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The gp note
Part One
 📕
Index - Part 1
Sl No. Index Page No.
1 Common Lab Values 11
2 Common Instruments 16

3 Prescription Format 20

4 Fever 21

5 Antibiotics 32

6 Antipyretics 36

7 Vitamins 37

8 Anti ulcerants 39
9 COUGH 41
10 Analgesics 46

11 Abdominal Pain 48
12 Febrile seizures 52
13 Vomiting 53

14 Loose stools 55

15 Anaphylactic shock 58

16 Patient with wheeze 59

17 Dog Bite 60

18 Injury 62

19 Abrasion 65

20 I&D 66

21 Suturing & Removal 67

22 Burns 76

23 Chest Trauma 79
24 COPD a/c Exacerbation + LRTI 80

25 Laryngo-tracheo-bronchitis(Viral Croup) 81

26 Incessant crying of infants/children 81

Index - Part 1 1
 Sl No. Index Page No.

27 Allergy/pruritus(itch)/urticaria(hives) 82

28 Insect Bite Reaction 84

29 Epistaxis 85

30 Nasopharyngitis/ cold/ acute coryza 86

31 Sore Throat 88

32 Parotitis 88

33 Foreign body ear 89

34 Globus sensation/globus pharyngis(feeling of lump in the throat) 89

35 Foreign Body Throat 90

36 Laryngitis 92

37 Tonsillitis 93

38 A/c bronchiolitis 94

40 Quinsy 95
41 A/c epiglottitis 96

42 Foreign body in Nose 97

43 Nasal bone fractures 97

44 Furuncle of the nose 98

45 Sinusitis 99

46 Nasal Polyp 100

47 Otalgia(Earache) 101
48 Wax in the Ear 102

49 Foreign body in ear 103

50 Trauma to external auditory canal 103
51 A/c otitis external 104

52 Otomycosis(fungal infection of ear canal) 104

53 Vertigo 105

54 Perforation of tympanic membrane 107

55 Tinnitus 107

56 Stridor 108

57 AOM 109

58 Perichondritis of pinna 109

59 Constipation 110

Index - Part 1 2
 Sl No. Index Page No.

60 Bitter taste in mouth 112

61 Anorexia 113

62 Hiccups/Singultus 115

63 Continous belching/flatulence 116

64 Epigastic Pain 117

65 Dyspepsia & For weight gain in children 118

66 Rectal Bleeding/hematochezia/melena 119

67 Anal itching/pruritus ani 120

68 Joint sprain 121

69 Pain of muscle spasm / musculoskeletal/osteoarthritic pain 122

70 Neck Pain 123

71 X-ray Views 125

72 Back Pain 129

73 Heel pain 131

74 First Aid in Fractures 132

75 Anaemia 133

76 Fall/impaired consciousness 136

77 Feeling tired or fatigue/weakness 138

78 Insomnia 140
79 Aggressive Psychiatric Patient 141
80 Chronic alcoholic with tremors 141

81 A/c alcoholic intoxication 142

82 Shivering 143
83 Hypotension 144

84 Oedema 145

85 Left ventricular failure 150

86 Hypoglycemia 154
89 Hyperglycemia 156

90 Diabetic Ketoacidosis 160

91 UTI 162

92 Hematuria 163

93 Hyperventilation 163

Index - Part 1 3
 Sl No. Index Page No.

94 Hypertension 164

95 Palpitation 170

96 Chest pain 173

97 Heartburn/pyrosis/cardialgia/acid indigestion 176

98 Unstable Angina 177

99 Nocturnal leg cramps 178

100 Status Epilepticus 179

101 Haemoptysis 181

102 Drugs predisposing to renal dysfunction 182

103 Newly Detected Systemic Hypertension 183

104 Hyperlipidaemia 188

105 Hyperuricemia 192

106 Steroid tapering 193

107 Hypothyroidism 194

110 Sensory Disturbances 198

111 Facial Nerve Palsy 200

112 Trigeminal Neuralgia 202

113 Giddiness/syncope 203

114 Motion Sickness 204
115 Memory defects & Forgetfulness 205
116 Headache 207

117 Migraine 210

118 Tremor 212

119 Caries Tooth 213

120 Gum Abscess 214

121 Gingivitis 215

122 Cheilosis/angular stomatitis 217

123 Halitosis 218

124 Aphthous Ulcers 219

125 Oral Candidiasis(Oral Thrush) 220

126 Dry Mouth(xerostomia) 221

127 Opthalmology 222

Index - Part 1 4
 Sl No. Index Page No.

128 Conjunctivitis 223

129 Scleritis 224

130 Superficial punctuate Keratitis 225

131 Corneal Ulcer 226

132 Fungal Corneal Ulcer 227

133 Simple Allergic conjunctivitis 229

134 Hordeolum Internum, Externum, Chalazion 230

135 Blepharitis 232

136 Corneal abrasion 232

137 A/c Dacrocystitis 233

138 Foreign body eye 234

139 Blunt injury to eyeball 235

140 A/c congestive glaucoma 237
141 A/c iridocyclitis 238

142 Liver abscess 240

143 Scrub typhus 240

144 Rheumatoid arthritis 241
145 Suspected Weils 243

146 Suspected Dengue 244

147 Suspected Meningitis 245
148 Suspected Enteric Fever(Typhoid fever) 246

149 Tetanus 247

150 Infective Endocarditis Prophylaxis 248

151 TB Prophylaxis 248

152 Post- exposure Prophylaxis in HIV 249

153 Post-exposure Prophylaxis in Hepatitis B 252

154 Upper GI Bleed 253

155 Irritable Bowel Syndrome 256

156 Hepatic Encephalopathy 258

157 Viral Hepatitis 260

158 ADD/Gastroenteritis 261

159 Malaria 262

Index - Part 1 5
 Sl No. Index Page No.

160 Influenza / H1N1 262

161 Pneumonia 263

162 Filariasis 265

163 Chronic Lower limb ischemia 266

164 Lumps 267

165 Head injury 268

Index - Part 1 6
 11

All Normal Lab Values

Common lab values

CBC - Blood collected in EDTA tube/lavender/ purple color

 TC = 4000 – 11,000/microL
Infants (1 yr) = 6000 – 16,000/microL
At birth = 10,000 – 25,000/microL
Pregnancy = 12,000 – 20,000/microL
 Hb = 13 – 17 (men) g/dL
12 – 15 (female) g/dL
 RBC = 4.5 – 6.5 × 1012/L (males)
3.8 – 5.8 × 1012/L (females)
 PCV = 40 – 54% (men)
37 – 47% (female)
 MCV = 80 – 100 fL
 MCH = 0.4 – 0.5 fmol/cell or 27 – 32 pg
 MCHC = 30 – 35 g/dL
 Normal Reticulocyte Count: 0.8 – 1.5%
 Red Cell Distribution Width (RDW): 11.5 – 14.5%
 Neutrophils = 40 – 75%
 Lymphocytes = 20 – 50%
 Eosinophils = 1 – 6%
 Basophils = 0 – 1%
 Monocytes = 2 – 8%
 ESR = 0 – 9mm/hr (men) [Age/2]
0 – 20mm/hr (female) [Age+10/2] Wintrobes Method
 ESR = 0 – 15 mm/hr (men)
0 – 20 mm/hr (female) Westegren Method

 CRP = 0 – 3 g/dL

LFT - Collect blood in Red test tube

 SGOT or AST : <40 units/ml (12 – 38 U/L)

 SGPT or ALT : <40 units/ml (7 - 41 U/L)
 Total Bilirubin = 0.3 – 1.3 mg/dL
 Direct Bilirubin = 0.1 – 0.4 mg/dL
 S. Total Protein = 6.7 – 8.6g/dL
 S. Albumin = 3.5 – 5.5g/dL

Effort
 12

 S.ALP = 30 – 120 U/L (adult)

:
<350 U/L (child)
 Gamma Glutamyl Trans = 0 – 40 U/L

RFT - Collect blood in Red Test tube

 Urea = 20 – 40 mg/dL or 2.5 – 6.6 mmol/L

 BUN = 7 – 20 mg/dL
 S. Creatinine = 0.6 – 1.36 mg/dL or 60 – 120 mmol/L
 S.Uric acid = 3.1 – 7 mg/dL (males)
2.5 – 5.6 mg/dL (females)

S. Electrolytes - Collect blood in Red test tube

 S.Na = 136 – 145 mM/L or meq/L

 S.K+ = 3.5 -5.5 mM/L or meq/L
 S.Ca = 8.5 – 10.5 mg%
 S.PO4 = 2.5 – 4.5 mg/dL
 S.Mg = 1.5 – 2 mEq/L
 S.Cl = 95 – 107 mEq/L or mM/L

Lipid Profile - Collect blood in Red Test tube

Should be done in fasting

 Total cholesterol = 150 – 200mg%

Borderline = 200 – 239mg/dL
High = >240mg/Dl
 Triglycerides = 50 – 160mg% (160mg/dL)
 HDL = 40 – 69mg% (desirable >60mg%)
 LDL = 80 – 160mg%
Desirable = <130mg%
Borderline = 10 – 159mg%
High = >160mg%

Coagulation Screening - Collect blood in blue test tube

 Normal Bleeding Time = 2 – 7 min

 Normal Clotting Time = 4 – 9 min
 PT = 12 – 15s
 aPTT = 28 – 31s
 INR = 1
 13

Blood Sugar Monitoring - Collect blood in Grey test tube

 HbA1c = 4 – 6 %  assess the average blood glucose levels for the last two to three months
 FBS = Normal: 70 – 100 mg/dL
DM: >126mg/dL
 PPBS = Normal: <140mg/dL
DM: >200mg/dL
 RBS = DM: >200mg/Dl

