More Related Content More from Sherif Elbadrawy More from Sherif Elbadrawy (16) Classical Rx mrcp3. ▦ normal saline
▦ bisphosphonates
▦ Steroids in sarcoidosis
▦ lasix only if can't take fluids
1b
BADRAWY MRCP NOTES
Classical Rx
9. ▦ Acute: IV C1 inhibitor or
concentrate or FFP
▦ Anabolic steroid; Danazol
4b
BADRAWY MRCP NOTES
Classical Rx
11. ▦ haloperidol 0.5 mg (DOCH)
then lorazepam
▦ later Rx cause, Modification of
environment
5b
BADRAWY MRCP NOTES
Classical Rx
15. ▦ hyoscine is the most effective Rx
but limited use dt SEs
▦ cyclizine or cinnarizine (Non-
sedating antihistamines )
7b
BADRAWY MRCP NOTES
Classical Rx
19. ▦ autologous BM transplants
▦ or chemotherapy bortezomib &
dexamethasone
9b
BADRAWY MRCP NOTES
Classical Rx
27. ▦ No smoking
▦ IV α1-antitrypsin protein
concentrates
▦ volume ↓ surgery, lung
transplantation
13b
BADRAWY MRCP NOTES
Classical Rx
37. ▦ Weight loss
▦ Acetazolamide
▦ CST
▦ Repeated lumbar puncture
▦ optic nerve sheath
decompression
18b
BADRAWY MRCP NOTES
Classical Rx
40. NSTEMI (no drug allergies) -
antiplatelets:
20a
BADRAWY MRCP NOTES
Classical Rx
58. When to start Rx for Parkinsonism
29a
BADRAWY MRCP NOTES
Classical Rx
59. delay Rx until the onset of
disabling Sx
29b
BADRAWY MRCP NOTES
Classical Rx
60. Drugs used to Rx Parkinsonism
30a
BADRAWY MRCP NOTES
Classical Rx
61. ✾ 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
67. ▦ Propranolol is 1st-line
▦ Primidone when propanolol is
CI
33b
BADRAWY MRCP NOTES
Classical Rx
69. ▦ DONEPEZIL (galantamine &
rivastigmine) ➜ ACH inhibitors
▦ Memantine ➜ moderate - severe
Alzheimer's.
34b
BADRAWY MRCP NOTES
Classical Rx
71. ▦ Haloperidol ➜ 1st-line
▦ Tetrabenazine long-term Rx
35b
BADRAWY MRCP NOTES
Classical Rx
73. ▦ prednisolone within 72 hours of
onset
▦ Eye care
▦ aciclovir gives no additional
benefit
36b
BADRAWY MRCP NOTES
Classical Rx
75. ▦ 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
81. ✺ Rx of underlying cancer
✺ prednisolone and/or
azathioprine
✺ Plasmapheresis, IV Igs
40b
BADRAWY MRCP NOTES
Classical Rx
85. ✺ Plasma exchange
✺ IV Igs
✺ FVC regularly to monitor
respiratory function
✺ Steroids & immunosuppressants
➜ NO BENIFIT
42b
BADRAWY MRCP NOTES
Classical Rx
95. ✺ oral duloxetine 1st-line
✺ Oral amitriptyline if duloxetine
is CI
47b
BADRAWY MRCP NOTES
Classical Rx
97. ✺ 100% O₂
✺ subcutaneous sumatriptan (5-
HT1D receptor agonist)
✺ nasal lidocaine
48b
BADRAWY MRCP NOTES
Classical Rx
103. ✺ 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
105. ✺ β-blockers ➜ 1st-line ➜
propranolol
✺ Topiramate
52b
BADRAWY MRCP NOTES
Classical Rx
107. ✺ Paracetamol is 1st-line
✺ If Pt has migraine é aura ➜ COC
is absolutely CI dt risk of stroke
53b
BADRAWY MRCP NOTES
Classical Rx
109. ✺ Supportive initially (analgesia,
rest)
✺ if > 72 hours blood patch,
epidural saline & IV caffeine
54b
BADRAWY MRCP NOTES
Classical Rx
115. ✺ Rx cause
✺ Pyridoxine
57b
BADRAWY MRCP NOTES
Classical Rx
119. ✺ Blood product replacement
✺ Anticoagulation
✺ Eculizumab ➜ a monoclonal Ab
✺ Stem cell transplantation
59b
BADRAWY MRCP NOTES
Classical Rx
121. ✺ Venesection - 1st line
✺ Hydroxyurea
✺ Allopurinol & Phosphorus-32
60b
BADRAWY MRCP NOTES
