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Classical Rx MRCP
BY
DR.SHERIF BADRAWY
BADRAWY MRCP NOTES
Classical Rx
hypercalcemia
1a
BADRAWY MRCP NOTES
Classical Rx
Digitally signed by Dr.Sherif Badrawy
DN: cn=Dr.Sherif Badrawy, o=KKUH,
ou=Critical Care,
email=sherif_badrawy@yahoo.com,
c=SA
Date: 2015.02.07 02:13:53 +03'00'
▦ normal saline
▦ bisphosphonates
▦ Steroids in sarcoidosis
▦ lasix only if can't take fluids
1b
BADRAWY MRCP NOTES
Classical Rx
Vitamin D-Resistant Rickets
2a
BADRAWY MRCP NOTES
Classical Rx
▦ High-dose vitamin D
▦ Oral phosphate
2b
BADRAWY MRCP NOTES
Classical Rx
prevent acute mountain sickness
3a
BADRAWY MRCP NOTES
Classical Rx
▦ Acetazolamide
3b
BADRAWY MRCP NOTES
Classical Rx
Hereditary Angioedema
4a
BADRAWY MRCP NOTES
Classical Rx
▦ Acute: IV C1 inhibitor or
concentrate or FFP
▦ Anabolic steroid; Danazol
4b
BADRAWY MRCP NOTES
Classical Rx
Acute Confusion (Delirium)
5a
BADRAWY MRCP NOTES
Classical Rx
▦ haloperidol 0.5 mg (DOCH)
then lorazepam
▦ later Rx cause, Modification of
environment
5b
BADRAWY MRCP NOTES
Classical Rx
terminal illness agitation or
restlessness
6a
BADRAWY MRCP NOTES
Classical Rx
▦ midazolam
6b
BADRAWY MRCP NOTES
Classical Rx
Motion sickness
7a
BADRAWY MRCP NOTES
Classical Rx
▦ hyoscine is the most effective Rx
but limited use dt SEs
▦ cyclizine or cinnarizine (Non-
sedating antihistamines )
7b
BADRAWY MRCP NOTES
Classical Rx
Acute intermittent porphyria
8a
BADRAWY MRCP NOTES
Classical Rx
Hematin
8b
BADRAWY MRCP NOTES
Classical Rx
Amyloidosis
9a
BADRAWY MRCP NOTES
Classical Rx
▦ autologous BM transplants
▦ or chemotherapy bortezomib &
dexamethasone
9b
BADRAWY MRCP NOTES
Classical Rx
otitis externa
10a
BADRAWY MRCP NOTES
Classical Rx
topical antibiotic é steroid
10b
BADRAWY MRCP NOTES
Classical Rx
Ramsay Hunt syndrome
11a
BADRAWY MRCP NOTES
Classical Rx
oral aciclovir & CST
11b
BADRAWY MRCP NOTES
Classical Rx
Hyperhidrosis
12a
BADRAWY MRCP NOTES
Classical Rx
▦ Topical aluminium chloride
▦ Botulinum toxin
12b
BADRAWY MRCP NOTES
Classical Rx
Α-1 Antitrypsin ↓
13a
BADRAWY MRCP NOTES
Classical Rx
▦ No smoking
▦ IV α1-antitrypsin protein
concentrates
▦ volume ↓ surgery, lung
transplantation
13b
BADRAWY MRCP NOTES
Classical Rx
Fibromyalgia
14a
BADRAWY MRCP NOTES
Classical Rx
▦ Cognitive behavioural Rx
▦ amitriptyline
14b
BADRAWY MRCP NOTES
Classical Rx
Subarachnoid Hge
15a
BADRAWY MRCP NOTES
Classical Rx
▦ AVM coiling
▦ Nimodipine
15b
BADRAWY MRCP NOTES
Classical Rx
Wernicke Encephalopathy
16a
BADRAWY MRCP NOTES
Classical Rx
urgent replacement of thiamine
16b
BADRAWY MRCP NOTES
Classical Rx
Normal Pressure Hydrocephalus
17a
BADRAWY MRCP NOTES
Classical Rx
Ventriculoperitoneal shunting
17b
BADRAWY MRCP NOTES
Classical Rx
Idiopathic Intracranial HTN
18a
BADRAWY MRCP NOTES
Classical Rx
▦ Weight loss
▦ Acetazolamide
▦ CST
▦ Repeated lumbar puncture
▦ optic nerve sheath
decompression
18b
BADRAWY MRCP NOTES
Classical Rx
Antiplatlet in STEMI
19a
BADRAWY MRCP NOTES
Classical Rx
aspirin + clopidogrel for 12 months
19b
BADRAWY MRCP NOTES
Classical Rx
NSTEMI (no drug allergies) -
antiplatelets:
20a
BADRAWY MRCP NOTES
Classical Rx
aspirin (lifelong) & clopidogrel (12
months)
20b
BADRAWY MRCP NOTES
Classical Rx
Pituitary Apoplexy
21a
BADRAWY MRCP NOTES
Classical Rx
▦ IV Hydrocortisone
▦ to prevent adisonian crisis
21b
BADRAWY MRCP NOTES
Classical Rx
Subacute Combined Degeneration
of Spinal Cord
22a
BADRAWY MRCP NOTES
Classical Rx
vitamin B12
22b
BADRAWY MRCP NOTES
Classical Rx
Motor Neuron Disease
(amyotrophic lateral sclerosis,..)
23a
BADRAWY MRCP NOTES
Classical Rx
▦ Non-invasive ventilation
(BiPAP)
▦ Riluzole (Anti-glutamate drug)
23b
BADRAWY MRCP NOTES
Classical Rx
generalised seizures
24a
BADRAWY MRCP NOTES
Classical Rx
Na valproate is 1st line
24b
BADRAWY MRCP NOTES
Classical Rx
partial seizures
25a
BADRAWY MRCP NOTES
Classical Rx
Carbamazepine is 1st line then
lamotrigine
25b
BADRAWY MRCP NOTES
Classical Rx
Tonic-Clonic Seizures
26a
BADRAWY MRCP NOTES
Classical Rx
Na valproate then lamotrigine
26b
BADRAWY MRCP NOTES
Classical Rx
Absence Seizures
27a
BADRAWY MRCP NOTES
Classical Rx
Na valproate or ethosuximide
27b
BADRAWY MRCP NOTES
Classical Rx
Myoclonic Seizures
28a
BADRAWY MRCP NOTES
Classical Rx
Sodium valproate then clonazepam
28b
BADRAWY MRCP NOTES
Classical Rx
When to start Rx for Parkinsonism
29a
BADRAWY MRCP NOTES
Classical Rx
delay Rx until the onset of
disabling Sx
29b
BADRAWY MRCP NOTES
Classical Rx
Drugs used to Rx Parkinsonism
30a
BADRAWY MRCP NOTES
Classical Rx
✾ Dopamine receptor agonists
(Bromocriptine, Pramipexole, Ropinirole,
Cabergoline, Apomorphine)
✾ Levodopa +L-Dopa
✾ MAO-B inhibitors (Selegiline)
✾ Amantadine
✾ COMT inhibitors (Entacapone)
✾ Antimuscarinics (procyclidine, benzotropine,
trihexyphenidyl)
30b
BADRAWY MRCP NOTES
Classical Rx
Progressive Supranuclear Palsy
31a
BADRAWY MRCP NOTES
Classical Rx
L-dopa (Poor response)
31b
BADRAWY MRCP NOTES
Classical Rx
Pick Disease
32a
BADRAWY MRCP NOTES
Classical Rx
supportive Rx
32b
BADRAWY MRCP NOTES
Classical Rx
Essential tremor
33a
BADRAWY MRCP NOTES
Classical Rx
▦ Propranolol is 1st-line
▦ Primidone when propanolol is
CI
33b
BADRAWY MRCP NOTES
Classical Rx
Alzheimer's Disease
34a
BADRAWY MRCP NOTES
Classical Rx
▦ DONEPEZIL (galantamine &
rivastigmine) ➜ ACH inhibitors
▦ Memantine ➜ moderate - severe
Alzheimer's.
34b
BADRAWY MRCP NOTES
Classical Rx
Hemiballism
35a
BADRAWY MRCP NOTES
Classical Rx
▦ Haloperidol ➜ 1st-line
▦ Tetrabenazine long-term Rx
35b
BADRAWY MRCP NOTES
Classical Rx
Bell's palsy
36a
BADRAWY MRCP NOTES
Classical Rx
▦ prednisolone within 72 hours of
onset
▦ Eye care
▦ aciclovir gives no additional
benefit
36b
BADRAWY MRCP NOTES
Classical Rx
Multiple Sclerosis
37a
BADRAWY MRCP NOTES
Classical Rx
▦ reducing the frequency & duration of
relapses,There is no cure
▦ IV methylprednisolone
▦ Spasticity: baclofen & gabapentin are 1st-line
▦ β-interferon ↓ the relapse rate by up to 30%.
▦ Glatiramer acetate ➜ immunomodulating
drug
▦ Natalizumab ➜ monoclonal Ab
37b
BADRAWY MRCP NOTES
Classical Rx
Myasthenia Gravis
38a
BADRAWY MRCP NOTES
Classical Rx
✺ Pyridostigmine
✺ prednisolone
✺ Thymectomy
38b
BADRAWY MRCP NOTES
Classical Rx
myasthenic crisis
39a
BADRAWY MRCP NOTES
Classical Rx
✺ Plasmapheresis
✺ IV Igs
39b
BADRAWY MRCP NOTES
Classical Rx
Lambert-Eaton Myasthenic
Syndrome
40a
BADRAWY MRCP NOTES
Classical Rx
✺ Rx of underlying cancer
✺ prednisolone and/or
azathioprine
✺ Plasmapheresis, IV Igs
40b
BADRAWY MRCP NOTES
Classical Rx
Glomus Jugulare Tumours
41a
BADRAWY MRCP NOTES
Classical Rx
Surgical resection
41b
BADRAWY MRCP NOTES
Classical Rx
Guillain-Barre Syndrome
42a
BADRAWY MRCP NOTES
Classical Rx
✺ Plasma exchange
✺ IV Igs
✺ FVC regularly to monitor
respiratory function
✺ Steroids & immunosuppressants
➜ NO BENIFIT
42b
BADRAWY MRCP NOTES
Classical Rx
HSV Encephalitis
43a
BADRAWY MRCP NOTES
Classical Rx
IV aciclovir ASAP
43b
BADRAWY MRCP NOTES
Classical Rx
Cerebral Toxoplasmosis in HIV
44a
BADRAWY MRCP NOTES
Classical Rx
sulfadiazine & pyrimethamine
44b
BADRAWY MRCP NOTES
Classical Rx
Trigeminal neuralgia
45a
BADRAWY MRCP NOTES
Classical Rx
Carbamazepine is 1st-line
45b
BADRAWY MRCP NOTES
Classical Rx
non- DM neuropathic pain
46a
BADRAWY MRCP NOTES
Classical Rx
amitriptyline or pregabalin 1st-line
46b
BADRAWY MRCP NOTES
Classical Rx
DM neuropathy
47a
BADRAWY MRCP NOTES
Classical Rx
✺ oral duloxetine 1st-line
✺ Oral amitriptyline if duloxetine
is CI
47b
BADRAWY MRCP NOTES
Classical Rx
Acute attack of Cluster headache
48a
BADRAWY MRCP NOTES
Classical Rx
✺ 100% O₂
✺ subcutaneous sumatriptan (5-
HT1D receptor agonist)
✺ nasal lidocaine
48b
BADRAWY MRCP NOTES
Classical Rx
Prophylaxis of Cluster headache
49a
BADRAWY MRCP NOTES
Classical Rx
verapamil, prednisolone
49b
BADRAWY MRCP NOTES
Classical Rx
Chronic Paroxysmal Hemicrania
50a
BADRAWY MRCP NOTES
Classical Rx
indomethacin
50b
BADRAWY MRCP NOTES
Classical Rx
Acute attack of Migraine
51a
BADRAWY MRCP NOTES
Classical Rx
✺ Standard analgesia ➜1st-line ➜
Paracetamol, ibuprofen, aspirin
✺ Sumatriptan ➜ 5-HT1 agonist
✺ Ergotamine ➜ α-blocker & a
partial 5-HT1 agonist
51b
BADRAWY MRCP NOTES
Classical Rx
Prophylaxis of Migraine
52a
BADRAWY MRCP NOTES
Classical Rx
✺ β-blockers ➜ 1st-line ➜
propranolol
✺ Topiramate
52b
BADRAWY MRCP NOTES
Classical Rx
Migraine during pregnancy
53a
BADRAWY MRCP NOTES
Classical Rx
✺ Paracetamol is 1st-line
✺ If Pt has migraine é aura ➜ COC
is absolutely CI dt risk of stroke
53b
BADRAWY MRCP NOTES
Classical Rx
Headache following Lumbar
Puncture
54a
BADRAWY MRCP NOTES
Classical Rx
✺ Supportive initially (analgesia,
rest)
✺ if > 72 hours blood patch,
epidural saline & IV caffeine
54b
BADRAWY MRCP NOTES
Classical Rx
Warm AIHA
55a
BADRAWY MRCP NOTES
Classical Rx
✺ CST
✺ immunosuppression
✺ splenectomy.