Other

 S. Amylase = 20 – 96U/L
 S. Lipase = 0 – 160U/L
 S. Vit. B12 = 140 – 980ng/L
 Rheumatoid Factor = <30U/L
 S. Ferritin = 30 – 250ng/mL (males)
10 – 150ng/mL (females)
 S. Prolactin = 2 – 20ng/ml (males)
2 – 30ng/ml (females)
10 – 209ng/ml (pregnant woman)
 LDH = 208 – 460U/L

Plasma Protein

 Albumin: 3.5 – 5.5g/dL

 Globulin: 2 – 3.5g/dL
 Fibrinogen: 0.2 – 0.4g/dL
 A/G: 1.5 – 3.1

TFT

 T4 : 5.4 – 11.7g/dL or 70 – 151 nmol/L

 T3 : 77 – 151ng/dL or 1.2 – 2.1nmol/L
 TSH : 0.4 – 5 U/ml or 0.4 – 5 mU/L
 FT3 : 1.4 – 4.2 pg/ml
 FT4 or Thyroxine : 0.9 – 2ng/dL

URE

 pH = 5 – 9
 Protein excretion(24hr) = <150mg/day
 Red cell = 0 – 2/hpf
 Microalbumin (24hr) = 0 – 30mg
 14

 Epithelial cells = 0 – 2/hpf

 Pus cells = 0 – 5/hpf

Cast in Urine

 Hyaline cast = dehydration, strenuous exercise

 Granular cast = CKD, strenuous exercise
 RBC cast (always pathological) = glomerulonephritis, vasculitis
 WBC cast = inflammation/infection

Vacutainer Tubes
Color Anticoagulant Uses

• No anticoagulant LFT, RFT, S.Electrolyte Lipid Profile

BE Sodium Fluoride Glucose estimation

MME. EDTA CBC, ESR, CRP

3.2% sodium citrate Coagulation studies like PT, APTT

of Heparin Bone Marrow Studies

Bama _T I -
Citrate Blood culture

Blood Bank Tests, Blood typing, ABO

(K2)EDTA grouping etc.
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Stool Examination

 Coproporphyrin: 400 – 1000mg/day

 Fecel fat excretion: <6g/day
 Occult blood: negative (<2ml blood/day)
 Urobilinogen: 40 -280mg/day

Analysis of ABG

Reference range
Analysis SI Units Non SI Units
Bicarbonate 21 – 29 mmol/L 21 – 29 meq/L
Hydrogen ion 37 – 45 nmol/L pH 7.35 – 7.43
PaCO2 4.5 – 6.0 kPa 34 – 45 mmHg
PaO2 12 – 15 kPa 90 – 113mmHg
Oxygen saturation >97%

CSF Analysis

 Opening pressure: 90 – 180 mm H2O

 Appearance and color: Clear, colorless
 Blood cell count, WBC: <5, RBC: <5
 Glucose: 50 -80 mg/dL or >60% of blood level
 T. protein: 15 – 60mg/dL or <0.45g/dL
 Oligoclonal bands: Negative
 16
Common Instruments
Catheters

The type of urinary catheters.

Legend:

A Simple urethral catheter

B Open-ended (whistle-tip) catheter

C Coude Catheter (Tiemann) Catheter

D Wing-tip (Malecot) catheter

E Mushroom (de Pezzer) catheter

F Foley catheter

1 Urine drainage

2 Balloon inflation

Foley catheter

Tf
Size of Foley catheter measured by French Scale

o
Diameter (mm) =

Catheter French sizing chart

1. F12 (White)
2. F14 (Green) Commonly available in
3. F16 (Orange) wards
4. F18 (Red)

Catheter: French Size

Cannula: Gauge Size
 17

Points to remember while catheterizing

They
During catherization, insert to the hilt; wait until urine emerges before inflating the balloon
Remember to reposition the foreskin in uncircumcised after the catheter is inserted to prevent massive edema of the
glans and paraphimosis.
In men, stretch the penis perpendicular to the body and then insert the catheter.
Position of women: knees flexed, hips abducted with heels together.
Urine output should be >400 ml in 24 hours or >0.5 ml/kg/hr.

Ryle s tube

Place lubricated tube in nostril with its natural curve promoting passage down, rather than up
Advance directly backwards (not upwards). When the tip is estimated to be entering the throat, rotate the tube by 180
to discourage passage into the mouth.
Advance the tube into the esophagus during a swallow
It may be easier to swallow with a sip of water
Advance >60 cm

FG12 White
FG14 Green
FG16 Orange
 18

Cannula

Catheter: French Size

Cannula: Gauge Size

Color Code Gauge Ext. Dia. Length Flow Rate Recommend

mm mm mL/min
Orange 14G 2.1 mm 45 mm 240 mL/min Trauma
(1 liter 4 menit) Rapid blood
transfusion
Surgery
Grey 16G 1.8 mm 45 mm 180 mL/min Rapid fluid
(1 liter 5.5menit) replacement
Trauma
Rapid blood
transfusion
Green 18G 1.3 mm 32/45 mm 90 mL/min Rapid fluid
(1 liter 11 menit) replacement
Trauma
Rapid blood
transfusion
Pink 20G 1.1 mm 32 mm 60 mL/min Most
(1 liter 17 menit) infusions
Rapid fluid
replacement
Trauma
Rapid blood
transfusion
Blue 22G 0.9mm 25 mm 36 mL/min Most
(1 liter 28 menit) infusions
Rapid blood
transfusion
Yellow 24G 0.7mm 19mm 20mL/min Most
(1 liter 50 menit) infusions
Rapid blood
transfusion
Pediatrics
Neonates
Violet 26G 0.6mm 19mm 13 mL/min Pediatrics
(1 liter 77menit) Neonates
 19

Endotracheal tube

Adult Children
6 3
6.5 3.5
7 4
7.5 4.5
8 5
8.5

Venturi mask

Colour Flow O2 %
Blue 2 L/min 24%
White 4 L/min 28%
Orange 6 L/min 31%
Yellow 8 L/min 35%
Red 12 L/min 40%
Green 15 L/min 60%
 20

Prescription Format

Tab. Fasigyn DS 1gm. × BD × 3 days (Anti-amoebic Tinidazole)

Sample Trade name, at The standard dose and The Pharmacological name
random, used for duration of of the drug (or the group,
representing a prescription. treatment, which may where any drug in that
(Brands available all over vary on individual group may be prescribed) is
India are used to avoid requirement and given in brackets.
unknown names) response.
 21

Fever
Normal body temperature 97.7 99.5 F (36.5 - 37.5 C)
Normal children temperature 97.4 - 100 F (36.33 37.78 C)
Note: C × 1.8+32 = F

Fever Temperature

Axillary temperature 99.7 99.5 F

Oral temperature 99.5 99.9 F
Rectal temperature 100.4 F
Core temperature
Tympanic temperature 100.4 F

Causes

1. Pneumonia Continuous fever (Do not fluctuate more than 1 C in 24 hours) + Chills and rigor
2. Typhoid fever Continuous fever + Abdominal pain
3. Brucellosis Continuous fever + Myalgia (Classical for viral fever)
4. Urinary Tract Infection Recurrent fever + Chills and rigor
5. Malaria Intermittent fever (Temperature elevation for certain period then returning back to normal)
i. Falciparum Malaria Quotidian (Periodicity of 24 hours)
ii. Vivax and Orale Tertian (Periodicity of 48 hours)
iii. Plasmodium Malaria Quartan (Periodicity of 72 hours)
6. Tuberculosis Night sweats
7. Infective endocarditis Remittent fever (Temperature remains above normal throughout the day with fluctuations
more than 1 C in 24 hours)

Evaluation

Evaluation of Fever Patients

1. Temperature Axillary temperature 99 F
2. White Blood Cell Count 12,000 or 4,000 or
10% bands
3. Heart Rate 90bpm*
4. Respiratory Rate 24bpm^ or PaCO2 32mm Hg
Sepsis = SIRS** + Infection
Severe sepsis = SIRS** + Infection + End organ damage
Septic shock = Severe sepsis + Refractory hypotension
( 90mm Hg or 40% below baseline)
*beats per minute
^ breaths per minute
** SIRS Systemic Inflammatory Response Syndrome
 22

Fever Workup

All patients Specific Workup

1. CBC ESR/CRP 1. Autoimmune workup
2. Blood smear For malarial parasites i. RF

☐☐
3. CXR PA ii. ANA
Lateral 2. Specific Viral Serologies
4. URE + Urine Culture 3. LP, Thoracocentesis, Anthrocentesis,
5. Blood culture Paracentesis
6. RFT 4. CT Scan HEAD
7. LFT 5. Stool culture Gram stain/
8. S.Na+/K+/Ca2+/Mg2+/PO43- Clostridium difficle/ Toxin etc.
9. HIV test 6. Sputum culture/AFB
7. Skin biopsy

Symptoms

Fever Only Neurological Symptoms

1. Malaria with chills 1. Cerebral Malaria
2. Typhoid fever 2. Meningitis
3. Leptospirosis 3. Encephalitis
4. Ricketsia 4. C/C Meningitis TB/Cryptococcal

☐☐☐
5. Relapsing fever Meningitis
6. Other viral illness 5. Rabies
7. HIV 6. Japanese Encephalitis
7. West Nile Encephalitis
8. HIV Dementia
Abdominal Symptoms 9. Toxoplasmosis
10. Trypanosomiasis
1. Typhoid
2. Infectious colitis: Shigella/E.Coli/Salmonella
Camphylobacter/Amoeba
3. Amoebic Liver Disease
4. Abdominal TB
5. Appendicitis, Pyelonephritis
6. HIV
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 23