Classical Rx
123. ✺ < 5% blasts in the BM ➜
conservative Rx
✺ ↑WBC ➜ gentle chemotherapy
✺ < 60 years old ➜ Intensive
chemotherapy
61b
BADRAWY MRCP NOTES
Classical Rx
125. ✺ Imatinib ➜ tyrosine kinase
inhibitor
✺ Interferon- α
✺ Hydroxyurea
✺ Allogenic BM transplant
(optimum Rx)
62b
BADRAWY MRCP NOTES
Classical Rx
127. 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
131. ✺ 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
133. ✺ Only when indicated
✺ Chlorambucil
✺ fludarabine
✺ PCP prophylaxis (co-
trimoxazole)
66b
BADRAWY MRCP NOTES
Classical Rx
135. ✺ cladribine, pentostatin ➜ 1st-line
✺ rituximab, interferon-α ➜ 2nd
line
✺ Splenectomy
67b
BADRAWY MRCP NOTES
Classical Rx
137. ✺ Early (I & II) ➜ radiatiotherapy
& chemotherapy
✺ Late (III & IV) ➜ chemotherapy
alone
✺ Large mass in the chest ➜
radiatiotherapy & chemotherapy
68b
BADRAWY MRCP NOTES
Classical Rx
143. ✺ ↑dose CST + Steroid sparing
agents (cyclophosphamide or
azathioprine)
71b
BADRAWY MRCP NOTES
Classical Rx
145. ✺ Thromboembolic events lifelong
warfarinisation
✺ Heparinisation during
pregnancy
✺ Antithrombin III concentrates
(surgery or childbirth)
72b
BADRAWY MRCP NOTES
Classical Rx
149. ✺ CST
✺ Splenectomy if platelets < 30
after 3 months of steroid
✺ IV Igs
✺ Cyclophosphamide
74b
BADRAWY MRCP NOTES
Classical Rx
151. ✺ Plasma exchange is the Rx of
choice
✺ Steroids, immunosuppressants
✺ Vincristine
75b
BADRAWY MRCP NOTES
Classical Rx
153. ✺ Stop Heparin
✺ alternative anticoagulant
(Danaparoid,,Lepirudin
,Argatroban)
76b
BADRAWY MRCP NOTES
Classical Rx
155. ✺ doxorubicin if young
✺ rituximab
✺ chlorambucil, cyclophosphamide
✺ CST
✺ Plasmapheresis if hyperviscosity
77b
BADRAWY MRCP NOTES
Classical Rx
159. ✿ ATDs ➜ carbimazole
✿ Propranolol
✿ radioiodine & surgery
79b
BADRAWY MRCP NOTES
Classical Rx
161. ✿ Radioiodine
✿ Subtotal thyroidectomy
✿ In pregnancy ➜ medical Rx ➜ if
failed ➜ subtotal thyroidectomy
80b
BADRAWY MRCP NOTES
Classical Rx
163. ✿ Paracetamol
✿ ATDs ➜ Methimazole or
propylthiouracil
✿ Lugol's iodine
✿ Dexamethasone
✿ Propranolol
81b
BADRAWY MRCP NOTES
Classical Rx
165. ✿ Usu. self-limiting don't require
Rx
✿ NSAIDs
✿ steroids esp. if hypothyroidism
82b
BADRAWY MRCP NOTES
Classical Rx
169. ✿ 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
171. ✿ IV Fluids
✿ Total parathyroidectomy
✿ Bisphosphonates
85b
BADRAWY MRCP NOTES
Classical Rx
177. ✿ Weight loss if BMI > 27
✿ Stop oral hypoglycaemic (Can
use metformin) & start insulin
✿ Folic acid 5 mg/day
88b
BADRAWY MRCP NOTES
Classical Rx
181. ✿ Na+ restriction
✿ Adrenal adenoma: surgery
✿ Bilateral adrenocortical
hyperplasia ➜ Spironolactone
90b
BADRAWY MRCP NOTES
Classical Rx
185. ✿ 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
187. ✿ 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
193. ✿ ORAL metronidazole
✿ ORAL vancomycin
✿ For life-threatening infections ➜
IV metronidazole + ORAL
vancomycin
96b
BADRAWY MRCP NOTES
Classical Rx
195. ✿ FFP, vitamin K
✿ terlipressin (DOCH) ➜ if IHD ➜
Octreotide
✿ Endoscopic variceal band
ligation
97b
BADRAWY MRCP NOTES
Classical Rx
197. ✿ ↓grade dysplasia ➜ high-dose
PPI
✿ ↑grade dysplasia: surgery or
cryotherapy.
