1. symptoms:
1. 6m/o – 6y/o
2. oral vesicular lesions
3. pain on eating
4. halitosis due to bacterial growth
5. superficial wound after vesicle rupture
6. self-limited in 1-2 weeks
2. Treatment
1. Tab acyclovir 15mg/kg/dose qid (tab 200, 400mg)
2. Cocktail
1. Syrup diphenhydramine #1
2. Cap tetracycline #8
3. Amp lidocaine
4. mouth washing for 2 mins then spit out
#
1. Common viral infection in Autumn
2. Characteristic:
1. vesicular lesions only on
1. soft palate
2. tonsils
3. oropharynx
2. low grade fever
3. sore throat
3. Treatment
1. Syrup acetaminophen 120mg/5ml w/2cc qid
2. syrup diphenhydramine w/3cc bid
#
1. Treatment in pregnancy
1. susp MOM 30cc tds
1. or sachet Psyllium #30 qd
2. Treatment post pregnancy
1. Supp Anti hemorrhoid #15 qd
2. Susp MOM 30cc tds
3. Oint hydrocortisone 1% #1 qd ⇒ not very important
4. other drugs:
1. Oint Hemorrho-Herb
2. Oint Hemrex
3. Oint Rectol
4. Oint Anti-fissure
3. Fissure treatment
1. Tab ibuprofen 400mg #30 tds
2. Susp mom 30cc tds
3. Gel lidocaine #1 topical 30 mins before defecation
#
1. Take ECG always
2. Heartburn
1. Tab digestive 40 mg qd
2. or Tab famotidine 20 mg bid
3. or Syrup ALMgS 15 cc tid
4. continue treatment for 2 weeks
3. Dyspepsia
1. Tab digestive enteric #40 with food
2. Tab pantoprazole 40 mg qd #14
3. or cap omeprazole 20 mg qd #14
4. continue treatment for 2 weeks
5. if no response after 2 weeks ⇒ evaluate for H. pylori
#
1. Migraine
1. Treatment:
1. tab Ibuprofen 400 mg q8-12h #30
2. or tab diclofenac 50-100 mg q8-12h #30
3. or Tab naproxen 250 mg q8h #30
4. tab metoclopramide 10 mg q12h #20 if N/V
5. if not controlled:
1. tab sumatriptan 50 mg #20
2. or Nasal spray sumatriptan 20 mg #1 (for age 12-17 y/o start with spray 10 mg)
3. or Amp sumatriptan 6 mg SQ #1
6. if recurrent:
1. Tab ergotamine with 1-2 mg #30, 2 tab stat repeat q30min (max 6 tabs)
7. Combined pills:
1. tab Treximet (Sumatriptan + naproxen) 85-500 mg q6h #30 for age >12 y/o
2. Tab Novafen q6h #30
3. Tab Excedrin q12h #30
2. Emergency treatment
1. Amp ketorolac 30 mg IV
2. Amp metoclopramide 10 mg IV + Amp dexamethasone 4-8 mg IM
3. Prophylaxis:
1. Tab propranolol 20 mg q12h #60
2. or Tab metoprolol 50-100 mg q12h #60
3. Tab amitriptyline 10 mg qd #60
4. if not controlled at all ⇒ REFER the PT
1. Tab Na-valproate 300-1000 mg bid
2. or Tab Topiramate 25 mg qid or 50 mg bid
2. Tension headache
1. Treatment:
1. tab Ibuprofen 400 mg qid #30
2. or tab Naproxen 250 mg tid #30
3. or Tab ACA qid #30
4. or Tab Ergotamine C 1-2 mg #30
2. prophylaxis
1. tab amitriptyline 10-150 mg qd
3. Cluster headache
1. O2 therapy
2. Amp sumatriptan 6mg SQ
3. Discharge the pt with
1. Tab verapamil 80 mg q8h #40
2. tan Naproxen 250 mg q8h #30
3. Tab prednisolone 50 mg #15 taper in 2 weeks
—
1. Migraine Headache
1. treatment
1. Amp ketorolac 30mg IM
2. Amp betamethasone IM
3. Serum N/S 100cc IV
4. Tab Naproxen 500mg #30 q8h
5. Tab sumatriptan 50mg #10, 1 pill in headache, 1 pill 2 hrs later if still + headache
1. or Tab ergotamine-c 1-2mg #30, 2 tabs if headache
2. Prophylaxis
1. Tab inderal 20mg bid
1. or Tab amitriptyline 10mg qhs
2. Tension headache in pregnancy
1. Tab acetaminophen 500mg #30 q8h
2. Amp apotel 1gr in 500cc N/S IV slow infusion
3. check BP is crucial
3. Red Flags
1. Trauma specially in last 3 days
2. decreased LOC
3. High grade fever
4. Neurologic deficit
5. on Narcotics
6. Worst ever headache
4. If referred the pt, do not prescribe anything
5.