Fever with Rash

1. Macular 2. Haemorrhagic

88
i. Measles i. Meningeococal
ii. Rubella ii. Viral haemorrhagic fever
iii. Toxoplasmosis

Macule
Haemorrhagic

3. Vescicular 4. Nodular
i. Chicken pox i. Erythema Nodosum TB and Leprosy
ii. Shingles
iii. Herpes Simplex

Vesicles Nodular

5. Erythomatous
i. Drug rash
ii. Dengue fever

☐ Erythematous
 24

Haemorrhagic Symptoms Bone and Joint Gynaecological Symptoms

Haematamasis Fever with joint/bone pain Pelvic pain
Malena Vaginal discharge
Epistaxis 1. Sickle cell disease
Petechiae 2. Septic arthritis
1. PID
Purpura 3. Osteomyelitis
2. Tubo-ovarian abscess
Puncture site bleeding 4. Pyomyositis
3. Postpartum endometritis
5. Rheumatic fever
4. Septic abortion
1. Dengue 6. Chickungunya
5. Ectopic
2. Relapsing fever 7. Brucellosis
3. Ebola / Lassa / Marbung
4. Yellow fever

Treatment
T 100.4 F
T 98.9 F
1. Inj. PMOL 2cc (150/1) IM STAT ATD
1. T.PMOL 500 mg 1-1-1-1 × 5 days

☐ Or
T.DOLO 650 mg 1-1-1 × 5 days

Paediatric
☐ If allergic to PMOL
Inj. DOLONEX (Pyroxicam) 2cc IM STAT ATD
Or
Infusion PMOL 100ml STAT

N.B:
1. Syp. PMOL (125/5) wt/2 1-1-1 × 3 days
(250/5) wt/4 1-1-1 × 3 days Absolute CI for PMOL
2. Tepid Sponging
i. Infants 2kg
3. Steam Inhalation
ii. Liver disease
4. T./Syp. Multi Vitamin × OD
iii. Renal disease
T 100.4 C iv. Drug allergy

15kg

☐
T 102 F
1. Inj. PMOL 1cc (150/1) IM STAT ATD
1. Syp. MEFTAL (100/5)
15kg (15 mg/weight/dose)

1. Supp. PMOL 80 mg 1 year

170 mg 1-4 years
250 mg 4 years
☐ (8mg/kg/dose)
(200/5)
 25

1. Do BRE, ESR/CRP, URE

If HGF for more than 3 days not resolving with PARACETAMOL

Suspect infection

Give ANTIBIOTICS
2. If antibiotics like MACROLIDES, NSAIDS STEROIDS started, add ANTIULCERANTS

Fever Classic PUO Nosocomial Neutropenic HIV associated

Examples Infections (30%): Thrombophlebitis Virus, Bacteria, Tuberculosis,
Tuberculosis, UTI Parasites Mycobacterium
Malaria, Amebiasis, Sinusitis Drugs avium-
EBV, Lyme, Drugs Aspergillosis intracellulare
Endocarditis, Intra- Clostridium Perianal infection infection.
abdominal abscess, difficile colitis Empiric antibiotics
Osteomyelitis, indicated in neutropenic
dental abscess, patient:
sinusitis For fever of unknown
CTD (30%): origin: Monotherapy
Rheumatic fever, with Piper/ Tazo,
PAN, Rheumatoid Ticar/Clav, Imipenem
arthritis, Giant cell or Ceftazidime or
arteritis, Temporal Ceftriaxone
arteritis. For sepsis or
Neoplasms (30%): pneumonia, or
Lymphoma, pseudomonas
Leukemia, Cancer infection:
(Hepatocellular, Combination therapy
Colon, Pancreas, with antipseudomonal
Liver, Secondaries) -lactum, i.e. any of
Miscellaneous(20%): the above drug used
Drugs, Hematoma, in monotherapy with
Thyroid or adrenal aminoglycoside or
insufficiency fluoroquinolone
For mucositis,
catheter site
infection: Any drug
used above in
monotherapy with
vancomycin.
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 26

History

Duration
2 5 days Viral (Dengue, Chikungunya)
Protozoal (Malaria)
Bacterial (Leptospirosis, Scrub)
URTI, LRTI, UTI, Others
5 7 days All of the above + Enteric (Typhoid) fever
3 weeks Infections, Neoplasms, CTD

Questions for symptoms and

signs/clues Possible Diagnosis
Anorexia Hepatitis
Dark colour urine Jaundice, hepatitis
Chills Malaria, filarial, UTI, cellulitis, abscess, biliary tract obstruction, pyelonephritis,
septicemia, pneumonia, viral infections
Cough, chest pain, breathlessness Pneumonia
Dysuria, pyuria UTI
Diarrhea Enteric fever, colitis, drug-induced diarrhea
Delirium Meningitis, encephalitis, typhoid, pneumonia
Epidemic Dengue, influenza
Headache Sinusitis, otitis media, typhoid, malaria, viral fevers
Pain, body ache Viral fever
Ear Otitis
Throat Tonsillitis
Joints CTD/Rheumatic fever/Chikungunya
Muscles Viral fever
Jaundice Hepatitis A, B, C, Malaria, leptospirosis, dengue, cholangitis
Exanthems/Blisters Sepsis Chickenpox (day 1), measles (day 4)
Rash (apart from exanthems)
Drug allergy Ampicillin
Erythema nodosum Tuberculosis, leprosy, fungal infections, streptococcal infection
Erythema multiforme Herpes simplex, mycoplasma, drugs
Butterfly rash SLE
Septicemia Meningococcal, gonococcal, gram-negative sepsis, staphylococcal toxic
epidermolysis
Ecthyma gangrenosum Pseudomonas infection
 27

Nutrition Type and source of food. Is food poisoning a possibility?

Sexual history Any exposure to sexually transmitted infections?
Work Exposed to pathogens or unusual chemicals at work? Consider work-related
exposures to infectious disease if patients work in sewers, laboratories or with
live animals (e.g. leptospirosis.
Travel Recently travelled to hot climate with increase prevalence of tropical infections
(e.g. malaria, typhoid, fever)?
Hobbies Any contact with animals and birds (e.g. psittacosis) or spirochete-infected
animal contact, or indirect contact with water or soil with rat urine (e.g.
leptospirosis). Have there been any recent tick bites?
Past and current medical problems Recent infections: Consider abscess formation and recurrence
Operations: Recent surgery raises the possibility of postoperative infection or
deep venous thrombosis
Trauma: Ask about any recent trauma with extensive muscle damage. A resolving
hematoma may also cause fever

Medication Drugs caused fever: Is patient taking any drugs (isoniazid, -lactum antibiotics,
procainamide, phenytoin)? Check prescription and over-the-counter medication
as well as illicit substances (e.g. doping body building)
Antipyretics: Have these been taken? Are they effective in reducing the fever
and alleviating symptoms? Antipyretics may also mask the fever and its diurnal
pattern
Antibiotics: Has the patient taken any antibiotics already, such as those
prescribed by another practitioner or leftover.
Steroids: Long-term oral steroids increase the risk of infection and may mask
symptoms.
Chemotherapy and drugs causing neutropenia. Consider neutropenia, if the
patient has recently undergone chemotherapy or is taking drugs that any cause
blood dyscrasias (e.g. carbimazole)
Allergies Ask about allergies to any antibiotics needed to be prescribed for treatment of
infection
Home How has home life been affected by the symptoms? Do other people who live in
the same accommodation also suffer from fever or other symptoms?
 28

Patient Examination and Clues for Diagnosis of Fever

Region Look for Possible cause of fever

1. Eyes Jaundice Hepatitis
2. Sinuses Tenderness Sinusitis
3. Teeth Caries Dental
4. Ear Ear discharge, tenderness ASOM, CSOM
5. Throat Redness, any membrane Tonsillitis, pharyngitis
6. Lymph nodes In neck, axilla, groin TB, Lymphoma, EBV, Cancer
7. Skin Blisters, rash Chickenpox, measles
8. Respiratory system Tachypnea, diminished breath sounds, Pneumonia, bronchitis, cavities, pleurisy,
bronchial breathing, crepitation, rhonchi, effusion, empyema
rub, dullness
9. Cardiovascular system Heart rate, murmurs, pericardial rub Endo-/Per-/Myo-carditis
10a. Abdomen Tenderness, hepatosplenomegaly, free Hepatitis, splenomegaly in various
fluid, mass, right-sided chest infections, intra-abdominal abscesses,
wall/intercostal tenderness is liver peritonitis
abscess
b. Genitalia Scrotum, testes, vagina, cervix Orchitis, pyocele, balanoposthitis, STDs
abscess
c. Per rectal Perianal abscess, prostate and seminal Perianal abscess, prostatitis, seminal
vesicles vesiculitis
d. Pelvic examination Tenderness, discharge PID
11. Musculoskeletal Muscle tenderness in shoulders, gluteal Dengue, leptospirosis, arthritis, myositis,
region, calf; joint pain, swelling, DVT, etc.
tenderness; spine tenderness
12. Central nervous system Altered sensorium, neck stiffness, ocular Meningitis, encephalitis, brain abscess
fundi, neurological deficits
 29

Investigations (Part 1) (Choices Include)

Duration Probable cause of fever Investigations (choices include)