98b
BADRAWY MRCP NOTES
Classical Rx
199. ✿ botulinum toxin intrasphincteric
✿ Heller cardiomyotomy
✿ Balloon dilation
99b
BADRAWY MRCP NOTES
Classical Rx
201. ✿ PPI + amoxicillin +
clarithromycin, or
✿ PPI + metronidazole +
clarithromycin
100b
BADRAWY MRCP NOTES
Classical Rx
207. ✿ Pancreatic enzyme supplements
✿ Analgesia
✿ Antioxidants
103b
BADRAWY MRCP NOTES
Classical Rx
209. ✿ Small pseudocysts ➜ resolve
spontaneously
✿ > 6cm ➜ endoscopic or
percutanous drainage
104b
BADRAWY MRCP NOTES
Classical Rx
211. ✿ Inducing remission by rectal
mesalazine
✿ then Oral aminosalicylates or
steroids
105b
BADRAWY MRCP NOTES
Classical Rx
215. ✿ IV steroids, fluids, subcutaneous
heparin & elemental diet
107b
BADRAWY MRCP NOTES
Classical Rx
217. ✿ 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
223. ✿ 1st-line ➜ Pain: antispasmodic
✿ Constipation: laxatives
✿ Diarrhea: loperamide
✿ 2nd line TCA ➜ amitriptyline
✿ Resistant ➜ CBT,hypnotherapy or
psychological Rx
111b
BADRAWY MRCP NOTES
Classical Rx
225. ✿ gluten-free diet avoid ➜
Wheat,Barley (beer),Rye ± Oats
112b
BADRAWY MRCP NOTES
Classical Rx
229. ✿ IV & rectal hydrocortisone ➜ if
no improvement
✿ urgent colectomy
✿ Antibiotics have no use
114b
BADRAWY MRCP NOTES
Classical Rx
231. ✿ IV cefotaxime
✿ if Hx of SBP ➜ prophylactic
antibiotics
115b
BADRAWY MRCP NOTES
Classical Rx
233. ✿ Ursodeoxycholic acid
✿ Pruritus: cholestyramine
✿ Fat-soluble vitamin
supplementation
✿ Liver transplantation ➜ If bilirubin
> 100 (PBC is a major indication)
116b
BADRAWY MRCP NOTES
Classical Rx
239. ✿ bile acid sequestrants
119b
BADRAWY MRCP NOTES
Classical Rx
247. ❅ Early disease: surgical resection
❅ Liver transplantation
❅ Radiofrequency ablation
❅ Transarterial
chemoembolisation
❅ Sorafenib: a multikinase (-)
123b
BADRAWY MRCP NOTES
Classical Rx
249. ❅ Drainage
❅ Amoxicillin + ciprofloxacin +
metronidazole
❅ If penicillin allergic:
ciprofloxacin + clindamycin
124b
BADRAWY MRCP NOTES
Classical Rx
251. ❅ difficult to Rx
❅ liver transplantation
❅ terlipressin
❅ 20% albumin
❅ TIPS
125b
BADRAWY MRCP NOTES
Classical Rx
253. ❅ 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
255. ❅ 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
257. ❅ steroids, if resistant use
monoclonal Abs
128b
BADRAWY MRCP NOTES
Classical Rx
259. ❅ (80%) are steroid responsive
❅ Cyclophosphamide for steroid
resistant
129b
BADRAWY MRCP NOTES
Classical Rx
263. ❅ Diclofenac IM ➜ analgesia of
choice,A 2nd dose can be given
after 30 minutes if necessary
131b
BADRAWY MRCP NOTES
Classical Rx
266. Type 2 RTA (proximal)
133a
BADRAWY MRCP NOTES
Classical Rx
269. ❅ 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
273. ❅ supportive
❅ no role for antibiotic
❅ plasma exchange ➜ severe cases
of HUS NOT associated é diarrhea
136b
BADRAWY MRCP NOTES
Classical Rx
277. ❅ vitamin B6 supplements
138b
BADRAWY MRCP NOTES
Classical Rx
281. ❅ 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
283. ❅ life expectancy < 10 years ➜
watchful waiting
❅ life expectancy > 10 years ➜
Radical prostatectomy , Radical
radiotherapy
141b
BADRAWY MRCP NOTES
Classical Rx
287. ❅ Synthetic GnRH agonist ➜
Goserelin ➜ -Ve feedback
to the anterior pituitary.
