inhibitor angioedema 'does NOT respond' to adrenaline/antihistamines/steroids is stated as an absolute; sources say generally ineffective (bradykinin-mediated), with adrenaline still given when anaphylaxis cannot be excluded or the airway is threatened. (cs006 answer, first statement)SNLE_Part02_Ch11_Immunology_Allergy-cs006— Make explicit that adrenaline, antihistamines and steroids are given only when anaphylaxis cannot be excluded or the airway is threatened (not 'routinely').SNLE_Part02_Ch11_Immunology_Allergy::s14— 11.13 calls acute rejection 'the commonest' without saying it is the commonest early (first months) type; late graft loss is mostly chronic rejection and non-adherence (as the chapter's own q020 teaches).
Eye, Ear, Nose & Throat العين والأذن والأنف والحنجرة — 27 correction(s)
SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s05— Wrong rationale: the adult external auditory canal does not "run upward and backward"; it is S-shaped, and pulling the pinna up and back straightens it. (Arabic also omits the pen grip / bracing-the-hand points and has a feminine imperative.)SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-fc003— Incomplete answer to "Eye emergencies": the chapter's four eye emergencies are chemical splash, sudden loss of vision, sudden severe pain with a red eye, and penetrating injury. The card omits penetrating injury (a classic emergency that must not be missed) and substitutes the retinal-detachment symptoms.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-fc041— Epidemiology figure wrong by roughly an order of magnitude: congenital hearing loss affects about 1-3 per 1,000 births (Saudi hospital screening data 1.4/1,000 well babies, 2.6/1,000 overall; higher where consanguinity is common), not 1 in 2,000-6,000SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-fc051— Absolute claim overstated: amblyopia is much harder to treat after the critical period but some recovery is possible in older children and adults; qualifier suggested (practice point - early referral - unchanged)SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-cs002— Physiologically wrong and unsafe: light causes pupil constriction, darkness causes dilation. In suspected acute angle closure the patient should be kept in a well-lit room (dim light/mydriasis precipitates or worsens closure); darkening the room contradicts the chapter's own flashcard fc060 and quiz q037SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-cs009— Imprecise: by definition haemorrhage within 24 h is primary and bleeding after 24 h is secondary (most often days 5-10), so at two days this is already classed as secondary, earlier than the usual window; "either mechanism is possible" is misleading. The matching Arabic is supplied in the cs009 translation finding that adds the omitted sentence.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q028— Absolute claim overstated: amblyopia is much harder to treat after the critical period but some recovery is possible in older children and adults; qualifier suggested (practice point - early assessment - unchanged)SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q030— "not more antibiotics" can be read as "no antibiotics"; orbital spread needs urgent assessment and usually intravenous antibiotics, so the point is that further oral antibiotics alone are not enoughSNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q062— The English tells staff to orient a blind patient 'by touch rather than by pointing or describing'. Good practice combines clear verbal description (room layout, positions relative to the bed) WITH placing the patient's hand on items; only pointing is useless. 'Rather than ... describing' is therefore misleading. The Arabic also uses second-person feminine forms («وجّهيه ... مغطّيةً»), rewritten impersonally in the sSNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s10— Misleading Key point: dry eye IS dryness of the ocular surface (tear-film instability and hyperosmolarity); watering is a recognised reflex-tearing symptom that can accompany it, which the section's own dry-eye card already states. Reworded in both languages.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— Unverified statistic: 96% was reported by a single tertiary hospital; national coverage is published as 89% (MOH, Int J Neonatal Screen 2020) and 92.6% (2021, J Otol 2024). Softened to 'about 90%' in every place it appears.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— Unverified statistic: 96% was reported by a single tertiary hospital; national coverage is published as 89% (MOH, Int J Neonatal Screen 2020) and 92.6% (2021, J Otol 2024). Softened to 'about 90%' in every place it appears.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-fc042— Unverified statistic: 96% was reported by a single tertiary hospital; national coverage is published as 89% (MOH, Int J Neonatal Screen 2020) and 92.6% (2021, J Otol 2024). Softened to 'about 90%' in every place it appears.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— The figure '~50% of referred infants complete diagnostic follow-up' (and 'half the referred infants never reach diagnosis') has no source; published Saudi series report 18-35% of infants who fail the screen lost to follow-up. Replaced with the sourced range in the stat box, narrative and key point (EN and AR).SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— The figure '~50% of referred infants complete diagnostic follow-up' (and 'half the referred infants never reach diagnosis') has no source; published Saudi series report 18-35% of infants who fail the screen lost to follow-up. Replaced with the sourced range in the stat box, narrative and key point (EN and AR).SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— The figure '~50% of referred infants complete diagnostic follow-up' (and 'half the referred infants never reach diagnosis') has no source; published Saudi series report 18-35% of infants who fail the screen lost to follow-up. Replaced with the sourced range in the stat box, narrative and key point (EN and AR).SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— The figure '~50% of referred infants complete diagnostic follow-up' (and 'half the referred infants never reach diagnosis') has no source; published Saudi series report 18-35% of infants who fail the screen lost to follow-up. Replaced with the sourced range in the stat box, narrative and key point (EN and AR).SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-cs004— The model answer gave the national newborn hearing screening coverage as about 96% (that figure comes from a single Eastern Province hospital; the national figure is about 90%, which the chapter's section 12.18 and flashcard fc042 already use) and stated that 'only about half' of referred infants complete diagnostic follow-up nationally, for which no national source exists. Published Saudi series report roughly 27-35SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-fc042— The flashcard already gives about 90% coverage (the 96% in the original finding is gone), but still stated that 'only around half' of referred infants complete diagnostic follow-up nationally, which has no national source. Published Saudi series report roughly 27-35% lost to follow-up. Replaced with the softer, sourced wording used in section 12.18.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q024— 'Only about half of referred infants complete it' has no national source; published Saudi series report roughly 27-35% lost to follow-up. Replaced with the softer statement used in section 12.18.SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q050— 'Never seal all four sides' was stated as an absolute, but practice differs: North American nursing teaching tapes an occlusive dressing on three sides, while the UK Royal Marsden Manual advises an occlusive sterile dressing with urgent medical review without specifying three sides. Option B (three-sided dressing and call for help) remains the single best answer (reinsertion, leaving open and clamping are all wrong),SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q066— Guidance on sending topical anaesthetic drops home is not unanimous: the traditional/AAO position is that they are never dispensed (corneal toxicity with repeated use), whereas a 2024 ACEP-led consensus (Annals of Emergency Medicine) says a very short supply of dilute drops 'seems safe' for selected adults with simple abrasions, a statement the AAO did not endorse. The absolute 'never' is therefore softened to 'not rSNLE_Part02_Ch12_Eye_Ear_Nose_Throat-q066— Guidance on sending topical anaesthetic drops home is not unanimous: the traditional/AAO position is that they are never dispensed (corneal toxicity with repeated use), whereas a 2024 ACEP-led consensus (Annals of Emergency Medicine) says a very short supply of dilute drops 'seems safe' for selected adults with simple abrasions, a statement the AAO did not endorse. The absolute 'never' is therefore softened to 'not rSNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s09— Consistency with the softened question q066: the Watch-out card said the drops are 'never' given to take away; changed to 'not routinely' (see q066).SNLE_Part02_Ch12_Eye_Ear_Nose_Throat-fc088— Consistency with the softened question q066: the flashcard said the drops are 'never' given to take away; changed to 'not routinely' (see q066).SNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s05— 'Cover BOTH eyes if possible' for a penetrating eye injury is traditional nursing teaching, but current trauma guidance shields only the injured eye with a rigid shield, with no pad and no pressure (shielding both eyes increases anxiety); the same list already says 'rigid cover, no pad and no pressure'. Changed to shield the injured eye only, with covering the other eye described as not required (not an absolute eithSNLE_Part02_Ch12_Eye_Ear_Nose_Throat::s19— 'Hereditary hearing loss ... one in two thousand to one in six thousand live births' has no source and is too low: congenital hearing loss affects roughly 1-3 per 1,000 newborns (Saudi screening series: about 2.6 per 1,000) and about half of it is genetic. Replaced with the standard figures.
Burns & Wound Care الحروق والعناية بالجروح — 10 correction(s)
SNLE_Part02_Ch13_Burns_Wound_Care::s03— Teaches that applied traditional substances «must be rubbed (scrubbed) off later»; burn wounds are cleansed gently (soap/water or saline), and the chapter itself states that removing them causes further pain and damage.SNLE_Part02_Ch13_Burns_Wound_Care::s04— Unsupported specific interval: «after two hours». The chapter's own teaching is that airway swelling develops progressively over hours and the airway can become impossible to intubate later (see fc014); no source gives two hours.SNLE_Part02_Ch13_Burns_Wound_Care::s07— English wording error: haemoconcentration is a raised haematocrit BECAUSE plasma is lost, not «despite» hypovolaemia. The Arabic line also omits haemoconcentration, metabolic acidosis and the mechanisms of hyperkalaemia/hyponatraemia.SNLE_Part02_Ch13_Burns_Wound_Care::s08— Silver sulfadiazine is not contraindicated in pregnancy as a whole: the label contraindication is pregnancy approaching or at term (plus premature infants and newborns in the first 2 months, and hypersensitivity). «في الحمل» over-generalises.SNLE_Part02_Ch13_Burns_Wound_Care::s16— Memory aid says black necrotic eschar «needs debridement» without the exception taught in the same section: stable dry eschar on an ischaemic heel is left alone. Debriding it can create an unhealable wound and limb loss.SNLE_Part02_Ch13_Burns_Wound_Care-fc009— States that applied traditional substances «must be scrubbed off later»; burn wounds are cleansed gently (soap/water or saline), and scrubbing adds pain and tissue damage (the chapter itself says removing them causes further pain and damage).SNLE_Part02_Ch13_Burns_Wound_Care::s06— Step 5 said the leak "seals at about 48 hours - which is why the resuscitation is front-loaded into the first 24", which is internally inconsistent (a leak that lasted 48 h would not justify limiting the crystalloid resuscitation to 24 h) and conflicts with the same section's Key point, which says the leak is greatest in the first eight hours. Reworded so the step states what drives front-loading (the leak is worst eSNLE_Part02_Ch13_Burns_Wound_Care::s17— Evisceration positioning disagreed within the chapter: the s17 (13.16) step list says low Fowler with knees bent (Arabic: فاولر المنخفضة), but the Watch-out, q041 explanation and fc068 said 'supine with knees flexed' (Arabic 'مستلقياً'). All now say low Fowler with knees bent.SNLE_Part02_Ch13_Burns_Wound_Care-q041— Evisceration positioning disagreed within the chapter: the s17 (13.16) step list says low Fowler with knees bent (Arabic: فاولر المنخفضة), but the Watch-out, q041 explanation and fc068 said 'supine with knees flexed' (Arabic 'مستلقياً'). All now say low Fowler with knees bent.SNLE_Part02_Ch13_Burns_Wound_Care-fc068— Evisceration positioning disagreed within the chapter: the s17 (13.16) step list says low Fowler with knees bent (Arabic: فاولر المنخفضة), but the Watch-out, q041 explanation and fc068 said 'supine with knees flexed' (Arabic 'مستلقياً'). All now say low Fowler with knees bent.
Fluids, Electrolytes & Acid-Base السوائل والشوارد والتوازن الحمضي القاعدي — 16 correction(s)
SNLE_Part02_Ch14_Fluids_Electrolytes::s04— Memory aid ('clear before cloudy') calls the cloudy insulin a 'long-acting suspension'. The cloudy insulin drawn up second is NPH (isophane), which is intermediate-acting. Current long-acting analogues (glargine, detemir, degludec) are clear and must not be mixed. The EN body of this box comes from the chapter source and is not shown in the bi packet. The same wording recurs in an MCQ explanation in part 2 of 2.SNLE_Part02_Ch14_Fluids_Electrolytes::s13— Over-generalised: only chronic respiratory ACIDOSIS (CO2 retention, e.g. COPD) raises the bicarbonate. Chronic respiratory alkalosis is compensated by a FALL in bicarbonate. The AR line leaves out this clause, so no AR change is needed.SNLE_Part02_Ch14_Fluids_Electrolytes-fc071— Over-generalised: blood taken from the arm above (upstream of) a running infusion is contaminated by the infusate, which raises the potassium only if the fluid contains potassium; saline or dextrose contamination dilutes the sample and lowers it (the chapter's own q047 explanation says the sample is 'diluted by the fluid'). Qualifier added.SNLE_Part02_Ch14_Fluids_Electrolytes-q023— The scenario is air embolism DURING removal of a central line. The first action is immediate occlusion of the insertion site/tract (pressure or occlusive dressing), because clamping the catheter does not stop air entering through the tract once the catheter is out. 'Clamp the line' alone is therefore incomplete. The left-lateral head-down position is correct. Also feminine imperatives in the AR (أغلقي، أعطِ، استدعي).SNLE_Part02_Ch14_Fluids_Electrolytes-q027— The stem says 'intermediate-acting insulin', but the explanation calls the cloudy insulin a 'long-acting suspension'. The cloudy insulin drawn up second is NPH (isophane), which is INTERMEDIATE-acting; the long-acting analogues (glargine, detemir, degludec) are clear and must not be mixed with other insulins. The same wording was flagged in packet p1of2 (section s04).SNLE_Part02_Ch14_Fluids_Electrolytes-q046— Over-generalised: blood taken from the arm above (upstream of) a running infusion raises the potassium only if the infusate contains potassium; saline or dextrose contamination dilutes the sample and lowers it (q047's own explanation says the sample is 'diluted by the fluid'). Qualifier added.SNLE_Part02_Ch14_Fluids_Electrolytes-q046— Guidelines differ: UKKA 2023 treats K+ >=6.5 mmol/L as severe (urgent treatment) whereas StatPearls advises confirming before aggressive therapy when there is no ECG change, symptom or cause. The stem gave no reason to suspect a spurious result, so 'repeat first' was not unambiguous. Stem now states a haemolysed sample, normal ECG and no renal or other cause; explanation states the urgent repeat, informing the doctorSNLE_Part02_Ch14_Fluids_Electrolytes-q046— Guidelines differ: UKKA 2023 treats K+ >=6.5 mmol/L as severe (urgent treatment) whereas StatPearls advises confirming before aggressive therapy when there is no ECG change, symptom or cause. The stem gave no reason to suspect a spurious result, so 'repeat first' was not unambiguous. Stem now states a haemolysed sample, normal ECG and no renal or other cause; explanation states the urgent repeat, informing the doctorSNLE_Part02_Ch14_Fluids_Electrolytes-fc073— "Repeat it before treating if the electrocardiogram is normal" had no qualifier. A repeat-first approach is accepted only when pseudohyperkalaemia is likely (patient well, normal ECG, no plausible cause such as renal failure, crush injury or tumour lysis) and the repeat is done urgently with the doctor informed; an abnormal ECG, an unwell patient or a plausible cause means treatment starts while the repeat is processSNLE_Part02_Ch14_Fluids_Electrolytes-fc073— "Repeat it before treating if the electrocardiogram is normal" had no qualifier. A repeat-first approach is accepted only when pseudohyperkalaemia is likely (patient well, normal ECG, no plausible cause such as renal failure, crush injury or tumour lysis) and the repeat is done urgently with the doctor informed; an abnormal ECG, an unwell patient or a plausible cause means treatment starts while the repeat is processSNLE_Part02_Ch14_Fluids_Electrolytes-cs001— The answer told the nurse to stop every potassium-containing fluid "including balanced solutions such as Ringer's lactate". Ringer's lactate/Hartmann's contains only about 4-5 mmol/L potassium, well below this patient's serum 6.8 mmol/L, and the chapter's own cs008 and q024 teach the softer position that Hartmann's is "used cautiously or avoided" in hyperkalaemia. Aligned cs001 with that wording: stop fluids with potSNLE_Part02_Ch14_Fluids_Electrolytes::s08— Osmotic demyelination was called 'irreversible' (Arabic «غير عكوس» / «لا رجعة فيه»); sources report variable outcomes (roughly a quarter to two fifths recover fully), so the wording is softened to 'often permanent' in every place in the chapter (s08 tree and Watch-out, q007 explanation, fc015, cs004).SNLE_Part02_Ch14_Fluids_Electrolytes::s08— Osmotic demyelination was called 'irreversible' (Arabic «غير عكوس» / «لا رجعة فيه»); sources report variable outcomes (roughly a quarter to two fifths recover fully), so the wording is softened to 'often permanent' in every place in the chapter (s08 tree and Watch-out, q007 explanation, fc015, cs004).SNLE_Part02_Ch14_Fluids_Electrolytes-q007— Osmotic demyelination was called 'irreversible' (Arabic «غير عكوس» / «لا رجعة فيه»); sources report variable outcomes (roughly a quarter to two fifths recover fully), so the wording is softened to 'often permanent' in every place in the chapter (s08 tree and Watch-out, q007 explanation, fc015, cs004).SNLE_Part02_Ch14_Fluids_Electrolytes-fc015— Osmotic demyelination was called 'irreversible' (Arabic «غير عكوس» / «لا رجعة فيه»); sources report variable outcomes (roughly a quarter to two fifths recover fully), so the wording is softened to 'often permanent' in every place in the chapter (s08 tree and Watch-out, q007 explanation, fc015, cs004).SNLE_Part02_Ch14_Fluids_Electrolytes-cs004— Osmotic demyelination was called 'irreversible' (Arabic «غير عكوس» / «لا رجعة فيه»); sources report variable outcomes (roughly a quarter to two fifths recover fully), so the wording is softened to 'often permanent' in every place in the chapter (s08 tree and Watch-out, q007 explanation, fc015, cs004).