#
1. emergency CT scan without contrast in:
1. GCS<13
2. GCS<14-13 if no cure in 1-2 hours
3. base skull Fx sign and symptoms
4. GCS<15 with severe constant headache, vomiting, 2 times seizure at least, penetrating Fx, focal neurological deficit
2. emergency CT in children if:
1. >3 times vomit or seizure
2. <1 y/o with GCS<15 or >1 y/o with GCS<14
3. >1 hr of amnesia
4. >5 cm sign of Fx or laceration
5. >40 km/hr crash or >1 m fall
1. symptoms
1. self-limiting
2. vesicle/papule with erythema
2. if pruritus:
1. Syrup diphenhydramine 12.5mg/5ml w/4cc qid
3.
1. Male pattern alopecia
1. Solution minoxidil 5% 1cc for 1 hour on hair
2. Tab finasteride 1mg qd
2. Female pattern alopecia
1. Solution minoxidil 2% 1 cc for 1 hour on hair
1. if causes pruritus and exfoliation, use foam shape
2. Tab finasteride 5 mg qd
3. do not use in pregnancy
3. Alopecia areata
1. coin shape alopecia
2. exclamation shape hair on examination
3. Amp triamcinolone 2.5mg/ml diluted, 0.1cc/1cm injection, max 3-4 cc in every session, sessions are monthly
4. Generalized hair loss
1. Acute
1. after febrile disease
2. after drug use
3. usually resolves in 3-6 months
2. Lab test:
1. CBC, DIFF, Serum iron,
2. TSH, T3, T4
3. Vit d and Zinc level
3. Treatment
1. Tab zinc plus
2. Amp dexpanthenol weekly IM for 6 weeks
3. amp biotin weekly IM for 6 weeks
4. cap hair-vit
5. Acti-Derm
6. Cysttine
7. Tab biotoin
8. Pomeol
9. Perfectil
1. Who to treat?
1. peptic ulcer
2. long term anti acid use
3. cancer risk factor
4. more than 1 year use of anti acid
2. Test:
1. Urea Breath Test (UBT)
2. or Fecal H. pylori Antigen (no use of Ab in last month and no use of anti acid in last 2 weeks)
3. or Serum H. pylori IgG
3. Triple therapy:
1. Cap esomeprazole 40 mg bid #28
2. tab clarithromycin 500 mg bid #28
3. Cap amoxicillin 500 mg 2tabs bid #60
1. or tab metronidazole 500 mg bid #28
4. Quadruple therapy:
1. Cap amoxicillin 500 mg 2tabs bid #60
2. Cap esomeprazole 40 mg bid #28
3. tab metronidazole 500 mg bid #28
1. tab clarithromycin 500 mg bid #28
4. tab bismuth sub citrate 2 tab bid #60
5. 2nd line treatment: for 2 weeks
1. Cap amoxicillin 500 mg 2 tab bid
2. Cap levofloxacin 500 mg bid
1. or cap rifampin 150 mg bid
2. or Tab furazolidone 100 mg bid
3. Cap esomeprazole 40 mg bid
6. Side effects:
1. clarithromycin: bitter taste, skin rash
2. Metronidazole: iron taste
3. Bismuth: dark stool
4. Amoxicillin: pseudomembranous colitis, diarrhea
5. tetracycline: skin rash, photosensitivity