Archive

Cardiac arrhythmias

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1. Drugs classification:

    1. Class 1: use for VT

        1. procainamide

        2. Lidocaine

    2. Class 2: B-blockers

    3. Class 3: Amiodarone ⇒ for VT and SVT and AF

    4. Class 4: Calcium channel blockers

2. Bradycardia: <50-60 bpm

    1. Amp atropine 0.5 mg IV, repeat q5min, max 3 mg

    2. if no response, Amp dopamine 5-10 ugr/min IV infusion

3. 1st degree heart block: no Tx

4. 2nd and 3rd degree heart block:

    1. Amp dopamine 10-10 ugr/kg/min

    2. or Amp epinephrine 2-10 ugr/kg/min

5. 2nd degree due to BB or CCB:

    1. Amp glucagon 5-10 mg stat then 2-5 mg/hr infusion

6. Sinus tachycardia:

    1. look for underlying cause rather than treating the mere tachycardia

7. Atrial flutter: 250-350 HR, sawtooth appearance

    1. if unstable: 50-100 j cardioversion

    2. if stable: Echo for clot formation if >48 hrs is passed

        1. Amp heparin 5,000 u IV stat then 1000 u/hr IV infusion

        2. Amp Diltiazem 20 mg IV over 2 mins then 5-15 mg/hr, repeat with 25 mg if no response seen

    3. if HF +: Amp Digoxin 0.25 mg IV in 5 mins repeat q2hr (max 1.5 mg)

    4. if no response: Amp MgSO4 4 gr in 4 mins

8. PSVT: regular, 200-180 HR, AVNRT

    1. Vagus massage, cold water, gag reflex

    2. Amp adenosine 6,g IV push then 12 mg IV (Amp 3mg/ml)

9. AF: 400 HR + 120-170 ventricular response

    1. instable: synchronized cardioversion 120-200j

    2. stable:

        1. Amp digoxin 1/2 amp stat slowly

        2. start anticoagulants using CHA2DS2 Vacs scoring system

10. VT: wide complex, regular, 15-200 HR

    1. unstable: unsynchronized or synchronized cardioversion 100-200j

    2. stable:

        1. Amp procainamide 100mg + 10cc D/W (25-50 mg/min) then 3mg/min infusion

        2. or Amp Amiodarone 150 mg + 50 cc D/W in 10 mins then 1 mg/hr infusion for 6 hrs

        3. or Amp lidocaine 1.5 mg/kg IV then 2-4 mg/kg IV infusion

    3. if polymorphic VT:

        1. Amp MgSO4 2 gr + 50 cc D/W in 15 mins infusion then 1-2 gr/hr infusion

11. PVSs:

    1. Tab metoprolol 50 mg bid

    2. Tab propranolol 20 mg tds

    3. Tab Concor (bisoprolol) 5 mg qd

    4. Tab verapamil 40 mg tds

    5. tab diltiazem 60 mg tds

DDx, General Topics
April 16, 2026 (0)

Candidiasis

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1. Whitish lesion on newborns’ tongue

2. Check these if recurrent

    1. CBC, diff

    2. ESR

    3. HIV Ab

3. Treatment

    1. Drop nystatin qid #4 (each container = 15 cc) for 7 days

        1. 1 cc for <1m/o

        2. 2 cc for , 12 m/o

        3. 4cc for >1 y/o

    2. use both for infant and nipple

    3. do not use milk bottle

    4. if no response, repeat for a week

DDx, Inf. Diseases
April 16, 2026 (0)

Candida Vaginitis

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1. Symptoms

    1. diabetic

    2. use of OCP

    3. pregnancy

    4. caseous, non malodor, pruritic, whitish discharges

2. Treatment

    1. Tab fluconazole 150mg #1 SD

    2. Vaginal cream clotrimazole 1% #1 qd up to 7 days

    3. Oint triamcinolone #1 qd

    4. if complicated

        1. Tab fluconazole 150mg #3 for 3 days

        2. Vaginal cream clotrimazole 1% #1 qd for 7 days

    5. if recurrent for 4 times/year

        1. Tab fluconazole 150mg #30 weekly

        2. vaginal cream clotrimazole 1% #1 qd for 7 days

    6. multiple recurrence or non-albicans candida

        1. Cap boric acid 600mg #14 qhs

DDx, Inf. Diseases
April 16, 2026 (0)

Bursitis

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1. Tab Naproxen 250 mg bid

2. or cap celexib 100 mg bid

3. or cap Indomethacin 75 mg bid

4. gel piroxicam tid #2

5. Cap omeprazole 20 mg bid

6. after 4 weeks refer to orthopedics

DDx
April 16, 2026 (0)

