e SVjEi0H I Ce MMO Te OW DWUW TREATMENT GUIDE RU u Cee ee a eg ue cus mre for House Officers, Medical Officers, Interness & Trainess. MSU ThCONTENTS PAGE NO. CHAPTER-1- HISTORY TAKING AND EXAMINATION CHAPTER-2 SYMPTOMS AND QUESTIONARY CHAPTER-3 PROCEDURES AND WARD SKILLS Passing IV line (IV cannulation) Setting up a drip Venepuncture/phlebotomy Vacutainer Tube Guide — Draw tubes Blood cultures Blood transfusion Guidelines for blood transfusion Arterial Blood Gas (ABGs) Sampling Intramuscular, subcutaneous, and intradermal drug injection 10. Nasogastric intubation 11. Male catheterization 12. Female catheterization 13. Endotracheal intubation 14. Joint Aspiration (Arthrocentesis) 15. Lumber puncture 16. Paracentesis Abdominis (Ascitic tapping) 17. Paracentesis Thoracis (Pleural fluid tapping OR Thoracentesis) 18. Bedside Blood Glucose Measurement 19. Scrubbing up for theatre CEN aMaAwne CHAPTER-4 PRESCRIBING, ADMINISTRATIVE AND COMMUNICATION SKILLS . Explaining Skills .. Endoscopies Explanation |. Obtaining Consent |. Breaking Bad news .. Requesting investigations for histopathology of specimen after procedure 3. Call to other department/consultation form /. Discharge planning and negotiation . Taking Consent for LAMA/DAMA. 1. Death confirmation and death certification Pen anaeneCHAPTER-5 INFECTIOUS DISEASES Fever of unknown origin Fever with chills and rigors Enteric fever (Typhoid fever) Malaria fever (Falciparum fever) Brucellosis Weil's Disease (Leptospirosis) Schistosomiasis Tick typhus/scrub typhus |. Epidemic typhus 10. Endemic typhus 11. Rocky mountain spotted fever 12. Syphilis, 13. Coxiella Burnetii (Q-Fever) = Questionable Fever 14, Shigellosis peranaeene CHAPTER-6 PULMONOLOGY Fever with dry cough Fever With Productive Cough Community-Acquired Pneumonia (CAP) Outpatient (OPD) Community-Acquired Pneumonia (CAP) Inpatient (ward/ER) Nosocomial Pneumonia/Hospital-Acquired Pneumonia (HAP) Ventilator-Associated Pneumonia (VAP) Chlamydia Psittaci Pneumonia Mycoplasma Pneumonia 9. Legionnaires Disease (Legionellosis/Legionella Pneumonia) 10. Staphylococcal Pneumonia 11. Pneumococcal Pneumonia 12. Lung Abscess 13. Pulmonary Tuberculosis, 14. Bronchial Asthma 15. Chronic Obstructive Pulmonary Disease (COPD) 16. Asthamatic Patient With Severe Coughing 17. Fever with dry cough +/- Sore throat 18. Fever with Productive Cough 19, Productive cough with Postnasal drip 20. Asthmatic patient with severe coughing 21. Pleural Effusion SPN ON awn CHAPTER-7 CARDIOLOGY 1. Evaluation to The Management of Hypertension 2. Anti-Hypertensive Treatment Based on Comorbidities 3. Acute Myocardial Infarction With ST-Segment ElevationStable Angina Pectoris (Chronic) Un-Stable Angina Congestive Cardiac Failure (CHF) Acute Heart Failure & Pulmonary Edema Infective Endocarditis Rheumatic Heart Disease CHAPTER-8 GASTROENTEROLOGY & HEPATOLOGY Approach to Management Nausea & Vomiting Life-Threatening causes of Nausea & Vorniting Oral Ulcer (Aphthous Ulcer, Stomatitis) Gastro-Esophageal Reflex Disease (GERD) Gastric Ulcer (Peptic ulcer) Duodenal Ulcer (Peptic ulcer) Helicobacter Pylori