2-5 days Viral fever, malaria, URTI, LRTI, UTI, others CBC, MP, QBC, dengue, NS1, LFT, Urine routine
(none, if clearly viral)
5-7 days All the above and enteric (typhoid) fever CBC
Urine routine
LFT
Malarial parasite in blood and malarial card test
Culture sensitivity (blood, urine, stool)
Serological tests (card tests/ELISA):
Typhipoint (typhoid)
IgM ELISA for leptospirosis, dengue NS1,
IgM, Chickungunya
CXR, US, CT
7-15 days Headache Sinusitis, otitis, dental Refer investigations (Part 2) €0
on page 68
sepsis, malaria, meningitis,
migraine
Cough Tonsillitis, pneumonia,
bronchitis, malaria,
tuberculosis
Chest pain Pleural effusion/Empyema,
pericarditis, liver abscess,
root pain, emphysematous
bullae, costochondritis
Diarrhea Enteric fever, colitis, drug
induced
Pain abdomen Hepatitis, liver abscess,
appendicitis, PID, other
intra-abdominal sepsis
Consider: Prolonged viral fevers (e.g. infectious mononucleosis, CMV, HIV); malaria, enteric fever
or tuberculosis (partially treated or resistant)
 30

Approach to Patient with Neutropenic FUO

Fever 38 C with neutropenia [absolute neutrophil count (ANC) 500/ ]

History Blood cultures

Urine cultures
Physical examination Chest films

Start broad-spectrum antibiotics according to clinical setting

Fever of unknown Pneumonia or Mucositis or

origin sepsis syndrome or catheter site
Pseudomonas inflammation
infection

Monotherapy Monotherapy choices Monotherapy choices

Carbapenems or plus aminoglycoside plus Vancomycon
third-or fourth- (i.e. two drugs) (i.e. two drugs)
generation
Cephalosporin,
(cefepime,
ceftazidime)

Reassess after 3-5 days

Rapid defervescence Persistent fever at day 4

Add amphotericin B and/or

ANC 500/ ANC < 500/

Stop antibiotics after B. * modify antibiotic regimen

*µ
total of 5-7 days Clinically well and High-risk mucosal
low risk lesion ANC < 100/
Unstable vital signs

Stop antibiotics May continue

after total of 5-7 antibiotics until
afebrile days ANC 500/ and clinica!y we!
 31

Investigations (Part 2) to Consider in FUO (Pyrexia of Unknown Origin) (Choices Include)

Investigation Comments
1. Blood tests
CBC Leukopenia with relative lymphocytosis = Viral
Leukopenia = Typhoid
Platelets may be decreased in dengue, leptospirosis and typhoid
ESR May be elevated in infection, CTD
CRP May be elevated in infection, CTD
Blood picture May show malarial parasite
LFT May be abnormal in liver abscess, dengue, leptospirosis
D-dimer Increased levels may suggest DVTV/PE
Antinuclear antibodies ACCP, ANA, RF amy be positive in CTD
Serological tests (CARD/ELISA Viral infections: Dengue, leptospira, chikungunya, HIV
IgG/IgM test) Bacterial infections: Typhoid, infectious mononucleosis, brucellosis, scrub,
syphilis
Protozoal infections: Malaria, amebiasis
Serum electrophoresis
Creatinine, electrolytes, calcium
Serum iron, transferrin, TIBC,
Vitamin B12
2. Urine test
Urine routine, urine C/S
3. Imaging
CXR
US (Abdomen, lungs)
CT/MRI (abdomen, chest, CNS)
Color Doppler (limbs for DVT)
4. Microbiology
C/S of blood, urine, sputum, stool,
CSF, tissue or pus
5. Biopsy Needle biopsy of liver or other tissue indicated by potentially diagnostic clues

Key Points for Clinical Practice

-0
Simple viral fevers do not need antibiotics. No investigations are needed.
Before labeling a fever as viral, look for pallor, jaundice and neck stiffness. Auscultate chest and examine the abdomen
for liver/spleen enlargement.
If fever is not subsiding in 3-4 days of empirical treatment, investigate the patient thoroughly or refer to higher
center.
 32

Antibiotics
Note: In general, for mild infections use milder antibiotics

SL Brand Name Dosage and Duration Generic Name Inference

No.
1. C MOX or NOVAMOX 500 mg 1-1-1 × 5 days Amoxicillin For RTI including
bronchitis
Sinusitis
Otitis media
UTI
2. C ROSCILLIN 500 mg 1-1-1-1 × 5 days Ampicillin For RTI including
bronchitis
Sinusitis
Otitis media
UTI
3. C or T AUGMENTIN/ 1-0-1 × 5 days Amox + Clavulanic acid For RTI
AUGPEN/ MOX CV UTI
625/375 Dental
T.N:- T MOXIFORCE-CV 20 mg/kg/dose BD Skin and soft tissue
or MEGA-CV 625, infections
NOVACLAV 625, KID- Intra-abdominal and
TAB - 228 gynecological sepsis
Cat scratches
Infected animal/human
bites
4. C NOVACLOX 1-1-1 × 5 days Amoxicillin + Dicloxacillin Ped tab available
Dramaclox
5. C MEGAPEN 1-1-1-1 × 5 days Ampicillin + Cloxacillin Kid tab available
6. C ALDINIR or ZEFDINIR 300 mg 1-0-1 × 5 days Cefdinir Very expensive
Pneumonia
a/c exacerbations of c/c
bronchitis
ENT
Skin
7. C PHEXIN/ SPORIDEX 500 mg 1-1-1-1 × 5 days Cephalexin For bone and joint
infections
Pharyngitis
Skin and soft tissue
Tonsillitis
UTI
8. T AZITHRAL or AZEE 500 mg 1-0-0 × 3 days 1 Azithromycin Specific foe respiratory
hr before food infections
Also for skin
 33

STDs
PID
Urethritis
Cervicitis
9. T ROXID 150 mg 1-0-1 × 5 days 30 Roxythomycin For RTI
min before food ENT
Skin and soft tissue
Genital tract infections
10. T DROXYL 500mg 1-0-1 × 5 days Cefadroxil Strep throat infections
Syp. 125/5 or 250/5 30 mg/kg/day in 2 div UTI
available doses Skin
11. T TAXIM-O/ TOPCEF 50/100/200 mg (DT tab Cefixime Respiratory
available) 1-0-1 × 5 days Urinary
Biliary infections
12. T CEFTAS-AL 1-0-1 × 5 days Cefixime +Ambroxol +
Lactobacillus spores
13. T CIPLOX 500 mg (500/250/750) 1- Ciprfloxacin For UTI
0-1 × 5 days Bone
Soft tissue
Gynecological
Wound infection
Bact gastroenteritis
Respiratory

children
14. T NORFLOX 400 mg 1-0-1 × 5 days Norfloxacin For UTI
GIT problems
Advise to drink more water
Best if taken empty stomach

dairy products
15. T OFLOX/ZENFLOX 200 mg 1-0-1 × 5 days Ofloxacin c/c bronchitis
other respiratory
ENT
16. T LEVOBACT or 500 mg 1-0-0 × 5 days Levofloxacin Advise to drink more water
LEVODAY or LOXOF
17. T SEPTRAN/BACTRIM 1-0-1 ×5 days Sulfamethoxazole 800 + Advise to drink more water
D.S, Syp available (200+40)/5 ml trimethoprim 160
18. T PROFLOX 400mg 1-0-1 × 5 days Pefloxacin For UTI
GIT problems
19. T CEPODEM/MONOCEF- 100/200 mg 1-0-1 × 5 Cefpodoxime For RTI
O/PODOCEF/MACPOD days UTI
Skin and soft tissue
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 34

20. T KLOX 250/500 mg tds/Qid Cloxacillin Furuncle

Abscess
Carbuncle
Impetigo
Osteomyelitis
Syp (125/5) 100-200 mg/kg/day in 4 Bites
divided doses
21. T 250/500 mg 1-0-1 × 5 Clarithromycin Respiratory
CLARITHRO/CLARIBID/ days Skin and soft tissue
SYNCLAR
22. T ALTACEF 200/500 1-0-1 Cefuroxime URI
LRI
UTI
For children and infants, most pediatric medicines are available in syrup/drops.

1-2 years = ½ tsp tds 3-6 years = 1 tsp tds 6-10 years = 2 tsp tds or ½ adult tabs.

This can be used as a rough guideline to prescribe common pediatric medicines. The dose should be adjusted according to the
built and weight.

Commonly Used Antibiotics in Children:

Sl Brand Name Dosage and Duration Generic Name Inference

No.
1. Syp AMOXICILLIN 30-50 mg/kg daily in
(125/5 or 250/5) divided doses Q8H or Q12H
T N:- MOX, NOVAMOX In practice 15 mg/kg/dose
DT 125,250 mg Q8H NOVAMOX Dps
available (100/1) available
Amoxicillin + Clavulanic Each 1 ml contain amox=80
Syp AUGMENTIN/MOX acid mg, Clavulanic acid=11.4 mg.
CV 228/5, 158/5, 312/5 Augmentin/Mox CV Syp 457
available (400+57)/5ml,
NOVAMOX CV/MOX 156(125+31)/5ml,
CV dps 228(200+28)/5ml,
312(250++62) available.
2. Syp AMPICILLIN (125/5 50-100 mg/kg/daily in
or 250/5) divided doses Q6H
3. Syp AZITHROMYCIN Children above 6 months
(100/5 or 200/5) 10mg/kg/day for 5 days
T N;- AZEE, ATM
4. Syp CEFIXIME (50/5 or 8mg/kg/day in divided
100/5) doses Q12H
Dps 25/1 available
 35

T N;- TAXIM-O,
TOPCEF
5. Syp SEPTRAN 6-10mg/kg/24 hr (TMP) Sulfamethoxazolw 200 +
divided into 2 PO (dose Trimethoprim 40
calculated in terms of mg
OF tmp)
Paed tablets: (100+20)
6. Syp AMPOXIN or Syp Ampicillin+cloxacillin
ROSCILOX
7. Syp SYNCLAR/MACLAR 15mg/kg/day divided into Clarithromycin LRTI
(125/5) 2 doses URTI
Sinusitis
Otitis media
125 DT available
8. Syp KEPFOD/MACPOD 10 mg/kg/day divided into Cefpodoxime LRTI
(50/5 or 100/5) 2 doses PO URTI
9. Syp PHEXIN (125/5 or 50-100 mg/kg/day in 3 or Cephalexin DT 125, 250 mg available
250/5) 4 doses PO Phexin Dps 100/1 available
10. Syp ALTACEF (125/5) 30mg/kg/day divided into Cefuroxime
2-3

For pregnant ladies

-
Amoxicillin, Cephalosporins, Ampicillin and Cloxacillin combination, Amoxicillin and Clavulanate combination, Penicillin G,
Azithromycin (Class B)
 36
Antipyretics
Note: In Children, if fever is accompanied by rashes, especially vesicular or maculo popular suspect Chickenpox or Measles
respectively. In measles, the child is usually sick looking with, rashes starting from face.