Burn

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1. Refer all:

    1. 3rd degree burn

    2. >20% of 2nd degree burn

    3. electrical, chemical, respiratory burn

    4. hand, foot, perinium, face, joint burn

    5. 2nd and 3rd degree burn in elderly and children

    6. burn + PMHx

    7. Burn + trauma

2. Treatment

    1. IV therapy

        1. w*%*4, half in 8 hours and rest of it in 16 hours

        2. keep Urine output >0.5cc/kg/hr in child and >1cc/kg/hr in adult

    2. Consider ECG in electrical burn

    3. Consider intubation in smoke burn

3. Treatment of mild burns

    1. immediate cooling with water

    2. Cream silver sulfadiazine bid

    3. Oint fibrinolysin tds

    4. Serum N/S for irrigation

    5. Cap mefenamic acid

    6. tab hydroxyzine 25mg

    7. cap cefalexin 500 mg qid if infected

    8. tetanus vaccination

General Topics
April 16, 2026 (0)

Brucellosis

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1. Symptoms:

    1. prolong fever

    2. myalgia

    3. back pain

    4. malaise

2. lab data

    1. Wright ≥1/160, if negative: repeat 2 weeks later or use coombs wright

    2. 2ME

3. Treatment:

    1. tab doxycycline 100 bid #90 (may cause esophagitis)

    2. Amp streptomycin 1gr qd IM #14

        1. or Cap rifampin 300mg 2tabs before breakfast #90

    3. treat for 6 weeks

4. If relapses: treat for 12 weeks with:

    1. tab ciprofloxacin 500 mg bid #90

    2. Cap rifampin 300 mg 2 tabs before breakfast #90

    3. Tab cotrimoxazole 400 mg 2 tab bid #180

5. For pregnant pt:

    1. cap rifampin 300 mg 2 tab before breakfast #90

    2. Tab doxycycline 100 mg bid #90

6. Prophylaxis:

    1. Cap rifampin 300 mg 2 tabs before breakfast #90

    2. tab doxycycline 100 mg bid #90

DDx, Inf. Diseases
April 16, 2026 (0)

Breast/cervical cancer screening

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1. For breast

    1. >20y/o ⇒ yearly by pt

    2. 20-40 y/o ⇒ every 3 years by physicians in high risk pt

    3. >40/yo ⇒ yearly mammography in NL population and yearly MRI in high risk pt

    4. perform the examination in 7th day of cycle

2. For cervix

    1. start 3 years after first sex or at age 21

    2. 21-29 y/o ⇒ liquid base pap smear every 1-2 year

    3. >30y/o ⇒ if last 3 exams were NL, continue pap smear q3y

    4. >70y/o ⇒ if last 3 exams were NL, no need for more examination

General Topics
April 16, 2026 (0)

BPH

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1. Treatment

    1. Alpha-blocker

        1. Cap Tamsulosin 0.4mg #30 qhs or bid

        2. Tab prazosin 1mg

        3. Tab terazosin 2mg

        4. side effects:

            1. retrograde ejaculation

            2. dizziness

            3. low BP

            4. palpitation

    2. 5-alpha reductase

        1. Tab finasteride 5mg

        2. cap dutasteride 0.5mg

        3. treat for 6-12m

    3. Herbals:

        1. Tab prostatan (گزنه) #30 tds

    4. supplement:

        1. Tab prosta vital for age>50y/o

DDx
April 16, 2026 (0)

Blepharitis

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1. Etiology: Staph

2. DDx:

    1. Herpes

    2. cellulitis

    3. Hordeolum

3. Symptoms

    1. Erythema

    2. redness

    3. xerophthalmia

    4. lacrimation

    5. foreign body sensation

4. Treatment

    1. Baby shampoo tds

        1. or shampoo tea tree oil tds

    2. Oint opht Hydrocortisone 1# #1 qd, prescribe with caution due to possibilty of atrophy

    3. Drop opht Sulfacetamide #1 qid 1 drop

    4. Oint opht erythromycin #1 tds

    5. warm compress for 10 mins qid

    6. For very severe cases:

        1. Cap doxycycline 100mg bid for 2 weeks

DDx, Inf. Diseases
April 16, 2026 (0)

Bell’s palsy

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1. Tab prednisolone 50 mg qd #7

2. tab prednisolone 5 mg 2 tab qd #20

3. Tab acyclovir 400 mg q6h #50

4. Drop ophthalmic artificial tear q4h #2

5. Oint Vit-A qhs #1

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– Treatment

    – Prednisolon 50 mg qd for 10 days

    – Aciclovir 400 mg q4h #50

DDx
April 16, 2026 (0)