1. How it looks:
1. single ulcer
2. superficial
3. peripheral redness
2. DDx:
1. herpes zoster
2. Trauma
3. Iron, folate, B12 deficiency
4. poor hygiene
3. Cocktail tds for 2 minutes mouth washing then spit out
1. Elixir diphenhydramine 12.5mg/5cc #1
2. Cap tetracycline 250 mg #8
1. or cap cefalexin 500 mg #8
3. Amp lidocaine 2% 1cc #1
4. Amp dexamethasone 1cc #1
4. Oral/gingival infections:
1. Tab Penicillin 800 mg qd for 4 days
2. or Metronidazole + azithromycin tds
1. Treatment
1. Tab paroxetine 20mg #60 qd
2. Tab lorazepam 1mg #60 tds or bid
1. or tab alprazolam 1mg #60 bid
1. mostly a side effect of drug or as a result of a disease
2. Use
1. Syrup Zinc gluconate 1cc/kg/day
2. Syrup multivitamin
1. take x-rays in
1. can not walk >4 steps
2. tenderness in 6 cm of medial and lateral malleolus
3. tenderness on base of 5th metatarsus
4. Use AP, Lateral, Mortise view
2. Treatment
1. no Fx:
1. 3 month of rubber band
2. use NSAIDs
2. No response to conservative treatment
1. possibility of soft tissue injury
2. refer to orthopedics
3. almost always refer knee sprains
1. Order:
1. Vaccine TD 0.5 cc IM
2. or Vaccine DT 0.5 cc IM
3. Amp TIG (tetabulin) (250u/ml) 3000-6000 unit IM
2. Vaccination:
1. no prior vaccination
1. 0-3-7-10 days IM
2. 0-3-7 days intra dermal (2 injection each time in different limbs)
2. prophylaxis
1. 0-7 days IM or ID
3. >3 months from prior dosage:
1. 0-3 days IM
3. TIG:
1. 20 unit/kg in 7 days from the time of bite
2. injection only around the wound
4. Antibiotics:
1. Cap co-amoxiclav 625mg tds #15
2. Cap cefalexin 500mg qid #20
3. cap cloxacillin 500mg qid #20
5. Next visit: 24-48 hours later
1. cheilitis
1. Cream miconazole bid #1
2. Oint betamethasone 0.1% bid #1
3. Vit A-D
4. Iron supplement
5. Vit B complex supplement
2. G. tongue
1. mouthwash
2. Gel fluocinonide 0.05% bid #1
1. Symptoms:
1. 38% with fever
2. diarrhea
3. OB +
4. weight loss
5. crampy abdominal pain
2. check
1. S/E, OB/OP
2. U/A, U/C
3. Treatment
1. for adults
1. Tab mebendazole 500-750mg tds for 7-10days
1. or Tab tinidazole 500 mf qid for 3 days
2. Tab iodoquinol 210mg 3tabs tds for 20 days
2. for children
1. susp metronidazole 35-50mg /kg/day tds for 7 days (susp 125mg/5cc)
1. or syrup paromomycin 25-30mg/kg/day tds for 7 days
1. Treatment: Antihistamine + Corticosteroids
1. Tab loratadine 10 mg qd #10
2. Spray Nasal fluticasone qd #1
2. Finest approach
1. if mild symptoms:
1. tab loratadine 10 mg qd #20 or Syrup 5mg/ml
2. or tab cetirizine 10 mg qd #20 or syrup 5mg/ml
3. or tab fexofenadine 60 mg bid #40
4. or Tab chlorpheniramine 4 mg qid #30 or syrup 2mg/ml
5. or Tab diphenhydramine 25 mg qid #30 or syrup 12.5 mg/ml
2. If more severe symptom:
1. Spray nasal fluticasone bid #1
1. or spray nasal fluticasone 2 puff qd
2. spray Mometasone 2 puff qd
2. syrup loratadine 5-10 cc #1 qd
3. for pregnant pt
1. spray nasal cromolyn qid #1
2. spray mometasone 2 puff qd #1
4. if not responded to antihistamine and corticosteroids
1. tab montelukast 10 mg qd #30
2. spray nasal fluticasone bid #1
1. Usually bilaterally affected
2. Treatment:
1. Tab hydroxyzine 10mg #10 bid
1. or tab cetirizine 10mg bid
2. or tab loratadine 10mg bid
2. Shampoo baby #1 tds
3. Drop opht ketotifen #1 tds
4. drop tear opht artificial 0.5% #1 qid
5. Cold compress
6. Only in severe cases
1. Drop opht betamethasone #1 tds
1. Mild aggression
1. Tab risperidone 2mg
1. or tab lorazepam 2mg
2. or tab olanzapine 5mg ⇒ do not use with lorazepam (any benzo)
2. Severe aggression but not psychotic
1. Amp lorazepam 0.5-2mg IV or IM (not available in Iran)
2. Amp Midazolam 2.5-5mg IV or IM
1. repeat every 3-5 mins
3. Severe aggression and psychotic
1. Amp haloperidol 2.5-10mg IV or IM
1. or Amp dropridol 2.5-5mg IV or IM
4. If drug fails, restrain the pt with 5 man
1. check pulses and hydration every 15mins
2. contraindicated in
1. CVD
2. Orthopedics
3. Metabolic disorders
4. Infections