Sl Brand Name Dosage and Duration Generic Name Inference

No.
1. T 500 mg/650 mg 1-1-1-1 ×
CALPOL/PANADOL/DOLO 3 days
2. T IBUGESIC or BRUFEN 200/400/600 mg 1-0-1 × Ibuprofen
3 days
3. T MEFTAL or PONSTAN 250 mg/500 1-1-1 × 3 Mefenamic acid Ideal for dental pain
days
4. T PIROX/DOLONEX 20 mg 1-0-0 × 3 days Piroxicam
5. T IBUGESIC PLUS 1-0-1
6. T MEFTAL Meftal 500 + P/L 450
FORTE/MEFTAGESIC
For Children
1. 10-15 mg/kg/dose × 4 C/I in less than 2kg
250/5) times Calpol, Dolo, Babygesic,
T N: CALPOL, CRCIN, DOLO, Crocin, Febrinil dps
FEBRINIL, FEBREX etc. available
Nopain dps (15
ml)(100/1) available, Tab
125 available
2. Syp. IBUPROFEN (100/5) 8-10 mg/kg/dose × 3 May precipitate aspirin
times
give to asthmatic or
dyspnoeic patients
Syp. IBUGESIC PLUS Ibuprofen 100 + P/L Another formula: dose in
162.5/5 ml) ml=wt/2
3. Syp. MEFTAL (50/5 or 8 mg/kg/dose × 3 times a DT-Tab 100 available Generally not used <6
100/5) day months
Wt×4/10 = dose in ml,
applicable only for 100/5
formulation
Syp. MEFTAGESIC P/L 125 mg, Mefenamic
acid 50 mg/5 ml
For Pregnant ladies
 37

Vitamins
Usual dose: 1 tab od or bd

Sl Generic Name Generic Name

No.
1. T BEPLEX FORTE (syp Vit B complex with flic
available) acid, Vit C
2. T BICOZINC (syp available) Vit B complex with folic
acid, Vit C, Zn sulphate
3. C BECOSULES (syp Vit B complex with folic
available) acid, Vit C
4. C NUTROLIN B PLUS (syp Vit B complex with folic
available) acid, Vit C
5. T POLYBION (syp available) Vit B complex with folic
acid, Vit C
6. T NEUROBION FORTE (syp Vit B complex
available)
7. T BC -Carotene, Vit E, Vit C-
Antioxidants
8. T CELIN 500 mg OD Vit C
9. T MVT OD Multivitamins
10. T HEALTH OK Multivitamins,
Multiminerals, Amino
acids with taurine and
ginseng
11. T BECOZYM C FORTE OD Vit B + Vit C

For Children

Sl Brand Name Dosage and Duration Generic Name

No.
1. Syp/Dps A to Z Vit A, Vit B complex, Vit
C, Vit D, Fe, Se, Iodine
2. Syp ZINCOVIT Vit A, Vit B complex, Vit
D, Vit E, Cu, Se, Zn, Iodine
3. Syp/Dps Delices Vit A,B,D,E, amino acids,
antioxidants
4. Syp OSTO-POLYBION D Vit B12, Vit D3, Ca2+
5. OH-D3/ULTRA D3/BON D 400 IU/ml Vitamin D3 or
LIGHT dps 1 ml OD for Infants Cholecalciferol
 38

Iron preparations (can be given in pregnancy)

Sl Brand Name Dosage and Duration Generic Name Inference

No.
1. T AUTRIN OD Fe fumarate+folic
acid+b12+c
2. T MACALVIT/SHELCA OD Ca carbonate +Vit D3 Syp SHELCAL AND SHELCAL
kid tab available
3. T FEFOL-Z OD Fe sulph+folic
acid+b12+c+Zn
4. Syp VITCOFOL Fe fumarate+folic
acid+b12
5. T OROFER-XT 0-1-0 Elemental Fe+folic acid Dps/syp available
 39

Antiulcerants
Sl Brand Name Dosage and Duration Generic Name Inference
No.
1. T RANTAC/ ZINETAC/ 150 mg 1-0-1 Ranitidine
ACILOC 30 min before food
Ped dose 2 mg/kg/dose
×2 PO, 1-2 mg/kg/dose
IV

Syp RANTAC 75/5

2. T PANTOCID 40 mg 1-0-0 Pantoprazole
30 min before food
Ped dose 1 mg/kg/dose
PO OD
T PANTOP-IT (with itopride)
PANTOP-L (with
levosulpiride)
Inj. PANTOP 40 mg iv od/bd
3. T RABICIP/HAPPI/RAZO 20 mg 1-0-0 Rabeprazole fast acid
suppression
Inj. RABICIP 20 mg iv od
4. C OMEZ 20 mg 1-0-0 Omeprazole
Empty stomach
1 hr before meal
5. C RABICIP D/ROLES-D (with
domperidone)
Pantop D (with domperidone)
6. T LANZOLE 30 mg 1-0-0 Lansoprazole
7. T LESURIDE 25 mg 1-0-0
Inj. LESURIDE 25 mg iv od
8. DIGENE 2tsp tds Simethicone + Mg(OH)2 +
Na
carboxymethylcellulose
9. GELUSIL MPS 2 tsp tds Simethicone +Mg(OH)2 +
Al(OH)2 + Mg Al Silicate
10. RANTAC MPS Magaldrate+Simethicone
11. MUCAINE Mg(OH)2 + Al(OH)2 +
Oxethazaine
12. TRICAINE MPS Simethicone + Mg(OH)2+
Al(OH)2 + Oxethazaine
 40

13. Syp SUCRALFATE Ulcer protective

Antacids: 1-2 ml/kg/dose in infants; 5-15 ml/dose every 4-6 hour in children

Note: Take antacids 2 hr before or after ingestion of the drug to prevent drug interaction

For children

By
Syp or Tab RANTAC, T PANTOP, T JUNIOR LANZOLE 15 mg OD (1mg/kg/day)

For pregnant women

1. DIGENE 2tsp tds

2. GELUSIL MPS 2tsp tds and other antacids
3. T RANITIDINE, FAMOTIDINE. Inj RANTAC can also be given

Steam inhalation may be with

1. Vicks/Amrutanjan/Tulsi leaves/ 2-3 drops of essential oils like eucalyptus oil, camphor etc.
2. Tincture Benzoin
3. Karvol Plus/ Sinarest/ Nosikind inhalant capsule (camphor, chlorthymol, eucalyptol, menthol, terpineol)
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The gp note
Part Two
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 Index - Part 2
Sl No. Of
Index
No. Pages

158 A/c Cholecystitis 11

159 A/c Appendicitis 12

160 A/c Pancreatitis 13

161 A/c intestinal obstruction 14

162 Peritonitis 15
163 Testicular/scrotal Pain or Swelling 14
164 Piles 19
165 Perforated peptic ulcer 20
166 Felon(whitlow or terminal pulp space infection) 23
167 Skin Ulcers 25
168 Deworming/Drenching 28
169 Calculation of rate of fluid infusion 30
170 Dermatology 31
171 Paronychia 32
172 Intertrigo 32

173 Pyodema 33

174 Dandruff 34

175 Acne Vulgaris 35

176 Alopecia 36

177 Corns & callosities 38

178 Contact Dermatitis 39

179 Excessive Sweating/hyperhydrosis 40
180 Stasis Dermatitis 41

181 Pediculosis 42

182 Ringworm infection of skin(Tinea/Dermatophytosis) 43

Index - Part 2 1
 Sl No. Of
Index
No. Pages

184 Seborrhoeic dermatitis 44

185 Scabies 45

186 Itching due to prickly heat in summer(miliaria rubra) 46

187 Eczema 46

188 Psoriasis 47

189 Fissuring of soles(athlet’s foot/tenia Pedis) 48

190 Premature Graying of Hair 49

191 Herpes zoster 50

192 Icthyosis 52

193 Hyper pigmentation of skin 53

194 Warts 54
195 Dry skin/Xeroderma 55
196 Herpes simplex 56
197 Hand-Foot-mouth Disease 58
198 Dyschromias in children 59
199 Chickenpox/varicella 60
200 Balanitis(balanoposthitis) 62
201 Non-specific urethritis in Men 63
202 Photodermatitis 63
204 Bipolar Disorder 64

205 Obsessive Compulsive Disorder 65

206 Panic attack 65

207 Generalized anxiety disorders(GAD) 66

208 Schizophrenia 67
209 Menorrhagia (hyper discharge of menses) 68
210 Amenorrhea(absence /abnormal stoppage of menses) 69

