 LEISHMANIASIS MANAGEMENT- 1ST LINE MILTEFOSINE.

 SODIUM STIBOGLUCONATE, AMPHOTERICIN-B AND

PAROMOMYCIN IN INDIAN SUBCONTINENT.
 Co-trimoxazole has the best evidence for the treatment of
Cyclospora infection. Nitazoxanide can be used as an alternative
to co-trimoxazole in patients who are unable to take sulfa-based
compounds.
 SECONDARY SYPHILIS; A single dose of 2.4 MU of penicillin
intramuscularly is the intervention of choice. Azithromycin 2 g as a
single dose can be given in patients who are penicillin allergic.
 Doxycycline bd for 21 days is treatment of choice
lymphogranuloma venereum (LV), acquired as a sexually
transmitted infection. It is caused by the L1, L2 or L3 serovars of
Chlamydia trachomatis.
 ANIMAL BITE-PENICILLIN IF ALLERGIC THEN COMBINATION OF
METRONIDAZOLE AND DOXYCYCLINE.
 Which of the following is the most appropriate malaria
prophylaxis for her-Atovaquone/proguanil.
 GOUT MANAGEMENT ;GAFU;ALLOPURINOL,FABOXUSTAT OR
URICASE.IF PT DEVELOPS SJS WITH ALLOPURINOL/FEBOXUSTAT
F/B IWMI-GIVE LOW DOSE COLCHICINE.
 REACTIVE ARTHRITIS MANAGEMENT; Non-steroidal anti-
inflammatory agents are the usual first step, with a short course
of oral steroids in patients who fail to respond. DMARDs can be
considered in patients who do not gain adequate symptom relief
from corticosteroids.
 Intravenous (IV) zoledronate- Bisphosphonates are the mainstay
of management of Paget’s disease.
 OSTEOPROSIS managed with DENOSUMAB,Receptor activator of
nuclear factor kappa-B (RANK) ligand inhibitor.
 Ankylosing spondylitis-Naproxen and Anti-TNF therapy.
 POLYMYALGIA RHEUMETICA is treated with STERIODS ,
Toclizumab is an anti-IL6 monoclonal antibody which has proven
effectiveness as both an initial therapy for giant cell arteritis, and
as add-in to reduce corticosteroid dose.
 Carpal tunnel syndrome- if the symptoms are mild-moderate
 corticosteroid injection AND wrist splints at night: particularly
useful if transient factors present e.g. pregnancy
 if there are severe symptoms or symptoms persist with
conservative management :surgical decompression (flexor
retinaculum division).
 Intravenous (IV) ceftriaxone This man’s duodenal appearance and
biopsy, coupled with arthralgia and symptoms of malabsorption, is
consistent with a diagnosis of Whipple’s disease.
 Systemic anti-tumour necrosis factor (TNF) therapy is effective in
controlling symptoms of Crohn’s disease and resolving ulceration
associated with pyoderma gangrenosum.
 Small bowel bacterial overgrowth syndrome-antibiotic therapy
and rifaximin is now the treatment of choice due to relatively low
resistance. Co-amoxiclav or metronidazole are also effective in the
majority of patients.
 PBC +PSC TREATMENT -Ursodeoxycholic acid(slows disease
progression and improves symptoms).
 OBETICHOLIC ACID -Farnesoid-X-receptor (FXR) agonist Bile acids
are FXR agonists, the receptor plays a role in bile acid homeostasis
and local inflammation.
 Primary sclerosing cholangitis (PSC)- Ursodeoxycholic acid.
 Short bowel syndrome in chrons -Cholestyramine.
 Lynch syndrome- Aspirin 600 mg has been proven in clinical
studies to reduce the risk of colorectal cancer when given for
more than two years.
 This patient has dermatomyositis, as illustrated by the proximal
muscle weakness, typical skin rash and elevated CRP and CK levels
 seen here. High-dose prednisolone is the intervention of choice,
with rapid tapering over a period of three months.
 IN MEMBRANOUS NEPHROPATHY . Loop diuretics are the initial
intervention of choice to reduce symptoms of oedema and may
help control blood pressure on top of angiotensin-converting
enzyme (ACE) inhibitors.
