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1. Symptoms
1. paresthesia worsening at night
2. can awake the pt from sleep
3. no radiation to neck
4. more common in diabetes and pregnancy
2. Dx: Fallen test, Tinel test
3. DDx: QdQuervain syndrome (Abductor pollicis longus inflammation)
4. Treatment:
1. Fixation with splint
2. Cap celexib 100mg bid #30
3. Tab vit B1 #30 qd
4. Can use Tab prednisolone instead of NSAIDs
5.
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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
#
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
#
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
#
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
#
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
#
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
#
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
#
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
#
– Treatment
– Prednisolon 50 mg qd for 10 days
– Aciclovir 400 mg q4h #50
#
1. Amp epinephrine 0.3-0.5mg repeat q10min (0.01mg/kg from 1mg/1ml in children)
2. Amp hydrocortisone 200mg IV q2-6h (2.5mg/kg/q6h)
3. Amp celmastine 1.34 or 2.68mg bid or tid
4. Tab chlorpheniramine 4mg immediate release q4-6h or 12mg ER q12h (max 24mg/day)
5. Spray salbutamol 4 puff and repeat it PRN
6. If LOW BP or Bradycardia:
1. Amp atropine 0.5 mg IV q5min (0.01-0.02 mg/kg, max 0.04 mg/kg)