#
1. check TSH, T4 in 3-5 days, if low T4 and high TSH
1. Start levothyroxine 10-15mic/kg/day (tab 0.5mg, 0.1mg)
2. check TSH monthly for 6 month, then every 2-3 month till 2y/o
3. D/C drug in 3 y/o if TSH and T4 are corrected
2. Dosage based on age:
1. 1-3 y/o ⇒ 4-6 mic/kg/day
2. 3-10 y/o ⇒ 3-5 mic/kg/day
3. 10-16 y/o ⇒ 2-4 mic/kg/day
#
1. Criteria
1. <3m/o
2. >3 days per week
3. >3 hours per days
4. self-limited
5. NL examination
6. more severe in afternoon
2. Treatment
1. Drop colicEZ 10drop qid
1. or drop colic aid 10 drop qid
2. or syrup Gripe mixture for >1m/o 1 tea spoon qd
3. or drop dimethicone 10 drop qid
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1. Cause
1. staph
2. strep
2. Treatment
1. for wet lesions:
1. Oint tetracycline
2. For dry lesions
1. Cream mupirocin 2%
3. or more severe cases add:
1. Cap cefalexin 500 mg #30 qid for 7-10 days (25mg/kg/day)
1. or syrup cefalexin w/4 qid #1
3. Risk of PSGN ⇒ 2% in 1-2 month post infection
#
1. Check
1. CBC, diff, ESR, CRP
2. Ca, TSH
3. S/E, OB
2. R/O celiac disease and other pathologies
3. Orders:
1. tab dicyclomine 20 mg tds #60
2. Tab amitriptyline 25 mg qd #60
3. if with diarrhea: tab loperamide 2 mg #8
4. if with constipation: Syrup lactulose 30 cc qd 3q
5. if with obstipation: Tab dimethicone 40 mg qd #40
1. BP > 140/90
if age>60 y/o ⇒ BP > 150/90
2. if there were any secondary cause for HTN, refer the pt to specialists otherwise, start treatment
3. Check:
1. CBC, BUN, Cr, Na, K, Ca U/A
2. TSH, FBS, TG, CHOLESTROL, LDL, HDL
3. URIC ACID, Urine Alb/ Urine Cr
4. CXRAY, ECG
4. First line treatment
1. ACIs
1. tab captopril 25, 50 mg bid, tds, qid
2. tab enalapril 5, 10 mg bd, qd
3. tab lisinopril 5, 10 mg bid, qd
2. ARBs
1. Tab losartan 25, 50 mg qd or bid
2. Tab valsartan 40, 80, 160 mg qd
3. CCBs:
1. Tab amlodipine 5 mg qd
2. Tab Diltiazem 60, 120 mg qd
4. Thiazide:
1. Tab Hydrochlorothiazide 50 mg qd
5. check BP after starting medication in 2-4 weeks
6. if started ACE/ARBs, check Na, K, BUN, Cr after one week
7. Goal of treatment BP<130/80
8. After using 3 drugs, if BP is not controlled, refer the pt for secondary causes
9. Combined Pills:
1. tab Losamix-H 50/12.5 mg (losartan, thiazide)
2. tab Valtizide 80/12.5 or 160/12.5 (Valsartan, thiazidde)
3. Tab valfort 5/160/12.5 (Amlodipine, valsartan, thiazide)
10. Tab Indapamide 1.25, 2.5 mg qd
1. another thiazide
2. less side effects than hydrochlorothiazide
11. If Cr>1.5 and GFR<30 ⇒ do not use Thiazide
12. ACIs may cause cough but resolves after 1 month of cessation
13. If Heart failure + Pulmonary edema + HTN
1. ACIs or ARBs
2. Tab frusemide (Lasix) 40 mg bid #30
14. If Angina or LVF is present use b-blockers
1. Tab metoprolol 50, 100 mg bid #60
2. do not use in
1. heart block
2. asthma
3. COPD with active wheezing
4. HR< 55 bpm
5. Pt follow-up
1. side effects:
1. Angioedema in ACIs
2. hyperkalemia in ACIs or ARBs
2. orthostatic hypotension
6. Urgent HTN: high BP without end-organ damage
Emergency HTN: high BP with end-organ damage
7. Emergency HTN treatment
1. IV drugs
2. Reach goal in 48 hours
3. start po drugs in 6-12 hours
4. in 2-4 hours, reduce 25% of BP to reach 160/100
8. Urgent HTN treatment
1. repeat BP check in 30 minutes
2. if still high, start Po drugs:
1. captopril
2. amlodipine
3. hydrochlorothiazide
3. after BP reaches <180/120, discharge with PO drugs and re-visit in 1-7 days
#
1. Treatment
1. Lotion Calamine D bid
2. Tab vit c daily
3. Tab hydroxyzine 25mg bid
4. Solution aluminum chloride 20% qhs for 7 nights, wash hands in the morning, after treatment weekly only
5. tab oxybutynin 5 mg 1/2 tab bid
6. tab propranolol 10 mg bid #30
1. Acute infection of tip of eyelids (گل مژه)
2. Always R/O cellulitis
3. Treatment
1. Baby shampoo #1 tds
2. Oint opht erythromycin 0.5% #1 qid
3. warm compress for 10 mins qid
#
1. Check
1. ovarian sonography
2. DHx and PMHx
3. FBS
4. TSH, T3, T4
5. 17-Hydroxyprogestrone (7-9 am)
6. Testosterone total and free
7. DHEAS
8. Progesterone days 20-22
9. LH, FSH
10. Estradiol
11. Urinary free cortisol
#
1. DDx:
1. Inferior MI
2. CNS problems
2. Treatment
1. Amp chlorpromazine 50mg/2cc IM #1
1. or tab Chlorpromazine 25mg qid #25
2. or Scored tab baclofen 10 mg qid #30