❅ Anti-androgen ➜ Cyproterone
acetate
❅ Orchidectomy
143b
BADRAWY MRCP NOTES
Classical Rx
289. ❅ Analgesia
❅ Steroid injection
❅ Immobilization é a thumb splint
(SPICA)
❅ Surgical Rx
144b
BADRAWY MRCP NOTES
Classical Rx
291. ❅ avoiding muscle overload
❅ analgesia
❅ Steroid injection
❅ Physiotherapy
145b
BADRAWY MRCP NOTES
Classical Rx
293. ❅ Carpal injection
❅ Wrist splints at night
❅ Surgical decompression (flexor
retinaculum division)
146b
BADRAWY MRCP NOTES
Classical Rx
299. ❅ 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
300. Pts who take the equivalent of ≥
prednisolone 7.5 mg /day for ≥ 3
months
150a
BADRAWY MRCP NOTES
Classical Rx
301. ❅ osteoporosis prophylaxis
❅ 1st-line: oral bisphosphonate
❅ Second-line: alfacalcidol or
calcitriol
150b
BADRAWY MRCP NOTES
Classical Rx
305. ❅ Stem cell transplant &
interferon-gamma
152b
BADRAWY MRCP NOTES
Classical Rx
307. ❅ IV fluids
❅ ± Urinary alkalinization
153b
BADRAWY MRCP NOTES
Classical Rx
309. ❅ High-dose chemotherapy é
hematopoietic stem-cell
transplantation
❅ Maintenance Rx ➜ thalidomide
154b
BADRAWY MRCP NOTES
Classical Rx
313. ❅ 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
314. if ≥ 2 attacks of gout in 12 month
period
157a
BADRAWY MRCP NOTES
Classical Rx
316. RA with joint inflammation
158a
BADRAWY MRCP NOTES
Classical Rx
317. ❅ a combination DMARD ASAP
❅ Methotrexate is the most widely
used DMARD
❅ analgesia, physiotherapy &
surgery.
158b
BADRAWY MRCP NOTES
Classical Rx
318. RA with joint inflammation In
Pregnancy
159a
BADRAWY MRCP NOTES
Classical Rx
319. ❅ 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
323. ❅ 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
325. ❅ 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
327. ❅ analgesia, NSAIDs, intra-
articular steroids
❅ Sulfasalazine & methotrexate for
persistent disease
❅ rarely last > 12 months
163b
BADRAWY MRCP NOTES
Classical Rx
329. ❅ NSAIDs
❅ Physiotherapy
❅ Sulphasalazine ➜ in peripheral
joint involvement
❅ TNF-α blockers etanercept &
adalimumab if 2 NSAIDS fail
164b
BADRAWY MRCP NOTES
Classical Rx
331. ❅ Topical steroid cream
❅ Oral antimalarials (2nd line)
❅ Avoid sun exposure
165b
BADRAWY MRCP NOTES
Classical Rx
333. ❅ immediate ↑dose steroids ➜↓
the chance of visual loss.