Patient Safety & Medication Administration سلامة المرضى وإعطاء الأدوية — 6 correction(s)
SNLE_Part02_Ch15_Patient_Safety_Medication::s05— Overstated claim: re-sheathing is NOT "the single commonest mechanism" of sharps injury (surveillance data: most injuries occur during use, then after use before disposal, then during disposal; recapping is a minority). The "never re-sheath" rule itself is correct. AR line is also duplicated verbatim and uses a feminine imperative (لا تُعيدي).SNLE_Part02_Ch15_Patient_Safety_Medication-cs003— Absolute statement that a high-alert medicine can never be ordered verbally is stronger than the authorities (verbal orders are limited to emergencies/urgent situations, and for chemotherapy are not used except to hold or stop); qualified, consistent with q049.SNLE_Part02_Ch15_Patient_Safety_Medication-fc051— Internal inconsistency: section 15.9 says the visible tasks (drugs, observations) are not what gets dropped in missed care, yet this card lists observations among the care left undone; observations removed so the card matches the section and the usual missed-care picture (repositioning, mouth care, ambulation, teaching, emotional support).SNLE_Part02_Ch15_Patient_Safety_Medication-q007— Absolute statement that verbal orders are never accepted for any high-alert medicine is stronger than the authorities; qualified (chemotherapy only to hold/stop; other high-alert medicines only in an emergency under extra safeguards), consistent with q049.SNLE_Part02_Ch15_Patient_Safety_Medication-q040— Second defensible answer: the standard unit-dose barcode does not necessarily carry the expiry date, so "in date" could also be something the scan does not confirm. Distractor A replaced by something a barcode medication-administration system does check (that the dose is due now, against the eMAR schedule), so only C (order still clinically appropriate) is correct. Key unchanged.SNLE_Part02_Ch15_Patient_Safety_Medication-q052— Option A overlapped with the key, which already includes a worried family (a relative asking for review is a recognised escalation trigger). Distractor made clearly non-clinical: a relative asking about visiting hours. Key unchanged.
Psychopharmacology & Substance Use الأدوية النفسية وتعاطي المواد — 18 correction(s)
SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-fc001— Card says 'Days to weeks for the full antipsychotic effect', which contradicts the chapter text ('the full effect takes weeks') and the usual teaching: some response can begin in the first week or two, but the full effect takes weeks.SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-q011— Option A ('act on them') has no antecedent: the stem never mentions suicidal thoughts, and 'He is developing mania' (B) is then an equally defensible risk of new energy on an antidepressant. Add the missing context so that A is the single best answer.SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-q016— The explanation says the thiamine-before-glucose rule 'applies ... to treating a hypoglycaemia'. Read literally this teaches delaying glucose in a hypoglycaemic patient. Guidance: give thiamine before or with the carbohydrate, but do not withhold or delay glucose for a hypoglycaemic patient while waiting for thiamine.SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-cs003— 'Around forty per cent of substance misuse in the Kingdom' is not a national figure: it matches only one single-centre rehabilitation series (Al-Qassim, amphetamine 40% of single-drug misuse, alcohol 7%), other Saudi series give 24% (rehabilitation) and 34.9% (Riyadh ED, where cannabis was commoner), and 'alcohol the least prevalent' is not supported (benzodiazepines and inhalants were least common). Reworded to a seSNLE_Part02_Ch16_Psychopharmacology_Substance_Use-fc029— 'Around forty per cent of substance misuse in the Kingdom' is not a national figure: it matches only one single-centre rehabilitation series (Al-Qassim, amphetamine 40% of single-drug misuse, alcohol 7%), other Saudi series give 24% (rehabilitation) and 34.9% (Riyadh ED, where cannabis was commoner), and 'alcohol the least prevalent' is not supported (benzodiazepines and inhalants were least common). Reworded to a seSNLE_Part02_Ch16_Psychopharmacology_Substance_Use-fc029— 'Around forty per cent of substance misuse in the Kingdom' is not a national figure: it matches only one single-centre rehabilitation series (Al-Qassim, amphetamine 40% of single-drug misuse, alcohol 7%), other Saudi series give 24% (rehabilitation) and 34.9% (Riyadh ED, where cannabis was commoner), and 'alcohol the least prevalent' is not supported (benzodiazepines and inhalants were least common). Reworded to a seSNLE_Part02_Ch16_Psychopharmacology_Substance_Use::s09— 'Around forty per cent of substance misuse in the Kingdom' is not a national figure: it matches only one single-centre rehabilitation series (Al-Qassim, amphetamine 40% of single-drug misuse, alcohol 7%), other Saudi series give 24% (rehabilitation) and 34.9% (Riyadh ED, where cannabis was commoner), and 'alcohol the least prevalent' is not supported (benzodiazepines and inhalants were least common). Reworded to a seSNLE_Part02_Ch16_Psychopharmacology_Substance_Use-q019— The explanation presented "around forty per cent" and "alcohol is the least prevalent" as general Saudi facts; the figures come from single-centre treatment-seeking cohorts and "least prevalent" is not supported. Wording qualified; key (amphetamine) unchanged.SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-q027— "Most people stop in the first fortnight" is an unsupported overstatement; softened to "many people who stop do so early". Teaching point (side effects precede benefit; warn in advance) unchanged.SNLE_Part02_Ch16_Psychopharmacology_Substance_Use::s07— Internal inconsistency in the alcohol-withdrawal timeline: the ladder gave seizures at 24-48 h while the memory aid, flashcard fc024 and case cs005 give 12-48 h. Seizure window aligned to 12-48 h (usual range 6/12-48 h).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-cs005— Delirium tremens timing harmonised with section 16.6, flashcard fc024 and the memory aid (48-72 h typical), keeping the fact that onset can extend to 96 h.SNLE_Part02_Ch16_Psychopharmacology_Substance_Use::s03— Clozapine monitoring was described as a UK-type scheme ('dispensed only through a registered monitoring system', 'no count means no dispensing'), which is not what the SFDA clozapine guide describes. Reworded to strict medical supervision with WBC/ANC weekly for the first 18 weeks, then at least every four weeks, in every place (s03 agranulocytosis card, fc009, cs008).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use::s03— Clozapine monitoring was described as a UK-type scheme ('dispensed only through a registered monitoring system', 'no count means no dispensing'), which is not what the SFDA clozapine guide describes. Reworded to strict medical supervision with WBC/ANC weekly for the first 18 weeks, then at least every four weeks, in every place (s03 agranulocytosis card, fc009, cs008).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use::s03— Clozapine monitoring was described as a UK-type scheme ('dispensed only through a registered monitoring system', 'no count means no dispensing'), which is not what the SFDA clozapine guide describes. Reworded to strict medical supervision with WBC/ANC weekly for the first 18 weeks, then at least every four weeks, in every place (s03 agranulocytosis card, fc009, cs008).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use::s03— Clozapine monitoring was described as a UK-type scheme ('dispensed only through a registered monitoring system', 'no count means no dispensing'), which is not what the SFDA clozapine guide describes. Reworded to strict medical supervision with WBC/ANC weekly for the first 18 weeks, then at least every four weeks, in every place (s03 agranulocytosis card, fc009, cs008).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-fc009— Clozapine monitoring was described as a UK-type scheme ('dispensed only through a registered monitoring system', 'no count means no dispensing'), which is not what the SFDA clozapine guide describes. Reworded to strict medical supervision with WBC/ANC weekly for the first 18 weeks, then at least every four weeks, in every place (s03 agranulocytosis card, fc009, cs008).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-cs008— Clozapine monitoring was described as a UK-type scheme ('dispensed only through a registered monitoring system', 'no count means no dispensing'), which is not what the SFDA clozapine guide describes. Reworded to strict medical supervision with WBC/ANC weekly for the first 18 weeks, then at least every four weeks, in every place (s03 agranulocytosis card, fc009, cs008).SNLE_Part02_Ch16_Psychopharmacology_Substance_Use-cs004— Case cs004 said NMS is slower in onset, 'usually days to weeks', whereas the sections (s02: hours to days; s06 and q012/fc021: over days) and cs002 (hours to days) give hours to days / over days. Aligned to 'usually over days'.
Community & Public Health Nursing تمريض المجتمع والصحّة العامّة — 12 correction(s)
SNLE_Part02_Ch17_Community_Public_Health_Nursing-q035— 'Most emergency admissions at end of life are avoidable' is an unsupported absolute quantifier (local data show a minority are classed as avoidable). Soften 'Most' to 'Many' in EN and AR; the key and the teaching point (anticipatory medicines + a plan and 24-hour contact) are unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q115— 'Most crisis admissions at the end of life happen because a symptom arose at night and nobody knew who to call' is an unsupported absolute quantifier; soften 'Most' to 'Many' in EN and AR (same fix as q035). Key unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q130— Over-absolute statement: compression on an ischaemic limb does not invariably cause necrosis; it is contraindicated in severe arterial disease because it can cause ischaemic damageSNLE_Part02_Ch17_Community_Public_Health_Nursing-q191— Stem says 'despite good adherence' while the key and explanation say to verify what the patient is actually taking; the premise contradicts the answer. Clarify that adherence is only apparent or reportedSNLE_Part02_Ch17_Community_Public_Health_Nursing-cs003— Unsupported superlative in the model answer: feeling well is "the single commonest reason" for non-adherence. Adherence is multifactorial (forgetting, side effects, cost, absence of symptoms, beliefs), so it is softened to "one of the commonest reasons"; the teaching point is unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q017— Level of prevention is source-dependent: cardiology usage calls prevention of recurrent events after MI "secondary prevention", so option B was defensible. The stem now names the public-health three-level model, under which rehabilitation of established disease is tertiary (the chapter section on the three levels already lists cardiac rehabilitation under TERTIARY). Key D unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q057— The claim that antibiotics "stopped early once the patient feels better" select for resistance is contested (BMJ 2017 analysis versus older WHO patient advice). The clause is replaced by the uncontested "not taken as prescribed", in line with current stewardship advice to use antibiotics only as prescribed.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q057— Option B said "incomplete" antibiotic use, which carried the same contested early-stopping idea. Changed to "inappropriate" so the option matches the revised explanation; key B unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q112— "The commonest reason" for stopping antihypertensives is an unsupported superlative; adherence studies list several leading reasons (forgetting, side effects, cost, feeling well). Softened to "One of the commonest reasons"; key B and the teaching point are unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q143— Option A ("They drink deliberately less") is partly true, and the explanation says many older people restrict fluids, so two options were defensible. The stem now asks for age-related changes and medicines, which only option B gives; the explanation still teaches deliberate fluid restriction as an additional cause. Key B unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q170— Emergency contraception is a UK community-pharmacy service; its dispensing status in Saudi community pharmacies could not be confirmed from an SFDA or MOH source. Replaced with medication counselling, a pharmacy service that does not depend on the local rule; the key is unchanged.SNLE_Part02_Ch17_Community_Public_Health_Nursing-q202— Option C ("It reaches more people") is literally true and echoed by the explanation, and "It is cheaper" is also arguable, so the stem did not single out D. The stem now asks for the population-approach rationale (a small shift across the whole population prevents more disease than treating only high-risk people), which only D gives; this matches q023 in the same chapter. Key D unchanged.