211 Discharge PV 70

212 Pelvic Inflammatory Disease 70

213 Early Pregnancy 71

214 Postponement of Periods 72

Index - Part 2 2
 Sl No. Of
Index
No. Pages

215 Post-coital contraception 72

216 Injectable Contraceptives 73

217 Dysmenorrhea(painful menstruation) 74

218 Enhancement of Lactation 75

219 Suppression of lactation 75

220 Menopause 76

221 Bleeding pv in pregnancy 77

222 Drugs use in Pregnancy and Lactation 79

224 Hyperemesis gravidarum 83

225 Fibroadenosis, Cyclic Mastalgia 84

226 Eclampsia 85
227 Poly Trauma Patient - Steps 88
228 Hanging 92
229 Drowning(Submersion injury) 94
230 Electrical injuries 95
231 Snake bite 96
232 Pulmonary embolism 99
233 ACS-STEMI 101
234 A/c on CKD 103
235 Hyperkalemia 104

236 CVA 106

237 Cardiac arrest 108

238 Needlestick injuries 112

239 Adrenal crisis 113

240 Poisoning 114

241 OP poisoning 117

242 Odollum poisoning 118

243 Adult Glasgow coma Scale 119

244 Abscesses 120

245 Excision of nail 121

Index - Part 2 3
 Sl No. Of
Index
No. Pages

246 Digital Nerve Block 122

247 Bites and Stings 123

248 CARDIOPULMONARY RESUSCITATION (CPR) 125

249 Fluid Balance and IV fluid therapy 131

313 Site where lignocaine with adrenaline should not be used 134

250 Postoperative Patient 135

251 ECG Basics 137

252 Common injections and its Volume 146

253 Ampicillin 148

254 Amoxicillin 148

255 Cloxacillin 148
256 Coamoxiclav 148
257 Cephalexin 148
258 Cefadroxil 148
259 Cefazolin 148
260 Cefaclor 148
261 Cefuroxime Axetil 148
262 Cefixime 148
263 Cefotaxime 148

264 Ceftazidime 148

265 Ceftriaxone 148

266 Cefdinir 148
267 Cefpodoxime Proxetil 148
268 Cefoperazone + sulbactum 148

269 Doxycycline 148

270 Gentamicin 148

271 Amikacin 148

272 Vancomycin 148

273 Teicoplanin 148

274 Aztreonam 148

Index - Part 2 4
 Sl No. Of
Index
No. Pages

275 Ciprofloxacin 148

276 Norfloxacin 148

277 Ofloxacin 148

278 Levofloxacin 148

279 Linezolid 148

280 Azithromycin 148

281 Piperacillin +Tazobactum 148

282 Meropenem 148

283 Metronidazole 148

284 Tinidazole 148

285 Vaccination 157
286 Ventilatory support 169
287 PULSELESS ARREST ALGORITHM 171
288 BRADYCARDIA ALGORITHM 174
289 TACHYCARDIA ALGORITHM 176
290 Sample Referral letter 178
291 WHAT TO DO WHEN A PATIENT DIES 178
293 Dietary advice 179
294 Exercise Prescription 184

295 Procedures in General Practice 190

297 Instant Releif 202

298 Basics of GP 219
299 Laws in GP 228
300 Choice of Antibiotics 232

301 Choice of NSAIDS in Pain 241

302 Choice of Antihypertensives 242

303 Am I missing Heart Attacks 246

304 Alternative to Bypass 247

305 Fat loss and Calorie Chart 249

306 Traveling Patients 253

Index - Part 2 5
 Sl No. Of
Index
No. Pages

307 Health Camps 256

308 Cocktail Drugs 258

309 IMPORTANT DATES 261

310 Blank Medical Certifcate 262

COVID : Post COVID Followup, Complications treatment, Management in
311 263
children, COVID management in Hospitalised

312 Paediatric Drug Dosage 275

313 List Of Abbrevations 281

Index - Part 2 6
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Acute Cholecystitis
Inflammation of the gall bladder

Clinical features

Upper abdomen pain

Nausea, Vomiting
Fever
Jaundice

Investigations

FBC LFT
URE USG Abdomen
RFT CT abdomen

Treatment

1. Bed rest
2. NPO
3. IV fluids, continuous nasogastric aspiration, antiemetics
4. Analgesics
5. Antibiotics Ceftriaxone/ Ciplox/ Taxim + Metrogyl/ Cefaperazone + Sulbactum Piperacillin + Tazobactum
6. Surgery consultation
 12

Acute Appendicitis
Clinical features

Right lower quadrant pain Constipation

Periumbilical hernia Rebound tenderness
Nausea and vomiting Pain on percussion
Anorexia Gaurding and rigidity
Diarrhea

Investigations

FBC CRP
URE USG abdomen, CT abdomen
LFT, RFT

Treatment

Bed rest
NPO
IV fluids
Nasogastric suction
Analgesics, antiemetics
Antibiotics if perforated/ Gangrene appendicitis or peritonitis. Eg: Taxim, Surgery
Surgery consultation
 13

Acute Pancreatitis
Clinical features

Abdominal pain/tenderness/guarding/distension Dyspnea

Nausea/vomiting Tachypnea
Diarrhea Diminished bowel sounds
Fever Left side basal crepts
Jaundice Hypotension
Hematemesis or melena

Investigations

FBC, RFT, LFT, S. Electrolyte with S. Calcium S. Amylase and S. Lipase

CRP LDH
Bun USG Abdomen and CT Abdomen
Lipid profile

Treatment

Bed rest
NPO
Aggressive IV fluid therapy, continuous nasogastric aspiration, antiemetics
Analgesics like Tramadol
Antibiotics only if associated infection is suspected
Inj Ranitidine or Pantoprazole
Inj OCTREOTIDE 100 µg iv or s/c bd/tds × 3 days
T CREON 10,000 1-1-1 × 2 weeks
 14

Acute Intestinal Obstruction

Etiology

Adhesion Intussusception
Hernia Volvulus
Carcinoma

Clinical features

Abdominal pain Absolute constipation

Distension Visible peristalsis
Vomiting

Examine the hernia orifice to rule out hernia obstruction/ Strangulation

Do PR examination to rule out rectal pathology

Investigations

BRE
LFT, RFT, S. Electrolyte
X ray abdomen (distal bowel lops, multiple air fluid levels)

Treatment

Nasogastric aspiration
IV fluids and electrolytes correction, blood transfusion if needed
Antibiotics, E.g. Taxim + Metrogyl
Refer to surgery for early surgical intervention
 15

Peritonitis
Etiology

Localized: Inflammation of underlying viscera

Generalized: Due to perforation/ Hemorrhage

Clinical features

Guarding Silent abdomen

Severe tenderness Rebound tenderness
Rigidity

Investigations

CBC, URE
S. amylase, S. electrolytes
Urea, Creatinine
Plain X-ray Abdomen erect view, USG Abdomen, CT Abdomen

Treatment

Bed rest
NPO
IV fluid
Nasogastric aspiration
Analgesics and antibiotics (eg. Taxim/ciplox + metrogyl)
Emergency surgical intervention
 16

Testicular/ Scrotal Pain or Swelling

Etiology

Acute Epididymoorchitis Hydrocele

Testicular torsion Varicocele
Inguinal hernia Spermatocele

*
17
 18

Investigation: USG Doppler scrotum

Sudden onset of testicular pain testicular torsion
Urologic emergency
Immediate surgery/Urologic consultation
Symptoms Swelling, retraction, and severe discomfort
Occurs unilaterally and may follow/ precipitated by exercise/ spontaneously
Abrupt cessation of blood flow, testicular ischemia and infarction
Irreversible after 12 hours
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Piles
Also known as hemorrhoids.
Dilated plexus of superior hemorrhoidal veins, in relation to anal canal.
Classically situated in the 3, 7, 11 O'clock position (left lateral, right posterior, and right anterior respectively).

CLASSIFICATION
1. Internal hemorrhoids - above the dentate line, covered with mucous membrane.
2. External hemorrhoids - above the dentate line, covered with skin.
3. Interno-external - both varieties together.
CLINICAL FEATURES
Painless bleeding per rectum
Mucus discharge
Pruritus
Tenesmus
COMPLICATIONS
Chronic anemia Ulceration
Prolapse Thrombosis

INVESTIGATIONS
Digital Rectal Examination (DRE)
Proctoscopy (Anoscopy)
Sigmoidoscopy / Colonoscopy

-z
TREATMENT
NON-OPERATIVE
For LA;
1. Proctosedyl ointment - Butyl amine Benzoate + Framycetin + Hydrocortisone acetate
2. Faktu - policresulen, cinchocaine
3. Shield - Hydrocortisone,Lidocaine,Zn oxide, allantoin
4. Anovate - beclomethasone +phenylephrine+Lidocaine
5. Smuth cream - calcium, dobesilate, lignocaine, hydrocortisone, Zn.
Syp Cremaffin 3tsp HS
Tab Venusmin / Venux 300 mg TDS (Diosmin) OR Daflon TDS (diosmin + hesperidin)
Tab Caldob QD/ BID

Sitz bath - 20 minutes BID

High fiber diet & plenty of oral fluids.
OPERATIVE

&
Barron's band application
Cryosurgery
Hemorrhoidectomy
Milligan-Morgan ligature & excision
Hill-Ferguson.
 20

Perforated Peptic Ulcer

A sore developed into a hole in the stomach or duodenum
Etiology: Bacteria, drugs, excessive stomach acids
Food or antacids relieve the pain of duodenal ulcers
but provide minimal relief of gastric ulcer pain
Only 20-25% of patients with symptoms suggestive of
peptic ulceration are found on investigation to have a peptic ulcer.