 ACE inhibitors are the intervention of choice to reduce proteinuria
and slow renal progression in patients with Alport syndrome.
 Ig A NEPHROPATHY managed with ACE INHIBITORS,HIGH DOSE
STEROIDS AND AZATHIOPRINE.
 Granulomatosis with polyangiitis;IV methylprednisolone and
cyclophosphamide The history of sinusitis, coupled with evidence
of pulmonary haemorrhage and glomerulonephritis, fits well with
a diagnosis of granulomatosis with polyangiitis.2ND LINE Rituximab
in combination with corticosteroids is an alternative initial therapy
for the treatment of the disease.
 LUPUS NEPHRITIS MANAGEMENT; Mycophenolate mofetil and
cyclophosphamide .
 MANAGEMENT OF ASYMPTOMATIC LONG -QT; Beta blockade is
effective in preventing cardiovascular events in 70% or more of
patients, with propranolol, nadolol, atenolol and metoprolol all as
potential treatment options. If drug treatment is unsuccessful,
then stellate ganglionectomy may be a potential option.
SYMPTOMATIC LONG-QT THEN ICD IS Ist LINE.
 ICD insertion is usually reserved for high-risk patients who have
suffered an episode of collapse related to VT or those who have
periods of VT despite beta blockade or stellate ganglionectomy.
 A combination of NSAIDs and colchicine is now generally used for
first-line for patients with acute idiopathic or viral pericarditis.
 Although HNF-1 alpha MODY can be treated for many years with a
sulfonylurea such as gliclazide, eventually beta-cell failure
progresses and initiation of insulin is necessary. Long-acting
 insulin may be all that is needed for some years, in conjunction
with the sulfonylurea which deals with mealtime glucose peaks.
 IN GESTATIONAL DIABETES FBG MORE THAN 7mmol/l START INSULIN.
 In patients who have trialled at least two anti-epileptic agents and
still have disabling seizures , anterior temporal lobectomy results
in a higher seizure-free rate, compared to continuing anti-epileptic
medication, and a much better quality of life.NEW QUESTION
 30mg CODEINE=4.5mg MORPHINE.
 MANAGEMENT OF BIPOLAR DISORDER; Both olanzapine and
risperidone can be used to manage an acute psychotic episode
associated with mania.
 First-line treatment of schizophrenia is with atypical
antipsychotics such as risperidone. In patients who refuse to take
oral medication and are acutely distressed, intramuscular
haloperidol is a potential option.
 This patient is agitated and paranoid, with likely drug-induced
psychosis-1st LINE IS HALOPERIDOL esp when unmanageable.
Where patients will take oral agents, then risperidone, quetiapine
and olanzapine are all potential initial interventions.
 Steroid-resistant THYROID EYE disease;TOCLIZUMB,Toclizumab is
an anti-interleukin 6 monoclonal antibody.
 In a patient with a solitary toxic thyroid nodule who has
completed her family, with older children,radioiodine therapy is
the definite treatment.
 GRAVES DISEASE IN PREGNANCY-Propylthiouracil is used in the
first trimester of pregnancy in place of carbimazole, as the latter
drug may be associated with an increased risk of congenital
abnormalities. At the beginning of the second trimester, the
woman should be switched back to carbimazole.
 Waldenström’s macroglobulinaemia (WM)-Bendamustine plus
rituximab (BR); The British Society of Haematology guidelines
recommend a rituximab-containing regimen as initial treatment
 for patients who are able to tolerate it, and bendamustine
plusrituximab is acceptable as initial combination therapy.
 Hospital-acquired pneumonia-Piperacillin–tazobactam.
 Community-acquired pneumonia- Amoxicillin and clarithromycin.
 PHEOCHROMOCYTOMA-Phenoxybenzamine.
 STEROID RESISTANT ASTHMA WITH ALLERGIC RHINITIS WITH
EOSINOPHILIA- Subcutaneous omalizumab.
 SEVERE ASTHMA, which is associated with raised eosinophil count
and isn’t responsive to conventional therapies- Mepolizumab is an
anti-IL5 monoclonal antibody.
 PDE4 inhibitor used in the treatment of COPD is roflumilast.