Antenatal Care & Fetal Development الرعاية قبل الولادة ونموّ الجنين — 30 correction(s)
SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s08— Imprecise: genetic sex is established at fertilisation (gonads differentiate ~weeks 6-7 after conception); what is true by the end of the first trimester is that the external genitalia are distinguishable as male or female. 'Sex is determined' at the end of the first trimester could be learned as a wrong exam fact. (The Arabic for this row omits the sentence entirely, so it is added.)SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s11— AR line is printed twice in the source (duplicated sentence); States that anti-D is 'useless' after the usual 72-hour window. Guidance is that if the window is missed anti-D should still be given as soon as possible (up to 10 days), because it may still give some protection; a nurse who believes it is useless may omit a late dose and the woman may become sensitised. The Arabic also contains a garbled word ('والأمتأخّSNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs003— "Too late" overstates the point (neural tube closure is complete about 4 weeks after conception, so folic acid started at a positive test is late, not useless) and contradicts q004's "already late" and the Arabic ("متأخّر أصلاً"); Arabic already matches the corrected English, so no Arabic change is needed.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs005— A woman at 32 weeks must not be kept "flat" (supine): the gravid uterus compresses the inferior vena cava/aorta (aortocaval compression) and worsens hypotension in a bleeding patient. Correct position is left lateral (or left lateral tilt), as the chapter itself teaches in q003. Arabic repeats the error (أبقيها مسطّحةً) and uses the imperative form.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs001— Model answer teaches that a left lateral tilt is maintained during resuscitation; current guidance prioritises manual left uterine displacement, with tilt only if it does not compromise compressions.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s03— Step 5 says never lay a pregnant woman flat 'in resuscitation'; in cardiac arrest she must lie on her back for effective compressions and the uterus is displaced manually to the left.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs009— 'Nil by mouth initially' is not part of current inpatient hyperemesis protocols, which give IV fluids with oral intake as tolerated; qualified so it is correct under both older and current practice.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-q005— High BMI is listed as a higher-dose folic acid criterion without noting that guidelines differ (NICE 2025 no longer lists it). Qualified; the key (diabetes) is unaffected.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-q057— Obesity is listed as a higher-dose folic acid indication without noting that guidelines differ. Qualified; the key (diabetes or previous NTD) is unaffected.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-fc006— Internal consistency with q005/q057: flashcard lists high BMI as a higher-dose folic acid criterion without the qualifier.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s07— Internal consistency with q005/q057: section tree lists obesity as a higher-dose folic acid criterion without the qualifier.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s07— Internal consistency with q005/q057: Key point lists a high body mass index as a higher-dose folic acid criterion without the qualifier.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s07— Iron is presented as 'where indicated rather than universally' (the NICE approach) as if it were the single rule; WHO recommends daily iron-folic acid for all pregnant women and national protocols vary. Qualified to defer to the national protocol; the Saudi MOH antenatal protocol itself was not located or confirmed.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s05— Hyperemesis was taught as 'needs admission' (s05 1.4 comparison list, fc030, cs009). RCOG Green-top Guideline 69 (2024) places ambulatory day care first and uses inpatient care only when criteria are met (e.g. symptoms/ketonuria and weight loss continuing despite ambulatory treatment, inability to tolerate oral antiemetics, a comorbidity needing inpatient care). Reworded in all three places; thiamine and IV fluids unSNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-fc030— Hyperemesis was taught as 'needs admission' (s05 1.4 comparison list, fc030, cs009). RCOG Green-top Guideline 69 (2024) places ambulatory day care first and uses inpatient care only when criteria are met (e.g. symptoms/ketonuria and weight loss continuing despite ambulatory treatment, inability to tolerate oral antiemetics, a comorbidity needing inpatient care). Reworded in all three places; thiamine and IV fluids unSNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs009— Hyperemesis was taught as 'needs admission' (s05 1.4 comparison list, fc030, cs009). RCOG Green-top Guideline 69 (2024) places ambulatory day care first and uses inpatient care only when criteria are met (e.g. symptoms/ketonuria and weight loss continuing despite ambulatory treatment, inability to tolerate oral antiemetics, a comorbidity needing inpatient care). Reworded in all three places; thiamine and IV fluids unSNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s08— The embryonic period was given as 'weeks 3-8' (s08/1.7 comparison tile, Watch-out and figure caption; q009 explanation) without saying the weeks are counted from conception, whereas fc013 does. Because gestational age is dated from the last period elsewhere in the chapter, 'after conception' (بعد الإخصاب) is now stated, and the adjacent fetal tile ('week 9') is given the same reference point.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s08— The embryonic period was given as 'weeks 3-8' (s08/1.7 comparison tile, Watch-out and figure caption; q009 explanation) without saying the weeks are counted from conception, whereas fc013 does. Because gestational age is dated from the last period elsewhere in the chapter, 'after conception' (بعد الإخصاب) is now stated, and the adjacent fetal tile ('week 9') is given the same reference point.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s08— The embryonic period was given as 'weeks 3-8' (s08/1.7 comparison tile, Watch-out and figure caption; q009 explanation) without saying the weeks are counted from conception, whereas fc013 does. Because gestational age is dated from the last period elsewhere in the chapter, 'after conception' (بعد الإخصاب) is now stated, and the adjacent fetal tile ('week 9') is given the same reference point.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s08— The embryonic period was given as 'weeks 3-8' (s08/1.7 comparison tile, Watch-out and figure caption; q009 explanation) without saying the weeks are counted from conception, whereas fc013 does. Because gestational age is dated from the last period elsewhere in the chapter, 'after conception' (بعد الإخصاب) is now stated, and the adjacent fetal tile ('week 9') is given the same reference point.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-q009— The embryonic period was given as 'weeks 3-8' (s08/1.7 comparison tile, Watch-out and figure caption; q009 explanation) without saying the weeks are counted from conception, whereas fc013 does. Because gestational age is dated from the last period elsewhere in the chapter, 'after conception' (بعد الإخصاب) is now stated, and the adjacent fetal tile ('week 9') is given the same reference point.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s05— Hyperemesis gravidarum was still described with ketosis/ketonuria and escalated by unspecified admission criteria; Part03 Ch03 (GTG 69) defines it by dehydration, weight loss over 5% or electrolyte disturbance and says ketonuria does not indicate severity and should not guide decisions. (s05 comparison card: feature list)SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s05— Hyperemesis comparison card: weight-loss threshold added to match Ch03 (second half of the same list item).SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development::s05— Hyperemesis comparison card: admission now stated as when day care fails or there are complications (not unspecified criteria).SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-fc030— Hyperemesis gravidarum was still described with ketosis/ketonuria and escalated by unspecified admission criteria; Part03 Ch03 (GTG 69) defines it by dehydration, weight loss over 5% or electrolyte disturbance and says ketonuria does not indicate severity and should not guide decisions. (flashcard definition)SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-fc030— Flashcard: admission wording aligned with Ch03 and a short note that ketonuria does not indicate severity.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs009— Case answer used ketonuria as a defining feature that "shows" starvation/severity; it now defines hyperemesis by inability to keep fluids down and weight loss over 5% (the dipstick finding in the stem is kept as realistic).SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs009— Case answer: explicit statement that the ketones on the dipstick are expected but do not indicate dehydration or severity and must not guide decisions.SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs009— Case answer: admission criterion now "when day care fails or there are complications" (as in Ch03).SNLE_Part03_Ch01_Antenatal_Care_Fetal_Development-cs009— Case answer: an example of day-care failure no longer uses persistent ketonuria as the escalation marker (weight loss and dehydration instead).
Prenatal Screening & Genetics الفحص قبل الولادة والوراثة — 24 correction(s)
SNLE_Part03_Ch02_Prenatal_Screening_Genetics-q014— Unverified superlative: 'Saudi Arabia has been reported to have the highest prevalence of autosomal recessive disorders per capita in the world.' The literature supports a very high consanguinity rate (about 56% in a large Saudi community sample) and a high burden of recessive disorders, but no ranking as world-highest was found. Softened to 'one of the highest' (true whichever country ranks first).SNLE_Part03_Ch02_Prenatal_Screening_Genetics-q019— Key contradicts the item's own explanation. Key A ('Give the result and offer an appointment') gives a high-chance screening result over the telephone, but the explanation states 'A result of this weight is not delivered over the telephone, but saying nothing is worse ... Tell her honestly it is back and give a specific appointment before ending the call.' That describes option B (arrange to see her in person, with a (answer key changed to B)SNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc013— GBS screening window: the card gave only 35-37 weeks, which is the older CDC 2010 window (and the one used in RCOG-based local guidance); current ACOG Committee Opinion 797 (2020) specifies 36 0/7 to 37 6/7 weeks so that the culture stays valid for five weeks (covering birth up to 41 0/7 weeks). Added a short qualifier so both windows are stated and the card is correct under current ACOG guidance; the 35-37 wording iSNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc021— Unsupported superlative: 'the highest prevalence of autosomal recessive disorders per capita in the world'. Published Saudi sources support a consanguinity rate above 55% with first cousins the commonest form, a consanguinity rate among the highest in the world and a high burden of recessive/rare disease, but none ranks Saudi Arabia first for autosomal recessive disorders per capita. Reworded to what the sources suppSNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc022— Start year of the national premarital screening programme: the card said 'Introduced in 2001'; the primary programme papers date the government decision to 2003 and mandatory implementation to February 2004, with no 2001 start or pilot. Changed to the supported 2003 decision (2004 mandatory date unchanged).SNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc022— The claim that the premarital programme 'is integrated with the national newborn screening programme' could not be confirmed in any programme paper (the evaluation papers treat premarital screening as primary prevention separate from neonatal screening). Replaced with the supported statement that its scope was later widened to include hepatitis B, hepatitis C and HIV (consistent with fc025, q015 and section s08 stepSNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc033— 'Both are compatible with a normal lifespan' is inaccurate: survival is reduced in Turner syndrome (mainly cardiovascular disease, including aortic dissection) and life expectancy is also somewhat shorter in Klinefelter syndrome. Reworded to survival into adulthood with modestly reduced life expectancy and lifelong follow-up.SNLE_Part03_Ch02_Prenatal_Screening_Genetics-q015— 'It was introduced in 2001': the primary programme papers give a 2003 government decision and mandatory implementation in February 2004, with no 2001 start. Changed to the supported 2003 approval; 2004 mandatory date unchanged and consistent with fc022 and section s08.SNLE_Part03_Ch02_Prenatal_Screening_Genetics-q041— Option C ('It sounds less alarming to the woman') is a commonly given reason for preferring 'chance' to 'risk', so two options were partly defensible. Replaced with a clearly non-reason (the chapter says a number must always be given and 'low/high risk' without a number fails); key D ('Risk implies the child is a misfortune') is unchanged and remains the single best answer, matching the explanation and section s10.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s08— Start year of the national premarital screening programme in the timeline: 'Introduced in 2001' is not supported by the programme papers (government decision 2003; mandatory from February 2004). Changed to the 2003 approval; step 2 (mandatory 2004) unchanged.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s08— Same start-year correction in the Key point box of section s08 ('began in 2001' to 'was approved in 2003'), so the timeline and the key point agree.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s10— Over-narrow criterion: step 2 said termination for fetal anomaly requires an abnormality 'incompatible with life', whereas the ruling the chapter rests on (Islamic Fiqh Academy of the Muslim World League, 12th session, Makkah, 1410 AH / 1990) permits it before 120 days where a committee of trustworthy specialist physicians confirms a severe, untreatable malformation, at the parents' request; flashcard fc039 and the sSNLE_Part03_Ch02_Prenatal_Screening_Genetics::s04— Newborn blood-spot panel: the text taught a UK-style panel (haemoglobinopathies, cystic fibrosis) as if it were the Saudi programme. The Saudi national newborn screening programme covers congenital hypothyroidism, congenital adrenal hyperplasia and inherited metabolic disorders; haemoglobinopathies are covered by the premarital programme. Panels now stated as differing by country.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s04— Newborn blood-spot panel: the text taught a UK-style panel (haemoglobinopathies, cystic fibrosis) as if it were the Saudi programme. The Saudi national newborn screening programme covers congenital hypothyroidism, congenital adrenal hyperplasia and inherited metabolic disorders; haemoglobinopathies are covered by the premarital programme. Panels now stated as differing by country.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s04— Newborn blood-spot panel: the text taught a UK-style panel (haemoglobinopathies, cystic fibrosis) as if it were the Saudi programme. The Saudi national newborn screening programme covers congenital hypothyroidism, congenital adrenal hyperplasia and inherited metabolic disorders; haemoglobinopathies are covered by the premarital programme. Panels now stated as differing by country.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s04— Newborn blood-spot panel: the text taught a UK-style panel (haemoglobinopathies, cystic fibrosis) as if it were the Saudi programme. The Saudi national newborn screening programme covers congenital hypothyroidism, congenital adrenal hyperplasia and inherited metabolic disorders; haemoglobinopathies are covered by the premarital programme. Panels now stated as differing by country.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s04— Newborn blood-spot panel: the text taught a UK-style panel (haemoglobinopathies, cystic fibrosis) as if it were the Saudi programme. The Saudi national newborn screening programme covers congenital hypothyroidism, congenital adrenal hyperplasia and inherited metabolic disorders; haemoglobinopathies are covered by the premarital programme. Panels now stated as differing by country.SNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc034— Newborn blood-spot panel: the text taught a UK-style panel (haemoglobinopathies, cystic fibrosis) as if it were the Saudi programme. The Saudi national newborn screening programme covers congenital hypothyroidism, congenital adrenal hyperplasia and inherited metabolic disorders; haemoglobinopathies are covered by the premarital programme. Panels now stated as differing by country.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s05— CVS was taught as carrying a higher miscarriage risk than amniocentesis (and amniocentesis as 'lower risk of the two'). RCOG GTG 8 (2021) gives one similar additional risk for both, probably below 0.5%, so the two tests now differ in timing, not safety. q005 key (C, earlier in pregnancy) is unchanged and still the only correct option.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s05— CVS was taught as carrying a higher miscarriage risk than amniocentesis (and amniocentesis as 'lower risk of the two'). RCOG GTG 8 (2021) gives one similar additional risk for both, probably below 0.5%, so the two tests now differ in timing, not safety. q005 key (C, earlier in pregnancy) is unchanged and still the only correct option.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s05— CVS was taught as carrying a higher miscarriage risk than amniocentesis (and amniocentesis as 'lower risk of the two'). RCOG GTG 8 (2021) gives one similar additional risk for both, probably below 0.5%, so the two tests now differ in timing, not safety. q005 key (C, earlier in pregnancy) is unchanged and still the only correct option.SNLE_Part03_Ch02_Prenatal_Screening_Genetics::s05— CVS was taught as carrying a higher miscarriage risk than amniocentesis (and amniocentesis as 'lower risk of the two'). RCOG GTG 8 (2021) gives one similar additional risk for both, probably below 0.5%, so the two tests now differ in timing, not safety. q005 key (C, earlier in pregnancy) is unchanged and still the only correct option.SNLE_Part03_Ch02_Prenatal_Screening_Genetics-fc009— CVS was taught as carrying a higher miscarriage risk than amniocentesis (and amniocentesis as 'lower risk of the two'). RCOG GTG 8 (2021) gives one similar additional risk for both, probably below 0.5%, so the two tests now differ in timing, not safety. q005 key (C, earlier in pregnancy) is unchanged and still the only correct option.SNLE_Part03_Ch02_Prenatal_Screening_Genetics-q005— CVS was taught as carrying a higher miscarriage risk than amniocentesis (and amniocentesis as 'lower risk of the two'). RCOG GTG 8 (2021) gives one similar additional risk for both, probably below 0.5%, so the two tests now differ in timing, not safety. q005 key (C, earlier in pregnancy) is unchanged and still the only correct option.