History

H pylori infection
Ingestion of NSAIDs I

Smoking

Physical

Epigastric tenderness
Right upper quadrant tenderness Biliary etiology
Guaiac-positive stool Occult blood loss
Melena Acute or subacute gastrointestinal bleeding
Succession splash - Complete gastric outlet obstruction

SIGNS AND SYMPTOMS

Epigastric pain (most common)

Gnawing or burning sensation after meal
Pain often at night
Pain in a daily pattern
Pain with radiation to the back posterior penetrating and complicated by pancreatitis

Clinical manifestations

Dyspepsia, including belching, bloating, distention, and fatty food intolerance

Heartburn
Chest discomfort
Hematemesis or melena
Rarely, a briskly bleeding ulcer can present as hematochezia
Symptoms consistent with anemia
Sudden onset of symptoms may indicate perforation
NSAID induced gastritis or ulcers may be silent
 21

Diagnosis

H pylori test Serum gastrin level

Endoscopy Secretin stimulation test
Radiography Biopsy and histological findings
Angiography

Differential diagnosis

Acute Cholangitis Emergent Treatment of Gastroenteritis

Acute Cholecystitis and Biliary Coilc Esophageal Rupture and Tears
Acute Coronary Syndrome Esophagitis
Acute Gastritis Gallstones (Cholelithiasis)
Acute Cholecystitis Gastroesophageal Reflux Disease
Chronic Gastritis Inflammatory Bowel Disease
Diverticulitis

Gastroenterology

Bleeding or anemia

☐
Early satiety
Unexplained weight loss
Progressive dysphagia or odynophagia
Recurrent vomiting
Family history of gastrointestinal cancer

Treatment

NPO
IV fluids
Analgesics and Antibiotics
Early surgical intervention
22
 23

FELON (Whitlow or Terminal Pulp Space Infection)

Space commonly gets infected due to prick injuries
Commonly involved: thumb or index
Causative organism: Staph. Aureus (most common)
Bone of the terminal phalanx can also become infected, resulting in sequestrum
Digital artery which is an end-artery runs in this closed space

-=
Trapped pus between Fibrous septa which bind specialized fingertip skin to the underlying bone.
Pathophysiology
1. Minor trauma
2. Infection to pulp scale
3. Collection of puss in space
4. Increased pressure in the closed compartment
5. Compression of terminal artery
Gangrene of pulp space
Osteomyelitis if phalanx

Clinical features
Throbbing pain
Swelling and fever
Pulp is indurated, red and tense
Touch, movement worsens pain

Complications
Septicemia
Tenosynovitis
Osteomyelitis and necrosis
Pyogenic arthritis of distal IP joints
Neuroma
Involving little finger infection can spread to the palm of hand without aggressive treatment
 24

Management
1. Warm water or saline soaks
2. Incision and drainage pus
Midline/Mid-lateral incision adequate division of fibrous septa
Do not divide vertical fascial strands
Incision should not cross the Distal Inter Phalangeal joint to prevent flexion contracture at DIP flexion crease
Probing not carried out proximally, avoids extension of infection to flexor tendon sheath
Loose gauze pack prevent skin closure
Loose dressing, splint the finger and, elevate the hand above the heart.
Update tetanus immunization
3. Cap Megapen: 1-1-1-1
4. Tab Lyser - D
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 25

Skin Ulcers
Open spores on skin
Pathogenesis: Circulatory or metabolic disorders

Etiology

Venous stasis Malignancy

Arterial insufficiency Infection(TB, Syphilis)
Dermatomyositis Trauma (Pressure)
Lymphoedema Drugs
Vasculitis Pyoderma

Pathology
·
Classical presentations

1. Diabetic ulcers: On heel or on the plantar surface of the metatarsal heads

2. Venous stasis: On the medial aspect of the lower leg or ankle and are associated with chronic edema
Associated with chronic edema
3. Arterial insufficiency: Distally on the tips of the toes or at or near the lateral malleolus
 26

Management

Optimize nutrition:
Stop-smoking
Correct- anemia, protein and vitamin deficiency
Analgesics rest to the affected part
Cleaning:
Solutions Normal saline, or diluted povidone Iodine
Avoid routine use of Antiseptic solutions toxic to tissues and impede healing
Alternatives Oxum spray, megaheal ointment
Clean wounds minimal debridement and damp gauze or hydrogel based dressings
Suspected diabetic foot ulcer infection
1. Inpatient wound care
2. Broad spectrum antibiotic therapy: gram +ve and gram ve
Infected wounds:
1. Thorough exploration and drainage of all abscess cavities
2. Debridement of infected, necrotic, or devitalized tissues
3. Topical antibiotics may be given
Wound cultures Obtain prior to antibiotic initiation
Acute phases parenteral treatment
1. Mild infections (limited to soft tissues): therapy 1-2 weeks
2. Moderate or severe: 2-4 weeks of antibiotics
3. Osteomyelitis (viable bone): 4 to 6 weeks of IV therapy
Post healthy granulation of tissues:
1. No antibiotics
2. Surgical interventions: Secondary suturing, skin graft, flaps

Pressure ulcers

Skin care:
1. Well moisturized
2. Protect from excessive contact with extraneous fluids
3. Avoid friction and shear stress
4. Repositioning at a minimum of every 2 hours
Bowel and bladder care
Appropriate support surfaces: Air/water mattresses
 27

Treatment:
1. Debridement
2. Wound cleansing
3. Dressings Ensure moist wound bases
4. Systemic antibiotic therapy
5. Systemic antibiotic therapy
6. Nutrition High protein diet, vitamins (**Vit C)

** Note: Phenytoin powder/ ointment is also effective in treating pressure ulcers

 28

Deworming/ Drenching
Intake of anthelmintic drug (chemical solution) to get rid of parasites in body

Symptoms Common Types of Intestinal Worms

Abdominal pain Tapeworms

=>
Blood in stools Flukes
Weight loss Pinworms
Gagging Hookworms
Rashes Ascariasis
Anal itching

Etiology

1. Consumption of contaminated water and soil

2. Contact with contaminated feces
3. Poor sanitation and hygiene

Complications

Anemia
Intestinal blockages
Malnutrition
High frequency of complications in patients with HIV/AIDS infection
High risk during pregnancy

Diagnosis

Fecal test
Blood tests
Imaging: X-ray, CT, MRIs
Tape test
Colonoscopy

Differential diagnosis

Vague and Ill-defined complaints

Pneumonitis, Abdominal colics, Hepatitis & Pluritis and Epiletic seizures
Dermatological symptoms Larval penetration and Migration
Malnutrition and Anemia
Poor growth and development in children
 29

Management

Deworming in:
Normal child - > 1 yr - With Pica 9 month
Intervals
Children up to 6 yrs every 6 months Adult every 2 years
Children up to 12 yrs once a year Adult with Pica every 3 months
Supplements after deworming
Vitamins/ Iron/ Appetizer
In Pica Iron
2nd dose on 15th day for extra intestinal coverage
Not given in case of Fever
Choice of deworming therapy based on stool RE for ova/parasites
Advise to cut nails regularly

Treatment

Pyrantel Pamoate

ago
< 2 yrs safety and efficacy not established
11 mg/kg/day single dose
Syp 250 mg/5 m repeat after 15 days
Up to 3 yrs half bottle HS
> 3 yrs, one bottle HS

Piperazine Citrate

DoC in worm vomiting

Safe in pregnancy
75-100 mg/kg OD × 2 days, adult 4 g OD × 2 days
1 2 yrs 5 ml, 2 5 yrs 10 ml, > 5 yrs 15 ml
Worm allergy: Nil orally, IVF, Piperazine Citrate (Antepar) 120 mg/kg HS ×2 days (750 mg/ml)
Adult: Repeat on 15 th day 4 mg (30 ml) one bottle
Child: Small doses over few hours Up to 12 yrs, 2 mg

Albendazole (Zentel, Bendex 400, Albend)

400 mg HS, repeat on 15th day

Syp 200 mg/5 ml, < 2 yrs 200 mg HS, 2 yrs 400 mg HS

Mebendazole (Hook Worm Infestation)

Tab Mebex 100 mg BD × 3 days

Syp Mebex 100 mg/5 ml
 30

Calculation of Rate of Fluid Infusion

Calculation methods:

€⑥☆☆g
1. Rule of Ten
2. Rule of Four
Drip factor (gtts/mL)
1. Macrodrip 10,15, 20 gtts/mL
2. Microdrip 60 gtts/mL
Rate of fluid infusion in 24 hours Rule of Ten
IV fluid in litre/ 24 hours × 10 = Drop rate/ minute
E.g. 2.0 litre in 24 hours = 2.0 × 10 = 20 drops/ minute
Calculation of Fluid volume in 24 hours from drop rate Rule of Ten
Drop rate per minute/ 10 = IV fluid in litre/ 24 hours
E.g. 15 drops/min = 15/10 n= 1.5 litre/24 hours

**Note: At end of 24 hours, 4% less fluid will be infused

Calculation of rate of Fluid infusion in 1 hour Rule of Four

Drop rate per minute/ 10 = IV fluid in litre/ 24 hours
E.g. 15 drops/min = 15/10 = 1.5 litre/ 24 hours
Calculation of drop rate/min from fluid volume to be infused in 1 hour
Volume in ml/hour divided by 4 = Drop rate/minute
E.g. 60 mL/ Hour = 60/4 = 15 drops/ minute
Calculation of fluid volume in 1 hour from drop rate
Drop rate/min × 4 = Volume in mL/hour
E.g. 10 drops/min = 10 × 4 = 40 mL/hour
Perfect method to calculate fluid volume from drop rate in 24 hours
Drop rate × 96 = Volume in mL per 24 hour
E.g. 10 drops/min = 10 × 96 = 960 ml/24 hours
Drop rate calculation for any parameters
Volume to be infused (in ml) = Drop rate/minute
Duration of infusion in hours × 4
Micro IV drip set: 1 mL = 60 drops
Calculation of volume from drops in micro drip set
Micro drop rate/minute = Volume in mL/hour
E.g. 35 micro drops/minute = 35 mL/hour
Volume in ml/hour = Drop rate per minute
E.g. 30 mL/1 hour = 30 micro drops per minute
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 31