❅ dramatic response should be
seen ➜if not ➜ consider another Dx
166b
BADRAWY MRCP NOTES
Classical Rx
335. steroids ± steroid sparing
methotrexate or azathioprine
167b
BADRAWY MRCP NOTES
Classical Rx
341. warfarin é a target INR of 2-3 for 6
months
170b
BADRAWY MRCP NOTES
Classical Rx
343. lifelong warfarin if occurred while
taking warfarin ➜ ↑target INR to
3-4
171b
BADRAWY MRCP NOTES
Classical Rx
347. ❅ ↓ -dose aspirin
❅ LMWH ➜ D/C at 34 weeks
gestation
173b
BADRAWY MRCP NOTES
Classical Rx
353. ❅ CCBs
❅ IV prostacyclin infusions
176b
BADRAWY MRCP NOTES
Classical Rx
355. ACE-I to control BP & delay
progression to CRF
177b
BADRAWY MRCP NOTES
Classical Rx
357. ❅ NSAIDs
❅ Limited benefit from steroids
❅ Raynaud's & Severe digital
ulceration ➜ CCBs &IV
prostacyclin infusions
178b
BADRAWY MRCP NOTES
Classical Rx
363. ❅ Attacks are self-limiting, &
require analgesia
❅ Colchicine may ↓ attack
frequency
181b
BADRAWY MRCP NOTES
Classical Rx
371. ❅ flucloxacillin + gentamicin
❅ (benzylpenicillin + gentamicin if
Sx less severe)
185b
BADRAWY MRCP NOTES
Classical Rx
372. Initial blind Rx if prosthetic valve
endocarditis or Pt. is penicillin
allergic
186a
BADRAWY MRCP NOTES
Classical Rx
377. ❅ benzylpenicillin + gentamicin
(vancomycin + GENTAMICIN if
penicillin allergic)
188b
BADRAWY MRCP NOTES
Classical Rx
385. ❅ aspirin & analgesics
❅ CST &NSAIDS better avoided in
the 1st 4 weeks after MI
❅ If Recurrence ➜ colchicine
192b
BADRAWY MRCP NOTES
Classical Rx
389. ❅ Aspirin should be continued
indefinitely
❅ clopidogrel Rx for at least 12
months
194b
BADRAWY MRCP NOTES
Classical Rx
391. ❅ Valsalva
❅ Adenosine 6mg ➜ 12mg ➜ 12mg
- CI in asthmatics - verapamil is a
preferable
❅ DC cardioversion
195b
BADRAWY MRCP NOTES
Classical Rx
398. HD stable V Tach in Digoxin
Toxicity
199a
BADRAWY MRCP NOTES
Classical Rx
399. ❅ lidocaine & phenytoin
❅ Avoid Amiodarone &
Procainamide (↑Toxicity)
❅ D/C shock when all measures
fail (but usu. unsuccessful)
199b
BADRAWY MRCP NOTES
Classical Rx
401. ❅ IV magnesium sulphate
❅ Correct K+ if hypo
❅ Override pacing
❅ D/C shock
200b
BADRAWY MRCP NOTES
Classical Rx
403. ❅ Rate-limiting CCBs are often
used 1st-line
❅ Correction of hypoxia &
electrolyte disturbances
❅ Cardioversion & digoxin are not
useful
201b
BADRAWY MRCP NOTES
Classical Rx
405. ❅ Atropine is the 1st line
❅ potential risk of asystole ➜
transvenous pacing is indicated
202b
BADRAWY MRCP NOTES
Classical Rx
407. ❅ 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
409. ❅ sotalol is the most widely used
antiarrhythmic
❅ Catheter ablation
❅ ICD
204b
BADRAWY MRCP NOTES
Classical Rx
411. ❅ 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
415. ❅ ICD
❅ Quinidine in VF storm ➜ (fast
repeated ICD shocks)
207b
BADRAWY MRCP NOTES
Classical Rx
417. ❅ Amiodarone
❅ β-blockers or verapamil
❅ ICD
❅ Dual chamber pacemaker
❅ Endocarditis prophylaxis
208b
BADRAWY MRCP NOTES
Classical Rx
419. ❅ AVR if symptomatic
❅ otherwise cut-off is gradient of
50 mmHg
209b
BADRAWY MRCP NOTES
Classical Rx
421. ❅ 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
427. ❅ Diuretics if right HF
❅ Anticoagulation
❅ Vasodilator Rx ➜ CCB, IV
PGs,bosentan
❅ Heart-lung transplant
213b
BADRAWY MRCP NOTES
Classical Rx
428. PDA want to closes the connection
214a
BADRAWY MRCP NOTES
Classical Rx
430. PDA want to keep the connection
till surgical repair of associated
another congenital heart defect
215a
BADRAWY MRCP NOTES
Classical Rx
433. ❅ Surgical repair
❅ even é repair sometimes
recurrence happen.
