Last Min MRCP revision Part -E

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In Gout :

# Raburicase is recombinant urate oxidase preferable in Rx of gout induced by chemotherapy for haematological malignancies.

# Lesinurad is
 - is an OAT-1 Inhibitor which drives high urate excretion.
- it can be used in combination with xanthine oxidase inhibitor.
- effective for long term  gout management ; it can drive plasma urate down towards the normal range


 🔴remember Ivabradine is CI in AF


 indications of digoxin:
1.AF in sedentary pt. sp. if there is heart failure
2. peripartum cardiomypathy.



Rx for ABPA:
1st line... steroids.. if not effective or can't take due SE...then itraconazole



Rx for Aspirgilloma:
1st line... Long term oral itraconazole; if not effective or tolerate then do surgery

Pt of Aspirgilloma with haemptosis...1st line or do immediately angiography and emobilization...then after lobar resection



Rx for invasive aspergillosis:
1st line... iv Voriconazole then orally for 10days..if not effective or tolerate then liposomal Amphotericin


HLA types Related to Drug reaction:

HLA B1502 is associated with Stevens Johns synd in chines people taking *phenytoin*

HLA A3101 associated with Stevens Johnson syn in European or Japanese puts treated with *carbamazepine*

HLA B5701 is associated with *Abacavir* Hypersensitivity

HLA B5801 is associated with *Allopurinol* Hypersenstivity


Multiple painful shallow genital ulcers under d foreskin -----HSV

A single painless indurated well-circumscribed genital ulcer--Syphilis(T.pallidum)

A single painless shallow genital  ulcer with buboes---LGV(c.trachomatis L1-3)

One or more painless ulcerated genital nodules with kissing lesions and pseudobuboes----Granuloma inguinale(k.granulomatis)

Multiple painful genital ulcers with deep ragged edges and a purulent base-----Chancroid(H.ducreyi)


 💉💉💉 504
If you diagnose carcinoid syndrome in young Patient; diagnose something else.
Because average age of onset of carcinoid syndrome is 61years.
Moral of the History -
1.OLD age + Flushing + Diarrhea ➡ Carcinoid Syndrome.
2.YOUNG age + Flushing + Diarrhea + Urticaria ➡ Systemic Mastocytosis.


 Lymphoma staging
A 👉if no symptoms ( night sweets wt loss and fever)
B👉 if there is one or more Symptom
I,II👉 one side of the diaphragm
III👉 both sides of diaphragm
IV 👉extra nodal involvement

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