Infection Functional Dyspepsia Hiccups (Singultus) 10. Non-Alcoholic Fatty Liver Disease (NAFLD) Or "Fatty Liver 11. Irritable Bowel syndrome (IBS) 12. Ulcerative Colitis 13. Adults Constipation 14, Non-Alcoholic Fatty Liver Disease (NAFLD) Or "Fatty Liver/Hapatic Steatosis 15. Amoebic Liver Abscess (Hepatic Abscess) 16. Chronic Hepatitis-B viral Infection 17. Chronic Hepatitis-C viral Infection 18, Decompensated Chronic Liver Disease (DCLD) = Liver Cirrhosis + Ascites 19. Ascites PONaVawne CHAPTER-9 ENDOCRINOLOGY Diabetes Mallitus Injectable Anti-Diabetic/ Hypoglycemic Drug Brands Insulin Regimens Principles of Insulin Adjustment Sliding-Scale Insulin Regimen Insulin Regimens for Glucocorticoid-Induced Hyperglycemia Characteristics of Insulin Therapy Diagnosis Of Diabetes Mellitus 9. Type-1 Diabetes Mallitus (DM Type-!) 10. Type-2 Diabetes Mallitus (OM Type-I!) 11. Diabetic Nephropathy 12. Diabetic Neuropathy 13. Diabetic Retinopathy 14. Hypothyroidism 15. Hyperthyroidism & Thyrotoxicosis 16. Pheochromocytoma SN OMA wn17. Hyperprolactinemia CHAPTER-10 NEPHROLOGY & UROLOGY Fever with Burning Micturition Urinary Tract infection (UTI) in Adults Acute Pyelonephritis Tiny Renal Stones (Nephrolithiasis) Conservative Rx Benign Prostatic Hyperplasia (BPH) International Prostate Symptom Score (IPSS) Urinary Incontinence Urge Incontinence Stress Incontinence 10. Overactive Bladder (OAB) 11. Male Sexual Dysfunction & Erectile Dysfunction 12. Painful Bladder Syndrome (Interstitial Cystitis) 13, Nephritic Syndrome 14, Nephrotic Syndrome 15, Acute Renal Injury (AKI) 16. Acute Renal Injury (AKI) Ward/ER Rx Penaneene CHAPTER-11 HAEMATOLOGY Iron Deficiency Anemia Megaloblastic Anemia Acute Leukemia Thrombotic Thrombocytopenic Purpura (TTP) Immune Thrombocytopenic Purpura (ITP) Aplastic Anemia oy aeNe CHAPTER-12 NEUROLOGY & PSYCHIATRY Migraine Headache Cluster Headache Tension Headache Transient Ischaemic Attacks (TIA) Cerebrovascular Accident (Ischemic Stroke) Postherpetic Neuralgia Trigeminal Neuralgia Bell's Palsy (Facial Palsy/7th CN Paralysis) 9. Parkinson's Disease 10. Resting Tremors PN OM AwN 12. Alzheimer’s Disease 13. Cerebral Palsy (CP) 14. Dhat Syndrome (Semen leakage after urination) 15. Premature ejaculation (Rapid/Early ejaculation)16. Insomnia Disorder 17. Acute Stress Disorder 18. Panic Attack 19. Panic Disorder 20. Generalized Anxiety Disorder (GAD) 21. Bipolar Affective Disorder (BIPAD) 22. Schizophrenia 23. Opioid Withdrawal Syndrome (Symptomatic) CHAPTER-13 RHEUMATOLOGY & ORTHOPADIC 1. Osteoporosis Post-menopausal Osteoporosis Arthritis Post Chikungunya Arthritis, Osteoarthritis conservative Rx Rheumatoid Arthritis Gouty Arthritis Plantar Fasciitis Polymyalgia Rheumatica 10. Fibromyalgia PENanewn CHAPTER-14 ENT 1. Acute Tonsillitis Acute Sinusitis (Acute Sinus Infection) Acute Sinusitis (Acute Sinus Infection) Chronic Sinusitis Acute Rhinitis Chronic Simple Rhinitis Hypertrophic Rhinitis (Chronic) Allergic Rhinitis 9. Deviated Nasal Septum (DNS) 10. Septal Haematoma 11. Septal Abscess 12, Adult with Ear Discharge/Infection 13. Acute Supporative Otitis Media (ASOM) 