Discomforts & Minor Disorders of Pregnancy مضايقات الحمل واضطراباته البسيطة — 26 correction(s)
SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q003— Numeric thresholds are given without units (bile acids are measured in micromol/L); thresholds themselves (preterm risk from ~40, stillbirth risk concentrated at >=100) are correct.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q025— Absolute causal claim: a strap lying across the bump 'is what causes' placental abruption. Mis-positioned belts increase force transmitted to the uterus (about 3-4 fold) and the risk of uterine injury/abruption, but abruption is not caused by the strap alone; soften to 'can contribute to'.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-cs008— Laterality over-simplified: nocturnal leg cramps in pregnancy usually affect one calf at a time (either leg), so 'bilateral' does not discriminate cramp from DVT; the real discriminators are brief and relieved by stretching versus persistent with swelling, warmth and tenderness.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q005— Option C described orthopnoea (breathlessness relieved by sitting up), which is not physiological in pregnancy and can signal cardiac disease (e.g. peripartum cardiomyopathy, mitral stenosis), so the distractor was arguably also in need of assessment. Reworded to an unambiguously benign pattern consistent with the explanation; key D unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q009— 'Add extra pillows under the head' is defensible in some patient-information sources (e.g. NHS advises propping up the head and shoulders), so the item had two arguable answers. Distractor replaced by a clearly wrong measure (caffeinated drinks worsen reflux), leaving 'raise the head of the bed' as the single best answer; key A unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q009— Explanation updated to match the reworded distractor C and to state the point precisely: raising the head of the bed inclines the whole trunk; pillows that only bend her at the waist are less effective; caffeine worsens reflux.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q019— Stem made a single-best-answer question about the safety step: with the key now the calf examination, 'first' makes the priority explicit.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q019— Premise unsupported: the Cochrane review (2020) found no clear benefit of calcium or vitamin D (+calcium) for leg cramps in pregnancy and does not recommend routine vitamin D/calcium testing for them; the safety step is to exclude DVT (as cs008 and the chapter's cramp-versus-clot teaching state). Key A kept, but option A rewritten to the calf examination for DVT; B-D (BP, glucose, thyroid) remain unrelated distractorSNLE_Part03_Ch03_Discomforts_Minor_Disorders-q019— Explanation rewritten: DVT must be excluded in a pregnant woman with calf pain; cramp is brief and eases with stretching; calcium and vitamin D supplements are not shown to relieve pregnancy cramps.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q036— During resuscitation of a pregnant woman current guidance prefers continuous manual left uterine displacement with her supine; a lateral tilt degrades chest-compression quality. Qualifier added.SNLE_Part03_Ch03_Discomforts_Minor_Disorders::s03— 'Antacids are safe' over-general: aluminium/magnesium, calcium and alginate antacids are used in pregnancy, but products containing sodium bicarbonate, magnesium trisilicate or aspirin are not advised. Qualifier added (also in s04).SNLE_Part03_Ch03_Discomforts_Minor_Disorders::s04— 'Antacids are safe' over-general: qualifier added (aluminium/magnesium, calcium or alginate antacids safe).SNLE_Part03_Ch03_Discomforts_Minor_Disorders::s04— English counterpart of the Arabic addition: avoid products containing sodium bicarbonate, magnesium trisilicate or aspirin.SNLE_Part03_Ch03_Discomforts_Minor_Disorders::s03— Hyperemesis gravidarum was defined by persistent vomiting plus ketosis, said to need admission, and 'escalate on ketonuria'. RCOG GTG 69 (2024): diagnosis = severe nausea and vomiting with dehydration, weight loss (>5% of pre-pregnancy weight) or electrolyte disturbance; ketonuria is not an indicator of dehydration or severity and should not guide decisions; ambulatory day care is first line, admission when day careSNLE_Part03_Ch03_Discomforts_Minor_Disorders::s03— Hyperemesis gravidarum was defined by persistent vomiting plus ketosis, said to need admission, and 'escalate on ketonuria'. RCOG GTG 69 (2024): diagnosis = severe nausea and vomiting with dehydration, weight loss (>5% of pre-pregnancy weight) or electrolyte disturbance; ketonuria is not an indicator of dehydration or severity and should not guide decisions; ambulatory day care is first line, admission when day careSNLE_Part03_Ch03_Discomforts_Minor_Disorders::s03— Hyperemesis gravidarum was defined by persistent vomiting plus ketosis, said to need admission, and 'escalate on ketonuria'. RCOG GTG 69 (2024): diagnosis = severe nausea and vomiting with dehydration, weight loss (>5% of pre-pregnancy weight) or electrolyte disturbance; ketonuria is not an indicator of dehydration or severity and should not guide decisions; ambulatory day care is first line, admission when day careSNLE_Part03_Ch03_Discomforts_Minor_Disorders-q033— Hyperemesis gravidarum was defined by persistent vomiting plus ketosis, said to need admission, and 'escalate on ketonuria'. RCOG GTG 69 (2024): diagnosis = severe nausea and vomiting with dehydration, weight loss (>5% of pre-pregnancy weight) or electrolyte disturbance; ketonuria is not an indicator of dehydration or severity and should not guide decisions; ambulatory day care is first line, admission when day careSNLE_Part03_Ch03_Discomforts_Minor_Disorders-q033— Hyperemesis gravidarum was defined by persistent vomiting plus ketosis, said to need admission, and 'escalate on ketonuria'. RCOG GTG 69 (2024): diagnosis = severe nausea and vomiting with dehydration, weight loss (>5% of pre-pregnancy weight) or electrolyte disturbance; ketonuria is not an indicator of dehydration or severity and should not guide decisions; ambulatory day care is first line, admission when day careSNLE_Part03_Ch03_Discomforts_Minor_Disorders-q033— Hyperemesis gravidarum was defined by persistent vomiting plus ketosis, said to need admission, and 'escalate on ketonuria'. RCOG GTG 69 (2024): diagnosis = severe nausea and vomiting with dehydration, weight loss (>5% of pre-pregnancy weight) or electrolyte disturbance; ketonuria is not an indicator of dehydration or severity and should not guide decisions; ambulatory day care is first line, admission when day careSNLE_Part03_Ch03_Discomforts_Minor_Disorders-cs006— Ketones were listed as part of assessing hydration; urinary ketones do not indicate dehydration or severity (RCOG GTG 69), so they are removed from the hydration list (this case is third-trimester vomiting, not hyperemesis).SNLE_Part03_Ch03_Discomforts_Minor_Disorders::s07— Obstetric cholestasis: 'increased fetal surveillance' was presented as a firm requirement. RCOG GTG 43 (2022): there is no evidence that antenatal fetal monitoring predicts or prevents stillbirth; timing of birth is guided by the bile acid level. Reworded as local practice / reassurance while keeping the bile-acid-based timing of birth (s07, q035, cs001, cs004, cs005); q035 key unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-q035— Obstetric cholestasis: 'increased fetal surveillance' was presented as a firm requirement. RCOG GTG 43 (2022): there is no evidence that antenatal fetal monitoring predicts or prevents stillbirth; timing of birth is guided by the bile acid level. Reworded as local practice / reassurance while keeping the bile-acid-based timing of birth (s07, q035, cs001, cs004, cs005); q035 key unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-cs005— Obstetric cholestasis: 'increased fetal surveillance' was presented as a firm requirement. RCOG GTG 43 (2022): there is no evidence that antenatal fetal monitoring predicts or prevents stillbirth; timing of birth is guided by the bile acid level. Reworded as local practice / reassurance while keeping the bile-acid-based timing of birth (s07, q035, cs001, cs004, cs005); q035 key unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-cs005— Obstetric cholestasis: 'increased fetal surveillance' was presented as a firm requirement. RCOG GTG 43 (2022): there is no evidence that antenatal fetal monitoring predicts or prevents stillbirth; timing of birth is guided by the bile acid level. Reworded as local practice / reassurance while keeping the bile-acid-based timing of birth (s07, q035, cs001, cs004, cs005); q035 key unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-cs004— Obstetric cholestasis: 'increased fetal surveillance' was presented as a firm requirement. RCOG GTG 43 (2022): there is no evidence that antenatal fetal monitoring predicts or prevents stillbirth; timing of birth is guided by the bile acid level. Reworded as local practice / reassurance while keeping the bile-acid-based timing of birth (s07, q035, cs001, cs004, cs005); q035 key unchanged.SNLE_Part03_Ch03_Discomforts_Minor_Disorders-cs001— Obstetric cholestasis: 'increased fetal surveillance' was presented as a firm requirement. RCOG GTG 43 (2022): there is no evidence that antenatal fetal monitoring predicts or prevents stillbirth; timing of birth is guided by the bile acid level. Reworded as local practice / reassurance while keeping the bile-acid-based timing of birth (s07, q035, cs001, cs004, cs005); q035 key unchanged.
Complications & High-Risk Pregnancy مضاعفات الحمل والحمل عالي الخطورة — 27 correction(s)
SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s04— Antenatal corticosteroid-induced hyperglycaemia in diabetes lasts longer than "a day or two": extra insulin is typically needed for about 3-5 days (peak increments around days 2-4, back to baseline by about day 6-7). Understating the duration risks stopping closer monitoring/insulin adjustment too early.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-fc033— "Missed has ended without bleeding" is misleading: a missed miscarriage is defined by non-expulsion of a pregnancy that has stopped developing; it is often but not always symptom-free (bleeding/brown discharge can occur). Consistent with the chapter text ("nothing has been expelled, and she may have no symptoms").SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-fc043— Antenatal corticosteroid-induced hyperglycaemia in diabetes lasts longer than "a day or two": extra insulin is typically needed for about 3-5 days (largest increments around days 2-4, back to baseline by about day 6-7).SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q035— Key option says 'Monitoring plus anti-D' for every woman, but the stem never gives her rhesus status. Anti-D is indicated only for non-sensitised RhD-negative women (abdominal trauma is a sensitising event). As written the option teaches that all women after trauma get anti-D.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-fc050— In pregnancy a heart rate of 110 bpm is above the normal range and triggers escalation on maternity early-warning charts (IMEWS normal 60-99 bpm, yellow trigger from 100 bpm), so calling 110 'not alarming in itself' misleads. The principle (trend over threshold) is right; the example is changed to 80 to 98 bpm, which stays inside the normal range yet shows a steady climb.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q007— Option C (fluid balance) is also a real reason for hourly urine measurement in severe pre-eclampsia, so the question 'why' left two options arguable. The stem is reworded to ask for the main SAFETY reason during magnesium therapy, which is magnesium accumulation in oliguria (option A); the key is unchanged.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q008— The key option said the calcium gluconate antidote is kept 'at the bedside, drawn up'. Immediate bedside availability is the requirement in the product information; pre-drawn syringes left at the bedside are not supported by medication-safety guidance (medicines are prepared immediately before use). Reworded to 'at the bedside, immediately available' (key unchanged), and the same 'drawn up' wording was aligned in theSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s03— The key option said the calcium gluconate antidote is kept 'at the bedside, drawn up'. Immediate bedside availability is the requirement in the product information; pre-drawn syringes left at the bedside are not supported by medication-safety guidance (medicines are prepared immediately before use). Reworded to 'at the bedside, immediately available' (key unchanged), and the same 'drawn up' wording was aligned in theSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s03— The key option said the calcium gluconate antidote is kept 'at the bedside, drawn up'. Immediate bedside availability is the requirement in the product information; pre-drawn syringes left at the bedside are not supported by medication-safety guidance (medicines are prepared immediately before use). Reworded to 'at the bedside, immediately available' (key unchanged), and the same 'drawn up' wording was aligned in theSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-fc012— The key option said the calcium gluconate antidote is kept 'at the bedside, drawn up'. Immediate bedside availability is the requirement in the product information; pre-drawn syringes left at the bedside are not supported by medication-safety guidance (medicines are prepared immediately before use). Reworded to 'at the bedside, immediately available' (key unchanged), and the same 'drawn up' wording was aligned in theSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-cs001— The key option said the calcium gluconate antidote is kept 'at the bedside, drawn up'. Immediate bedside availability is the requirement in the product information; pre-drawn syringes left at the bedside are not supported by medication-safety guidance (medicines are prepared immediately before use). Reworded to 'at the bedside, immediately available' (key unchanged), and the same 'drawn up' wording was aligned in theSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q034— The explanation understated the duration of steroid-induced hyperglycaemia ('a day or two'). Evidence: onset within hours, peak in the first 48 h, return to baseline by about day 3-4, and glucose may stay raised up to 5 days. Reworded to 'several days (typically about three to five)', which also matches the chapter's own flashcard and Key point on corticosteroids in a diabetic mother.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q040— 'Most consistently skipped' is a subjective ranking: the incident form and restocking are also commonly omitted, and the explanation adds a further omitted step (team debrief). The stem now asks which step is most often overlooked in the care of the woman herself, so that only option D is about her; the key is unchanged and the explanation's 'consistently' is softened to 'often'.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q040— 'Most consistently skipped' is a subjective ranking: the incident form and restocking are also commonly omitted, and the explanation adds a further omitted step (team debrief). The stem now asks which step is most often overlooked in the care of the woman herself, so that only option D is about her; the key is unchanged and the explanation's 'consistently' is softened to 'often'.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s08— Blanket statement that miscarriage and termination are sensitising events requiring anti-D in every rhesus D negative woman: guidance depends on gestation and management (NICE NG126 offers anti-D only after surgical management of miscarriage/ectopic, not for solely medical management, threatened or complete miscarriage; a Scottish hospital protocol (NHS Lanarkshire) uses 12 weeks, and NICE NG140 uses 10+0 weeks for aSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s03— Magnesium sulfate was taught as one that 'does not lower the blood pressure'. It is not an antihypertensive (a separate antihypertensive is still needed), but a transient fall in blood pressure is a listed effect. Reworded to 'not used to lower the blood pressure; a transient fall can occur; separate antihypertensive still needed' in s03 (text and Watch-out) and fc008; q005 and cs001 already say 'anticonvulsant, notSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s03— Magnesium sulfate was taught as one that 'does not lower the blood pressure'. It is not an antihypertensive (a separate antihypertensive is still needed), but a transient fall in blood pressure is a listed effect. Reworded to 'not used to lower the blood pressure; a transient fall can occur; separate antihypertensive still needed' in s03 (text and Watch-out) and fc008; q005 and cs001 already say 'anticonvulsant, notSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-fc008— Magnesium sulfate was taught as one that 'does not lower the blood pressure'. It is not an antihypertensive (a separate antihypertensive is still needed), but a transient fall in blood pressure is a listed effect. Reworded to 'not used to lower the blood pressure; a transient fall can occur; separate antihypertensive still needed' in s03 (text and Watch-out) and fc008; q005 and cs001 already say 'anticonvulsant, notSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s01— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s05— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s05— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-q041— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-fc017— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-cs002— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy-cs007— 'NO VAGINAL EXAMINATION' until placenta praevia is excluded: guidelines (RCOG GTG 63) prohibit DIGITAL vaginal examination until praevia is excluded; a gentle speculum examination is allowed. Reworded to 'digital vaginal examination' in s01 objective 13, s05 (text and Watch-out), q041 explanation, fc017, cs002 and cs007 (EN and AR); q013 and the speculum/digital wording in s07, q024, q047, fc029 already specify DIGITSNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s06— Gestational diabetes was defined as 'first recognised in pregnancy', which does not exclude overt (pre-existing) diabetes first detected in pregnancy. Reworded to the ADA definition: diabetes first diagnosed in the second or third trimester that was not clearly overt diabetes before pregnancy.SNLE_Part03_Ch04_Complications_High_Risk_Pregnancy::s10— Obstetric cholestasis was said to be monitored "with increased fetal surveillance, because it is associated with stillbirth"; now birth is timed by bile acid level and extra fetal monitoring is described as local practice for reassurance (it does not predict or prevent stillbirth), as in Ch03.
