Archive

Polycystic ovarian syndrome (PCOS)

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1. Symptoms

    1. hirsutism, thick hair

    2. irregular mensuration

    3. acnes

    4. obesity and metabolic syndrome

    5. men pattern hair loss

    6. oligomenorrhea

    7. anovulation

2. Dx: sonography or hyperandrogenism symptoms

3. Imaging:

    1. sonography of both ovaries, uterus and adnexa

4. Check

    1. testestron, 17. hydroxy progestron, DHEA, Prolactin, LH, FSH

    2. B-hCG

    3. TSH, T3, T4

    4. LDL, HDL, Total cholesterol, TG

    5. CBC, FBS

    6. ALT, AST, ALKP

5. Treatment

    1. Tab OCP for 6 months

    2. Metformin 500 mg bid for obesity, lipid profile and anovulation

    3. Tab spironolactone 50mg bid for hirsutism

    4. Ta clomiphene 50 mg qd from 5th days of cycle for 5 days, increase up to 100 mg, for ovulation

        1. or tab letrozole start from 3rd day of mensuration for 5 days in cases resistant to clomiphene

    5. Treat acnes

DDx
April 23, 2026 (0)

Pneumonia

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1. treatment

    1. NO previous ab-therapy

        1. tab azithromycin 250, 500 mg #6 (500mg stat then 250 mg qd)

    2. Previous ab-therapy

        1. Tab levofloxacin 250, 500, 750 mg qd (750 mg for 5 days, 500 mg for 14 days)

    3. If poor condition or afraid of fluoroquinolones side effects

        1. Amp ceftriaxone 1 gr IV stat

        2. Tab azithromycin 250 mg #6 500 mg stat then 250 mg qd

    4. If with fever

        1. Tab acetaminophen 500 mg qid #30

    5. If productive cough

        1. Syrup expectorant 5cc qid #1

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

PID – Pelvis inflammatory disease

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1. symptoms:

    1. hypogastric pain

    2. N/V

    3. Fever

    4. Vaginal discharges

    5. dyspareunia

    6. menstruations problems

    7. usually Hx of STDs

2. If pregnant, + abscess formation or severe symptoms, admit. otherwise treat:

    1. outpatient treatment

        1. Amp ceftriaxone 1gr IM stat

        2. Tab metronidazole 500mg #28 bid

        3. Tab doxycycline 100 mg #28 bid

            1. can cause esophagitis

            2. use with a cup of water

            3. do not lye down after use

    2. inpatient treatment

        1. Amp clindamycin 600mg IV q6h

        2. Amp gentamycin 1.5mg/kg IV q8h

        3. continue IV treatment till 48 hours post fever, then shift to PO treatment for 14 days

            1. Tab clindamycin 300mg qid

            2. Tab metronidazole 500 mg bid

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

Pharyngitis

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1. symptoms

    1. 3-15 y/o

    2. sore throat

    3. exudate in oropharynx

2. Treatment

    1. Amp penicillin 6-3-3 #(1 for <27kg, 2 for >27kg) + **Penicillin Test**

        6: 600 unit P. Benzathine

        3: 300 unit P. procaine

        3: 300 unit P. G potassium

        1. or Amp penicillin benzathine 1,200,000 #(1 in >27kg and 1/2 in <27kg)

        2. or tab penicillin V 500 mg tds #30

        3. or susp Penicillin V 250mg/5ml tds #1 10 cc for >27kg and 5cc for <27 kg

        4. or Tab co-amoxiclav 625mg tds #28 (45mg/kg/day)

        5. or Syrup Farmentin 643 w/3 #1

    2. in case on hyper sensitivity

        1. Tab erythromycin 300 mg tds #30 for >5y/o

            1. or tab azithromycin 250 mg #6, 2 tab stat then 1 tab qd

        2. Syrup erythromycin 200mg for 3-5 y/o

            1. or syrup azithromycin 200mg/5ml #1

    3. Susp acetaminophen 120mg/5ml w/2 cc qid

    4. susp diphenhydramine 12.5mg/5ml #1 qid

    5. tab altadin #1 q4h میکدنی for adults only

    6. Drop NaCl 0.65% #1 q4h for nasal congestion

3. DDx: EBV

    1. pharyngitis + exudate

    2. myalgia + fever + malaise

    3. neck and submandibular lymphadenopathy

    4. leukocytosis + atypic lymphocyte + thrombocytopenia

    5. Tx: if thrombocytopenia + purpura ⇒ steroids

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

Pertussis

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1. symptoms

    1. barking cough

    2. Lacrimation

    3. rhinorrhea

    4. cyanosis and vomiting post cough

2. Admit

    1. infant <3m/o

    2. severe symptoms

3. Treatment

    1. Syrup azithromycin 10mg/kg/day then 5 mg/kg/day for 4 days

        1. or syrup erythromycin 12mg/kg/day qid for 14 days

4. isolation till 5 days after start of azithromycin

5. Vaccination

    1. <7y/o with uncompleted vaccination ⇒ TDP

    2. >9y/o ⇒ Tdap

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

Pediculosis

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1. Pruritus, secondary infection in itching areas, ova on hair

2. Treatment

    1. clothes in closed bag for 2 weeks

    2. >2m/o

        1. Shampoo permethrin 1% after bath for 10 min on hair, repeat 7 days later, group B in pregnancy

        2. Lotion Malathion for 12-8 hours on dry hair then washed, repeat 1 week later

            1. or Cap co-trimoxazole 400/80mg bid for 3-5 days then repeat next week

    3. Body pediculosis

        1. Lotion Lindane (contra indicated in children and pregnancy)

            1. or Cream permethrin 5% on body for 8-12 hours then washed

    4. children and pregnancy

        1. Sulfur precipitate 5%

        2. vaseline 90 gr

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

Paronychia

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1. Treatment

    1. I&D in case of puss formation

    2. warm compress

    3. Cap cefalexin 500 mg qid #30

        1. or syrup cefalexin w/4 qid #1

    4. for chronic forms: usually due to candida

        1. Cream clotrimazole tds for 1-2 months

        2. or cream miconazole tds for 1-2 months

        3. oint hydrocortisone 1% q12h #1

    5. if due to oral contact:

        1. Tab co-amoxiclav 625 q12h #20

2. DDx: Erf’s disease

    1. viral disease

    2. zoonotic

    3. self-limited

    4. if secondary bacterial infection on it ⇒ use cefalexin

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

Panic attack

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1. Treatment

    1. in attack:

        1. calm environment

        2. IV diazepam

    2. maintenance

        1. Cap fluoxetine 20mg qd ⇒ first choice is SSRIs

            1. or Tab sertraline 50 mg qd

        2. Tab alprazolam 0.5mg qd

            1. or tab diazepam 5mg PRN

DDx
April 23, 2026 (0)

Otomycosis

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1. Seen in pt with external otitis but did not recover after 1-2 courses of treatment specially with risk factors for DM and Immunodeficiency

2. Treatment

    1. clean the canal from debris

    2. Solution clotrimazole 1% 3drop tds for 10-14 days #1

    3. Solution Gentian Violet 1% 3drops tds for 10-14 days #1

3. if severely ill, use oral fluconazole and refer to ENT

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