 Idiopathic pulmonary fibrosis (IPF); Nintedanib is an intracellular
tyrosine kinase inhibitor with antifibrotic and anti-inflammatory
properties.
 Legionnaire’s disease; Levofloxacin. Doxycycline is a second or
third line option for treatment of Legionnaire’s disease in patients
who are unable to take quinolones or macrolides.
 PREMATURE MENOPAUSE ;1st LINE IS SEQUENTIAL HRT FOR 1 YR
F/B CONTINUOUS HRT.
 Sumatriptan can be used as an acute intervention for cluster
headache, although it is less effective vs high-flow oxygen. It also
appears that subcutaneous sumatriptan is more effective than the
intra-nasal preparation.
 Cystinuria-HYDRATION,D-penicillamine AND URINARY
ALKALINAZATION.
 ITP-PREDNISOLONE 1ST LINE AND Rituximab is a second-line option
for the treatment of ITP which is unresponsive to other
interventions.
 Factor V Leiden (activated protein C resistance)- treated with
WARFARIN.
 Dasatinib inhibits the activity of the BCR-ABL kinase and SRC
family kinases along with a number of other selected oncogenic
 kinases including c-KIT, ephrin (EPH) receptor kinases and PDGFβ
receptor. It has activity as a treatment for leukaemia both in
patients who are sensitive to imatinib and in those who have
developed imatinib resistance.
 Most appropriate alternative to thalidomide is Bortezomib.
 MYASTHENIA GRAVIS -long-acting acetylcholinesterase inhibitor;
pyridostigmine is 1ST-LINE,
 2ND LINE IMMUNOSUPRESSION-
 prednisolone initially then azathioprine, cyclosporine,
mycophenolate mofetil may also be used.
 3RD LINE-thymectomy.
 In SLE for patients who fail to gain control of their disease treated
with corticosteroids and conventional therapies such as
hydroxychloroquine alone are treated with Belimumab is a
monoclonal antibody which inhibits activation of the B-
lymphocyte stimulator (BLyS) receptor.
 BILATERAL RENAL ARTERY ATHEROMA WITH SINGLE EPISODE OF
PULMONARY EDEMA- Amlodipine 5 mg daily . Stenting is usually
reserved for patients with a progressive increase in serum
creatinine despite adequate blood pressure control, or there are
recurrent episodes of pulmonary oedema.
 Young female with relapsing -remitting multiple sclerosis- wants
to conceive- Dimethylfumarate. Other option is Natalizumab,
highly effective intervention for relapsing-remitting MS, although
it is also associated with the development of progressive
multifocal leukoencephalopathy.
 Central retinal artery occlusion -Intraarterial thrombolysis.
 Seborrheic dermatitis FACE and BODY-1ST LINE KETOCONAZOLE
and Topical Steroids for short period.
 FOR GENITAL HERPES IN PREGNANCY, with respect to managing
her to the point of delivery- Prophylactic acyclovir should be
started at week 36.
 A 73-year-old man who has benign prostatic hypertrophy is
admitted to the Emergency Department in urinary retention. He
has been drinking less and less fluid over the past few days and
suffering from nausea and vomiting. His blood pressure is 142/85
mmHg, and pulse 89 bpm and regular. He is tender in the
suprapubic region, and a scan reveals 350 ml of urine within the
bladder. Per rectum examination reveals a large, smoothly
enlarged prostate. He is hyperventilating. A catheter is passed
which is draining urine. Potassium (K+ ) 5.9 mmol/l 3.5–5.0 mmol/l
Creatinine 492 µmol/l 50–120 µmol/l Bicarbonate (HCO3 - ) 7
mmol/l 24–30 mmol/l pH 7.24 7.35–7.45 -This patient has acute-
on-chronic renal failure with metabolic acidosis. The cause is,
however, easily reversible and the acidosis and raised creatinine
level are likely to rapidly resolve with catheterisation and IV fluid
replacement. Trials suggest that administration of bicarbonate is
most useful in patients with acute renal failure where the pH is
below 7.2.
 The increase in relative risk for an embolic stroke attributable to a
patent foramen ovale is relatively small; this would involve a
paradoxical embolus .
 The most useful long-term intervention for benign intracranial
hypertension is diet and exercise.