55b
BADRAWY MRCP NOTES
Classical Rx
Hereditary spherocytosis
56a
BADRAWY MRCP NOTES
Classical Rx
✺ Folate replacement
✺ Splenectomy
56b
BADRAWY MRCP NOTES
Classical Rx
Sideroblastic anemia
57a
BADRAWY MRCP NOTES
Classical Rx
✺ Rx cause
✺ Pyridoxine
57b
BADRAWY MRCP NOTES
Classical Rx
Pure red cell aplasia
58a
BADRAWY MRCP NOTES
Classical Rx
✺ cyclosporin
✺ If dt erythropoietin ➜ stop
58b
BADRAWY MRCP NOTES
Classical Rx
Paroxysmal nocturnal
hemoglobinuria
59a
BADRAWY MRCP NOTES
Classical Rx
✺ Blood product replacement
✺ Anticoagulation
✺ Eculizumab ➜ a monoclonal Ab
✺ Stem cell transplantation
59b
BADRAWY MRCP NOTES
Classical Rx
Polycythemia Rubra Vera
60a
BADRAWY MRCP NOTES
Classical Rx
✺ Venesection - 1st line
✺ Hydroxyurea
✺ Allopurinol & Phosphorus-32
60b
BADRAWY MRCP NOTES
Classical Rx
Myelodysplasia
61a
BADRAWY MRCP NOTES
Classical Rx
✺ < 5% blasts in the BM ➜
conservative Rx
✺ ↑WBC ➜ gentle chemotherapy
✺ < 60 years old ➜ Intensive
chemotherapy
61b
BADRAWY MRCP NOTES
Classical Rx
CML
62a
BADRAWY MRCP NOTES
Classical Rx
✺ Imatinib ➜ tyrosine kinase
inhibitor
✺ Interferon- α
✺ Hydroxyurea
✺ Allogenic BM transplant
(optimum Rx)
62b
BADRAWY MRCP NOTES
Classical Rx
AML
63a
BADRAWY MRCP NOTES
Classical Rx
1. Induction All except M3 ➜
cytarabine (ara-C) + anthracycline
(daunorubicin or idarubicin) "7+3"
2. Consolidation ➜ to remove
undetected leukemic cells (For good-
prognosis leukemias)
3. allogeneic stem cell transplantation
63b
BADRAWY MRCP NOTES
Classical Rx
Acute Promyelocytic Leukemia
(M3)
64a
BADRAWY MRCP NOTES
Classical Rx
ATRA + induction chemotherapy
64b
BADRAWY MRCP NOTES
Classical Rx
CLL Indications for Rx
65a
BADRAWY MRCP NOTES
Classical Rx
✺ anemia and/or thrombocytopenia ➜
progressive
l✺ ymphadenopathy ➜ (>10 cm) or progressive
✺ splenomegaly ➜ (>6 cm) or progressive
✺ lymphocytosis: > 50% ↑over 2 months or
doubling time < 6 months
✺ Systemic Sx
✺ ITP
65b
BADRAWY MRCP NOTES
Classical Rx
CLL
66a
BADRAWY MRCP NOTES
Classical Rx
✺ Only when indicated
✺ Chlorambucil
✺ fludarabine
✺ PCP prophylaxis (co-
trimoxazole)
66b
BADRAWY MRCP NOTES
Classical Rx
Hairy Cell Leukemia
67a
BADRAWY MRCP NOTES
Classical Rx
✺ cladribine, pentostatin ➜ 1st-line
✺ rituximab, interferon-α ➜ 2nd
line
✺ Splenectomy
67b
BADRAWY MRCP NOTES
Classical Rx
Hodgkin's Lymphoma
68a
BADRAWY MRCP NOTES
Classical Rx
✺ Early (I & II) ➜ radiatiotherapy
& chemotherapy
✺ Late (III & IV) ➜ chemotherapy
alone
✺ Large mass in the chest ➜
radiatiotherapy & chemotherapy
68b
BADRAWY MRCP NOTES
Classical Rx
Non-Hodgkin's Lymphomas
69a
BADRAWY MRCP NOTES
Classical Rx
Chemotherapy
69b
BADRAWY MRCP NOTES
Classical Rx
Burkitt's Lymphoma
70a
BADRAWY MRCP NOTES
Classical Rx
✺ chemotherapy
✺ high incidence of 'tumor lysis
syndrome'
70b
BADRAWY MRCP NOTES
Classical Rx
Hyper Eesinophilic syndrome
71a
BADRAWY MRCP NOTES
Classical Rx
✺ ↑dose CST + Steroid sparing
agents (cyclophosphamide or
azathioprine)
71b
BADRAWY MRCP NOTES
Classical Rx
Antithrombin III ↓
72a
BADRAWY MRCP NOTES
Classical Rx
✺ Thromboembolic events lifelong
warfarinisation
✺ Heparinisation during
pregnancy
✺ Antithrombin III concentrates
(surgery or childbirth)
72b
BADRAWY MRCP NOTES
Classical Rx
Von Willebrand's disease
73a
BADRAWY MRCP NOTES
Classical Rx
✺ Tranexamic acid
✺ DDAVP
✺ Factor VIII concentrate
73b
BADRAWY MRCP NOTES
Classical Rx
ITP
74a
BADRAWY MRCP NOTES
Classical Rx
✺ CST
✺ Splenectomy if platelets < 30
after 3 months of steroid
✺ IV Igs
✺ Cyclophosphamide
74b
BADRAWY MRCP NOTES
Classical Rx
TTP
75a
BADRAWY MRCP NOTES
Classical Rx
✺ Plasma exchange is the Rx of
choice
✺ Steroids, immunosuppressants
✺ Vincristine
75b
BADRAWY MRCP NOTES
Classical Rx
HIT
76a
BADRAWY MRCP NOTES
Classical Rx
✺ Stop Heparin
✺ alternative anticoagulant
(Danaparoid,,Lepirudin
,Argatroban)
76b
BADRAWY MRCP NOTES
Classical Rx
Waldenstrom's Macroglobulinemia
77a
BADRAWY MRCP NOTES
Classical Rx
✺ doxorubicin if young
✺ rituximab
✺ chlorambucil, cyclophosphamide
✺ CST
✺ Plasmapheresis if hyperviscosity
77b
BADRAWY MRCP NOTES
Classical Rx
methemoglobinemia
78a
BADRAWY MRCP NOTES
Classical Rx
✿ ascorbic acid
✿ IV methylene blue
78b
BADRAWY MRCP NOTES
Classical Rx
Graves' Disease
79a
BADRAWY MRCP NOTES
Classical Rx
✿ ATDs ➜ carbimazole
✿ Propranolol
✿ radioiodine & surgery
79b
BADRAWY MRCP NOTES
Classical Rx
Toxic adenoma
80a
BADRAWY MRCP NOTES
Classical Rx
✿ Radioiodine
✿ Subtotal thyroidectomy
✿ In pregnancy ➜ medical Rx ➜ if
failed ➜ subtotal thyroidectomy
80b
BADRAWY MRCP NOTES
Classical Rx
Thyroid Storm
81a
BADRAWY MRCP NOTES
Classical Rx
✿ Paracetamol
✿ ATDs ➜ Methimazole or
propylthiouracil
✿ Lugol's iodine
✿ Dexamethasone
✿ Propranolol
81b
BADRAWY MRCP NOTES
Classical Rx
Subacute Thyroiditis (De
Quervain's Thyroiditis)
82a
BADRAWY MRCP NOTES
Classical Rx
✿ Usu. self-limiting don't require
Rx
✿ NSAIDs
✿ steroids esp. if hypothyroidism
82b
BADRAWY MRCP NOTES
Classical Rx
Thyrotoxicosis in Pregnancy
83a
BADRAWY MRCP NOTES
Classical Rx
✿ Propylthiouracil antithyroid
drug of choice
✿ Block-and-replace regimes,
Radioiodine Rx are CI
83b
BADRAWY MRCP NOTES
Classical Rx
papillary & follicular cancer
84a
BADRAWY MRCP NOTES
Classical Rx
✿ Total thyroidectomy
✿ Followed by radioiodine (I-131)
to kill residual cells
✿ Yearly thyroglobulin levels to
detect early recurrent disease
84b
BADRAWY MRCP NOTES
Classical Rx
Primary Hyperparathyroidism
85a
BADRAWY MRCP NOTES
Classical Rx
✿ IV Fluids
✿ Total parathyroidectomy
✿ Bisphosphonates
85b
BADRAWY MRCP NOTES
Classical Rx
Primary hypoparathyroidism
86a
BADRAWY MRCP NOTES
Classical Rx
alfacalcidol
86b
BADRAWY MRCP NOTES
Classical Rx
DM Gastroparesis
87a
BADRAWY MRCP NOTES
Classical Rx
metoclopramide, domperidone or
erythromycin
87b
BADRAWY MRCP NOTES
Classical Rx
DM in pregnancy
88a
BADRAWY MRCP NOTES
Classical Rx
✿ Weight loss if BMI > 27
✿ Stop oral hypoglycaemic (Can
use metformin) & start insulin
✿ Folic acid 5 mg/day
88b
BADRAWY MRCP NOTES
Classical Rx
Liddle's Syndrome
89a
BADRAWY MRCP NOTES
Classical Rx
amiloride or triamterene
89b
BADRAWY MRCP NOTES
Classical Rx
Primary Hyperaldosteronism
(Conn's Syndrome)
90a
BADRAWY MRCP NOTES
Classical Rx
✿ Na+ restriction
✿ Adrenal adenoma: surgery
✿ Bilateral adrenocortical
hyperplasia ➜ Spironolactone
90b
BADRAWY MRCP NOTES
Classical Rx
SIADH
91a
BADRAWY MRCP NOTES
Classical Rx
✿ fluid restriction
✿ Demeclocycline
91b
BADRAWY MRCP NOTES
Classical Rx
Pheochromocytoma
92a
BADRAWY MRCP NOTES
Classical Rx
✿ Surgery is the definitive Rx
✿ Pt. must be pre-stabilized é
medical Rx
✿ α-blocker (e.g.
Phenoxybenzamine), given before a
✿ β-blocker (e.g. Propranolol)
92b
BADRAWY MRCP NOTES
Classical Rx
Acromegaly
93a
BADRAWY MRCP NOTES
Classical Rx
✿ Trans-sphenoidal surgery is 1st-line Rx
✿ bromocriptine
✿ octreotide
✿ Pegvisomant ➜ GH receptor antagonist
✿ External irradiation ➜ if failed
surgical/medical Rx
93b
BADRAWY MRCP NOTES
Classical Rx
Remnant hyperlipidemia
94a
BADRAWY MRCP NOTES
Classical Rx
Fibrates
94b
BADRAWY MRCP NOTES
Classical Rx
Carcinoid syndrome
95a
BADRAWY MRCP NOTES
Classical Rx
✿ Octreotide
✿ cyproheptadine for Diarrhea
95b
BADRAWY MRCP NOTES
Classical Rx
Clostridium difficile
96a
BADRAWY MRCP NOTES
Classical Rx
✿ ORAL metronidazole
✿ ORAL vancomycin
✿ For life-threatening infections ➜
IV metronidazole + ORAL
vancomycin
96b
BADRAWY MRCP NOTES
Classical Rx
Esophageal Varices
97a
BADRAWY MRCP NOTES
Classical Rx
✿ FFP, vitamin K
✿ terlipressin (DOCH) ➜ if IHD ➜
Octreotide
✿ Endoscopic variceal band
ligation
97b
BADRAWY MRCP NOTES
Classical Rx
Barrett's Esophagus
98a
BADRAWY MRCP NOTES
Classical Rx
✿ ↓grade dysplasia ➜ high-dose
PPI
✿ ↑grade dysplasia: surgery or
cryotherapy.