Labour, Delivery & Fetal Monitoring المخاض والولادة ومراقبة الجنين — 27 correction(s)
SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc023— Conflates the two numbers of a prolonged deceleration, contradicting section 5.6 of the same chapter: the definition is a fall of at least 15 bpm lasting 2-10 minutes; the point at which urgent action is required is 3 minutes. 'Lasting more than two minutes. It demands immediate action' teaches the wrong threshold (and 'more than two' differs from the 2-10 minute definition).SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-cs001— Overstatement: late decelerations are not 'the' most ominous trace pattern (acute bradycardia, sinusoidal pattern, or recurrent lates with absent variability are worse)SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-q026— The explanation never mentions the keyed answer (continuous one-to-one support): it starts with 'also' about freedom of movement, so it does not support the key. Add a lead sentence on continuous supportSNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-cs001— Routine maternal oxygen was listed as a standard step of intrauterine resuscitation. NICE advises against facial oxygen for fetal resuscitation, ACOG (2022) advises against routine oxygen when the mother is not hypoxic, and AWHONN keeps it only as an option for selected women. Qualified: oxygen only if she is hypoxic or per protocol.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-cs005— Routine maternal oxygen was listed as a standard step of intrauterine resuscitation for late decelerations. NICE advises against facial oxygen for fetal resuscitation and ACOG (2022) against routine oxygen when the mother is not hypoxic. Qualified: oxygen only if she is hypoxic or per protocol.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-cs008— Routine maternal oxygen was listed as a standard step for a prolonged deceleration after epidural hypotension. NICE advises against facial oxygen for fetal resuscitation and ACOG (2022) against routine oxygen when the mother is not hypoxic; the cause here (maternal hypotension) is corrected by position, fluid and vasopressor. Qualified: oxygen only if she is hypoxic or per protocol.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc024— LION listed routine maternal oxygen. The letter O is kept (the mnemonic still works) but qualified, in the same wording as the section's memory aid: oxygen only if she is hypoxic or per protocol.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc029— Maternal oxygen was listed as a fixed step in cord prolapse, but RCOG GTG 50 does not include it and ACOG (2022) advises against routine oxygen when the mother is not hypoxic. Qualified in the same wording as the section's memory aid: oxygen only if she is hypoxic or per protocol.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc060— The card taught 'four' trace categories, but NICE defines three (normal, suspicious, pathological); urgent intervention for acute bradycardia or a prolonged deceleration of 3 minutes or more is a trigger for action, not a fourth category. The title no longer states a count.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc060— The card taught 'four' trace categories, but NICE defines three (normal, suspicious, pathological); the acute bradycardia / single prolonged deceleration of 3 minutes or more is the trigger for urgent intervention (NG229 rec 1.5.9), stated separately.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-q071— 'Without improving neonatal outcomes' was too broad: continuous CTG roughly halves neonatal seizures but does not reduce cerebral palsy or perinatal death, while raising caesarean and instrumental birth rates. The explanation now says what the evidence shows; the key (intermittent auscultation for low-risk labour) is unchanged.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-q071— Key option C ('without improving outcomes for the baby') had the same over-broad wording as the explanation; it now matches the Cochrane findings. It remains the single best answer.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s02— Overstatement: the fetal heart rate does not 'tell you at once' whether cord prolapse has occurred - prolapse can coexist with a normal rate and may first be found on vaginal examination; an abnormal rate after rupture is the warning sign that prompts examination.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s05— Absolute claim 'carry no fetal risk' for water immersion and heat. Evidence shows no increased adverse effects for the baby, but pool use is run with controls (water not above 37.5 C; the woman's and the water temperature checked on entry and hourly). The sentence now states the condition.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s08— Over-general claim 'Induction raises the rate of operative birth': against expectant management at term, induction lowers caesarean (RR 0.90) with no change in operative vaginal birth (RR 1.03). What NICE asks staff to explain is that induction may not succeed and brings further interventions (oxytocin, continuous monitoring, epidural, assisted birth), and that the woman decides. The sentence now says that.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s08— The LION memory aid taught maternal oxygen as a routine part of intrauterine resuscitation. ACOG (2022) and NICE-based UK guidance advise against routine maternal oxygen for fetal indications when the mother is not hypoxic, while AWHONN keeps it as an option for selected women; the section's own six-step list has no oxygen step. The letter O is kept (the mnemonic still works) but qualified: oxygen only if she is hypoSNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s08— Step 4 and the hyperstimulation row said 'stop or reduce the oxytocin' while the Watch-out box and the LION aid said late decelerations mean it is stopped, not reduced. Harmonised with current guidance: reduce when the trace is only suspicious (or hyperstimulation with a normal trace), stop when the trace is pathological or shows late decelerations. This edit adds the rule to step 4.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s08— Same harmonisation in the induction 'uterine hyperstimulation' row: stop the oxytocin, reducing it only when the trace is merely suspicious (consistent with step 4, the Watch-out box and LION).SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s09— The cord-prolapse memory aid listed maternal oxygen as a routine step. Cord-prolapse guidance (RCOG GTG 50, NHS GGC) has no oxygen step, and ACOG (2022) advises against routine maternal oxygen for fetal indications when the mother is not hypoxic. Oxygen is now qualified (only if hypoxic or per protocol), as in the LION aid. 'Stop oxytocin' is kept: current guidance says to stop any running oxytocin infusion immediateSNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s06— Late decelerations were called 'the most ominous pattern' (s06 Watch-out, fc022, q011 stem, and 'most ominous of the three' / 'among the most ominous' in cs005 and cs001). They are always non-reassuring and especially concerning when repetitive or with reduced variability, but a sinusoidal trace, acute bradycardia, or recurrent decelerations with absent variability (Category III / the chapter's most serious classes)SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-q011— Late decelerations were called 'the most ominous pattern' (s06 Watch-out, fc022, q011 stem, and 'most ominous of the three' / 'among the most ominous' in cs005 and cs001). They are always non-reassuring and especially concerning when repetitive or with reduced variability, but a sinusoidal trace, acute bradycardia, or recurrent decelerations with absent variability (Category III / the chapter's most serious classes)SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc022— Late decelerations were called 'the most ominous pattern' (s06 Watch-out, fc022, q011 stem, and 'most ominous of the three' / 'among the most ominous' in cs005 and cs001). They are always non-reassuring and especially concerning when repetitive or with reduced variability, but a sinusoidal trace, acute bradycardia, or recurrent decelerations with absent variability (Category III / the chapter's most serious classes)SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-cs005— Late decelerations were called 'the most ominous pattern' (s06 Watch-out, fc022, q011 stem, and 'most ominous of the three' / 'among the most ominous' in cs005 and cs001). They are always non-reassuring and especially concerning when repetitive or with reduced variability, but a sinusoidal trace, acute bradycardia, or recurrent decelerations with absent variability (Category III / the chapter's most serious classes)SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-cs001— Late decelerations were called 'the most ominous pattern' (s06 Watch-out, fc022, q011 stem, and 'most ominous of the three' / 'among the most ominous' in cs005 and cs001). They are always non-reassuring and especially concerning when repetitive or with reduced variability, but a sinusoidal trace, acute bradycardia, or recurrent decelerations with absent variability (Category III / the chapter's most serious classes)SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring::s11— The 5.10 (s11) 'Active management' list included 'clamping and cutting the cord', but 5.11 (s12) and the Key point teach delayed clamping (at least a minute). Active management now lists delayed clamping and cutting (at least a minute) in s11, q021 explanation, fc036 and the mock copy.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-q021— The 5.10 (s11) 'Active management' list included 'clamping and cutting the cord', but 5.11 (s12) and the Key point teach delayed clamping (at least a minute). Active management now lists delayed clamping and cutting (at least a minute) in s11, q021 explanation, fc036 and the mock copy.SNLE_Part03_Ch05_Labour_Delivery_Fetal_Monitoring-fc036— The 5.10 (s11) 'Active management' list included 'clamping and cutting the cord', but 5.11 (s12) and the Key point teach delayed clamping (at least a minute). Active management now lists delayed clamping and cutting (at least a minute) in s11, q021 explanation, fc036 and the mock copy.
Postpartum Care الرعاية بعد الولادة — 9 correction(s)
SNLE_Part03_Ch06_Postpartum_Care::s05— Overstatement: postpartum constipation is very common but not 'almost universal' (about 47% after vaginal and about 57% after caesarean birth in a 2020 survey).SNLE_Part03_Ch06_Postpartum_Care-q006— Stem asks which loss is 'abnormal on any of them', but option A (any bleeding needing transfusion) and option D (1000 mL or more) are also abnormal on every definition, so more than one option is defensible. Ask instead for the lowest threshold (500 mL), which keeps C as the single best answer.SNLE_Part03_Ch06_Postpartum_Care-q017— 'The highest-risk time in a woman's life' overstates the evidence: the postnatal period is the highest-risk period for VTE relative to pregnancy and to non-pregnant women of reproductive age (per-day risk about 35-fold), but absolute VTE incidence is higher in old age. Add a qualifier.SNLE_Part03_Ch06_Postpartum_Care-cs001— The resuscitation paragraph of the model PPH answer did not include tranexamic acid. WHO recommends IV tranexamic acid 1 g within 3 hours of birth for any clinically diagnosed PPH, alongside the uterotonic and other measures; the woman in this case is two hours after birth, so it falls inside the window. Added to the resuscitation list (dose and window only; the prescriber and protocol remain the authority).SNLE_Part03_Ch06_Postpartum_Care-q025— The explanation gave no upper limit for nifas. Forty days is the maximum (Hanafi and Hanbali schools, most scholars and the Saudi Permanent Committee): a woman who is clean earlier bathes and prays, and bleeding beyond forty days is not nifas. Added a sentence stating that forty days is a maximum, not a fixed period; the key (C) and the wrong option A ('a fixed forty days regardless') are unchanged.SNLE_Part03_Ch06_Postpartum_Care-q056— 'Most maternal deaths after discharge involve a delay in seeking help' is an unsourced quantitative claim; no source states it. Delay in seeking care is a recognised contributor (three-delays model), so the sentence now says that without a proportion.SNLE_Part03_Ch06_Postpartum_Care::s04— Unsourced figure ('essentially all of them bled within the first four hours') that conflicted with the chapter's own flashcard fc012 (ninety minutes). The best current data (E-MOTIVE nested observational study) show every PPH after vaginal birth was diagnosed within 90 minutes, so the section now says so.SNLE_Part03_Ch06_Postpartum_Care::s04— The immediate PPH steps (uterotonic, cannulas, bloods, fluids) did not mention tranexamic acid, which WHO recommends IV within 3 hours of birth for any clinically diagnosed PPH alongside standard care. Added to step 5 (IV access), where it is given; the chapter's deference to 'your protocol' is kept by 'as prescribed'.SNLE_Part03_Ch06_Postpartum_Care::s03— The 6.2 timeline (s03) said the fundus is 'no longer palpable by about day 10', while the Memory aid, q005 explanation and fc003 give day ten to fourteen. The timeline step is aligned to 'day 10 to 14' (EN and AR).
Family Planning & Reproductive Health تنظيم الأسرة والصحّة الإنجابية — 10 correction(s)
SNLE_Part03_Ch07_Family_Planning_Reproductive_Health::s06— "In every case ... it prevents or delays ovulation" is true of oral emergency contraception (levonorgestrel, ulipristal) but not of the copper IUD, whose main action is preventing fertilisation (via copper ions' effect on sperm). Arabic duplicated and the closing sentence omitted.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-cs003— "It is not immediately effective" is wrong for female sterilisation (tubal occlusion/ligation), which is effective as soon as the procedure is done; the "not immediately effective" teaching point applies to VASECTOMY (backup contraception until semen analysis confirms) and to the discontinued hysteroscopic method. Stating it about this woman's tubal ligation misinforms the learner. Replace with the accurate counselliSNLE_Part03_Ch07_Family_Planning_Reproductive_Health-cs004— Calf pain/swelling in a combined-pill user with breathlessness is suspected DVT with possible pulmonary embolism; same-day assessment is too slow. Advice is immediate emergency/hospital assessment, with emergency services if she worsens.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-fc029— Laparoscopy is taught as simply "the gold standard" for diagnosing endometriosis; ESHRE 2022 no longer recommends it as the diagnostic gold standard (imaging is part of the work-up; laparoscopy for negative imaging or failed/unsuitable empirical treatment). Keep the exam-relevant traditional teaching but add the current qualifier.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-fc032— Card teaches the timing of a monthly self-examination without the caveat that section 7.6 gives (breast awareness has replaced a rigid monthly technique). Keep the timing (it is examined in q021) but add the awareness framing so the packet is internally consistent.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-q013— Option B is itself a true statement (emergency contraception cannot act on an established pregnancy), so it competes with D. Replaced with a clearly false distractor that contradicts the explanation.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-q013— Option C is also defensible as written: mechanisms genuinely differ by method (oral EC delays ovulation; the copper IUD inhibits fertilisation and may prevent implantation), so it is not clearly wrong. Reworded so it is clearly false (no method ends an established pregnancy) while keeping the "depends on the option" distractor.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-q018— Explanation says direct visualisation "is required", which no longer matches current guidance. Keep laparoscopy as the keyed traditional gold standard, qualify the explanation with the ESHRE 2022 position, and add "traditional" to the stem so that ultrasound/MRI are not defensible alternatives.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health-q018— Stem qualified with "traditional" so that the keyed laparoscopy remains the single best answer under current guidance that also accepts imaging.SNLE_Part03_Ch07_Family_Planning_Reproductive_Health::s07— Memory aid presents laparoscopy as simply "the gold standard"; ESHRE 2022 no longer recommends it as the diagnostic gold standard. Keep the traditional exam teaching and add the current qualifier.
Newborn Care & Neonatal Complications رعاية الوليد ومضاعفاته — 15 correction(s)
SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-cs002— Absolute overstatement: a baby fed through NEC does not invariably perforate; correct teaching is that continued feeding risks progression and perforationSNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-q025— Absolute overstatement: a baby fed through NEC does not invariably perforate; correct teaching is that continued feeding risks progression and perforationSNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-cs004— The baby is symptomatic (jittery, weak cry, cool) yet management was feed-and-recheck with IV glucose only if he cannot feed or the level does not respond. Guidance (BAPM 2024, AAP 2011) treats a symptomatic baby with a low glucose as needing urgent medical review and intravenous glucose, with feeding as an adjunct. Management sentence corrected (consistent with case cs007).SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-cs006— Five inflation breaths is the RCUK/ERC sequence; the AAP/AHA NRP (widely taught in Saudi hospitals) instead begins positive-pressure ventilation at 40-60 breaths per minute. Both are current, so the algorithm is named to avoid a single unattributed rule.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications::s03— Step 4 describes the RCUK/ERC five inflation breaths as "sustained"; the breaths are held about 2-3 s each, and the AAP/AHA NRP does not use this step (ventilation starts at 40-60/min). Wording made precise and the algorithm named.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-fc008— Internal inconsistency: card gave newborn heart rate 110-160 whereas section s04 gives 100-160. Aligned to 100-160 (also consistent with the HR <100 threshold for starting ventilation).SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-fc025— Routine "extra fluids" for babies on phototherapy conflicts with NICE CG98 (no additional fluids for breastfed babies; continue feeding; monitor hydration). Replaced with continued feeding and hydration monitoring.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-q018— Explanation said extra fluids are required during phototherapy; current guidance is to continue feeding and monitor hydration, not to give routine extra fluids. Key (covering the eyes) unchanged.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-q038— The premise "most often dropped" is an unreferenced frequency claim and weight, gestation and feeding method are also omitted at times. Stem reworded so the key (what the parents have said) follows logically: it is the only option that is not a recorded detail. Key unchanged (C).SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-q038— Explanation supplemented so that it supports the reworded stem (recorded details versus the parents' report).SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications-fc052— Flashcard front repeats the unreferenced "most often dropped" premise of q038; reworded to match the corrected stem. Back unchanged.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications::s06— Phototherapy step 5 taught routine "extra fluids"; NICE CG98 advises no additional fluids for breastfed babies, continued feeding and hydration monitoring (daily weight, wet nappies), expressed breast milk as the supplement of choice when an additional feed is indicated.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications::s06— Phototherapy step 5 taught routine "extra fluids"; NICE CG98 advises no additional fluids for breastfed babies, continued feeding and hydration monitoring (daily weight, wet nappies), expressed breast milk as the supplement of choice when an additional feed is indicated.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications::s06— Phototherapy step 5 taught routine "extra fluids"; NICE CG98 advises no additional fluids for breastfed babies, continued feeding and hydration monitoring (daily weight, wet nappies), expressed breast milk as the supplement of choice when an additional feed is indicated.SNLE_Part03_Ch08_Newborn_Care_Neonatal_Complications::s08— Absolute claim in the NEC "Watch out" callout: feeding through suspected NEC raises the risk of perforation but does not invariably cause it (perforation is a late stage, stage 3B); aligned with case cs002 ("at risk of perforation").