114. Chronic Suppurative Otitis Media (CSOM) 15. Tinnitus 16. Vertigo 17. Benign Paroxysmal Positional Vertigo (BPPV) 18. Ear, Nose and Throat Drug Brands in Pakistan. eNanAWN CHAPTER-15 EYE 1. Hordeolum (Stye) 2. Chalazion (Meibomian Gland Lipogranuloma)Iritis (Anterior Uveitis) ‘Acute Mucopurulent Conjunctivitis Chlamydial Conjunctivitis Allergic Conjunctivitis Viral Conjunctivitis (Adenovirus Conjunctivitis) Herpes Simplex Keratitis Blepharitis (Blepharitis Squamosa) 10. Corneal Abrasion 11. Sub-Conjunctival Hemorrhage 12. Ocular Chemical Burns Injuries (Non-Mechanical) 13. Corneal Foreign Bodies (Mechanical) 14, Acute Angle Closure Glaucoma (AACG) 15. Bye/Ophthalmic Drug Brands In Pakistan wearnanaw CHAPTER-16 DERMATOLOGY 1. Scabies 2. Acne vulgaris 3. Psoriasis 4, Seborrheic Dermatitis (Seborrheic eczema) 5. Tinea pedis/(Athlete's foot)/and Tinea manuum) 6. Tinea Corporis (Ring worm) 7. Tinea varsicolor (Pityriasis Varsicolor) 8. Tinea cruris (Jock itch) 9, Melasma 10. Vitiligo 11. Herpes-Zoster (Shingles) 12, Atopic Dermatitis/Atopic Eczema 13. Allergic Contact Dermatitis 14, Napkin Dermatitis (Pamper Rashes) 15. Pompholyx (Dyshidrotic Eczema) 16. Hyperhidrosis, 17. Hirsutism 18. Commonly used Dermatological/Skin CHAPTER-17 EMERGENCY MEDICNE & POISONING 1. The primary and secondary surveys Pain management approaches Oral Opioid and Non-opioid Analgesics Foreign Body Aspiration Evaluation and Management of Coma Hypertensive Emergency management Approach to Diarrhea Gastroenteritis of infectious origin 9. Evaluation of Gastroenteritis 10. Acute Gastroenteritis/Food poisoning in adults 11 Typhoid Fever (Enteric Fever) exyanawn12, Status Epilepticus (Seizures/Fits) 13, Epistaxis (Bleeding through Nose) ER Rx 14. Diabetic Ketoacidosis (DKA) 15, Hyperosmolar Hyperglycemic State (HHS) 16. Acute Viral Hepatitis (Hepatitis-A/Jaundice) 17. Upper Gastrointestinal bleeding 18. Upper Gastrointestinal bleeding 2°CLD 19, Hepatic Encephalopathy 20. Amoebic Liver Abscess 21. Pyogenic Liver Abscess 22, Acute Blood loss (Hemorrhagic shock) 23, Acute Haemolytic Transfusion Reaction 24. Dengue Fever with Severe/Progressive thrombocytopenia 25. Iron Deficiency Anemia 26. Megaloblastic Anemia 27. Acute Asthma 28. Status Asthmaticus 29, Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) 30. Acute Renal Colic pain (2° Nephrolithiasis) 31. Acute Pyelonephritis 32. Acute Chest Pain/Acute Coronary syndrome 33, Cardiac Arrest 34, Pulmonary Edema 35, Acute Myocardial Infarction 36, Pulmonary Embolism 37. Fever with ALOC 38. Meningitis in complete detail 39, Bacterial Meningitis, 40. Viral Meningitis 41. HSV Encephalitis 42. Intracerebral hemorrhage (Hemorrhagic stroke) 43. Ischaemic Stroke 44, Anaphylaxis 45. Organophosphate Poisoning 46. Benzodiazepines poisoning 47. Opiates/Opioid Poisoning 48. Acids/Caustic Ingestion 49. Kerosene Poisoning 50. Human Bites 511. Dog Bites (Rabies Virus) 52. Unknown Insect Bites/Sting Bites 53, Snake Bites 54. Hypokalemia 55, Hyperkalemia 56. Hypoglycemia CHAPTER-18 COVID-19 (Coronavirus Disease 2019)*CHAPTER-19 GENERAL SURGERY 1. Approach to