98b
BADRAWY MRCP NOTES
Classical Rx
Achalasia
99a
BADRAWY MRCP NOTES
Classical Rx
✿ botulinum toxin intrasphincteric
✿ Heller cardiomyotomy
✿ Balloon dilation
99b
BADRAWY MRCP NOTES
Classical Rx
H. pylori
100a
BADRAWY MRCP NOTES
Classical Rx
✿ PPI + amoxicillin +
clarithromycin, or
✿ PPI + metronidazole +
clarithromycin
100b
BADRAWY MRCP NOTES
Classical Rx
Zollinger-Ellison Syndrome
101a
BADRAWY MRCP NOTES
Classical Rx
✿ Octreotide
✿ interferon
✿ chemotherapy
✿ PPI to control Sx
101b
BADRAWY MRCP NOTES
Classical Rx
Angiodysplasia
102a
BADRAWY MRCP NOTES
Classical Rx
✿ Endoscopic cautery
✿ Tranexamic acid
✿ Estrogens
102b
BADRAWY MRCP NOTES
Classical Rx
Chronic Pancreatitis
103a
BADRAWY MRCP NOTES
Classical Rx
✿ Pancreatic enzyme supplements
✿ Analgesia
✿ Antioxidants
103b
BADRAWY MRCP NOTES
Classical Rx
PancreaticPseudocysts
104a
BADRAWY MRCP NOTES
Classical Rx
✿ Small pseudocysts ➜ resolve
spontaneously
✿ > 6cm ➜ endoscopic or
percutanous drainage
104b
BADRAWY MRCP NOTES
Classical Rx
distal colitis ulcerative colitis
105a
BADRAWY MRCP NOTES
Classical Rx
✿ Inducing remission by rectal
mesalazine
✿ then Oral aminosalicylates or
steroids
105b
BADRAWY MRCP NOTES
Classical Rx
Maintaining remission ulcerative
colitis
106a
BADRAWY MRCP NOTES
Classical Rx
✿ Oral aminosalicylates
(Mesalazine)
106b
BADRAWY MRCP NOTES
Classical Rx
severe ulcerative colitis
107a
BADRAWY MRCP NOTES
Classical Rx
✿ IV steroids, fluids, subcutaneous
heparin & elemental diet
107b
BADRAWY MRCP NOTES
Classical Rx
Crohn's disease
108a
BADRAWY MRCP NOTES
Classical Rx
✿ stop smoking
✿ Steroids
✿ Enteral Feeding With An Elemental Diet
✿ Mesalazine
✿ Azathioprine or Mercaptopurine not
used as monotherapy.
✿ Infliximab in refractory disease &
fistulating crohn's
108b
BADRAWY MRCP NOTES
Classical Rx
1st-line for isolated Perianal
Crohn's disease
109a
BADRAWY MRCP NOTES
Classical Rx
✿ Metronidazole
109b
BADRAWY MRCP NOTES
Classical Rx
Whipple's disease
110a
BADRAWY MRCP NOTES
Classical Rx
✿ IV penicillin
110b
BADRAWY MRCP NOTES
Classical Rx
irritable bowel syndrome
111a
BADRAWY MRCP NOTES
Classical Rx
✿ 1st-line ➜ Pain: antispasmodic
✿ Constipation: laxatives
✿ Diarrhea: loperamide
✿ 2nd line TCA ➜ amitriptyline
✿ Resistant ➜ CBT,hypnotherapy or
psychological Rx
111b
BADRAWY MRCP NOTES
Classical Rx
coeliac disease
112a
BADRAWY MRCP NOTES
Classical Rx
✿ gluten-free diet avoid ➜
Wheat,Barley (beer),Rye ± Oats
112b
BADRAWY MRCP NOTES
Classical Rx
Tropical Sprue
113a
BADRAWY MRCP NOTES
Classical Rx
✿ Tetracyclines
✿ if allergic ➜ Ampicillin
✿ Folate & B12
113b
BADRAWY MRCP NOTES
Classical Rx
Toxic Megacolon
114a
BADRAWY MRCP NOTES
Classical Rx
✿ IV & rectal hydrocortisone ➜ if
no improvement
✿ urgent colectomy
✿ Antibiotics have no use
114b
BADRAWY MRCP NOTES
Classical Rx
Spontaneous bacterial peritonitis
115a
BADRAWY MRCP NOTES
Classical Rx
✿ IV cefotaxime
✿ if Hx of SBP ➜ prophylactic
antibiotics
115b
BADRAWY MRCP NOTES
Classical Rx
Primary Biliary Cirrhosis
116a
BADRAWY MRCP NOTES
Classical Rx
✿ Ursodeoxycholic acid
✿ Pruritus: cholestyramine
✿ Fat-soluble vitamin
supplementation
✿ Liver transplantation ➜ If bilirubin
> 100 (PBC is a major indication)
116b
BADRAWY MRCP NOTES
Classical Rx
Wilson's Disease
117a
BADRAWY MRCP NOTES
Classical Rx
✿ D-penicillamine
117b
BADRAWY MRCP NOTES
Classical Rx
Crigler-Najjar Syndrome
118a
BADRAWY MRCP NOTES
Classical Rx
✿ liver transplantation
118b
BADRAWY MRCP NOTES
Classical Rx
Bile Acid Malabsorption
119a
BADRAWY MRCP NOTES
Classical Rx
✿ bile acid sequestrants
119b
BADRAWY MRCP NOTES
Classical Rx
Hepatitis B
120a
BADRAWY MRCP NOTES
Classical Rx
✿ interferon-α
✿ lamivudine, tenofovir &
entecavir
120b
BADRAWY MRCP NOTES
Classical Rx
Autoimmune hepatitis
121a
BADRAWY MRCP NOTES
Classical Rx
✿ Steroids
✿ Azathioprine
✿ Liver transplantation
121b
BADRAWY MRCP NOTES
Classical Rx
NAFLD
122a
BADRAWY MRCP NOTES
Classical Rx
✿ lifestyle changes (esp. weight
loss)
122b
BADRAWY MRCP NOTES
Classical Rx
Hepatocellular carcinoma
123a
BADRAWY MRCP NOTES
Classical Rx
❅ Early disease: surgical resection
❅ Liver transplantation
❅ Radiofrequency ablation
❅ Transarterial
chemoembolisation
❅ Sorafenib: a multikinase (-)
123b
BADRAWY MRCP NOTES
Classical Rx
Pyogenic liver abscess
124a
BADRAWY MRCP NOTES
Classical Rx
❅ Drainage
❅ Amoxicillin + ciprofloxacin +
metronidazole
❅ If penicillin allergic:
ciprofloxacin + clindamycin
124b
BADRAWY MRCP NOTES
Classical Rx
Hepatorenal Syndrome
125a
BADRAWY MRCP NOTES
Classical Rx
❅ difficult to Rx
❅ liver transplantation
❅ terlipressin
❅ 20% albumin
❅ TIPS
125b
BADRAWY MRCP NOTES
Classical Rx
acute anal fissure (< 6 weeks)
126a
BADRAWY MRCP NOTES
Classical Rx
❅ high-fiber diet é ↑fluid intake
❅ Bulk-forming laxatives are 1st
line - if not tolerated ➜ lactulose
❅ Lubricants
❅ Topical anesthetics
126b
BADRAWY MRCP NOTES
Classical Rx
Anemia in CRF
127a
BADRAWY MRCP NOTES
Classical Rx
❅ Correction o iron é IV if needed
❅ Ferritin should be > 200 ng/mL
before starting EPO
❅ EPO to target Hb 10-12
127b
BADRAWY MRCP NOTES
Classical Rx
acute graft failure (< 6 months)
128a
BADRAWY MRCP NOTES
Classical Rx
❅ steroids, if resistant use
monoclonal Abs
128b
BADRAWY MRCP NOTES
Classical Rx
Minimal Change GN
129a
BADRAWY MRCP NOTES
Classical Rx
❅ (80%) are steroid responsive
❅ Cyclophosphamide for steroid
resistant
129b
BADRAWY MRCP NOTES
Classical Rx
Mesangiocapillary GN
130a
BADRAWY MRCP NOTES
Classical Rx
❅ steroids
130b
BADRAWY MRCP NOTES
Classical Rx
Acute renal colic
131a
BADRAWY MRCP NOTES
Classical Rx
❅ Diclofenac IM ➜ analgesia of
choice,A 2nd dose can be given
after 30 minutes if necessary
131b
BADRAWY MRCP NOTES
Classical Rx
Proteinuria
132a
BADRAWY MRCP NOTES
Classical Rx
❅ ACE-I
❅ ARBs
132b
BADRAWY MRCP NOTES
Classical Rx
Type 2 RTA (proximal)
133a
BADRAWY MRCP NOTES
Classical Rx
❅ Bicarb replacement + Thiazide
diuretics
133b
BADRAWY MRCP NOTES
Classical Rx
Renal Cell Cancer
134a
BADRAWY MRCP NOTES
Classical Rx
❅ Radical nephrectomy
❅ α-interferon & interleukin-2 ➜ ↓
tumor size
❅ tyrosine kinase inhibitors (e.g.
Sorafenib, sunitinib) superior
efficacy compared to interferon-α
134b
BADRAWY MRCP NOTES
Classical Rx
Goodpasture's syndrome
135a
BADRAWY MRCP NOTES
Classical Rx
❅ Plasma exchange
❅ Steroids
❅ Cyclophosphamide
135b
BADRAWY MRCP NOTES
Classical Rx
Hemolytic Uremic Syndrome
136a
BADRAWY MRCP NOTES
Classical Rx
❅ supportive
❅ no role for antibiotic
❅ plasma exchange ➜ severe cases
of HUS NOT associated é diarrhea
136b
BADRAWY MRCP NOTES
Classical Rx
Cystinuria
137a
BADRAWY MRCP NOTES
Classical Rx
❅ Hydration
❅ D-penicillamine
❅ Urinary alkalinization
137b
BADRAWY MRCP NOTES
Classical Rx
Homocystinuria
138a
BADRAWY MRCP NOTES
Classical Rx
❅ vitamin B6 supplements
138b
BADRAWY MRCP NOTES
Classical Rx
Alkaptonuria
139a
BADRAWY MRCP NOTES
Classical Rx
❅ nitisinone
139b
BADRAWY MRCP NOTES
Classical Rx
Benign prostatic hyperplasia
(BPH)
140a
BADRAWY MRCP NOTES
Classical Rx
❅ α-1 antagonists e.g. tamsulosin,
alfuzosin ➜ 1st-line
↓ smooth muscle tone (prostate &
bladder)
❅ 5 α-reductase inhibitors e.g. finasteride
Block the conversion of testosterone to
DHT ➜ ↓ in prostate volume
➜ slow disease progression.
140b
BADRAWY MRCP NOTES
Classical Rx
Prostate cancer Localized disease =
T1/2
141a
BADRAWY MRCP NOTES
Classical Rx
❅ life expectancy < 10 years ➜
watchful waiting
❅ life expectancy > 10 years ➜
Radical prostatectomy , Radical
radiotherapy
141b
BADRAWY MRCP NOTES
Classical Rx
Prostate cancer Locally advanced
disease (T3/4)
142a
BADRAWY MRCP NOTES
Classical Rx
❅ Radiotherapy
142b
BADRAWY MRCP NOTES
Classical Rx
Prostate cancer Disseminated
disease - hormonal Rx
143a
BADRAWY MRCP NOTES
Classical Rx
❅ Synthetic GnRH agonist ➜
Goserelin ➜ -Ve feedback
to the anterior pituitary.