Breastfeeding & Infant Nutrition الرضاعة الطبيعية وتغذية الرضيع — 3 correction(s)
SNLE_Part03_Ch09_Breastfeeding_Infant_Nutrition::s05— EN: 'massage during' is unqualified; ABM Clinical Protocol #36 (2022) advises avoiding deep massage of the lactating breast (light, lymphatic-drainage-type touch only), and the chapter's own flashcards (fc016, fc018) and Arabic key point already say 'gentle'. Add 'gentle'. AR: Arabic is duplicated verbatim, the feminine imperative 'أرضعي' addresses the reader, and chin position/warmth/massage are omitted.SNLE_Part03_Ch09_Breastfeeding_Infant_Nutrition-cs004— Unsupported/overstated epidemiology: most breastfeeding is NOT stopped in the first two weeks (UK IFS 2010: 81% initiated, 69% still breastfeeding at 1 week, 55% at 6 weeks, 34% at 6 months), and 'usually pain' conflicts with cs005 (perceived insufficient milk is the commonest reason). Softened to a safe statement.SNLE_Part03_Ch09_Breastfeeding_Infant_Nutrition-q015— Refrigerator storage limits differ between guidance bodies, so 'How long can expressed breast milk be kept in a refrigerator?' has no single unqualified answer. The stem now states the guidance followed (CDC/AAP: freshly expressed milk, refrigerator 4 C or colder, up to 4 days), so key B is unambiguous.
Growth, Development & Immunisation النموّ والتطوّر والتطعيمات — 22 correction(s)
SNLE_Part03_Ch10_Growth_Development_Immunisation::s07— «ولا تفاعل غير تأقي لجرعة سابقة» (nor a non-anaphylactic reaction to a previous dose) is far too broad: encephalopathy within 7 days of a previous pertussis-containing dose is a non-anaphylactic reaction and IS a genuine contraindication (listed in the same section), and other severe non-anaphylactic reactions are precautions. Same error as flashcard fc028; the section's own list says 'Mild local reaction to a previoSNLE_Part03_Ch10_Growth_Development_Immunisation-fc028— A blanket 'non-anaphylactic reaction to a previous dose' is NOT a safe item for a 'not a contraindication' list: encephalopathy within 7 days of a previous pertussis-containing dose is a non-anaphylactic reaction and IS a contraindication (the chapter itself lists it in section 10.6), and other severe non-anaphylactic reactions are precautions. Only a mild local reaction is correctly non-contraindicating.SNLE_Part03_Ch10_Growth_Development_Immunisation-q026— Outdated: since August 2019 the Saudi MOH gives BCG at 6 months of age, not at birth; hepatitis B is the only routine birth vaccine. Option B must not state that BCG is given at birth. Please re-check against the latest MOH schedule before publishing.SNLE_Part03_Ch10_Growth_Development_Immunisation-q026— Explanation says BCG is a routine birth vaccine in this country; it is routine but given at 6 months since August 2019. Arabic also uses the gendered 'ممرضة' for a generic nurse.SNLE_Part03_Ch10_Growth_Development_Immunisation-q041— Oversimplified: during chemotherapy only inactivated influenza vaccine is advised; other non-live vaccines are generally avoided or must be repeated after immune recovery, so 'should have the inactivated ones' is misleading. Short qualifier added (key unchanged). The Arabic sentence also had broken grammar ('لا يستطيع اللقاحات الحيّة') and a second-person clause ('كيف تحمين طفلاً'), rewritten here.SNLE_Part03_Ch10_Growth_Development_Immunisation-q002— Sources differ on when birth weight doubles: WHO median curves reach double at about 4 months, other paediatric sources say about 4-5 months and some nursing texts say about 6 months, so 'about 4 months' and 'about 6 months' were both defensible. Item made unambiguous: stem asks for typical timing, the key option is the range 'about 4 to 6 months', and the distractors (2, 9, 12 months) are clearly wrong. Key moves frSNLE_Part03_Ch10_Growth_Development_Immunisation-q002— Sources differ on when birth weight doubles: WHO median curves reach double at about 4 months, other paediatric sources say about 4-5 months and some nursing texts say about 6 months, so 'about 4 months' and 'about 6 months' were both defensible. Item made unambiguous: stem asks for typical timing, the key option is the range 'about 4 to 6 months', and the distractors (2, 9, 12 months) are clearly wrong. Key moves frSNLE_Part03_Ch10_Growth_Development_Immunisation-q002— Sources differ on when birth weight doubles: WHO median curves reach double at about 4 months, other paediatric sources say about 4-5 months and some nursing texts say about 6 months, so 'about 4 months' and 'about 6 months' were both defensible. Item made unambiguous: stem asks for typical timing, the key option is the range 'about 4 to 6 months', and the distractors (2, 9, 12 months) are clearly wrong. Key moves fr (answer key changed to B)SNLE_Part03_Ch10_Growth_Development_Immunisation-q002— Sources differ on when birth weight doubles: WHO median curves reach double at about 4 months, other paediatric sources say about 4-5 months and some nursing texts say about 6 months, so 'about 4 months' and 'about 6 months' were both defensible. Item made unambiguous: stem asks for typical timing, the key option is the range 'about 4 to 6 months', and the distractors (2, 9, 12 months) are clearly wrong. Key moves frSNLE_Part03_Ch10_Growth_Development_Immunisation-q002— Sources differ on when birth weight doubles: WHO median curves reach double at about 4 months, other paediatric sources say about 4-5 months and some nursing texts say about 6 months, so 'about 4 months' and 'about 6 months' were both defensible. Item made unambiguous: stem asks for typical timing, the key option is the range 'about 4 to 6 months', and the distractors (2, 9, 12 months) are clearly wrong. Key moves frSNLE_Part03_Ch10_Growth_Development_Immunisation-fc042— In the Saudi schedule the first measles-containing vaccine is the single-antigen measles vaccine at 9 months; MMR is given at 12 and 18 months. 'Around twelve months' describes the first MMR dose, not the first measles-containing vaccine.SNLE_Part03_Ch10_Growth_Development_Immunisation-q025— In the Saudi schedule the first measles-containing dose is the single-antigen measles vaccine at 9 months; 12 months is the first MMR dose. The stem is made specific to MMR so that key C (12 months) is exact.SNLE_Part03_Ch10_Growth_Development_Immunisation-q025— Explanation aligned with the corrected stem: states the 9-month single-antigen measles dose and the 18-month second MMR dose of the Saudi schedule.SNLE_Part03_Ch10_Growth_Development_Immunisation-q043— In the Saudi schedule a measles dose at 9 months is a routine dose, so the premise 'an early dose at 9 months does not count' was wrong for this exam. The principle (an outbreak dose before the routine age does not replace the routine doses) is kept by changing the age to 6 months.SNLE_Part03_Ch10_Growth_Development_Immunisation::s10— Consistency with the corrected item q043: in the Saudi schedule a dose at 9 months is routine, so 'earlier than twelve months' no longer describes an outbreak (non-counting) dose; the outbreak dose is given from 6 months.SNLE_Part03_Ch10_Growth_Development_Immunisation-fc054— Consistency with the corrected item q043: the outbreak dose is given from 6 months and does not count towards the routine schedule (which includes a routine 9-month measles dose in Saudi Arabia).SNLE_Part03_Ch10_Growth_Development_Immunisation::s09— In the Saudi schedule the first measles-containing vaccine is the single-antigen measles vaccine at 9 months; MMR is given at 12 and 18 months. The key point stated 'around twelve months' for the first measles-containing vaccine.SNLE_Part03_Ch10_Growth_Development_Immunisation::s09— The s09 (10.8) Key point and flashcard fc041 ('At birth in the Saudi schedule') said 'Hepatitis B and BCG' at birth, contradicting q026 (answer: hepatitis B only), which says BCG has been given at 6 months since August 2019. Aligned to the current MOH schedule: hepatitis B only at birth; BCG stays routine but is given at 6 months (not at birth). The mock copy of q026 (snle-m03-q039) still had the old option B and expSNLE_Part03_Ch10_Growth_Development_Immunisation::s09— The s09 (10.8) Key point and flashcard fc041 ('At birth in the Saudi schedule') said 'Hepatitis B and BCG' at birth, contradicting q026 (answer: hepatitis B only), which says BCG has been given at 6 months since August 2019. Aligned to the current MOH schedule: hepatitis B only at birth; BCG stays routine but is given at 6 months (not at birth). The mock copy of q026 (snle-m03-q039) still had the old option B and expSNLE_Part03_Ch10_Growth_Development_Immunisation-fc041— The s09 (10.8) Key point and flashcard fc041 ('At birth in the Saudi schedule') said 'Hepatitis B and BCG' at birth, contradicting q026 (answer: hepatitis B only), which says BCG has been given at 6 months since August 2019. Aligned to the current MOH schedule: hepatitis B only at birth; BCG stays routine but is given at 6 months (not at birth). The mock copy of q026 (snle-m03-q039) still had the old option B and expSNLE_Part03_Ch10_Growth_Development_Immunisation-fc041— The s09 (10.8) Key point and flashcard fc041 ('At birth in the Saudi schedule') said 'Hepatitis B and BCG' at birth, contradicting q026 (answer: hepatitis B only), which says BCG has been given at 6 months since August 2019. Aligned to the current MOH schedule: hepatitis B only at birth; BCG stays routine but is given at 6 months (not at birth). The mock copy of q026 (snle-m03-q039) still had the old option B and expSNLE_Part03_Ch10_Growth_Development_Immunisation-fc042— card omitted the school-entry MMR dose in the Saudi schedule
Paediatric Respiratory & Cardiac التنفّس والقلب عند الأطفال — 17 correction(s)
SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s08— Coarctation is listed under 'Acyanotic - left to right (oxygenated blood shunts back to the lungs / pulmonary overcirculation)', but coarctation is an obstructive acyanotic lesion, not a left-to-right shunt. Add a short qualifier. The AR line also omits the lesion list and the presentation line.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s08— Imprecise mechanism: knee-chest position raises systemic vascular resistance, which REDUCES the right-to-left shunt (and sends more blood to the lungs); it does not 'reverse' the shunt. The chapter's own Watch-out box says 'يقلّل التحويلة'.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s09— Overstatement: Kawasaki disease is NOT the single exception to avoiding aspirin in children; low-dose aspirin is also used as antiplatelet therapy (e.g. after cardiac surgery/shunts), and rheumatic fever is traditionally treated with aspirin. Kawasaki disease is the classic exception.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-q031— Absolute claim: completing treatment of streptococcal pharyngitis lowers but does not eliminate the risk of rheumatic fever (primary prevention is imperfect; some cases follow subclinical/untreated infection). 'Does not cause' overstates the evidence.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-fc020— Contact precautions follow CDC (standard + contact), but other reputable guidance adds droplet precautions; a short qualifier keeps the keyed answer (contact, not airborne) correct under both.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s04— Contact precautions follow CDC (standard + contact), but other reputable guidance adds droplet precautions; a short qualifier keeps the keyed answer (contact, not airborne) correct under both.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-q026— Knee-chest/squatting is also described as reducing systemic venous return, so option C was not clearly false. Option C is reworded so that it is unambiguously wrong; the key (D, increased systemic vascular resistance, the main effect) is unchanged.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-q044— The sentence 'A plan written at three in the morning by a frightened parent is not a plan' contradicts the key (a written plan). The intended point is that a plan that depends on a frightened parent remembering it at 3 a.m. is not a plan; it must already be written down. The Arabic also rendered 'parent' as father only (والد).SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-q060— A handover legitimately includes the admission diagnosis and plan, so option C was defensible. 'Only' makes it clearly incomplete; key B (the trend) is unchanged.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-q060— A handover legitimately includes the latest observations, so option A was defensible. 'Only' makes it clearly incomplete (a snapshot); key B (the trend) is unchanged.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s08— Digoxin toxicity was presented as 'gastrointestinal first' (vomiting often first); arrhythmia and sinus bradycardia are the earliest and most frequent signs in infants and children. Same message now in the s08 ladder and flashcard fc043 (11.7). (bold lead-in of the ladder step)SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s08— Digoxin toxicity was presented as 'gastrointestinal first' (vomiting often first); arrhythmia and sinus bradycardia are the earliest and most frequent signs in infants and children. Same message now in the s08 ladder and flashcard fc043 (11.7). (rest of the ladder step and its Arabic line)SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-fc043— Digoxin toxicity was presented as 'gastrointestinal first' (vomiting often first); arrhythmia and sinus bradycardia are the earliest and most frequent signs in infants and children. Same message now in the s08 ladder and flashcard fc043 (11.7).SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s09— The Kawasaki list listed fever and the five principal features but omitted the rule that at least four of the five must be present with the fever for the classic diagnosis. Rule added to ladder step 1 (11.8).SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac::s09— The Kawasaki list listed fever and the five principal features but omitted the rule that at least four of the five must be present with the fever for the classic diagnosis. Rule added to the 11.8 memory aid.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-fc045— The Kawasaki list listed fever and the five principal features but omitted the rule that at least four of the five must be present with the fever for the classic diagnosis. Same rule added to the Kawasaki flashcard.SNLE_Part03_Ch11_Paediatric_Respiratory_Cardiac-q032— With the four-of-five rule now stated in 11.8, the stem (fever plus only oral changes and red eyes, i.e. two of five features) no longer met the criteria taught; a rash and swollen hands added so the stem fulfils fever plus four of five features. Answer key (Kawasaki disease) unchanged.