216b
BADRAWY MRCP NOTES
Classical Rx
437. ❅ Surgical repair
❅ Cyanotic episodes ➜ β-blockers
to ↓ infundibular spasm
218b
BADRAWY MRCP NOTES
Classical Rx
438. Asthma Dx - if ↑probability of
asthma
219a
BADRAWY MRCP NOTES
Classical Rx
441. 〚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
442. Which Pt. should receive long-term
O₂ Rx (LTOT) ?
221a
BADRAWY MRCP NOTES
Classical Rx
443. 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
444. O₂ Rx of COPD Pts
222a
BADRAWY MRCP NOTES
Classical Rx
445. ❅ 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
446. Massive PE + hypotension
223a
BADRAWY MRCP NOTES
Classical Rx
451. ❅ Co-trimoxazole
❅ IV pentamidine in severe cases
❅ Steroids if hypoxic (if pO2 <
9.3kPa)
225b
BADRAWY MRCP NOTES
Classical Rx
455. ❂ 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
457. ❅ Usu. metastatic disease by time
of Dx
❅ Chemotherapy (mainstay of Rx)
228b
BADRAWY MRCP NOTES
Classical Rx
461. ❅ Hypercalcemia
❅ Worsening lung function
❅ bilateral posterior uveitis
❅ Heart or neuro involvement
230b
BADRAWY MRCP NOTES
Classical Rx
463. ❅ 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
465. ❅ 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
467. ❅ Steroids ( ALLERGIC)
❅ Itraconazole is a 2nd line agent
233b
BADRAWY MRCP NOTES
Classical Rx
471. ❅ 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
479. ❅ ciprofloxacin is the drug of
choice
❅ Rifampicin may be used
239b
BADRAWY MRCP NOTES
Classical Rx
481. ❅ flucloxacillin 1st-line Rx
❅ Erythromycin in Pts allergic to
penicillin
❅ oral clindamycin in Rx failure
240b
BADRAWY MRCP NOTES
Classical Rx
483. ❅ Urgent surgical debridement
❅ IV antibiotics
241b
BADRAWY MRCP NOTES
Classical Rx
490. standard Rx for active tuberculosis
245a
BADRAWY MRCP NOTES
Classical Rx
491. ❅ Initial phase - 1st 2 months
(RIPE)
❅ Continuation phase - next 4
months (RI)
245b
BADRAWY MRCP NOTES
Classical Rx
495. prolonged period (at least 12
months) é the addition of steroids
247b
BADRAWY MRCP NOTES
Classical Rx
507. ❅ almost always chloroquine
sensitive
❅ Primaquine in Plasmodium
vivax & Plasmodium ovale to
destroy
❅ liver hypnozoites
253b
BADRAWY MRCP NOTES
Classical Rx
509. ❅ Early disease: IV pentamidine or
suramin
❅ Later disease or CNS
involvement: IV melarsoprol
254b
BADRAWY MRCP NOTES
Classical Rx
511. ❅ acute phase using azole or
nitroderivatives ➜ benznidazole or
nifurtimox
❅ Chronic disease ➜ Rx the
complications e.g. HF
255b
BADRAWY MRCP NOTES
Classical Rx
517. ❅ 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
519. ❅ MMR give within 72 hours
❅ (vaccine-induced measles Ab
develops more rapidly than
infection)
259b
BADRAWY MRCP NOTES
Classical Rx