❅ Anti-androgen ➜ Cyproterone
acetate
❅ Orchidectomy
143b
BADRAWY MRCP NOTES
Classical Rx
De Quervain's Tenosynovitis
144a
BADRAWY MRCP NOTES
Classical Rx
❅ Analgesia
❅ Steroid injection
❅ Immobilization é a thumb splint
(SPICA)
❅ Surgical Rx
144b
BADRAWY MRCP NOTES
Classical Rx
Lateral Epicondylitis
145a
BADRAWY MRCP NOTES
Classical Rx
❅ avoiding muscle overload
❅ analgesia
❅ Steroid injection
❅ Physiotherapy
145b
BADRAWY MRCP NOTES
Classical Rx
Carpal Tunnel Syndrome
146a
BADRAWY MRCP NOTES
Classical Rx
❅ Carpal injection
❅ Wrist splints at night
❅ Surgical decompression (flexor
retinaculum division)
146b
BADRAWY MRCP NOTES
Classical Rx
Spinal Cord Compression dt cancer
147a
BADRAWY MRCP NOTES
Classical Rx
❅ High-dose dexamethasone
❅ Urgent oncological assessment
➜ radiotherapy or surgery
147b
BADRAWY MRCP NOTES
Classical Rx
Osteomalacia
148a
BADRAWY MRCP NOTES
Classical Rx
Calcium é vitamin D tablets
148b
BADRAWY MRCP NOTES
Classical Rx
Osteoporosis
149a
BADRAWY MRCP NOTES
Classical Rx
❅ Vitamin D & calcium supplement
❅ 【Alendronate is 1st-line】Pts
cannot tolerate bisphosphonates ➜
❅ Strontium ranelate & raloxifene
(SERM), Denosumab monoclonal
Ab (-) RANK ligand
149b
BADRAWY MRCP NOTES
Classical Rx
Pts who take the equivalent of ≥
prednisolone 7.5 mg /day for ≥ 3
months
150a
BADRAWY MRCP NOTES
Classical Rx
❅ osteoporosis prophylaxis
❅ 1st-line: oral bisphosphonate
❅ Second-line: alfacalcidol or
calcitriol
150b
BADRAWY MRCP NOTES
Classical Rx
Paget's Disease
151a
BADRAWY MRCP NOTES
Classical Rx
❅ 【Bisphosphonate】(either oral
risedronate or IV zoledronate)
151b
BADRAWY MRCP NOTES
Classical Rx
Osteopetrosis
152a
BADRAWY MRCP NOTES
Classical Rx
❅ Stem cell transplant &
interferon-gamma
152b
BADRAWY MRCP NOTES
Classical Rx
Rhabdomyolysis
153a
BADRAWY MRCP NOTES
Classical Rx
❅ IV fluids
❅ ± Urinary alkalinization
153b
BADRAWY MRCP NOTES
Classical Rx
Multiple Myeloma < 65 years
154a
BADRAWY MRCP NOTES
Classical Rx
❅ High-dose chemotherapy é
hematopoietic stem-cell
transplantation
❅ Maintenance Rx ➜ thalidomide
154b
BADRAWY MRCP NOTES
Classical Rx
Multiple Myeloma > 65 years
155a
BADRAWY MRCP NOTES
Classical Rx
❅ Chemotherapy (Bortezomib) é
melphalan & prednisone
155b
BADRAWY MRCP NOTES
Classical Rx
Gout Acute Rx
156a
BADRAWY MRCP NOTES
Classical Rx
❅ NSAIDs
❅ Intra-articular steroid injection
❅ Colchicine has slower onset of action
❅ If the Pt. is already taking allopurinol it
should be continued
❅ Rasburicase when other Rx can not be
given
156b
BADRAWY MRCP NOTES
Classical Rx
if ≥ 2 attacks of gout in 12 month
period
157a
BADRAWY MRCP NOTES
Classical Rx
❅ Allopurinol prophylaxis
157b
BADRAWY MRCP NOTES
Classical Rx
RA with joint inflammation
158a
BADRAWY MRCP NOTES
Classical Rx
❅ a combination DMARD ASAP
❅ Methotrexate is the most widely
used DMARD
❅ analgesia, physiotherapy &
surgery.
158b
BADRAWY MRCP NOTES
Classical Rx
RA with joint inflammation In
Pregnancy
159a
BADRAWY MRCP NOTES
Classical Rx
❅ Sulfasalazine (safe)
❅ Hydroxychloroquine (safe)
❅ Methotrexate & NSAIDs are
absolutely CI
❅ Azathiopurine can be given if the
above 2 are ineffective
159b
BADRAWY MRCP NOTES
Classical Rx
Adult Still's Disease
160a
BADRAWY MRCP NOTES
Classical Rx
❅ NSAIDs
❅ Steroids
❅ Methotrexate
160b
BADRAWY MRCP NOTES
Classical Rx
Septic Arthritis
161a
BADRAWY MRCP NOTES
Classical Rx
❅ Synovial fluid should be obtained
before starting Rx
❅ IV antibiotics
❅ Needle aspiration for
decompression
❅ Surgical drainage if frequent
needle aspiration is required
161b
BADRAWY MRCP NOTES
Classical Rx
Osteoarthritis
162a
BADRAWY MRCP NOTES
Classical Rx
❅ weight loss + muscle strengthening exercises
❅ Paracetamol & topical NSAIDs (only for OA of
the knee or hand) are 1st-line analgesics
❅ Second-line Rx is oral NSAIDs/cox-2
inhibitors (+ PPI), opioids, capsaicin cream &
intra-articular CST
❅ conservative methods fail ➜ joint replacement
162b
BADRAWY MRCP NOTES
Classical Rx
Reactive Arthritis
163a
BADRAWY MRCP NOTES
Classical Rx
❅ analgesia, NSAIDs, intra-
articular steroids
❅ Sulfasalazine & methotrexate for
persistent disease
❅ rarely last > 12 months
163b
BADRAWY MRCP NOTES
Classical Rx
Ankylosing Spondylitis
164a
BADRAWY MRCP NOTES
Classical Rx
❅ NSAIDs
❅ Physiotherapy
❅ Sulphasalazine ➜ in peripheral
joint involvement
❅ TNF-α blockers etanercept &
adalimumab if 2 NSAIDS fail
164b
BADRAWY MRCP NOTES
Classical Rx
Discoid Lupus Erythematous
165a
BADRAWY MRCP NOTES
Classical Rx
❅ Topical steroid cream
❅ Oral antimalarials (2nd line)
❅ Avoid sun exposure
165b
BADRAWY MRCP NOTES
Classical Rx
Temporal Arteritis
166a
BADRAWY MRCP NOTES
Classical Rx
❅ immediate ↑dose steroids ➜↓
the chance of visual loss.
❅ dramatic response should be
seen ➜if not ➜ consider another Dx
166b
BADRAWY MRCP NOTES
Classical Rx
Takayasu disease
167a
BADRAWY MRCP NOTES
Classical Rx
steroids ± steroid sparing
methotrexate or azathioprine
167b
BADRAWY MRCP NOTES
Classical Rx
Wegener's Granulomatosis
168a
BADRAWY MRCP NOTES
Classical Rx
❅ Steroids
❅ Plasma exchange
❅ Cyclophosphamide
168b
BADRAWY MRCP NOTES
Classical Rx
Thrombangiitis Obliterans
(Buerger's disease)
169a
BADRAWY MRCP NOTES
Classical Rx
❅ stop smoking
❅ supportive
169b
BADRAWY MRCP NOTES
Classical Rx
Antiphospholipid Syndrome Initial
venous thromboembolic events
170a
BADRAWY MRCP NOTES
Classical Rx
warfarin é a target INR of 2-3 for 6
months
170b
BADRAWY MRCP NOTES
Classical Rx
Antiphospholipid Syndrome
Recurrent venous thromboembolic
events
171a
BADRAWY MRCP NOTES
Classical Rx
lifelong warfarin if occurred while
taking warfarin ➜ ↑target INR to
3-4
171b
BADRAWY MRCP NOTES
Classical Rx
Antiphospholipid Syndrome
Arterial thrombosis
172a
BADRAWY MRCP NOTES
Classical Rx
lifelong warfarin é target INR 2-3
172b
BADRAWY MRCP NOTES
Classical Rx
Antiphospholipid Syndrome In
pregnancy
173a
BADRAWY MRCP NOTES
Classical Rx
❅ ↓ -dose aspirin
❅ LMWH ➜ D/C at 34 weeks
gestation
173b
BADRAWY MRCP NOTES
Classical Rx
Polymyalgia Rheumatica
174a
BADRAWY MRCP NOTES
Classical Rx
Prednisolone
174b
BADRAWY MRCP NOTES
Classical Rx
Cryoglobulinemia
175a
BADRAWY MRCP NOTES
Classical Rx
❅ Immunosuppression
❅ Plasmapheresis
175b
BADRAWY MRCP NOTES
Classical Rx
Raynaud's Phenomena
176a
BADRAWY MRCP NOTES
Classical Rx
❅ CCBs
❅ IV prostacyclin infusions
176b
BADRAWY MRCP NOTES
Classical Rx
Scleroderma renal crisis
177a
BADRAWY MRCP NOTES
Classical Rx
ACE-I to control BP & delay
progression to CRF
177b
BADRAWY MRCP NOTES
Classical Rx
Scleroderma
178a
BADRAWY MRCP NOTES
Classical Rx
❅ NSAIDs
❅ Limited benefit from steroids
❅ Raynaud's & Severe digital
ulceration ➜ CCBs &IV
prostacyclin infusions
178b
BADRAWY MRCP NOTES
Classical Rx
Active alveolitis
179a
BADRAWY MRCP NOTES
Classical Rx
cyclophosphamide + small dose of
steroids.
179b
BADRAWY MRCP NOTES
Classical Rx
Dermatomyositis
180a
BADRAWY MRCP NOTES
Classical Rx
steroids
180b
BADRAWY MRCP NOTES
Classical Rx
Familial Mediterranean Fever
181a
BADRAWY MRCP NOTES
Classical Rx
❅ Attacks are self-limiting, &
require analgesia
❅ Colchicine may ↓ attack
frequency
181b
BADRAWY MRCP NOTES
Classical Rx
Sjogren's syndrome
182a
BADRAWY MRCP NOTES
Classical Rx
❅ Artificial saliva & tears
❅ Pilocarpine
182b
BADRAWY MRCP NOTES
Classical Rx
HTN during pregnancy
183a
BADRAWY MRCP NOTES
Classical Rx
Methyldopa
183b
BADRAWY MRCP NOTES
Classical Rx
Bacteroides fragilis endocarditis
184a
BADRAWY MRCP NOTES
Classical Rx
Metronidazole
184b
BADRAWY MRCP NOTES
Classical Rx
Initial blind Rx for endocarditis
185a
BADRAWY MRCP NOTES
Classical Rx
❅ flucloxacillin + gentamicin
❅ (benzylpenicillin + gentamicin if
Sx less severe)
185b
BADRAWY MRCP NOTES
Classical Rx
Initial blind Rx if prosthetic valve
endocarditis or Pt. is penicillin
allergic
186a
BADRAWY MRCP NOTES
Classical Rx
vancomycin + rifampicin +
GENTAMICIN
186b
BADRAWY MRCP NOTES
Classical Rx
Endocarditis dt staphylococci
187a
BADRAWY MRCP NOTES
Classical Rx
flucloxacillin (vancomycin +
rifampicin if penicillin allergic or
MRSA)
187b
BADRAWY MRCP NOTES
Classical Rx
Endocarditis dt streptococci
188a
BADRAWY MRCP NOTES
Classical Rx
❅ benzylpenicillin + gentamicin
(vancomycin + GENTAMICIN if
penicillin allergic)
188b
BADRAWY MRCP NOTES
Classical Rx
Diastolic HF
189a
BADRAWY MRCP NOTES
Classical Rx
❅ diuretics
❅ ARBs are superior to ACE I
189b
BADRAWY MRCP NOTES
Classical Rx
Stable Angina
190a
BADRAWY MRCP NOTES
Classical Rx
β-blocker is the preferred initial Rx
190b
BADRAWY MRCP NOTES
Classical Rx
Prinzmetal angina
191a
BADRAWY MRCP NOTES
Classical Rx
dihydropyridine calcium channel
blocker (depine family;
amlodepine)
191b
BADRAWY MRCP NOTES
Classical Rx
Dressler's Syndrome
192a
BADRAWY MRCP NOTES
Classical Rx
❅ aspirin & analgesics
❅ CST &NSAIDS better avoided in
the 1st 4 weeks after MI
❅ If Recurrence ➜ colchicine
192b
BADRAWY MRCP NOTES