Management of Acute Abdomen Differential Diagnosis and Causes of Acute Abdomen Diagnostic approach of Acute Abdomen Radiological Approach of Acute Abdomen ‘Stepwise management of Acute Abdomen. ‘Acute Appendicitis, ‘Acute Cholecystitis Cholelithiasis Choledocolithisis 10. Acute Cholangitis 111. Acute Anal fissure conservative Rx 12. Hemorrhoids conservative Rx 13, Ano-Rectal Abscess 14, Pilonidal Sinus 15. Acute Pancreatitis 16. Intestinal Obstruction 17. Spontaneous Bacterial Peritonitis 18, Secondary Bacterial Peritonitis 19. Pressure ulcer (Bed sore) 20. Diabetic foot ulcer 21. Hypertrophic scar 22. Keloid scar penaneen CHAPTER-20 NEUROSURGERY Degenerative Disk Disease Brachialgia (Cervical Radiculopathy/Pinched nerve) Sciatica Pain Conservative treatment of Back pain Epidural Hematoma/Extradural hematoma (EDH) Subdural Hematoma (SDH) Brain Abscess Traumatic Brain Injury (Head Trauma) Pneumocephalus 10. Subarachnoid Hemorrhage PENA aAwNE CHAPTER-21 GYNAECOLOGY & OBSTETRICS Fever With Dry Cough in Pregnancy Fever With Productive Cough in Pregnancy UTI (Urinary tract infection) in Pregnancy Community-Acquired Pneumonia (CAP) Outpatient (OPD) in Pregnancy Community-Acquired Pneumonia (CAP) Inpatient (WARD) in Pregnancy Vaginal Yeast Infection (Vulvo-Vaginal Candidiasis) Chlamydial infection Leucorrhea SN aVeene9. Pelvic Inflammatory Diseases (PID) 10. Trichomoniasis 11. Atrophic Vaginitis 12. Primary Dysmenorthea (Menstrual Pain) 13, Secondary Dysmenorrhea 14, Premenstrual syndrome (PMS) 15, Mittleshmerz 16. Menorrhagia 17. Oligomenorrhea 18, Endometriosis 19. Uterine Leiomyomas (Fibroids) 20. Female Infertility 21. Polycystic ovary syndrome (PCOS) 22. Benign Ovarian Cyst 23. Post-Partum Hemorrhage (PPH) 24, Nausea And Vomiting Of Pregnancy (Uncomplicated) 25. Hyperemesis Gravidum 26. Chronic Hypertension in Pregnancy 27. Pre-Eclampsia 28, Eclampsia 29, Migraine Headache in Pregnancy 30. Gastroesophageal Reflux Disease (GERD) in Pregnancy 31. Peptic Ulcer Disease in Pregnancy 32, Helicobacter Pylori in Pregnancy 33. Constipation in Pregnancy 34, Hemorrhoids Conservative in Pregnancy 35, Anemia of pregnancy 36, Anti-Phospholipid Syndrome (APS) 37. Gestational Diabetes Mellitus (GDM) 38. Hypoglycemia in Pregnancy 39, Diabetic Ketoacidosis in Pregnancy 40. Hyperthyroidism in Pregnancy 41. Hypothyroidism in Pregnancy 42. Normal Pregnancy 43, Ectopic Pregnancy 44, Pregnancy Loss and types 45, Spontaneous abortion 46. Pueperal sepsis, 47. Postpartum Endometritis, 48. Emergency Contraception "Postcoital Contraception" 49. Overview of Different Types of Hormonal Contraceptives 50. Gynaecological Drug Brands in Pakistan 51. US. Food and Drug Administration Pregnancy Drug Categories, 1979 52. Drugs used in pregnancy with known adverse effects in human pregnancy 53. Safe medicines in pregnancy 54, World Health Organization General Cautions for Drugs and Breastfeeding55. 