Archive

Scabies

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1. features

    1. red papules with 1-2 mm burrows

    2. more in clefts

2. Treatment

    1. Cream permethrin 1% #1, put on cream for 12 hours then wash the body and hair with shampoo, repeat 1 week later

    2. Shampoo permethrin #1

    3. **all family members must do this**

    4. Tab hydroxyzine 25mg bid or qd for pruritus

    5. For pregnancy and children:

        1. ointment sulfur precipitate, use 3 nights, wash in 4th night, repeat 1 week later

    6. <2 m/o ⇒ only use olive oil, every 2 days for 2 weeks

    7. Spray Dermin (includes permethrin) for surfaces and stuff

DDx, Inf. Diseases
April 25, 2026 (0)

Restlessness leg syndrome

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1. DDx:

    1. Uremia

    2. Iron deficiency Anemia

    3. Neuropathies

    4. Idiopathic

2. Treatment:

    1. 1st line:

        1. Tab gabapentin 100 mg #20 qd

            1. or tab ropinirole 0.5mg #20 qd for 2 days then 1mg qd

    2. 2nd line:

        1. Tab clonazepam 1mg #30 qhs

DDx
April 25, 2026 (0)

Renal colic

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1. Treatment

    1. Pain control: the most important part

        1. Supp diclofenac 100 mg rectal

        2. amp ketorolac 30mg IV (up to 60mg IV, up to 90mg IM)

        3. amp hyoscine 10 mg IV or IM

        4. for severe pain

            1. Amp pethidine 25-50mg IM

                1. or Amp MS 4mg IM

                    1. repeat every 10-15 mins up to 2-3 times

                2. or Amp aminophylline 250mg + 200cc DW5% infusion in 20 mins

                3. or Visceral nerve block with Intradermal Tap water injection over pain site 0.5-1cc

    2. check

        1. CBC, K, Na, BUN, Cr, U/A

        2. Sonography

    3. If stone seen in sono:

        1. ≤5mm ⇒ easily passed

        2. >5mm ⇒ less likely to pass

    4. Herbals for stone passage:

        1. Drop Sankol #1 30cc tds

            1. or Tab Cystone #60 tds

            2. or Tab Lithorex. B #60 tds

    5. Refer to urologist with

        1. Tab ibuprofen 400mg #30 PRN

            1. or supp indomethacin #10 PRN

2. do not discharge if

    1. Obstruction

    2. Febrile

DDx
April 23, 2026 (0)

Reflux

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1. normally resolve in 1-2 y/o

2. Treatment

    1. cap omeprazole 2mg/kg/day (cap 20 mg) in milk

3. Look for other disease if regurgitation is repetitive or causes esophagitis or aspiration pneumonia

DDx, Pediatrics
April 23, 2026 (0)

Pyelonephritis

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1. Symptoms;

    1. frequency

    2. dysuria

    3. flank pain

    4. fever

    5. CVA tenderness

2. Lab data:

    1. U/C

    2. U/A

    3. B/C

    4. repeat 1 week after treatment as test of cure

3. Treatment

    1. Mild:

        1. Tab ciprofloxacin 500mg bid for 10-14 days

            1. or TMP-SMZ 800/160

    2. Severe cases:

        1. IV line fix

        2. CBC, diff, BUN, Cr, Na, K, BS, B/C, U/A, U/C-antibiogram

        3. Serum 1/3 2/3 1 lit iv q8h

        4. Amp ampicillin 1gr qid

        5. Amp gentamycin 1.5mg/kg/8h

            1. or Amp ceftriaxone 2gr bid

        6. Sonography

        7. if pregnant:

            1. Amp ceftriaxone 2gr bid

            2. then cap cefalexin 500 mg qid for 14 days

        8. Or Darab Hospital Ab regimen

            1. Ciprofloxacin 400mg q12h IV

            2. Meropenem 1gr q12h IV

    3. in prolong or relapsing cases, use sonography and CT scan

DDx, Inf. Diseases
April 23, 2026 (0)

Pruritus

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1. Look for underlying cause