Classical Rx
the gold-standard Rx for STEMI
193a
BADRAWY MRCP NOTES
Classical Rx
Primary percutaneous coronary
intervention (PCI)
193b
BADRAWY MRCP NOTES
Classical Rx
antiplatelet Rx post-PCI
194a
BADRAWY MRCP NOTES
Classical Rx
❅ Aspirin should be continued
indefinitely
❅ clopidogrel Rx for at least 12
months
194b
BADRAWY MRCP NOTES
Classical Rx
SVT
195a
BADRAWY MRCP NOTES
Classical Rx
❅ Valsalva
❅ Adenosine 6mg ➜ 12mg ➜ 12mg
- CI in asthmatics - verapamil is a
preferable
❅ DC cardioversion
195b
BADRAWY MRCP NOTES
Classical Rx
Prevention of SVT
196a
BADRAWY MRCP NOTES
Classical Rx
❅ β-blockers
❅ Flecainide
❅ Radio-frequency ablation
196b
BADRAWY MRCP NOTES
Classical Rx
'holiday heart syndrome'
197a
BADRAWY MRCP NOTES
Classical Rx
No specific Rx is required
197b
BADRAWY MRCP NOTES
Classical Rx
HD stable Ventricular Tachycardia
198a
BADRAWY MRCP NOTES
Classical Rx
❅ Amiodarone
❅ Lidocaine
❅ Procainamide
198b
BADRAWY MRCP NOTES
Classical Rx
HD stable V Tach in Digoxin
Toxicity
199a
BADRAWY MRCP NOTES
Classical Rx
❅ lidocaine & phenytoin
❅ Avoid Amiodarone &
Procainamide (↑Toxicity)
❅ D/C shock when all measures
fail (but usu. unsuccessful)
199b
BADRAWY MRCP NOTES
Classical Rx
Torsades De Pointes
200a
BADRAWY MRCP NOTES
Classical Rx
❅ IV magnesium sulphate
❅ Correct K+ if hypo
❅ Override pacing
❅ D/C shock
200b
BADRAWY MRCP NOTES
Classical Rx
Multifocal Atrial Tachycardia
(MAT)
201a
BADRAWY MRCP NOTES
Classical Rx
❅ Rate-limiting CCBs are often
used 1st-line
❅ Correction of hypoxia &
electrolyte disturbances
❅ Cardioversion & digoxin are not
useful
201b
BADRAWY MRCP NOTES
Classical Rx
Bradycardia
202a
BADRAWY MRCP NOTES
Classical Rx
❅ Atropine is the 1st line
❅ potential risk of asystole ➜
transvenous pacing is indicated
202b
BADRAWY MRCP NOTES
Classical Rx
Long QT Syndrome
203a
BADRAWY MRCP NOTES
Classical Rx
❅ Avoid drugs which prolong QT
❅ Mg+ IV
❅ β-blockers (Propranolol) not sotalol
❅ ICD if β-blockers fail
❅ Left stellate sympathectomy (if β-
blockers fail or when there is multiple ICD
shocks)
203b
BADRAWY MRCP NOTES
Classical Rx
Arrhythmogenic Right Ventricular
Cardiomyopathy
204a
BADRAWY MRCP NOTES
Classical Rx
❅ sotalol is the most widely used
antiarrhythmic
❅ Catheter ablation
❅ ICD
204b
BADRAWY MRCP NOTES
Classical Rx
WPW
205a
BADRAWY MRCP NOTES
Classical Rx
❅ Definitive Rx: radiofrequency
ablation of the accessory pathway
❅ Medical Rx: sotalol, amiodarone,
flecainide
❅ cardioversion: Flecainide is
superior to Amiodarone
205b
BADRAWY MRCP NOTES
Classical Rx
Catecholaminergic polymorphic
ventricular tachycardia
206a
BADRAWY MRCP NOTES
Classical Rx
❅ β-blockers
❅ ICD
206b
BADRAWY MRCP NOTES
Classical Rx
Brugada syndrome
207a
BADRAWY MRCP NOTES
Classical Rx
❅ ICD
❅ Quinidine in VF storm ➜ (fast
repeated ICD shocks)
207b
BADRAWY MRCP NOTES
Classical Rx
HOCM
208a
BADRAWY MRCP NOTES
Classical Rx
❅ Amiodarone
❅ β-blockers or verapamil
❅ ICD
❅ Dual chamber pacemaker
❅ Endocarditis prophylaxis
208b
BADRAWY MRCP NOTES
Classical Rx
AS
209a
BADRAWY MRCP NOTES
Classical Rx
❅ AVR if symptomatic
❅ otherwise cut-off is gradient of
50 mmHg
209b
BADRAWY MRCP NOTES
Classical Rx
Prosthetic Valve Thrombosis
210a
BADRAWY MRCP NOTES
Classical Rx
❅ Thrombolytic Rx for Pts in
pulmonary edema or hypotension
(right-sided PVT)
❅ surgery is a better option for left-
sided PVT
❅ Serial echocardiography ➜ if no
response ➜ repeat thrombolytic Rx
210b
BADRAWY MRCP NOTES
Classical Rx
Aortic dissection Type A -
ascending aorta -
211a
BADRAWY MRCP NOTES
Classical Rx
control BP(IV labetalol) + surgery
211b
BADRAWY MRCP NOTES
Classical Rx
Aortic dissection Type B -
descending aorta
212a
BADRAWY MRCP NOTES
Classical Rx
control BP(IV labetalol)
212b
BADRAWY MRCP NOTES
Classical Rx
Primary Pulmonary HTN
213a
BADRAWY MRCP NOTES
Classical Rx
❅ Diuretics if right HF
❅ Anticoagulation
❅ Vasodilator Rx ➜ CCB, IV
PGs,bosentan
❅ Heart-lung transplant
213b
BADRAWY MRCP NOTES
Classical Rx
PDA want to closes the connection
214a
BADRAWY MRCP NOTES
Classical Rx
Indomethacin
214b
BADRAWY MRCP NOTES
Classical Rx
PDA want to keep the connection
till surgical repair of associated
another congenital heart defect
215a
BADRAWY MRCP NOTES
Classical Rx
prostaglandin E1
215b
BADRAWY MRCP NOTES
Classical Rx
Coarctation of the Aorta
216a
BADRAWY MRCP NOTES
Classical Rx
❅ Surgical repair
❅ even é repair sometimes
recurrence happen.
216b
BADRAWY MRCP NOTES
Classical Rx
Eisenmenger's Syndrome
217a
BADRAWY MRCP NOTES
Classical Rx
Heart-lung transplantation
217b
BADRAWY MRCP NOTES
Classical Rx
TOF
218a
BADRAWY MRCP NOTES
Classical Rx
❅ Surgical repair
❅ Cyanotic episodes ➜ β-blockers
to ↓ infundibular spasm
218b
BADRAWY MRCP NOTES
Classical Rx
Asthma Dx - if ↑probability of
asthma
219a
BADRAWY MRCP NOTES
Classical Rx
start Rx
219b
BADRAWY MRCP NOTES
Classical Rx
stepwise approach for Rx of stable
asthma ?
220a
BADRAWY MRCP NOTES
Classical Rx
〚1〛【Inhaled short-acting β2 agonist 】
〚2〛【Add inhaled steroid】➜beclometasone 400
〚3〛【Add inhaled long-acting β2 agonist】➜SALMETEROl
(LABA) ➜
◍ Benefit from LABA but control still inadequate➜ continue
LABA & ↑inhaled steroid to 800
◍ No response to LABA➜ stop LABA & ↑inhaled steroid to
800
〚4〛【 ↑inhaled steroid 】up to 2000 mcg/d ,± Leukotriene
✘, ,theophylline)
〚5〛【steroid tablet】+ Maintain ↑dose inhaled steroid at
2000
220b
BADRAWY MRCP NOTES
Classical Rx
Which Pt. should receive long-term
O₂ Rx (LTOT) ?
221a
BADRAWY MRCP NOTES
Classical Rx
pO2 of < 7.3 kPa or to those é a pO2
of 7.3 - 8 kPa + one of the following
▦ Secondary polycythaemia
▦ Nocturnal hypoxaemia
▦ Peripheral oedema
▦ Pulmonary HTN
221b
BADRAWY MRCP NOTES
Classical Rx
O₂ Rx of COPD Pts
222a
BADRAWY MRCP NOTES
Classical Rx
❅ Before the availability of blood
gases, use a 28% Venturi mask at 4
l/min & aim for an O₂ saturation of
88-92%
222b
BADRAWY MRCP NOTES
Classical Rx
Massive PE + hypotension
223a
BADRAWY MRCP NOTES
Classical Rx
thrombolysis
223b
BADRAWY MRCP NOTES
Classical Rx
Mycoplasma pneumoniae
224a
BADRAWY MRCP NOTES
Classical Rx
❅ Erythromycin/clarithromycin
❅ doxycycline are an alternative
224b
BADRAWY MRCP NOTES
Classical Rx
PCP
225a
BADRAWY MRCP NOTES
Classical Rx
❅ Co-trimoxazole
❅ IV pentamidine in severe cases
❅ Steroids if hypoxic (if pO2 <
9.3kPa)
225b
BADRAWY MRCP NOTES
Classical Rx
Legionella pneumonia
226a
BADRAWY MRCP NOTES
Classical Rx
erythromycin
226b
BADRAWY MRCP NOTES
Classical Rx
pneumothorax
227a
BADRAWY MRCP NOTES
Classical Rx
❂ Primary pneumothorax
❃【Rim of air < 2cm & the Pt. is NOT DYSPNIC】 ➜
discharge
❃【Otherwise aspiration】 ➜ fails ➜ (defined as > 2 cm or
still short of breath) ➜ a chest drain
❂ Secondary pneumothorax (including Asthmatics)
❃ Pt. > 50 y +rim of air > 2cm +dyspnic➜ chest drain
❃ Otherwise ➜ attempt aspiration ➜fails ➜ chest drain
admit for 24 h
227b
BADRAWY MRCP NOTES
Classical Rx
Small Cell Lung Cancer
228a
BADRAWY MRCP NOTES
Classical Rx
❅ Usu. metastatic disease by time
of Dx
❅ Chemotherapy (mainstay of Rx)
228b
BADRAWY MRCP NOTES
Classical Rx
Sarcoidosis
229a
BADRAWY MRCP NOTES
Classical Rx
remits without Rx in ≅ 2/3 of pts
229b
BADRAWY MRCP NOTES
Classical Rx
steroids in Sarcoidosis
230a
BADRAWY MRCP NOTES
Classical Rx
❅ Hypercalcemia
❅ Worsening lung function
❅ bilateral posterior uveitis
❅ Heart or neuro involvement
230b
BADRAWY MRCP NOTES
Classical Rx
bronchiectasis
231a
BADRAWY MRCP NOTES
Classical Rx
❅ Physical training in non-CF
bronchiectasis
❅ Postural drainage
❅ IV antibiotics for exacerbations
❅ nebulized ABX for long term
❅ Bronchodilators
❅ Immunisations
❅ Surgery in selected cases
231b
BADRAWY MRCP NOTES
Classical Rx
OSA
232a
BADRAWY MRCP NOTES
Classical Rx
❅ Weight loss
❅ CPAP is 1st line for moderate or
severe OSA
❅ Intra-oral devices if CPAP is not
tolerated or é mild OSA where
there is no daytime sleepiness
232b
BADRAWY MRCP NOTES
Classical Rx
Allergic bronchopulmonary
aspergillosis
233a
BADRAWY MRCP NOTES
Classical Rx
❅ Steroids ( ALLERGIC)
❅ Itraconazole is a 2nd line agent
233b
BADRAWY MRCP NOTES
Classical Rx
Pseudomonas aeruginosa
colonisation in CF
234a
BADRAWY MRCP NOTES
Classical Rx
Inhaled Tobramycin
234b
BADRAWY MRCP NOTES
Classical Rx
cystic fibrosis
235a
BADRAWY MRCP NOTES
Classical Rx
❅ Regular chest physiotherapy & postural
drainage
❅ ↑calorie diet, including ↑fat intake
❅ Vitamin supplementation
❅ Pancreatic enzyme supplements taken é
meals
❅ Heart & lung transplant
235b
BADRAWY MRCP NOTES
Classical Rx
first-line for pregnancy-induced
hypertension
236a
BADRAWY MRCP NOTES
Classical Rx
Labetalol
236b
BADRAWY MRCP NOTES
Classical Rx
Diarrhea dt Cryptosporidium in
HIV
237a
BADRAWY MRCP NOTES
Classical Rx
supportive therapy
237b
BADRAWY MRCP NOTES
Classical Rx
Diarrhea dt Mycobacterium avium
intracellulare in HIV
238a
BADRAWY MRCP NOTES
Classical Rx
rifampicin, ethambutol &