531. oral or topical metronidazole or
topical clindamycin
265b
BADRAWY MRCP NOTES
Classical Rx
533. ❅ 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
539. ❅ Oral rehydration Rx
❅ doxycycline, ciprofloxacin
269b
BADRAWY MRCP NOTES
Classical Rx
551. ❅ supportive
❅ avoid contact sports for 8 weeks
for fear of splenic rupture
275b
BADRAWY MRCP NOTES
Classical Rx
553. ❅ Oseltamivir (Tamiflu) ➜ Oral
medication, neuraminidase (-)
❅ Zanamivir (Relenza) ➜ Inhaled
medication, neuraminidase (-)
276b
BADRAWY MRCP NOTES
Classical Rx
569. aspirin (lifelong) & clopidogrel (1m
if no/bare stent, 12 m if drug-
eluting stent)
284b
BADRAWY MRCP NOTES
Classical Rx
571. add a calcium channel blocker
285b
BADRAWY MRCP NOTES
Classical Rx
586. 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
589. ❅ 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
591. ❅ 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
593. ❅ Weight ↓
❅ Hirsuitism & acne ➜ COC
❅ Infertility ➜ clomifene most
effective Rx, Metformin
296b
BADRAWY MRCP NOTES
Classical Rx
595. ❅ 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
599. ❅ Topical or intralesional CST
❅ Topical minoxidil
299b
BADRAWY MRCP NOTES
Classical Rx
601. ❅ oral steroids as 1st-line Rx
❅ topical & intralesional steroids
❅ Cyclosporin & infliximab in
difficult cases
300b
BADRAWY MRCP NOTES
Classical Rx
605. Stop warfarin, give intravenous
vitamin K 5mg, prothrombin
complex concentrate
302b
BADRAWY MRCP NOTES
Classical Rx
607. ❅ 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
608. STEMI (allergy to aspirin) -
antiplatelets:
304a
BADRAWY MRCP NOTES
Classical Rx
611. ❅ zinc pyrithione ('Head &
Shoulders') & tar prareparations1st-
line
❅ second-line agent is ketoconazole
❅ Selenium sulphide & topical
corticosteroid
305b
BADRAWY MRCP NOTES
Classical Rx
613. ❅ Topical antifungals: e.g.
Ketoconazole
❅ Topical steroids
❅ short periods
306b
BADRAWY MRCP NOTES
Classical Rx
617. ❅ topical fusidic acid 1st-line
❅ oral flucloxacillin / topical
mupirocin
308b
BADRAWY MRCP NOTES
Classical Rx
619. ❅ Sun avoidance, sun cream
❅ Fluorouracil cream
❅ Topical diclofenac
❅ Topical imiquimod
❅ Cryotherapy
❅ Curettage
309b
BADRAWY MRCP NOTES
Classical Rx
623. ❅ 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
625. ❅ Simple emollients
❅ Coal tar
❅ Topical CST
❅ Calcipotriol
❅ Dithranol
312b
BADRAWY MRCP NOTES
Classical Rx
629. ✰ 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
633. ✰ 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
635. ✰ Stop precipitating factor
✰ ICU admission
✰ IV IG are1st-line
✰ plasmapheresis
✰ Cyclosporin &
cyclophosphamide
317b
BADRAWY MRCP NOTES
Classical Rx
637. ✰ Early keloids
✰ intra-lesional steroids e.g.