2015 U.S. Food and Drug Administration Pregnancy and Lactation Labeling Rule Required Information on Package Insert for Every Medication 56. Fetal Radiation Effects & Characteristics CHAPTER-22 PAEDIATRICS & NEONATOLOGY 1. The Newborn Infant Neonatal Resuscitation Assessment of the newborn Fluid Management in Newborn Dehydration & Treatment Plan Neonatal Hypothermia Vitamin-K deficiency bleeding of the newborn Neonatal Polycythemia 9. Neonatal Hypocalcemia 10. Neonatal Hypoglycemia 11. Neonatal Respiratory Distress Syndrome (NRDS) 12. Surfactant Replacement Therapy (Guidelines) 13, Neonatal jaundice 14. Guidelines For Phototherapy & Exchange Transfusion 15. Neonatal Seizures 16. Neonatal Sepsis 17. Acute Tonsillitis 18. Acute Epiglottitis 19. Laryngotracheobronchitis (CROUP) 20. Bronchiolitis 21. Lower Respiratory Tract Infections (LRTIs) 22. Community Acquired Pneumonia 23, Paediatric Pneumonia (CAP) in Patient (Ward) 24. Acute Asthma Attack ER Rx 25. Status Asthmaticus ER Rx 26. Fever with Burning Micturition 27. Urinary Tract infection (UTI) in Children’s 28. Allergic Rhinitis 29, Food Allergy 30. Child with cold & flue 311. Child with Dental Infection/Pain 32. Child with Ear Pain 33. Child with Ear Discharge/infection 34, Acute Supporative Otitis Media (ASOM) 35, Management of Fever 36. Enteric Fever (Typhoid Fever) 37. Enteric Fever (Severe/Complicated) 38. Malaria Fever (Falciparum Fever) 39, Severe complicated Malaria 40. Pulmonary Tuberculosis 41. Chickenpox (Varicella) 42. Mumps (Epidemic Parotitis) SN OMAN43, Measles (Rubeola) 44, H.Pylori infection 45. Iron Deficiency anemia 46. PICA Eating Syndrome 47. Infantile colic 48. Constipation 49, Vitamin-D Deficiency 50. Hypocalcaemia 51. Oral Ulcer (Aphthous Ulcer) 52. Assessment of Degree of Dehydration in Diarrhea 53. Treatment of Dehydration Based on Severity 54, Mild To Moderate Gastroenteritis/Acute Diarrhea 55, Severe dehydration/severe diarrhea 56. Lactose intolerance/Diarrhea due to Formula milk 57. Status Epilepticus 58. Febrile seizures 59, Bacterial meningitis 60. Tetanus 61. Scabies 62. Hypothyroidism (Congenital & Acquired) 63. Hypothyroidism CHAPTER-23 PAEDIATRICS DRUG DOSAGES CHAPTER-24 COMMON DRUG BRANDS IN PAKISTAN 1, Commonly used NSAIDs, Analgesic, Antipyretics, opioids analgesics Commonly used Antibiotics Commonly used Anti-hypertensive Commonly used Oral hypoglycemic drugs Commonly used Anti-depressants Commonly used Benzodiazepines, anxiolytic Commonly used Anti-Epileptics Commonly used Anti-Psychotics Commonly used Anti-Allergic/antihistamine 10. Commonly used ant-tussive cough suppressant 11. Commonly used laxative 12. Commonly used Anti-Peptic Ulcer 13. Commonly used Anti-Emetic/Anti-Vertigo 14, Commonly used Muscle Relaxant 15. Commonly used Multivitamins/Iron, supplements 16. Commonly used Anti-Viral 17. Commonly used Antacids, Anti-Flatulence and Anti-Spasmodic PPI AVawnURINARY INCONTINENCE RX DOCTOR ON DUTY TREATMENT GUIDE 2"° EDITION BY DR ASIF ALI KHAN. [ Name: Age: | Temperature: 8, Se Date: Pulse: Resp. Rate: A Urinary Incontinence c/s » Urge incontinence is a form of urinary incontinence characterized by a sudden urge to urinate, resulting in involuntary leakage of urine. » The condition is caused by sensory or motor dysfunction. >» Itis typically idiopathic but can also result