clarithromycin
238b
BADRAWY MRCP NOTES
Classical Rx
prophylaxis of contacts of
Meningitis
239a
BADRAWY MRCP NOTES
Classical Rx
❅ ciprofloxacin is the drug of
choice
❅ Rifampicin may be used
239b
BADRAWY MRCP NOTES
Classical Rx
Cellulitis
240a
BADRAWY MRCP NOTES
Classical Rx
❅ flucloxacillin 1st-line Rx
❅ Erythromycin in Pts allergic to
penicillin
❅ oral clindamycin in Rx failure
240b
BADRAWY MRCP NOTES
Classical Rx
Necrotising fasciitis
241a
BADRAWY MRCP NOTES
Classical Rx
❅ Urgent surgical debridement
❅ IV antibiotics
241b
BADRAWY MRCP NOTES
Classical Rx
Listeria monocytogenes infection
242a
BADRAWY MRCP NOTES
Classical Rx
❅ sensitive to
amoxicillin/ampicillin
❅ Insensitive to cephalosporins
242b
BADRAWY MRCP NOTES
Classical Rx
cutaneous anthrax
243a
BADRAWY MRCP NOTES
Classical Rx
ciprofloxacin
243b
BADRAWY MRCP NOTES
Classical Rx
Leptospirosis (Weil's disease)
244a
BADRAWY MRCP NOTES
Classical Rx
High-dose benzylpenicillin or
doxycycline
244b
BADRAWY MRCP NOTES
Classical Rx
standard Rx for active tuberculosis
245a
BADRAWY MRCP NOTES
Classical Rx
❅ Initial phase - 1st 2 months
(RIPE)
❅ Continuation phase - next 4
months (RI)
245b
BADRAWY MRCP NOTES
Classical Rx
Latent tuberculosis
246a
BADRAWY MRCP NOTES
Classical Rx
isoniazid alone for 6 months
246b
BADRAWY MRCP NOTES
Classical Rx
Meningeal tuberculosis
247a
BADRAWY MRCP NOTES
Classical Rx
prolonged period (at least 12
months) é the addition of steroids
247b
BADRAWY MRCP NOTES
Classical Rx
Pauci-bacillary leprosy (<5 lesions)
248a
BADRAWY MRCP NOTES
Classical Rx
rifampicin & dapsone for 6 months
248b
BADRAWY MRCP NOTES
Classical Rx
Multi-bacillary leprosy (>5 lesions)
249a
BADRAWY MRCP NOTES
Classical Rx
rifampicin, clofazimine & dapsone
for 12 months
249b
BADRAWY MRCP NOTES
Classical Rx
Uncomplicated falciparum malaria
250a
BADRAWY MRCP NOTES
Classical Rx
artemisinin-based combination
therapies are 1st-line Rx
250b
BADRAWY MRCP NOTES
Classical Rx
Severe falciparum malaria parasite
counts >2%
251a
BADRAWY MRCP NOTES
Classical Rx
IV artesunate preference to IV
quinine
251b
BADRAWY MRCP NOTES
Classical Rx
Severe falciparum malaria parasite
count > 10%
252a
BADRAWY MRCP NOTES
Classical Rx
exchange transfusion
252b
BADRAWY MRCP NOTES
Classical Rx
Non-falciparum malaria
253a
BADRAWY MRCP NOTES
Classical Rx
❅ almost always chloroquine
sensitive
❅ Primaquine in Plasmodium
vivax & Plasmodium ovale to
destroy
❅ liver hypnozoites
253b
BADRAWY MRCP NOTES
Classical Rx
Trypanosomiasis African (sleeping
sickness)
254a
BADRAWY MRCP NOTES
Classical Rx
❅ Early disease: IV pentamidine or
suramin
❅ Later disease or CNS
involvement: IV melarsoprol
254b
BADRAWY MRCP NOTES
Classical Rx
American Trypanosomiasis
(Chagas' disease)
255a
BADRAWY MRCP NOTES
Classical Rx
❅ acute phase using azole or
nitroderivatives ➜ benznidazole or
nifurtimox
❅ Chronic disease ➜ Rx the
complications e.g. HF
255b
BADRAWY MRCP NOTES
Classical Rx
Schistosomiasis
256a
BADRAWY MRCP NOTES
Classical Rx
Single oral dose of praziquantel
256b
BADRAWY MRCP NOTES
Classical Rx
Animal Bites
257a
BADRAWY MRCP NOTES
Classical Rx
❅ Cleanwound
❅ co-amoxiclav is DOCH
❅ penicillin-allergic ➜ doxycycline
+ metronidazole
257b
BADRAWY MRCP NOTES
Classical Rx
Chickenpox
258a
BADRAWY MRCP NOTES
Classical Rx
❅ Calamine lotion, Keep cool, trim nails
❅ School exclusion 5 days from start of
skin eruption until all lesions are crusted
❅ Immunocompromised Pts & newborns
➜ VZIG
❅ If chickenpox develops ➜ IV aciclovir
258b
BADRAWY MRCP NOTES
Classical Rx
Measles Rx of contacts
259a
BADRAWY MRCP NOTES
Classical Rx
❅ MMR give within 72 hours
❅ (vaccine-induced measles Ab
develops more rapidly than
infection)
259b
BADRAWY MRCP NOTES
Classical Rx
Gonorrhoea
260a
BADRAWY MRCP NOTES
Classical Rx
intramuscular ceftriaxone + oral
azithromycin
260b
BADRAWY MRCP NOTES
Classical Rx
Genital warts
261a
BADRAWY MRCP NOTES
Classical Rx
❅ Topical podophyllum
,cryotherapy are 1st-line Rxs
❅ Imiquimod 2nd line
261b
BADRAWY MRCP NOTES
Classical Rx
Herpes Gingivostomatitis
262a
BADRAWY MRCP NOTES
Classical Rx
❅ oral aciclovir
❅ chlorhexidine mouthwash
262b
BADRAWY MRCP NOTES
Classical Rx
Cold sores
263a
BADRAWY MRCP NOTES
Classical Rx
topical aciclovir
263b
BADRAWY MRCP NOTES
Classical Rx
Genital herpes
264a
BADRAWY MRCP NOTES
Classical Rx
oral aciclovir
264b
BADRAWY MRCP NOTES
Classical Rx
Bacterial vaginosis
265a
BADRAWY MRCP NOTES
Classical Rx
oral or topical metronidazole or
topical clindamycin
265b
BADRAWY MRCP NOTES
Classical Rx
Chlamydia
266a
BADRAWY MRCP NOTES
Classical Rx
❅ azithromycin (single dose) ➜ 1st-line
❅ Doxycycline (7 day) ➜ 2nd choice
❅ If pregnant ➜ erythromycin or amoxicillin
❅ symptomatic men ➜ partners from 4 weeks
should be contacted
❅ ♀& asymptomatic men ➜ partners from the
last 6 months
❅ test of cure following Rx.
266b
BADRAWY MRCP NOTES
Classical Rx
Asymptomatic bacteruria in
pregnant ♀
267a
BADRAWY MRCP NOTES
Classical Rx
amoxicillin or cephalosporin
267b
BADRAWY MRCP NOTES
Classical Rx
Toxoplasma Gondii
268a
BADRAWY MRCP NOTES
Classical Rx
Pyrimethamine + Sulphadiazine at
least 6 weeks
268b
BADRAWY MRCP NOTES
Classical Rx
Cholera
269a
BADRAWY MRCP NOTES
Classical Rx
❅ Oral rehydration Rx
❅ doxycycline, ciprofloxacin
269b
BADRAWY MRCP NOTES
Classical Rx
Giardiasis
270a
BADRAWY MRCP NOTES
Classical Rx
metronidazole
270b
BADRAWY MRCP NOTES
Classical Rx
Shigella
271a
BADRAWY MRCP NOTES
Classical Rx
ciprofloxacin
271b
BADRAWY MRCP NOTES
Classical Rx
Rocky Mountain Spotted Fever
272a
BADRAWY MRCP NOTES
Classical Rx
Doxycycline
272b
BADRAWY MRCP NOTES
Classical Rx
Mediterranean Spotted Fever
273a
BADRAWY MRCP NOTES
Classical Rx
Doxycycline
273b
BADRAWY MRCP NOTES
Classical Rx
Dengue fever
274a
BADRAWY MRCP NOTES
Classical Rx
symptomatic Rx
274b
BADRAWY MRCP NOTES
Classical Rx
Infectious mononucleosis
275a
BADRAWY MRCP NOTES
Classical Rx
❅ supportive
❅ avoid contact sports for 8 weeks
for fear of splenic rupture
275b
BADRAWY MRCP NOTES
Classical Rx
H1N1 influenza (Swine Flu)
276a
BADRAWY MRCP NOTES
Classical Rx
❅ Oseltamivir (Tamiflu) ➜ Oral
medication, neuraminidase (-)
❅ Zanamivir (Relenza) ➜ Inhaled
medication, neuraminidase (-)
276b
BADRAWY MRCP NOTES
Classical Rx
Nematodes
277a
BADRAWY MRCP NOTES
Classical Rx
❅ thiabendazole
❅ albendazole
❅ Ivermectin
277b
BADRAWY MRCP NOTES
Classical Rx
Cysticercosis
278a
BADRAWY MRCP NOTES
Classical Rx
niclosamide
278b
BADRAWY MRCP NOTES
Classical Rx
Hydatid disease
279a
BADRAWY MRCP NOTES
Classical Rx
albendazole
279b
BADRAWY MRCP NOTES
Classical Rx
erysipelas
280a
BADRAWY MRCP NOTES
Classical Rx
❅ Phenoxymethylpenicillin
❅ also in throat infections
(requiring antibiotics)
280b
BADRAWY MRCP NOTES
Classical Rx
long-term antiplatelet choice for
ischaemic stroke (no drug
allergies)
281a
BADRAWY MRCP NOTES
Classical Rx
clopidogrel (lifelong)
281b
BADRAWY MRCP NOTES
Classical Rx
Prophylaxis of variceal
haemorrhage , treatment of choice:
282a
BADRAWY MRCP NOTES
Classical Rx
propranolol
282b
BADRAWY MRCP NOTES
Classical Rx
long-term antiplatelet choice for
peripheral arterial disease (no drug
allergies)?
283a
BADRAWY MRCP NOTES
Classical Rx
clopidogrel (lifelong)
283b
BADRAWY MRCP NOTES
Classical Rx
long-term antiplatelet choice for
STEMI (no drug allergies)?
284a
BADRAWY MRCP NOTES
Classical Rx
aspirin (lifelong) & clopidogrel (1m
if no/bare stent, 12 m if drug-
eluting stent)
284b
BADRAWY MRCP NOTES
Classical Rx
newly diagnosed patient with
hypertension (> 55 years)?
285a
BADRAWY MRCP NOTES
Classical Rx
add a calcium channel blocker
285b
BADRAWY MRCP NOTES
Classical Rx
tricyclic antidepressant overdose?
286a
BADRAWY MRCP NOTES
Classical Rx
supportive, IV bicarbonate
286b
BADRAWY MRCP NOTES
Classical Rx
long-term antiplatelet choice for
ischaemic stroke (cannot take
clopidogrel)?
287a
BADRAWY MRCP NOTES
Classical Rx
Aspirin (lifelong) & dipyridamole
(lifelong)
287b
BADRAWY MRCP NOTES
Classical Rx
long-term antiplatelet choice for
TIA (cannot take clopidogrel)
288a
BADRAWY MRCP NOTES
Classical Rx
Aspirin (lifelong) & dipyridamole
(lifelong)
288b
BADRAWY MRCP NOTES
Classical Rx
peripheral arterial disease (cannot
take clopidogrel)
289a
BADRAWY MRCP NOTES
Classical Rx
Aspirin (lifelong)
289b
BADRAWY MRCP NOTES
Classical Rx
poorly controlled hypertension,
already taking an ACE inhibitor,
calcium channel blocker and a
thiazide diuretic. K+ > 4.5mmol/l?
290a
BADRAWY MRCP NOTES
Classical Rx
Increase dose of thiazide diuretic
290b
BADRAWY MRCP NOTES
Classical Rx
poorly controlled hypertension,
already taking an ACE inhibitor,
calcium channel blocker and a
thiazide diuretic. K+ < 4.5mmol/l?
291a
BADRAWY MRCP NOTES
Classical Rx
add spironolactone
291b
BADRAWY MRCP NOTES
Classical Rx
poorly controlled hypertension,
already taking an ACE inhibitor
and a calcium channel blocker ?
