Archive

Otitis media

#

1. more common in children

    if <6 m/o or 6 m/o-2 y/o with severe disease or >2 y/o with otorrhea and severe ⇒ immediately start treatment. otherwise, can wait for 2 days. if the pt did not got better, start treatment.

2. Treatment

    1. Anti biotics

        1. Syrup amoxicillin 250 mg/5cc bid #1 90mg/kg/day

        2. or syrup Farmenting (co-amoxiclav) 643 bid #1 weight/3 cc

        3. or Tab co-amoxiclav 625mg tds #30

        4. If penicillin hypersensitivity or no cure after 24-48 hours

            1. Amp ceftriaxone 1gr IM #3 qd for 3 days 50mg/kg

            2. or Syrup azithromycin 100mg #1 weight/2 stat then weight/4 for 4 days

    2. Irrigation

        1. Serum N/S 500 cc for irrigation #1

    3. Pain killer

        1. Susp acetaminophen 120 mg/5cc weight/2 cc qid #1

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

Osteoporosis

#

1. Risk factors:

    1. >50 y/o ⇒ start screening in all >65y/o

    2. menopause

    3. on steroids

    4. use of cig. and alcohol

2. Prophylaxis (Z score>-2, T score >-2.5)

    1. Tab osteofos 35mg #15 weekly

        1. or Tab risedronate 35mg #15 weekly

        2. or Amp Prolia 60mg #4 q6m SQ

3. Treatment (Z score←2, T score←2.5)

    1. Tab osteofos 70 mg #15 weekly

        1. Alendronate ⇒ Fosamax, Osteomax, Osimax

        2. or tab risedronate 150mg #15 monthly

            1. or tab risedronate 35mg #15 weekly

    2. Pearl Vit-D 50,000 unit #50 weekly

        1. or Amp Prolia 60 mg #4 q6m SQ

    3. Tab Ca-D 500mg #100 qd

DDx
April 23, 2026 (0)

Osteoarthritis

#

1. common involved joints:

    1. neck

    2. knee

    3. hip

    4. lumbosacral

2. Treatment

    1. mild pain

        1. Tab acetaminophen 325mg qid #60

    2. Low risk of GIB and high risk of CVD

        1. Tab naproxen 250, 500 mg bid #60

        2. Tab pantoprazole 40 mg qd #60

    3. High risk of GIB and low risk CVD

        1. Tab celecoxib 100, 200 mg bid or qd #60

        2. Tab pantoprazole 40 mg qd #60

    4. Another effective drug:

        1. gel Diclofenac 1% qid #1

    5. If above drugs were not effective

        1. Tab Tramadol 50 mg bid #60

        2. do not use if pt with risk of abuse or PMHx of seizure or warfarin use

    6. Other drugs:

        1. Tab Alflexil/ Cartigen Max/ Joint Free/ Pre flex/ MSM tds for 6 months

        2. Gel piroxicam/ Oint Phyto glucosamine

DDx
April 23, 2026 (0)

OCD

#

1. as an anxiety disorder

2. Treatment

    1. Cap fluoxetine 10mg #60 qd

    2. Tab nortriptyline 25mg #60 qd

3.

DDx
April 23, 2026 (0)

Nocturia

#

1. Can e NL up to school age

2. if it’s a new happening in a child, look for special reasons

3. If it’s due to constipation:

    1. Syrup lactulose #1 w cc tds

    2. syrup MOM #1 w*2 cc bid

4. R/O UTI

5. if constipation and UTI are ruled out, refer to Specialist for:

    1. Tab imipramine 10 mg #1 daily

    2. F/U next week for 3 months

DDx, Pediatrics
April 23, 2026 (0)

Non-febrile seizure in infancy

#

1. GTC is not common in infancy

2. do not use diazepam in infancy

3. Symptoms

    1. blinking

    2. changing HR

    3. hand jerking movements

    4. nystagmus

4. treatment

    1. Lorazepam IV ⇒ no available in Iran

    2. Next: Amp phenobarbital 20mg/kg, repeat with 5-10mg/kg, max dose 40mg/kg

    3. Next: Amp phenytoin 15-20mg/kg

DDx, Pediatrics
April 23, 2026 (0)

Nipple fissure

#

1. Treatment

    1. Oint vit A-D qid #1

    2. Oint mupirocin 2% #1 bid

    3. or

        1. Cream lanolin topical

        2. Nipple shield for 24hrs

DDx
April 23, 2026 (0)

Needle stick

#

1. check HBsAg, HIV Ab, HCV Ab

2. Check HBs AG:

    1. if >10 ⇒ OK

    2. if <10 ⇒ consider booster and Immunoglobulin

3. Vaccination for HBV ⇒ 0-1-6 months

4. Let the wound bleed for 5 minutes

DDx, General Topics
April 23, 2026 (0)

Nausea in Pregnancy

1. treatment

    1. Tab Vit B6 #20 qd

        1. or Pyridoxine

    2. Cap Zintoma #20 qd

2. in severe cases

    1. Amp promethazine 25mg

    2. or Amp ondansetron

DDx
April 23, 2026 (0)

Nasal congestion

#

1. Nasal spray mometasone (Nasonex) 2puff tds #1

2. Nasal drop NaCl 0.65% 2drop qid

    1. or Serum N/S 500 cc for irrigation #1

3. Tab pseudoephedrine 30mg tds #28

    1. or syrup pseudoephedrine tds #1

DDx
April 23, 2026 (0)