from neurologic conditions such as spinal cord injury and stroke Diagnostics » Detailed medical history (including medication) » Voiding diary: to assess the frequency and volume of micturition » Neurological, vaginal, and rectal examination: to detect local sites of infection (e.g., abscesses, sebaceous cysts, cystocele and/or rectocele), anomalies of local anatomy, neurological deficits, and rectal sphincter flaccidity » Laboratory tests * Urine dipsticks and urine culture to exclude urinary tract infections + Creatinine and blood urea nitrogen (BUN) to assess kidney function » Sonography * Quantification of residual urine after micturition = Renal ultrasound » Quantification of leaked urine * Positive bladder stress test: urinary leakage ‘on activities that increase intra-abdominal pressure (e.g., coughing, Valsalva maneuver) = Pad test: Used to quantify urine leakage over a 1-24-hour period. Patients are asked to ‘wear a preweighed sanitary pad, perform certain activities, and drink a certain volume of liquid. The pad is then weighed again to measure urinary leakage. » Additional diagnostic testing if indicated = Micturating cystourethrogram (MCU): to detect morphological abnormalities = Urodynamic examination: to measure bladder pressure & urethral closure pressure = cystoscopy: to rule out tumors and vesicorectal or vesicovaginal fistulae = MRI: to identify pelvic floor defects Re Conservative Management: Take 6-8 weeks to obtain benefit, should be continue ideally for at least 3 months Lifestyle modifications » Weight loss » Dietary changes (e.g., decrease consumption of alcohol, caffeine, carbonated drinks) » Smoking cessation » Modification of other contributing factors (2.g., drugs) » Fluid intake should be regulated to 6 to 8 glasses or 30 ccc/kg body weight per day with @ 1500 mL/day minimum at designated times unless contraindicated by any illness Behavioral therapies and exercises » Bladder training (eg, timed voiding, relaxation/distraction techniques) » Kegel exercises: an exercise targeting the pelvic floor in order to strengthen muscles that control urinary flow and bowel movements » Biofeedback » Vaginal-weighted cones © Physical measures to prevent leakage » Vaginal pessary (a device inserted into the vagina in order to provide more support for pelvic organs) or penile compression devices » Absorbent products » Catheterization » Urethral occlusion ® Management of reversible causes: constipation * Topical vaginal estrogen (in postmenopausal patients vaginal atrophy) Re First line therapy Rx 1 © Tab, Solifenacin Smg or 10mg (Sol, Solifen, Urgecin) = Or Tab. Fesoterodine 4mg or 8mg (Toviaz) Or Tab. Tolterodine 2mg, 4mg (Detrusitol, Detrifiow) Or Tab. Oxybutynin Smg (Urobutin, Butyn, Cystrin) Or Tab. Mirabegron 25mg, 50mg (Mirabet, Mibega) 0-0-1 (Once Daily) Z Combination Therapy Rx 2 1. Tab. Solifenacin 5mg, or 10mg (Solif, Solifen, Urgecin) 0-0-1 (Once Daily) 2. Tab. Mirabegron 25mg, 50mg (Mirabet, Mibega) Or Cap. Tamsulosin 0.4mg (Tamsolin, Maxflow, Prostreat) 0=0~1 (Once Daily) DOCTOR ON DUTY TREATMENT GUIDE 2"° EDITION BY DR ASIF AL! KHAN©