292a
BADRAWY MRCP NOTES
Classical Rx
Add a thiazide diuretic
292b
BADRAWY MRCP NOTES
Classical Rx
reduce the risk of developing pre-
eclampsia in high risk pts ? (HTN
during previous pregnancies, SLE
& Antiphospholipid, CKD,DM1 &2)
293a
BADRAWY MRCP NOTES
Classical Rx
Low-dose aspirin
293b
BADRAWY MRCP NOTES
Classical Rx
Eclampsia
294a
BADRAWY MRCP NOTES
Classical Rx
❅ Magnesium sulphate prevent seizures in
pre-eclampsia & Rx
seizures in eclampsia
❅ continue for 24 hours after last seizure or
delivery
❅ fluid restriction is essential
❅ monitor reflexes + respiratory rate while
on MgSO4
294b
BADRAWY MRCP NOTES
Classical Rx
Peripartum Cardiomyopathy
295a
BADRAWY MRCP NOTES
Classical Rx
❅ Mainstay of medical Rx is
digoxin & loop diuretics
❅ nitrates & dobutamine
❅ Heparin (during pregnancy) or
Warfarin (postpartum)
❅ Salt or Na+ restriction
295b
BADRAWY MRCP NOTES
Classical Rx
PCOS
296a
BADRAWY MRCP NOTES
Classical Rx
❅ Weight ↓
❅ Hirsuitism & acne ➜ COC
❅ Infertility ➜ clomifene most
effective Rx, Metformin
296b
BADRAWY MRCP NOTES
Classical Rx
PID
297a
BADRAWY MRCP NOTES
Classical Rx
❅ Oral ofloxacin + oral
metronidazole
or intramuscular ceftriaxone + oral
doxycycline + oral metronidazole
❅ intrauterine contraceptive devices
may be kept in in mild cases
297b
BADRAWY MRCP NOTES
Classical Rx
Polymorphic eruption of pregnancy
298a
BADRAWY MRCP NOTES
Classical Rx
❅ emollients
❅ topical steroids
❅ oral steroids
298b
BADRAWY MRCP NOTES
Classical Rx
Alopecia areata
299a
BADRAWY MRCP NOTES
Classical Rx
❅ Topical or intralesional CST
❅ Topical minoxidil
299b
BADRAWY MRCP NOTES
Classical Rx
Pyoderma Gangrenosum
300a
BADRAWY MRCP NOTES
Classical Rx
❅ oral steroids as 1st-line Rx
❅ topical & intralesional steroids
❅ Cyclosporin & infliximab in
difficult cases
300b
BADRAWY MRCP NOTES
Classical Rx
T2DM, inadequate control on
metformin, not at risk from
hypoglycaemia -
301a
BADRAWY MRCP NOTES
Classical Rx
add a sulfonylurea
301b
BADRAWY MRCP NOTES
Classical Rx
Warfarin overdose major bleeding
302a
BADRAWY MRCP NOTES
Classical Rx
Stop warfarin, give intravenous
vitamin K 5mg, prothrombin
complex concentrate
302b
BADRAWY MRCP NOTES
Classical Rx
Warfarin overdose INR > 8.0 (no
bleeding)
303a
BADRAWY MRCP NOTES
Classical Rx
❅ Stop warfarin, give oral vitamin
K 1-5mg, repeat dose of vitamin K
if INR high after 24 hours, restart
when INR < 5.0
303b
BADRAWY MRCP NOTES
Classical Rx
STEMI (allergy to aspirin) -
antiplatelets:
304a
BADRAWY MRCP NOTES
Classical Rx
clopidogrel (lifelong)
304b
BADRAWY MRCP NOTES
Classical Rx
Seborrhoeic dermatitis Scalp
disease Rx
305a
BADRAWY MRCP NOTES
Classical Rx
❅ zinc pyrithione ('Head &
Shoulders') & tar prareparations1st-
line
❅ second-line agent is ketoconazole
❅ Selenium sulphide & topical
corticosteroid
305b
BADRAWY MRCP NOTES
Classical Rx
Seborrhoeic dermatitis Face &
body Rx
306a
BADRAWY MRCP NOTES
Classical Rx
❅ Topical antifungals: e.g.
Ketoconazole
❅ Topical steroids
❅ short periods
306b
BADRAWY MRCP NOTES
Classical Rx
Venous Ulceration
307a
BADRAWY MRCP NOTES
Classical Rx
❅ Compression bandaging only Rx
shown real benefit
❅ Oral pentoxifylline
307b
BADRAWY MRCP NOTES
Classical Rx
Impetigo
308a
BADRAWY MRCP NOTES
Classical Rx
❅ topical fusidic acid 1st-line
❅ oral flucloxacillin / topical
mupirocin
308b
BADRAWY MRCP NOTES
Classical Rx
Actinic keratoses
309a
BADRAWY MRCP NOTES
Classical Rx
❅ Sun avoidance, sun cream
❅ Fluorouracil cream
❅ Topical diclofenac
❅ Topical imiquimod
❅ Cryotherapy
❅ Curettage
309b
BADRAWY MRCP NOTES
Classical Rx
Lichen Sclerosus
310a
BADRAWY MRCP NOTES
Classical Rx
Topical steroids & emollients
310b
BADRAWY MRCP NOTES
Classical Rx
Scabies
311a
BADRAWY MRCP NOTES
Classical Rx
❅ Permethrin 5% is 1st-line
❅ Malathion 0.5% is second-line
❅ Pruritus persists for up to 4-6 weeks
post eradication
❅ All household & close physical contacts
should be Rx
Launder, iron or tumble dry clothing,
bedding, towels
311b
BADRAWY MRCP NOTES
Classical Rx
Psoriasis Topical Rx
312a
BADRAWY MRCP NOTES
Classical Rx
❅ Simple emollients
❅ Coal tar
❅ Topical CST
❅ Calcipotriol
❅ Dithranol
312b
BADRAWY MRCP NOTES
Classical Rx
Flexural psoriasis
313a
BADRAWY MRCP NOTES
Classical Rx
❅ emollients
❅ topical steroids
313b
BADRAWY MRCP NOTES
Classical Rx
Phototherapy for psoriasis
314a
BADRAWY MRCP NOTES
Classical Rx
✰ Narrow band ultraviolet B light
is now the Rx of choice
✰ PUVA
✰ SEs: skin ageing, squamous cell
cancer (not melanoma)
314b
BADRAWY MRCP NOTES
Classical Rx
Systemic Rx for psoriasis
315a
BADRAWY MRCP NOTES
Classical Rx
✰ Methotrexate
✰ infliximab, etanercept &
adalimumab
✰ Cyclosporin
✰ Systemic retinoids
315b
BADRAWY MRCP NOTES
Classical Rx
Guttate psoriasis
316a
BADRAWY MRCP NOTES
Classical Rx
✰ resolve spontaneously within 2-3
months
✰ no firm evidence to support the use
of antibiotics
✰ Topical agents as per psoriasis
✰ phototherapy
✰ Tonsillectomy é recurrent episodes
316b
BADRAWY MRCP NOTES
Classical Rx
Toxic Epidermal Necrolysis (TEN)
317a
BADRAWY MRCP NOTES
Classical Rx
✰ Stop precipitating factor
✰ ICU admission
✰ IV IG are1st-line
✰ plasmapheresis
✰ Cyclosporin &
cyclophosphamide
317b
BADRAWY MRCP NOTES
Classical Rx
Keloid scars
318a
BADRAWY MRCP NOTES
Classical Rx
✰ Early keloids
✰ intra-lesional steroids e.g.
Triamcinolone
✰ Excision is sometimes required
318b
BADRAWY MRCP NOTES
Classical Rx
Eczema
319a
BADRAWY MRCP NOTES
Classical Rx
✰ Topical steroids
✰ moderate: Clobetasone butyrate
✰ potent: Betamethasone valerate
✰ very potent: Clobetasol
propionate
319b
BADRAWY MRCP NOTES
Classical Rx
Pompholyx
320a
BADRAWY MRCP NOTES
Classical Rx
✰ Cool compresses
✰ Emollients
✰ Topical steroids
320b
BADRAWY MRCP NOTES
Classical Rx
Pityriasis rosea
321a
BADRAWY MRCP NOTES
Classical Rx
Self-limiting, usu. disappears after
4-6 weeks
321b
BADRAWY MRCP NOTES
Classical Rx
Pityriasis Versicolor
322a
BADRAWY MRCP NOTES
Classical Rx
✰ Topical antifungal ➜ Terbinafine
or selenium sulphide
✰ If extensive disease ➜ oral
itraconazole
322b
BADRAWY MRCP NOTES
Classical Rx
Acne Rosacea
323a
BADRAWY MRCP NOTES
Classical Rx
✰ Topical metronidazole ➜ for mild Sx
✰ severe disease ➜ systemic antibiotics ➜
Oxytetracycline
✰ high-factor sunscreen
✰ Camouflage creams
✰ Laser Rx in Pts é prominent
telangiectasia
323b
BADRAWY MRCP NOTES
Classical Rx
Acne vulgaris
324a
BADRAWY MRCP NOTES
Classical Rx
✰ Single topical Rx (topical retinoids,
benzyl peroxide)
✰ Topical combination Rx (topical
antibiotic, benzoyl peroxide, topical
retinoid)
✰ Oral antibiotics: e.g. Oxytetracycline
✰ Oral isotretinoin in severe non
responsive cases
324b
BADRAWY MRCP NOTES
Classical Rx
Bullous pemphigoid
325a
BADRAWY MRCP NOTES
Classical Rx
✰ Oral CST are the mainstay of Rx
✰ Topical CST,
immunosuppressants & antibiotics
325b
BADRAWY MRCP NOTES
Classical Rx
Pemphigus vulgaris
326a
BADRAWY MRCP NOTES
Classical Rx
✰ Oral CST
✰ Immunosuppressants
326b
BADRAWY MRCP NOTES
Classical Rx
Dermatitis herpetiformis
327a
BADRAWY MRCP NOTES
Classical Rx
✰ Gluten-free diet
✰ Dapsone
327b
BADRAWY MRCP NOTES
Classical Rx
Porphyria Cutanea Tarda
328a
BADRAWY MRCP NOTES
Classical Rx
✰ Chloroquine
✰ Venesection
328b
BADRAWY MRCP NOTES
Classical Rx
Tinea corporis
329a
BADRAWY MRCP NOTES
Classical Rx
oral fluconazole
329b
BADRAWY MRCP NOTES
Classical Rx
Hirsuitism & Hypertrichosis
330a
BADRAWY MRCP NOTES
Classical Rx
✰ weight loss if overweight
✰ Cosmetic techniques as
waxing/bleaching
330b
BADRAWY MRCP NOTES
Classical Rx
Fungal nail infections
331a
BADRAWY MRCP NOTES
Classical Rx
✰ Dermatophyte infection: oral terbinafine 1st-
line
✰ oral itraconazole as an alternative
✰ 6 weeks Rx for fingernail,12 weeks Rx for
toenails
✰ Candida infection ➜ mild disease ➜ topical
antifungals (Amorolfine)
✰ severe infections ➜ oral itraconazole for 12
weeks
331b
BADRAWY MRCP NOTES
Classical Rx
Seasonal affective disorder
332a
BADRAWY MRCP NOTES
Classical Rx
Bright light Rx
332b
BADRAWY MRCP NOTES
Classical Rx
PTSD
333a
BADRAWY MRCP NOTES
Classical Rx
✰ CBT ,eye movement
desensitisation & reprocessing
(EMDR)
✰ Drug Rx ➜ paroxetine or
mirtazapine
333b
BADRAWY MRCP NOTES
Classical Rx
Sleep paralysis
334a
BADRAWY MRCP NOTES
Classical Rx
clonazepam
334b
BADRAWY MRCP NOTES
Classical Rx
Alcohol withdrawal
335a
BADRAWY MRCP NOTES
Classical Rx
✰ Benzodiazepines
✰ Carbamazepine
335b
BADRAWY MRCP NOTES
Classical Rx
Bulimia nervosa
336a
BADRAWY MRCP NOTES
Classical Rx
✰ CBT 1st-line Rx
✰ Interpersonal psychotherapy
✰ high-dose fluoxetine
336b
BADRAWY MRCP NOTES
Classical Rx
Chronic Fatigue Syndrome
337a
BADRAWY MRCP NOTES
Classical Rx
✰ CBT
✰ Graded exercise
✰ amitriptyline ➜ useful for poor
sleep
337b
BADRAWY MRCP NOTES
Classical Rx
Restless legs syndrome
338a
BADRAWY MRCP NOTES
Classical Rx
✰ Dopamine agonists are 1st-line
(Ropinirole, Pramipexole)
✰ Benzodiazepines
✰ Gabapentin
338b
BADRAWY MRCP NOTES
Classical Rx
depression:
339a
BADRAWY MRCP NOTES
Classical Rx
✰ SSRIs are 1st-line Rx
✰ Citlopram : Curved back (
elderly )
✰ Floxetine : Fetus ( preganancy )
✰ Sertaline : Stress ( MI )
✰ Paroxetine : PTSD
339b
BADRAWY MRCP NOTES
Classical Rx
Neuroleptic Malignant Syndrome
340a
BADRAWY MRCP NOTES
Classical Rx
✰ Stop antipsychotic
✰ IV fluids
✰ Dantrolene
✰ Bromocriptine
340b
BADRAWY MRCP NOTES
Classical Rx
Macular degeneration General Rx
341a
BADRAWY MRCP NOTES