Paediatric GI, Fluids & Renal الجهاز الهضمي والسوائل والكلى عند الأطفال — 21 correction(s)
SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal::s06— Zinc for diarrhoea is dosed by age band (10 mg/day under 6 months, 20 mg/day from 6 months), not by weight; zinc therefore does not belong in the list of weight-dosed items. Arabic «يُجرَّع بالوزن» is also an odd rendering of 'dosed by weight'.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal::s09— Medical error: a completed antibiotic course prevents rheumatic fever but has NOT been shown to prevent post-streptococcal glomerulonephritis (which can follow even a treated infection). The same claim appears in flashcard fc044 (EN) and must be corrected there too.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-fc011— Dose boundary is ambiguous: 'over six months' leaves a 6-month-old infant in neither band. WHO: 20 mg/day from 6 months of age, 10 mg/day under 6 months.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-fc044— Medical error: a completed antibiotic course prevents rheumatic fever but has NOT been shown to prevent post-streptococcal glomerulonephritis, which can follow even a treated infection. 'Untreated' is also wrong as a general statement for the trigger of GN.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q008— Zinc reduces the incidence of diarrhoea over the following 2-3 months; it does not "prevent recurrence". Wording overstated (the explanation of q007 already states the correct effect).SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q028— "Relapse" presupposes a known prior diagnosis, which the vignette does not give (first presentation of puffy eyes in a 4-year-old); the Arabic option already reads simply "nephrotic syndrome", so the English should match.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q031— "Relapse" presupposes a known prior nephrotic syndrome which the stem does not mention; the Arabic option already reads simply "nephrotic syndrome", so the English should match.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q031— Incorrect: antibiotic treatment of streptococcal pharyngitis prevents rheumatic fever but does NOT prevent post-streptococcal glomerulonephritis.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q031— Latent period is one to three weeks after streptococcal pharyngitis but three to six weeks after skin infection (pyoderma), not "a week or two" for both.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q032— "Relapse" is inappropriate: the question compares glomerulonephritis with nephrotic syndrome in general; the Arabic already reads "nephrotic syndrome".SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q039— Overstated: growth failure MAY precede bowel symptoms (e.g. Crohn disease, coeliac disease); it does not always do so. The Arabic option already says "قد يسبق" (may precede), so the English should match.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-cs001— The model answer says the kidney 'tries to hold on to hydrogen'. In pyloric stenosis the kidney does the opposite: volume depletion and low chloride raise renin and aldosterone, the distal tubule retains sodium in exchange for potassium and hydrogen, so potassium is lost in the urine and the urine can become paradoxically acidic despite the alkalaemia. Reworded to the correct mechanism.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-fc013— The benefits of reduced-osmolarity ORS over the old standard ORS are lower stool output, less vomiting and fewer unscheduled IV infusions; shortening of diarrhoea is the effect of zinc, not of the ORS formulation (duration is not a reported benefit).SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q067— Alcohol hand gel works poorly against norovirus and other infective-diarrhoea pathogens; soap-and-water handwashing is the recommended method and gel is only an addition. The advice to visitors and siblings is changed to soap and water, with the gel caveat.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal::s09— 12.8 key point: the English said a completed antibiotic course prevents both rheumatic fever and glomerulonephritis; the Arabic already (correctly) says it is not shown to prevent glomerulonephritis. English aligned to the Arabic, fc044 and q031.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal::s09— Latent period was given as one figure for throat and skin infection (1-3 weeks, 'a week or two'); throat infection is followed by about 1-2 weeks and skin infection by about 3-6 weeks. q031 already said '3-6 weeks after a skin infection' inside a '1-3 weeks' sentence, so all places were made to agree. (12.8 glomerulonephritis panel)SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal::s09— Latent period was given as one figure for throat and skin infection (1-3 weeks, 'a week or two'); throat infection is followed by about 1-2 weeks and skin infection by about 3-6 weeks. q031 already said '3-6 weeks after a skin infection' inside a '1-3 weeks' sentence, so all places were made to agree. (12.8 key point)SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q031— Latent period was given as one figure for throat and skin infection (1-3 weeks, 'a week or two'); throat infection is followed by about 1-2 weeks and skin infection by about 3-6 weeks. q031 already said '3-6 weeks after a skin infection' inside a '1-3 weeks' sentence, so all places were made to agree. (q031 explanation)SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-q031— q031 explanation said the antibiotic course 'does not prevent' glomerulonephritis; the evidence is insufficient to show prevention (CDC), as the 12.8 key point and fc044 now say.SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal-fc044— Latent period was given as one figure for throat and skin infection (1-3 weeks, 'a week or two'); throat infection is followed by about 1-2 weeks and skin infection by about 3-6 weeks. q031 already said '3-6 weeks after a skin infection' inside a '1-3 weeks' sentence, so all places were made to agree. (fc044)SNLE_Part03_Ch12_Paediatric_GI_Fluids_Renal::s03— 12.2 gave the shock bolus as 'conventionally 20 mL/kg'; current NICE (NG29) advises 10 mL/kg of isotonic crystalloid over less than 10 minutes, with reassessment after each bolus, while PALS/WHO-type protocols still use 20 mL/kg. Both figures are now stated, consistent with q006 ('follows your service's resuscitation protocol') and fc010 (no volume given).
Paediatric Neuro, Endocrine, Haematology & Infection الأعصاب والغدد والدم والعدوى عند الأطفال — 31 correction(s)
SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s03— Droplet precautions for suspected bacterial meningitis are not simply 'until the organism is known': for meningococcal (and Hib) disease they continue until 24 hours of effective antibiotic therapy; stopping as soon as the organism is identified could expose contactsSNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s03— 'The single exception is Kawasaki disease' is an over-simplification: aspirin is also used in children for thromboprophylaxis after cardiac surgery/stents (and was used in other conditions); 'main exception' is accurate. Arabic also duplicated and omits the consequence (encephalopathy and liver failure)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s05— Oxygen is indicated in a vaso-occlusive crisis when saturation is low (<=95%), not routinely; also Arabic uses second-person imperative (افعلي) and omits 'first and most important' for hydrationSNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s05— ACS is not strictly 'defined by' chest pain + fever + infiltrate: the definition is a new pulmonary infiltrate plus fever, chest pain or respiratory signs/hypoxia (any one); a child without fever can still have ACS. Arabic also has a stray leading 'و 'SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s05— Aligned with the corrected ACS definition (new infiltrate plus fever, chest pain or respiratory signs)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s07— 'and only these' is an over-generalisation: other infections also need airborne precautions (e.g. disseminated zoster, SARS-CoV-2 during aerosol-generating procedures); the rule is true only for the infections covered in this chapterSNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s07— 'The single exception is Kawasaki disease' is an over-simplification: aspirin is also used in children for thromboprophylaxis after cardiac surgery/stents; 'main exception' is accurate. Arabic also has a stray 'و ' before 'الاستثناء'SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s07— Callout repeats the error that the 10-day penicillin course prevents acute glomerulonephritis; antibiotics are proven to prevent rheumatic fever only (CDC: insufficient evidence for PSGN)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s07— 'The single recognised exception' over-simplifies: aspirin is also used for thromboprophylaxis after cardiac surgery/stents ('main exception' is accurate)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-fc015— Droplet precautions in suspected bacterial meningitis should continue until 24 hours of effective antibiotics (meningococcal/Hib) rather than the vague 'until the organism is known and treatment established'; Arabic 'ويترسّخ العلاج' (treatment becomes entrenched) also mistranslates 'established'SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-fc033— Oxygen is indicated in a vaso-occlusive crisis when saturation is low (<=95%), not routinelySNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-fc035— ACS is not strictly defined by chest pain + fever + infiltrate: a new infiltrate plus fever, chest pain or respiratory signs/hypoxia (any one)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-fc048— Antibiotics are proven to prevent acute rheumatic fever; there is no good evidence that they prevent post-streptococcal glomerulonephritis (CDC: insufficient evidence)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-fc049— 'The one exception' over-simplifies: aspirin is also used for thromboprophylaxis after cardiac surgery/stents ('main exception')SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-cs001— A first seizure under 18 months does not by itself make a seizure 'not a simple febrile seizure' (the child in the vignette, 18 months, is the typical age); age <18 months is a recurrence risk factor and a reason for a low threshold to escalate/consider LP, whereas focal, prolonged or incompletely recovering seizures are complex. Arabic also uses the imperative (فصعّدي)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-cs001— Contradicts the chapter's own evidence: a febrile seizure is linked to how high the temperature gets, not to a rapid rise (the rate-of-rise teaching is unsupported); 'which is why it happened without warning' does not follow. Arabic also uses the imperative (وأخبريهما)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-q009— Infection-control statement is wrong/misleading: droplet precautions do not stop when 'the organism is known'. If the organism is meningococcus (or Hib) they continue until 24 hours of effective antibiotics; if pneumococcus, standard precautions suffice.SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-cs004— Duration of droplet precautions is vague ('until effective treatment has been given' could be read as after the first dose); the standard is until 24 hours of effective antibiotic therapy.SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-q035— Explanation says 'both complications' are caused by the untreated infection and 'both are prevented by finishing the course' - this endorses option B (scarlet fever) as also correct. Scarlet fever is a toxin-mediated manifestation, not what the full 10-day course is for, and antibiotics do not prevent post-streptococcal glomerulonephritis either; the established reason is prevention of acute rheumatic fever.SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-q015— 'The single recognised exception' to the no-aspirin rule overstates: aspirin is also used under specialist direction in other paediatric conditions (e.g. juvenile arthritis, rheumatic fever, antiplatelet use). Kawasaki disease is the best-known exception.SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-q026— Definition is stated as requiring chest pain AND fever AND a new infiltrate; the accepted definition is a new pulmonary infiltrate plus fever and/or respiratory symptoms (any one suffices).SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-cs002— 'The combination is the definition' (chest pain + fever + hypoxia) is stricter than the accepted definition (new infiltrate plus fever and/or respiratory symptoms); it is the typical picture.SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s07— Antibiotic treatment of streptococcal pharyngitis is proven to prevent acute rheumatic fever; there is no good evidence that it prevents post-streptococcal glomerulonephritis (CDC: insufficient evidence), so the purpose of the 10-day course must not be stated as preventing glomerulonephritisSNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-cs003— 'Fluids first, then insulin, then potassium' implies potassium follows insulin. ISPAD 2022: insulin infusion starts 1 h after the start of IV fluids; potassium replacement starts after initial volume expansion and concurrently with insulin (before insulin if the child is hypokalaemic; deferred until urine output is documented if hyperkalaemic). Wording qualified; the rest of the reasoning (depleted total-body potassiSNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-q020— Option D ('fluids, then insulin, then potassium') remains the best of the four options (insulin is not started first or together with the fluids, and potassium is not given first), but the explanation implied potassium follows insulin. ISPAD 2022: insulin 1 h after fluids; potassium started alongside the insulin (earlier if low; held back while high until urine output is documented). Explanation qualified; the key isSNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s01— The kit taught the DKA order as 'fluids, then insulin, then potassium'; ISPAD 2022 starts potassium with the initial fluid when the level is low, otherwise alongside the insulin (the explanation of q020 and case cs003 already say so). Objective 15 now asks for the timing of potassium too.SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s04— The kit taught the DKA order as 'fluids, then insulin, then potassium'; ISPAD 2022 starts potassium with the initial fluid when the level is low, otherwise alongside the insulin (the explanation of q020 and case cs003 already say so). (13.3 treatment ladder, step 3 title)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s04— The kit taught the DKA order as 'fluids, then insulin, then potassium'; ISPAD 2022 starts potassium with the initial fluid when the level is low, otherwise alongside the insulin (the explanation of q020 and case cs003 already say so). (13.3 treatment ladder, step 3 text and its Arabic line)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection::s04— The kit taught the DKA order as 'fluids, then insulin, then potassium'; ISPAD 2022 starts potassium with the initial fluid when the level is low, otherwise alongside the insulin (the explanation of q020 and case cs003 already say so). (13.3 memory aid)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-fc027— The kit taught the DKA order as 'fluids, then insulin, then potassium'; ISPAD 2022 starts potassium with the initial fluid when the level is low, otherwise alongside the insulin (the explanation of q020 and case cs003 already say so). (flashcard fc027)SNLE_Part03_Ch13_Paediatric_Neuro_Endocrine_Haematology_Infection-q020— The kit taught the DKA order as 'fluids, then insulin, then potassium'; ISPAD 2022 starts potassium with the initial fluid when the level is low, otherwise alongside the insulin (the explanation of q020 and case cs003 already say so). The keyed option D (unchanged key) taught the same 'potassium last' order, so its wording was aligned with the q020 explanation; options A-C remain wrong.
Child Safety, Emergencies & Pain سلامة الطفل والطوارئ والألم — 15 correction(s)
SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-q016— Overstated figure: the cohort data give OR 0.6 (95% CI 0.4-0.8), i.e. about 40% lower odds of skin grafting, not 'more than 40%'. (Also an observational association.)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-q017— Same overstatement as q016: OR 0.6 means about 40% lower odds of grafting, not 'over 40%'. Key remains A.SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-cs004— Absolute wording: a spiral fracture from a twisting force is not expected in a short fall onto a flat surface, but accidental spiral/oblique long-bone fractures do occur in some ambulant children, and no fracture type is diagnostic of abuse. Softened 'does not occur' to 'is not expected'; the safeguarding point (the mechanism does not fit the history) is unchanged.SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-cs004— The reporting pathway named a 'provincial Social Protection Committee' and made onward referral conditional on the case being 'substantiated', which contradicts the same answer's point that the threshold is suspicion. The Saudi Child Protection Law implementing regulation requires immediate notification on becoming aware, with the health facility treating the child and notifying the Ministry of Social Affairs (now HuSNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-q017— 'it can be given cumulatively within the three-hour window' has no support: the evidence is 20 minutes of cool running water started within three hours of injury, not split or cumulative cooling. Reworded to what the evidence shows (it still helps when started up to three hours after the injury).SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain::s05— 14.4 key point, the '>40%' stat tile and fc017 said 'more than forty per cent' / '>40%'; the reported OR is 0.6 (95% CI 0.4-0.8), i.e. about 40% lower odds. Brought into line with q016 and q017 ('about 40%'). (stat tile)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain::s05— 14.4 key point, the '>40%' stat tile and fc017 said 'more than forty per cent' / '>40%'; the reported OR is 0.6 (95% CI 0.4-0.8), i.e. about 40% lower odds. Brought into line with q016 and q017 ('about 40%'). (14.4 key point)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-fc017— 14.4 key point, the '>40%' stat tile and fc017 said 'more than forty per cent' / '>40%'; the reported OR is 0.6 (95% CI 0.4-0.8), i.e. about 40% lower odds. Brought into line with q016 and q017 ('about 40%'). (flashcard fc017)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain::s04— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (14.3 text)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain::s04— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (14.3 key point)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-fc012— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (flashcard fc012)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-cs002— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (anaphylaxis case cs002; Resuscitation Council UK also gives 10 mL/kg)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-q009— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (q009 stem; key unchanged)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-q009— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (q009 keyed option C: volume changed so the key remains correct; option A stays wrong because it is hypotonic)SNLE_Part03_Ch14_Child_Safety_Emergencies_Pain-q009— The shock bolus was taught as 'conventionally 20 mL/kg'; current NICE advises 10 mL/kg. The 10 mL/kg figure (NICE) is now given with the note that some other protocols use up to 20 mL/kg, in the same form in every place of the chapter (14.3 text and key point, q009, fc012, cs002) and in Chapter 12. (q009 explanation)
Paediatric Surgical Nursing تمريض جراحة الأطفال — 16 correction(s)