2. Lab test:

    1. CBC, diff

    2. BUN, Cr

    3. AST, ALT, ALKP, BILL (T, D)

    4. TSH

3. Treatment

    1. Cap doxepin 25mg qhs #10

        1. or tab hydroxyzine 10 mg tds #20

        2. or lotion calamine topical tds

        3. or oint hydrocortisone 1%

    2. if due to cholestasis

        1. Sachet cholestyramine 4gr bid #30

        2. Cap ursobil 300mg 2tab bid #60

DDx
April 23, 2026 (0)

Pre-eclampsia and eclampsia

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1. Definitions:

    1. >20weeks HTN ⇒ Gestational HTN

    2. <20weeks HTN ⇒ chronic HTN

        1. 30% chance of eclampsia

        2. check BP every 2-3 week till 30w then weekly

        3. check CBC, diff, AST, ALT, ALKP, Na, K, Ca, P, BUN, Cr, Urine 24hr (Protein and Cr), Acid uric

    3. BP<140/90 ⇒ is acceptable in pregnant pt

    4. 140/90<BP<160-100 ⇒ no treatment but may be a pre eclampsia

        1. Hx of blurred vision, headache, N/V, epigastric pain

        2. Check CBC, diff, AST, ALT, ALKP, U/A

            1. look for proteinuria, thrombocytopenia, abnormal LFT

        3. OB/GYN visit

2. Management of pre-eclampsia (BP>140/90 + symptomatic)

    1. mild:

        1. >37w ⇒ delivery

        2. <37w ⇒ watchful waiting

    2. severe: (severe headache is very important BP>16-/100, proteinuria>5gr/dl or +3)

        1. >34w ⇒ delivery

        2. 32w< <34w ⇒ 48 hours on steroids then delivery

        3. <32w ⇒ watchful waiting

3. BP treatment

    1. treat all BPs>160/100

    2. Amp labetalol 20mg IV

        1. repeat with 40mg IV and then 80mg IV (max 220mg)

        2. or Amp hydralazine 5-10mg IV

            1. repeat with 20 mg IV, max 30 mg

    3. goal of BP: SBP≥150, DBP≥100-90

    4. ACI are contraindicated

4. Eclampsia: seizure

    1. LLP

    2. O2 with mask 8-10 lit/min, oral airway

    3. DIAZEPAM IS CONTRAINDICATED

    4. Amp MgSO4 4-6gr in 100cc N/S over 20 mins then 2gr/hr for 24 hours

        1. vial 20%: 20cc

        2. max speed: 1gr/min

    5. Amp MgSO4 5gr IM + Lidocaine 0.5cc in each buttock

    6. if not stopped after 15 mins:

        1. Amp  MgSO4 2gr in 2 min IV

    7. if still not stopped

        1. Amp phenytoin 1gr in N/S over 1 hr (max 50mg/min) then 500mg po 10h later

5. If MgSO4 poisoning:

    1. decreased Patellar reflex

    2. Decreased BP

    3. Decreased RR

    4. Treat with;

        1. Resuscitation stuff

        2. Amp Ca Gluconate 10% bedside

        3. Amp MgSO4 2gr

DDx, General Topics
April 23, 2026 (0)

Postnatal care

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1. Treatment

    1. Amp rhogam 300unit IM if MRh- and FRh+

    2. Discharge with

        1. Tab ferrous sulfate qd

        2. Syrup MOM 30 cc tds

        3. Tab Ca-D qd

        4. Cap cefalexin 500 mg qid

    3. re-visit in case of fever, pain, discharge, re-bleeding

    4. If + Mastitis

        1. Cap cefalexin 500mg qid for 6 days

        2. Tab acetaminophen 500mg qid

DDx
April 23, 2026 (0)

Post-gestational depressive disorder

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1. Treatment

    1. almost always screen all mothers

    2. Mild cases: try not to start the treatment

    3. Moderate to severe cases:

        1. Tab sertraline 50 mg qd, max 200 mg/day, increase weekly for 50 mg

    4. Use sertraline in pregnancy as well if needed (Group C, refer to specialists)

DDx
April 23, 2026 (0)