Classical Rx
✰ Stop smoking
✰ ↑does of β-carotene, vitamins C
& E, & zinc
341b
BADRAWY MRCP NOTES
Classical Rx
Dry macular degeneration
342a
BADRAWY MRCP NOTES
Classical Rx
no current medical Rxs
342b
BADRAWY MRCP NOTES
Classical Rx
Wet macular degeneration
343a
BADRAWY MRCP NOTES
Classical Rx
✰ Photocoagulation
✰ Photodynamic Rx
✰ intravitreal ranibizumab
343b
BADRAWY MRCP NOTES
Classical Rx
acute angle closure glaucoma
344a
BADRAWY MRCP NOTES
Classical Rx
acetazolamide + pilocarpine
344b
BADRAWY MRCP NOTES
Classical Rx
Dacryocystitis Lacrimal Glands
problems
345a
BADRAWY MRCP NOTES
Classical Rx
✰ systemic antibiotics. (IV
antibiotics are indicated if there is
associated periorbital cellulitis)
345b
BADRAWY MRCP NOTES
Classical Rx
Blepharitis
346a
BADRAWY MRCP NOTES
Classical Rx
✰ hot compresses
✰ Mechanical removal of the
debris
✰ Artificial tears
346b
BADRAWY MRCP NOTES
Classical Rx
Thyroid eye disease
347a
BADRAWY MRCP NOTES
Classical Rx
✰ Topical lubricants
✰ Steroids
✰ Radiotherapy
✰ Surgery
347b
BADRAWY MRCP NOTES
Classical Rx
Herpes Zoster Ophthalmicus
348a
BADRAWY MRCP NOTES
Classical Rx
✰ Oral antiviral Rx
✰ Oral CST
✰ urgent ophthalmology review
348b
BADRAWY MRCP NOTES
Classical Rx
Herpes Simplex Keratitis
349a
BADRAWY MRCP NOTES
Classical Rx
✰ Topical acyclovir
✰ Immediate referral to an
ophthalmologist
349b
BADRAWY MRCP NOTES
Classical Rx
Paracetamol Overdose
350a
BADRAWY MRCP NOTES
Classical Rx
N-acetyl cysteine
350b
BADRAWY MRCP NOTES
Classical Rx
Digoxin Toxicity
351a
BADRAWY MRCP NOTES
Classical Rx
Digibind
351b
BADRAWY MRCP NOTES
Classical Rx
Cyanide
352a
BADRAWY MRCP NOTES
Classical Rx
✰ 100% O₂
✰ IV dicobalt edetate
352b
BADRAWY MRCP NOTES
Classical Rx
Ethylene glycol toxicity
353a
BADRAWY MRCP NOTES
Classical Rx
✰ fomepizole
✰ ethanol
✰ hemodialysis
353b
BADRAWY MRCP NOTES
Classical Rx
Mercury
354a
BADRAWY MRCP NOTES
Classical Rx
✰ DMSA
✰ penicillamine
354b
BADRAWY MRCP NOTES
Classical Rx
Lead Poisoning
355a
BADRAWY MRCP NOTES
Classical Rx
✰ DMSA
✰ penicillamine
355b
BADRAWY MRCP NOTES
Classical Rx
Carbon Monoxide
356a
BADRAWY MRCP NOTES
Classical Rx
✰ 100% O₂
✰ Hyperbaric O₂
356b
BADRAWY MRCP NOTES
Classical Rx
Oculogyric Crisis
357a
BADRAWY MRCP NOTES
Classical Rx
✰ Procyclidine
✰ Benztropine
357b
BADRAWY MRCP NOTES
Classical Rx
intractable hiccups in palliative
care
358a
BADRAWY MRCP NOTES
Classical Rx
Chlorpromazine
358b
BADRAWY MRCP NOTES
Classical Rx
Lithium toxicity
359a
BADRAWY MRCP NOTES
Classical Rx
✰ Mild-moderate toxicity normal
saline
✰ Hemodialysis
359b
BADRAWY MRCP NOTES
Classical Rx
organophosphate poisoning
360a
BADRAWY MRCP NOTES
Classical Rx
✰ Atropine
✰ pralidoxime
360b
BADRAWY MRCP NOTES
Classical Rx
β-blocker overdose
361a
BADRAWY MRCP NOTES
Classical Rx
✰ atropine
✰ glucagon
✰ Transvenous pacing for Pts
unresponsive to glucagon
361b
BADRAWY MRCP NOTES
Classical Rx
Vasomotor Sx such as flushing,
insomnia & headaches
362a
BADRAWY MRCP NOTES
Classical Rx
HRT
362b
BADRAWY MRCP NOTES
Classical Rx
estrogen receptor +Ve breast
cancer
363a
BADRAWY MRCP NOTES
Classical Rx
Tamoxifen
363b
BADRAWY MRCP NOTES
Classical Rx
Prevention & Rx of osteoporosis
Hypercalcemia
Paget's disease
Pain from bone metatases
364a
BADRAWY MRCP NOTES
Classical Rx
Bisphosphonates
364b
BADRAWY MRCP NOTES
Classical Rx
Theophylline poisoning
365a
BADRAWY MRCP NOTES
Classical Rx
✰ Activated charcoal
✰ Charcoal hemoperfusion is
preferable to hemodialysis
365b
BADRAWY MRCP NOTES
Classical Rx
resistant diarrhoea in Crohn's
disease
366a
BADRAWY MRCP NOTES
Classical Rx
Cholestyramine
366b
BADRAWY MRCP NOTES
Classical Rx
Newly diagnosed patient of Afro-
Caribbean origin with hypertension
-
367a
BADRAWY MRCP NOTES
Classical Rx
add a calcium channel blocker
367b
BADRAWY MRCP NOTES
Classical Rx
Moderate-severe acne rosacea ,
treatment of choice:
368a
BADRAWY MRCP NOTES
Classical Rx
oral oxytetracycline
368b
BADRAWY MRCP NOTES
Classical Rx
exacerbations of chronic bronchitis
369a
BADRAWY MRCP NOTES
Classical Rx
Amoxicillin or tetracycline or
clarithromycin
369b
BADRAWY MRCP NOTES
Classical Rx
poorly controlled hypertension,
already taking an ACE inhibitor?
370a
BADRAWY MRCP NOTES
Classical Rx
add a calcium channel blocker
370b
BADRAWY MRCP NOTES
Classical Rx
otitis media (requiring antibiotics)
371a
BADRAWY MRCP NOTES
Classical Rx
Amoxicillin
371b
BADRAWY MRCP NOTES
Classical Rx
pelvic inflammatory disease
372a
BADRAWY MRCP NOTES
Classical Rx
✰ Oral ofloxacin + oral
metronidazole or intramuscular
ceftriaxone + ✰ oral doxycycline +
oral metronidazole
372b
BADRAWY MRCP NOTES
Classical Rx
Prophylaxis against calcium renal
stones , treatment of choice:
373a
BADRAWY MRCP NOTES
Classical Rx
a thiazide
373b
BADRAWY MRCP NOTES
Classical Rx
Newly diagnosed T2DM, failed trial
of lifestyle interventions
374a
BADRAWY MRCP NOTES
Classical Rx
add metformin
374b
BADRAWY MRCP NOTES
Classical Rx
Step 5 asthma management in
adults -
375a
BADRAWY MRCP NOTES
Classical Rx
use daily steroid tablet. Refer
patient for specialist care
375b
BADRAWY MRCP NOTES
Classical Rx
warfarin overdose, INR 5.0-8.0
(minor bleeding) -
376a
BADRAWY MRCP NOTES
Classical Rx
stop warfarin, give intravenous
vitamin K 1-3mg, restart when INR
< 5.0
376b
BADRAWY MRCP NOTES
Classical Rx
Syphilis -
377a
BADRAWY MRCP NOTES
Classical Rx
benzylpenicillin
377b
BADRAWY MRCP NOTES
Classical Rx
first-line treatment for lower
urinary tract infection?
378a
BADRAWY MRCP NOTES
Classical Rx
Trimethoprim or nitrofurantoin
378b
BADRAWY MRCP NOTES
Classical Rx
Cytomegalovirus retinitis ,
treatment of choice:
379a
BADRAWY MRCP NOTES
Classical Rx
intravenous ganciclovir
379b
BADRAWY MRCP NOTES
Classical Rx
Refractory diarrhoea
380a
BADRAWY MRCP NOTES
Classical Rx
✰ octreotide
✰ diphenoxylate
✰ loperamide
380b
BADRAWY MRCP NOTES
Classical Rx
Warfarin overdose INR > 8.0
(minor bleeding)
381a
BADRAWY MRCP NOTES
Classical Rx
✰ Stop warfarin, give intravenous
vitamin K 1-3mg, repeat dose of
vitamin K if INR high after 24
hours, restart when INR < 5.0
381b
BADRAWY MRCP NOTES
Classical Rx
T2DM, inadequate control on
metformin, at risk from
consequences of hypoglycaemia -
382a
BADRAWY MRCP NOTES
Classical Rx
add a DPP-4 inhibitor or a
thiazolidinedione
382b
BADRAWY MRCP NOTES
Classical Rx
tension-type headache prophylaxis
383a
BADRAWY MRCP NOTES
Classical Rx
Acupuncture
383b
BADRAWY MRCP NOTES
Classical Rx
ischaemic stroke (cannot take
clopidogrel)
384a
BADRAWY MRCP NOTES
Classical Rx
Aspirin (lifelong) & dipyridamole
(lifelong)
384b
BADRAWY MRCP NOTES
Classical Rx
TIA (cannot take clopidogrel)
385a
BADRAWY MRCP NOTES
Classical Rx
Aspirin (lifelong) & dipyridamole
(lifelong)
385b
BADRAWY MRCP NOTES
Classical Rx
initial empirical therapy of
meningitis (aged < 3 months)?
386a
BADRAWY MRCP NOTES
Classical Rx
Intravenous cefotaxime +
amoxicillin
386b
BADRAWY MRCP NOTES
Classical Rx
initial empirical therapy of
meningitis (aged > 50 years) ?
387a
BADRAWY MRCP NOTES
Classical Rx
Intravenous cefotaxime +
amoxicillin
387b
BADRAWY MRCP NOTES
Classical Rx
initial empirical therapy of
meningitis (aged 3 months - 50
years) ?
388a
BADRAWY MRCP NOTES
Classical Rx
Intravenous cefotaxime
388b
BADRAWY MRCP NOTES
Classical Rx
initial blind therapy of infective
endocarditis (native valve)
389a
BADRAWY MRCP NOTES
Classical Rx
Amoxicillin, consider adding low-
dose gentamicin
389b
BADRAWY MRCP NOTES
Classical Rx
acute prostatitis
390a
BADRAWY MRCP NOTES
Classical Rx
Quinolone or trimethoprim
390b
BADRAWY MRCP NOTES
Classical Rx
prophylaxis against menstrual
migraine
391a
BADRAWY MRCP NOTES
Classical Rx
Frovatriptan or zolmitriptan
391b
BADRAWY MRCP NOTES
Classical Rx
initial blind therapy of infective
endocarditis (prosthetic valve)
392a
BADRAWY MRCP NOTES
Classical Rx
Vancomycin + rifampicin + low-
dose gentamicin
392b
BADRAWY MRCP NOTES
Classical Rx
endocarditis caused by fully-
sensitive streptococci (e.g.
viridans)
393a
BADRAWY MRCP NOTES
Classical Rx
Benzylpenicillin
393b
BADRAWY MRCP NOTES
Classical Rx
benign paroxysmal positional
vertigo
394a
BADRAWY MRCP NOTES
Classical Rx
Epley manoeuvre
394b
BADRAWY MRCP NOTES
Classical Rx
essential thrombocytosis
395a
BADRAWY MRCP NOTES
Classical Rx
Hydroxyurea
395b
BADRAWY MRCP NOTES
Classical Rx
Prophylaxis of Mycobacterium
avium complex in HIV
396a
BADRAWY MRCP NOTES
Classical Rx
✰ azithromycin
✰ clarithromycin
396b
BADRAWY MRCP NOTES
Classical Rx
Warfarin overdose,INR 5.0-8.0 (no
bleeding)
397a
BADRAWY MRCP NOTES
Classical Rx
Withhold 1 or 2 doses of warfarin,
reduce subsequent maintenance
dose
397b
BADRAWY MRCP NOTES
Classical Rx
Initial blind therapy of infective
endocarditis (native valve,
penicillin allergic)
398a
BADRAWY MRCP NOTES
Classical Rx
vancomycin + low-dose gentamicin
398b
BADRAWY MRCP NOTES
Classical Rx
Strongyloides stercoralis
399a
BADRAWY MRCP NOTES
Classical Rx
Ivermectin
399b
BADRAWY MRCP NOTES
Classical Rx
Primary sclerosing cholangitis
400a
BADRAWY MRCP NOTES
Classical Rx
✰ no effective drug can retard the progression
✰ Fat-soluble vitamin supplementation
✰ Antibiotic prophylaxis during ERCP to reduce
the risk of bacterial
✰ cholangitis. Ciprofloxacin is DOCH
✰ Biliary stenting
✰ definitive treatment for PSC is hepatic
transplantation
400b
BADRAWY MRCP NOTES
Classical Rx

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