Triamcinolone
✰ Excision is sometimes required
318b
BADRAWY MRCP NOTES
Classical Rx
639. ✰ Topical steroids
✰ moderate: Clobetasone butyrate
✰ potent: Betamethasone valerate
✰ very potent: Clobetasol
propionate
319b
BADRAWY MRCP NOTES
Classical Rx
645. ✰ Topical antifungal ➜ Terbinafine
or selenium sulphide
✰ If extensive disease ➜ oral
itraconazole
322b
BADRAWY MRCP NOTES
Classical Rx
647. ✰ 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
649. ✰ 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
651. ✰ Oral CST are the mainstay of Rx
✰ Topical CST,
immunosuppressants & antibiotics
325b
BADRAWY MRCP NOTES
Classical Rx
653. ✰ Oral CST
✰ Immunosuppressants
326b
BADRAWY MRCP NOTES
Classical Rx
661. ✰ weight loss if overweight
✰ Cosmetic techniques as
waxing/bleaching
330b
BADRAWY MRCP NOTES
Classical Rx
663. ✰ 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
667. ✰ CBT ,eye movement
desensitisation & reprocessing
(EMDR)
✰ Drug Rx ➜ paroxetine or
mirtazapine
333b
BADRAWY MRCP NOTES
Classical Rx
673. ✰ CBT 1st-line Rx
✰ Interpersonal psychotherapy
✰ high-dose fluoxetine
336b
BADRAWY MRCP NOTES
Classical Rx
675. ✰ CBT
✰ Graded exercise
✰ amitriptyline ➜ useful for poor
sleep
337b
BADRAWY MRCP NOTES
Classical Rx
677. ✰ Dopamine agonists are 1st-line
(Ropinirole, Pramipexole)
✰ Benzodiazepines
✰ Gabapentin
338b
BADRAWY MRCP NOTES
Classical Rx
679. ✰ SSRIs are 1st-line Rx
✰ Citlopram : Curved back (
elderly )
✰ Floxetine : Fetus ( preganancy )
✰ Sertaline : Stress ( MI )
✰ Paroxetine : PTSD
339b
BADRAWY MRCP NOTES
Classical Rx
683. ✰ Stop smoking
✰ ↑does of β-carotene, vitamins C
& E, & zinc
341b
BADRAWY MRCP NOTES
Classical Rx
691. ✰ systemic antibiotics. (IV
antibiotics are indicated if there is
associated periorbital cellulitis)
345b
BADRAWY MRCP NOTES
Classical Rx
693. ✰ hot compresses
✰ Mechanical removal of the
debris
✰ Artificial tears
346b
BADRAWY MRCP NOTES
Classical Rx
697. ✰ Oral antiviral Rx
✰ Oral CST
✰ urgent ophthalmology review
348b
BADRAWY MRCP NOTES
Classical Rx
705. ✰ 100% O₂
✰ IV dicobalt edetate
352b
BADRAWY MRCP NOTES
Classical Rx
713. ✰ 100% O₂
✰ Hyperbaric O₂
356b
BADRAWY MRCP NOTES
Classical Rx
723. ✰ atropine
✰ glucagon
✰ Transvenous pacing for Pts
unresponsive to glucagon
361b
BADRAWY MRCP NOTES
Classical Rx
724. Vasomotor Sx such as flushing,
insomnia & headaches
362a
BADRAWY MRCP NOTES
Classical Rx
728. Prevention & Rx of osteoporosis
Hypercalcemia
Paget's disease
Pain from bone metatases
364a
BADRAWY MRCP NOTES
Classical Rx
731. ✰ Activated charcoal
✰ Charcoal hemoperfusion is
preferable to hemodialysis
365b
BADRAWY MRCP NOTES
Classical Rx
735. add a calcium channel blocker
367b
BADRAWY MRCP NOTES
Classical Rx
741. add a calcium channel blocker
370b
BADRAWY MRCP NOTES
Classical Rx
745. ✰ Oral ofloxacin + oral
metronidazole or intramuscular
ceftriaxone + ✰ oral doxycycline +
oral metronidazole
372b
BADRAWY MRCP NOTES
Classical Rx
750. Step 5 asthma management in
adults -
375a
BADRAWY MRCP NOTES
Classical Rx
751. use daily steroid tablet. Refer
patient for specialist care
375b
BADRAWY MRCP NOTES
Classical Rx
753. stop warfarin, give intravenous
vitamin K 1-3mg, restart when INR
< 5.0
376b
BADRAWY MRCP NOTES
Classical Rx
763. ✰ 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
764. T2DM, inadequate control on
metformin, at risk from
consequences of hypoglycaemia -
382a
BADRAWY MRCP NOTES
Classical Rx
765. add a DPP-4 inhibitor or a
thiazolidinedione
382b
BADRAWY MRCP NOTES
Classical Rx
784. initial blind therapy of infective
endocarditis (prosthetic valve)
392a
BADRAWY MRCP NOTES
Classical Rx
786. endocarditis caused by fully-
sensitive streptococci (e.g.
viridans)
393a
BADRAWY MRCP NOTES
Classical Rx
795. Withhold 1 or 2 doses of warfarin,
reduce subsequent maintenance
dose
397b
BADRAWY MRCP NOTES
Classical Rx
796. Initial blind therapy of infective
endocarditis (native valve,
penicillin allergic)
398a
BADRAWY MRCP NOTES
Classical Rx
801. ✰ 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