SNLE_Part03_Ch15_Paediatric_Surgical_Nursing::s03— Wrong clinical sign: in congenital diaphragmatic hernia breath sounds are REDUCED/ABSENT on the affected side and BOWEL sounds are heard over the chest; 'breath sounds heard over the chest' would be normal and misleads. (Arabic omitted this clause entirely.)SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q040— 'dehydration is the commonest reason for readmission' is not supported: in a population-based study of paediatric tonsillectomy, haemorrhage was the commonest reason for readmission (about 68%) and dehydration was second (about 15%). Dehydration is a leading, preventable reason, so the sentence is softened (the key and the advice remain correct).SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q077— 'no glycogen reserve' is an overstatement: infants and small children have LIMITED glycogen stores (hence the need for dextrose-containing maintenance fluid and glucose monitoring), not none.SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q038— The key and explanation overstated the evidence: the Cochrane review found that parental presence at induction does not reduce the child's anxiety, is less effective than sedative premedication, and does not show a reduced sedation requirement or post-operative behavioural disturbance, so 'reduces distress and sedation requirement' is unsupported and 'no measurable effect' was also defensible. Item reframed to a singSNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q038— Option A (key) claimed that parental presence reduces distress and sedation requirement, which the Cochrane review does not support; reworded so that A is the accurate statement (offered as family-centred care, not a reliable anxiety reducer).SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q038— Option C ('no measurable effect') was defensible against the Cochrane evidence and competed with the key; replaced with the outdated belief (reliable anxiety reduction replacing premedication), which the review shows to be wrong, so that A is the single best answer.SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q038— The key and explanation overstated the evidence: the Cochrane review found that parental presence at induction does not reduce the child's anxiety, is less effective than sedative premedication, and does not show a reduced sedation requirement or post-operative behavioural disturbance, so 'reduces distress and sedation requirement' is unsupported and 'no measurable effect' was also defensible. Explanation rewritten tSNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q050— The stem asks which checklist item is 'most often missed', a frequency claim with no evidence base (consent, identification/allergy band and fasting status are also well-documented checklist failures), so the key rested on opinion. Reworded to the verifiable point the explanation already makes (every dose and volume is calculated from weight); key D unchanged.SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q073— 'Preparation and parental presence ... measurably reduce this outcome' overstates the evidence: the 2015 Cochrane review found that parental presence at induction does not diminish the child's anxiety, and it reports no postoperative behaviour outcome. Preoperative anxiety predicting postoperative maladaptive behaviour (the first sentence) is supported, and family-centred preparation programmes have reduced anxiety aSNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q087— 'Prolonged intra-abdominal heat' is too narrow: most undescended testes are not intra-abdominal, and the damaging factor is prolonged residence outside the cooler scrotal environment (the precise role of temperature is still debated). Option reworded; key B unchanged.SNLE_Part03_Ch15_Paediatric_Surgical_Nursing::s02— 15.1 said an older child or adolescent with capacity may consent for himself; under the Saudi MOH informed-consent guidelines (2019) a minor never consents alone: guardian consent under 15, approval of both patient and guardian from 15 to 18, self-consent from 18. Same wording now in 15.1, q008, fc010 and q091. (15.1, first clause)SNLE_Part03_Ch15_Paediatric_Surgical_Nursing::s02— 15.1 said an older child or adolescent with capacity may consent for himself; under the Saudi MOH informed-consent guidelines (2019) a minor never consents alone: guardian consent under 15, approval of both patient and guardian from 15 to 18, self-consent from 18. Same wording now in 15.1, q008, fc010 and q091. (15.1, second clause)SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q008— 15.1 said an older child or adolescent with capacity may consent for himself; under the Saudi MOH informed-consent guidelines (2019) a minor never consents alone: guardian consent under 15, approval of both patient and guardian from 15 to 18, self-consent from 18. Same wording now in 15.1, q008, fc010 and q091. (q008 explanation; key unchanged, the child in the stem is five years old)SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-fc010— 15.1 said an older child or adolescent with capacity may consent for himself; under the Saudi MOH informed-consent guidelines (2019) a minor never consents alone: guardian consent under 15, approval of both patient and guardian from 15 to 18, self-consent from 18. Same wording now in 15.1, q008, fc010 and q091. (fc010, first clause)SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-fc010— 15.1 said an older child or adolescent with capacity may consent for himself; under the Saudi MOH informed-consent guidelines (2019) a minor never consents alone: guardian consent under 15, approval of both patient and guardian from 15 to 18, self-consent from 18. Same wording now in 15.1, q008, fc010 and q091. (fc010, second sentence)SNLE_Part03_Ch15_Paediatric_Surgical_Nursing-q091— 15.1 said an older child or adolescent with capacity may consent for himself; under the Saudi MOH informed-consent guidelines (2019) a minor never consents alone: guardian consent under 15, approval of both patient and guardian from 15 to 18, self-consent from 18. Same wording now in 15.1, q008, fc010 and q091. (q091 explanation: the basis for 'his refusal carries weight' is now the two-party approval rule; key uncha
Leadership & Management القيادة والإدارة — 7 correction(s)
SNLE_Part04_Ch01_Leadership_Management-q034— Two defensible answers: with only "five staff" stated, option A (one shift has more patients) can also make one shift unsafe. Stating equal patient numbers leaves skill mix (B) as the best answer; key unchanged.SNLE_Part04_Ch01_Leadership_Management-q045— Wrong key. The stem asks which action is INAPPROPRIATE: cutting staffing below safe levels (A) is the inappropriate action; reducing waste of consumables (D) is legitimate cost saving. The explanation itself says cost reduction never overrides safe staffing and that savings come from waste. Correct key is A. (answer key changed to A)SNLE_Part04_Ch01_Leadership_Management-cs003— 'The strongest single predictor of whether a nurse stays is her immediate manager' overstates the evidence: reviews rank managerial style and supervisory support among the most influential determinants of nurse turnover, not as a proven single strongest one. Softened to 'one of the strongest predictors'.SNLE_Part04_Ch01_Leadership_Management::s04— Same overstatement in the s04 'Key point' card (named in the finding): 'The strongest single predictor ... is the person she reports to'. Softened to 'one of the strongest predictors'.SNLE_Part04_Ch01_Leadership_Management-q021— The quiz stem asks for 'the strongest single predictor' of nurse retention, the same unsupported single-strongest claim. Reworded to a comparative association among the four options; key C (immediate manager) unchanged.SNLE_Part04_Ch01_Leadership_Management-q021— The explanation never states why the key (immediate manager) is correct; with the stem softened, the supporting evidence is added (managerial style and supervisory support carry the most weight among organisational factors).SNLE_Part04_Ch01_Leadership_Management-fc020— Overstatement: the immediate manager as 'the strongest single predictor' of nurse retention is not established; reviews show managerial style and supervisory support are among the most influential of several determinants (with stress, job dissatisfaction, workload, work environment). Softened to 'one of the strongest predictors'.
Delegation, Staffing & Team Working التفويض والتوظيف والعمل الفريقي — 2 correction(s)
SNLE_Part04_Ch02_Delegation_Staffing_Team_Working-q019— The key rested on an unsourced frequency claim ('most often omitted'). Literature lists pending tests among commonly omitted handover content but does not rank omissions, so the stem is reworded to the reasoning that holds: name, diagnosis and observations are recorded and visible, whereas a result that was chased and has not arrived leaves no trace in the record. Key C unchanged.SNLE_Part04_Ch02_Delegation_Staffing_Team_Working-q019— The explanation never mentions the keyed item. Added a sentence on why a chased-but-unreceived result is easily lost in a rushed handover.
Quality Improvement, Risk & Patient Safety تحسين الجودة والمخاطر وسلامة المرضى — 23 correction(s)
SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-q001— IOM/AHRQ recognised set has SIX aims; 'efficient' is missing from the listSNLE_Part04_Ch03_Quality_Risk_Patient_Safety-fc031— The card stated that accreditation is 'a prerequisite for renewal of the operating licence' and covers 'military' facilities as established fact. The sources support mandatory accreditation of public and private facilities under the 2013 Cabinet decree, and the CBAHI statute (Art. 6(6)) only directs coordination to link licensing and renewal to accreditation; an in-force licence-renewal prerequisite and the militarySNLE_Part04_Ch03_Quality_Risk_Patient_Safety-cs007— Compliance is lower BEFORE patient contact than after, so an audit weighted to 'before' moments would understate, not inflate, the figure; the inflating bias is a sample weighted to the 'after' moments.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-fc041— Memory aid omitted chemotherapy (in the chapter's classic list and on the ISMP list) and used 'concentrated sedatives', which is not an ISMP category; align with the classic list.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s04— Same memory-aid list repeated in section 3.3: replace 'concentrated sedatives' with chemotherapy so it matches the classic list and ISMP.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-fc045— 'Most are about communication' is not supported: in the systematic review treatment (15.6%) was the commonest issue and communication (13.7%) second, with clinical care about a third of issues. Soften to 'many'.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s04— Same unsupported 'most complaints are about communication' claim in the section key point; soften to 'many'.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-cs008— Same overstated proportion in the complaints case answer; soften to 'many'.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-fc054— 'An apology admits no legal liability' is stated as a universal legal rule, but protection of apologies is jurisdiction-dependent and no Saudi statute was found; restate as the safe principle (an apology is regret, not the same as accepting liability) and refer to the local disclosure policy.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-q026— 'Mandatory since a 2013 Cabinet decree ... military' cannot be supported: mandatory accreditation pre-dates 2013, the statute (Res. 346, 1436H) covers government and private facilities and links licensing/renewal to accreditation, and military facilities are not named. Restate on the statute, consistent with flashcard fc031.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-fc031— Same unsupported '2013 Cabinet decree' date in the CBAHI status flashcard; remove the date (the statute is the verifiable basis).SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-q036— 'Most patient complaints are about communication' is not supported (treatment 15.6% was the commonest issue, communication 13.7% second); reword so Communication is the single best answer among the options.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-q036— Explanation should state the evidence behind the reworded stem.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-q041— 'An apology admits no legal liability' is an absolute, jurisdiction-dependent statement; reworded to 'An apology is not, in itself, an admission of liability'. The key (C) is unchanged: it is still the only defensible option.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s02— 'The second is the one that matters' could be read as discounting injurious falls. Both total falls and falls with injury are reported as separate nurse-sensitive indicators; the teaching point is that falls without harm are the early warning. Reworded.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s06— 'Starting about six weeks in' is a specific time-frame with no source. NHS England's sustainability guide names ownership as a sustainability factor and describes decay but gives no time point. The number is removed.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s07— Leadership visibility described as 'the intervention with the best evidence'; the published evidence (leadership walkarounds, 2023 systematic review of 12 studies, only one on clinical outcomes) is encouraging but mainly on safety culture and reporting. Softened.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s08— 'An apology is not an admission of legal liability' stated as universal; legal effect of an apology is jurisdiction-dependent. Qualified with 'in itself'.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s08— Same absolute claim repeated in the Watch-out box of the same section ('An apology admits no legal liability'); aligned with the step-4 wording.SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s03— Sentinel-event definition: 3.2 said it triggers investigation 'regardless of the outcome' while the memory aid, q009 and fc011 used the legacy wording 'death or serious harm or the risk of it'. All now give the current definition: an event that reaches the patient and causes death, permanent harm or severe temporary harm (which also keeps it distinct from a near miss). (3.2 ladder step 3)SNLE_Part04_Ch03_Quality_Risk_Patient_Safety::s03— Sentinel-event definition: 3.2 said it triggers investigation 'regardless of the outcome' while the memory aid, q009 and fc011 used the legacy wording 'death or serious harm or the risk of it'. All now give the current definition: an event that reaches the patient and causes death, permanent harm or severe temporary harm (which also keeps it distinct from a near miss). (3.2 memory aid)SNLE_Part04_Ch03_Quality_Risk_Patient_Safety-q009— Sentinel-event definition: 3.2 said it triggers investigation 'regardless of the outcome' while the memory aid, q009 and fc011 used the legacy wording 'death or serious harm or the risk of it'. All now give the current definition: an event that reaches the patient and causes death, permanent harm or severe temporary harm (which also keeps it distinct from a near miss). (q009 explanation; key A, wrong-site surgery, unSNLE_Part04_Ch03_Quality_Risk_Patient_Safety-fc011— Sentinel-event definition: 3.2 said it triggers investigation 'regardless of the outcome' while the memory aid, q009 and fc011 used the legacy wording 'death or serious harm or the risk of it'. All now give the current definition: an event that reaches the patient and causes death, permanent harm or severe temporary harm (which also keeps it distinct from a near miss). (fc011)
Professional Practice, Ethics & Regulation الممارسة المهنية والأخلاقيات والتنظيم — 12 correction(s)
SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation-fc063— 'Family opposition may be overruled' was stated as a flat national rule. The fatwa and the 2017 Saudi Health Council national DNR policy make the order a physician decision that does not require family agreement, but the national policy is silent on how family disagreement is resolved and hospital policies differ (some refer conflicts to the ethics committee). Reworded to say what the sources support.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s08— 'Where three specialists agree futility, family opposition may be overruled' was stated as a flat national rule. The fatwa and the 2017 national DNR policy make the order a physician decision that does not require family agreement, but the national policy does not say how family disagreement is resolved; hospital policies differ and some route conflicts to the ethics committee. Reworded accordingly.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s08— The same overstatement ('family opposition may be overruled') is repeated in the 'Key point' card of this section; reworded consistently with the main text.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation-fc064— The flashcard says the do-not-resuscitate form is valid 'only within the hospital and only for that admission'; the national DNR policy makes the form time-limited (six months for inpatients, one year for outpatients) and accepts signed orders from other facilities on transfer.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s08— The section says the form is 'valid only in hospital, only for that admission'; the national DNR policy makes the form valid for six months for inpatients and one year for outpatients, with periodic review.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s08— Same unsupported validity statement repeated in the section's Key point; aligned with the national DNR policy.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation-q028— 'Over the registration cycle' is not supported: SCFHS pages give 20/40/60 hours by category for re-registration without stating a cycle basis (the executive rules speak of hours per year).SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation-fc031— Same unsupported 'over the registration cycle' qualifier on the CPD hours as in q028.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s06— Internal inconsistency: the section says conscientious objection 'never covers emergency care'; flashcard fc038 and the section's Key point say it does not extend to emergency care where no one else can act. Aligned to the qualified formulation.SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s06— Conscientious objection: the qualifier 'emergency care where no one else can act' is looser than the SCFHS Code of Ethics, which permits refraining only in non-emergency situations, with no harm to the patient and another capable practitioner available. Aligned to the stricter wording. (section 4.5 decision branch)SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation::s06— Conscientious objection: the qualifier 'emergency care where no one else can act' is looser than the SCFHS Code of Ethics, which permits refraining only in non-emergency situations, with no harm to the patient and another capable practitioner available. Aligned to the stricter wording. (section 4.5 key point)SNLE_Part04_Ch04_Professional_Practice_Ethics_Regulation-fc038— Conscientious objection: the qualifier 'emergency care where no one else can act' is looser than the SCFHS Code of Ethics, which permits refraining only in non-emergency situations, with no harm to the patient and another capable practitioner available. Aligned to the stricter wording. (fc038)
Research, Evidence-Based Practice & Informatics البحث والممارسة المبنية على الأدلّة والمعلوماتية — 6 correction(s)
SNLE_Part04_Ch05_Research_Evidence_Based_Practice_Informatics-cs004— The list runs from the strongest design (RCT) down to expert opinion, i.e. DESCENDING order of strength, not ascending; the AR repeats the errorSNLE_Part04_Ch05_Research_Evidence_Based_Practice_Informatics::s05— 'Only an experimental design with randomisation supports a causal claim' is over-stated: well-designed observational evidence (e.g. Bradford Hill considerations, smoking and lung cancer) can support causal conclusions when trials are impossible or unethical; randomisation gives the strongest protection against confounding but is not the only route. Softened to 'most strongly'.SNLE_Part04_Ch05_Research_Evidence_Based_Practice_Informatics::s03— Randomisation was described as making groups 'differ only in the intervention, including in ways nobody thought to measure', which can be read as saying the groups differ in unmeasured ways. Aligned in every place (s03 body and key point, q007 explanation, fc009 back) with the corrected key-term wording: by chance, with enough participants the groups are alike apart from the intervention, even in characteristics noboSNLE_Part04_Ch05_Research_Evidence_Based_Practice_Informatics::s03— Randomisation was described as making groups 'differ only in the intervention, including in ways nobody thought to measure', which can be read as saying the groups differ in unmeasured ways. Aligned in every place (s03 body and key point, q007 explanation, fc009 back) with the corrected key-term wording: by chance, with enough participants the groups are alike apart from the intervention, even in characteristics noboSNLE_Part04_Ch05_Research_Evidence_Based_Practice_Informatics-q007— Randomisation was described as making groups 'differ only in the intervention, including in ways nobody thought to measure', which can be read as saying the groups differ in unmeasured ways. Aligned in every place (s03 body and key point, q007 explanation, fc009 back) with the corrected key-term wording: by chance, with enough participants the groups are alike apart from the intervention, even in characteristics noboSNLE_Part04_Ch05_Research_Evidence_Based_Practice_Informatics-fc009— Randomisation was described as making groups 'differ only in the intervention, including in ways nobody thought to measure', which can be read as saying the groups differ in unmeasured ways. Aligned in every place (s03 body and key point, q007 explanation, fc009 back) with the corrected key-term wording: by chance, with enough participants the groups are alike apart from the intervention, even in characteristics nobo