If not responding to intermittent antihistamine spray (azelastine PRN). According toNICE guidance, the next step is a regular intranasal corticosteroid such as fluticasone propionate, which is the most effective treatment for persistent allergic rhinitis.
otitis externa.
The most common causative organism is Pseudomonas aeruginosa,
A: Haemophilus influenzae – Common cause of otitis media, not otitis externa.
C: Moraxella catarrhalis – Also causes otitis media and sinusitis, not external ear infection.
D: Streptococcus pneumoniae – Leading cause of acute otitis media, not otitis externa.
E: Adenovirus – A viral cause of pharyngoconjunctival fever, not bacterial otitis externa.
G I T
Oesophageal varices
Acute bleed: IV ABx, terlipressin, OGD etc.
Prophylaxis of bleed - propranolol, VBL.
Prednisolone is the first-line treatment for severe alcoholic hepatitis, defined by poor prognostic scores (e.g. Maddrey’s discriminant function ≥32, or hepatic encephalopathy). It reduces inflammation and short-term mortality.
NICE guidelines recommend transient elastography (FibroScan) to assess liver fibrosis severity in NAFLD
Before initiating azathioprine, it is essential to check thiopurine methyltransferase (TPMT) enzyme activity, as TPMT metabolises azathioprine.
Melanosis coli is caused by chronic laxative misuse, especially stimulant laxatives such as senna or cascara.
In a patient with suspected NAFLD, the most appropriate next investigation is transient elastography (FibroScan) to assess the degree of hepatic fibrosis and steatosis.
CREST
Calcinosis
Raynaud’s
Esophageal dysmotility
Sclerodactyly
Telangiectasia
Haematology
A: Hodgkin’s lymphoma – Causes Reed–Sternberg cells on biopsy, not associated with the Philadelphia chromosome.
B: Acute myeloid leukaemia – Associated with Auer rods and PML/RARα translocation, not BCR-ABL.
C: Chronic lymphocytic leukaemia – A lymphoid malignancy with smudge cells, not a myeloid process.
D: Waldenstrom’s macroglobulinaemia – Causes IgM paraproteinaemia and hyperviscosity, not leukocytosis or BCR-ABL positivity