Dermatology
Treatment depends on the stage of disease
Acute conditions - mild local application
1. Lotions for a/c conditions
2. Creams for sub a/c conditions
3. Creams/ointments for c/c conditions
Areas near the eyes & genitals - mild strength preparations
Hydration of the skin before topical application enhances absorption
Calamine Lotion - can cause dryness -Itching
Use limited to urticaria

ANTIFUNGALS
1. Sebifin cream - terbinafine, benzy alcohol
2. Candid, Surfaz, Canesten, Canazole - Clotrimazole
3. Candid B, Clocip-B - Clotrimazole + Beclomethasone
4. Ketovate cream, nizral cream - Ketoconazole
5. Nizral shampoo, Phytoral shampoo, Dandoff solution - Ketoconazole
6. Fungitop gel, Candistat Cream - Miconazole
7. Olamin, Batrafan, onylac - Cyclopirox olamine

ANTIFUNGALS + ANTIBACTERIALS + STEROID

1. Clobenate GM cream - clobetasol, gentamicin, miconazole
2. Clocip NB cream - beclomethasone, clotrimazole, neomycin, chlorocresol
3. Sigmaderm, candiderma - beclometasone, clotrimazole, gentamycin
4. Betnovate GM - betamethasone, gentamycin, miconazole
5. Surfaz-SN - clotrimazole + betamethasone + neomycin
6. Totalderm - oflox, ornidazole, terbinafine, clobetasol

STEROID + ANTIBACTERIAL/ANTIFUNGAL
1. Dipgenta, Gentopic - betamethasone, gentamycin
2. Eumosone G - clobetasone + gentamycin
3. Tenovate G - clobetasol + gentamycin
4. Eumosone M - clobetasone + miconazole

ANTIBACTERIALS
1. T-bact/ Bactroban - mupirocin 2%
2. Futop/fucidin - fusidic acid
3. Sisomicin cream
4. Neosporin ointment.
 32

Paronychia
Most common hand infection
If soft tissue swelling is present without fluctuance,
the infection may resolve with warm soaks 3-4 times daily.
If abscess, do I and D
Drain the pus by making an incision over the eponychium.
If there is a floating nail, removal of nail is required.
C AMPICLOX 1-1-1-1 × 5 days or amoxiclav or cephalexin or doxycycline
T LYSER D 1-0-1 × 5 days
FUCIDIN or T BACT oint for LA
C/C paronychia is commonly due to fungal infection
T FLUCOS 150 mg once weekly × 6 months (fluconazole) for c/c paronychia
Topical antifungals like DAKTARIN (miconazole) or ONVLAC NAIL LACQER (ciclopirox) to be applied over the
affected nails at bed time.
Should be applied starting from the skin adjacent to the nail bed. Use the brush provided to apply into crevasses
and ridges.
Cut nails weekly and rub over the nails using accessory provided once every week.
 33

Pyoderma
Introduction

Markedly painful ulcer rapid progression of ulceration type of skin lesion preceding the ulcer (papule, pustule, or
vesicle)
Minor trauma (pathergy) preceding development of the ulcer
Symptoms of an associated disease (eg. Inflammatory bowel disease or arthritis)
Drug history (eg. Bromides, iodide, hydroxyurea, or granulocyte-macrophage colony-stimulating factor)

Characteristic feature of ulcer

1. Tenderness
2. Necrosis
3. Irregular violaceous border undermined
4. Rolled edges

Treatment

Antibiotics Ampiclox/ciplox/amoxclav/doxycycline/cephalosporins
Analgesics, antihistamines
T-BACT/FUTOP/NEOSPORIN OINT for LA bd
Saline washing one tsp salt in 2 glasses of water
Good hygiene
 34

Dandruff
Introduction

1. Fine, dry, white

2. Scalp scaling with minor itching
3. Avoidance of washing allows scale to accumulate and
inflammation may occur.
4. The distribution of scaling and inflammation may be more diffuse and
occur in the seborrheic areas: scalp and scalp margins, eyebrows,
base of eyelashes, nasolabial folds, external ear canals posterior
auricular fold, and pre sternal area.

Causes

Irritated, oily skin

Dry skin
A yeast like fungus (malassezia) that feeds on oils on the scalps of most adults
Sensitivity to hair care products (contact dermatitis)
Other skin conditions, such as psoriasis and eczema

Symptoms

Skin flakes on your scalp, hair, eyebrows, beard or mustache, and shoulders
Itchy scalp
Scaly, crusty scalp in infants with cradle cap

Treatment

Warm oil massage: after 10 minutes, apply NIZRAL 2% shampoo on to scalp for a period of ten minutes; then wash away
all the oil. Repeat twice or thrice weekly × 2 months. Other options include Danclear shampoo, KTC medicated shampoo,
SCALPE/DANDROP SHAMPOO (Ketoconazole + Zn pyrithione)
IONAX-T (Coal tar + Salicylic acid): relieves itching and flaking in dandruff, seborrheic dermatitis and psoriasis of the
scalp.
 35

Acne Vulgaris
Introduction

Acne vulgaris is an inflammatory disorder of pilosebaceous unit, which runs a chronic course and it is self-limiting. Acne
vulgaris is triggered by propionibacterium acnes in adolescence, under the influence of normal circulating
dehydroepiandrosterone.

Acne occurs on centrofacial areas of the back, upper trunk, and deltoid region. Acne presents as polymorphic lesions
starting with comedones.

Pathophysiology

During puberty, under the influence of androgens, sebum secretion is increased as 5-alpha reductase converts testosterone
to more potent DHT, which binds to specific receptors in the sebaceous glands increasing sebum production.

Differential diagnosis

1. Acne conglobate
2. Acne fulminans
3. Acne keloidalis nuchae
4. Folliculitis Acne vulgaris

N
Treatment

1. Wash the face with soap and hot water 2-3 times a day
2. Avoid excessive exposure to sun
3. PERSOL-AC GEL or BENZAC AC 2.5%-5%, apply, wait for 2 minutes and then wash off (benzoyl peroxide) (start as
once daily, during day time)(for black heads) or
4. CLINDAC A gel (clindamycin) for inflammatory ad pustular lesion
5. RETINO-A/EUDYNA CREAM, to be applied 2-3 times a week HS (for black heads)
6. C Doxycycline 100 1-0-1 × 10 days or T Azithromycin 500 mg od × 5 days
7. Other drugs used: Azelaic acid 2% or Adapelene 0.1% gel (adaferin, deriva) Deriva-CMS gel (adapelene + clindamycin) T
isotretinoin 10 or 20 mg (isotret)(0.5 mg/kg/day) at night (teratogenic)
8. With all anti-acne creams look for irritation, dryness, redness, itching, burning every 10-15 days.
 36

Alopecia
Hair loss (alopecia) can affect just your scalp or your entire body, and it can be temporary or permanent. It can be the
result of heredity, hormonal changes, medical conditions or a normal part of aging. Anyone can lose hair on their head, but

TYPES OF ALOPECIA

1. Alopecia areata
2. Androgenetic Alopecia (Pattern Hair Loss)
3. Central Centrifugal Cicatricial Alopecia (Scarring Alopecia)
4. Chemotherapy Induced Alopecia (Anagen Effluvium)
5. Frontal Fibrosing Alopecia (Scarring Alopecia)
6. Lichen Planopilaris (Scarring Alopecia)
7. Telogen Effluvium
8. Traction Alopecia (hair loss)

Patchy hair loss

Auto immune disease

Alopecia areata

ANDROGENIC ALOPECIA

☐
 37

AETIOLOGY

1. Poor nutrition 6. Diabetes

2. Tinea capitis 7. Drugs (eg. Steroids)
3. Hyper/hypothyroidism 8. Excessive dandruff
4. Pregnancy 9. Check for iron deficiency
5. SLE 10. Genetics

Symptoms

Gradual thinning of hair

Circular or patchy bald spots
Sudden loosening of hair
Patches of scaling that spread over the scalp

Treatment

Multivitamin (with biotin) eg. T XTRAGLO OD ×1 month (biotin, L-Methionine, L-Cystine) or KERAGLO-MEN or KERAGLO
EVA (gamma lenolenic acid, multivitamin, natural extracts)
PROANAGEN shampoo for Alopecia areata: Diprovate scalp lotion (betamethasone) or FLUCORT LOTION (fluocinolone).
Apply OD for androgenic alopecia: MINOXIDIL topical solution BD. 2% for women, 5% for men (T.N: HAIR 4 U, MORR,
MORR-F)
 38

Corns and Callosites

·
Calluses are diffuse thickening of outermost layer of skin,
the stratum conreum, in response to repeated friction or pressure.
Corns develop similarly but they differ by having a central core
that is hyperkeratotic and often painful. Occurs at pressure points
secondary to ill fitting shoes, an underlying bony spur or an abnormal gait.

Differential diagnosis F

~
Corns Calluses
Plantar warts

Treatment

Use proper fitting footwear or MCR foot wears

Keratolytic agents like Salicylic acid 40% pads and plaster or solution. Apply and leave for 4-5 days. Also used 40%
urea cream, and 12% lactic acid cream.

Note: Patients with peripheral neuropathies should avoid or use topical salicylic acid with caution.

TN:- CLEANODERM/DUOFILM (salicylic acid + lactic acid) lotion/solution daily × 3 weeks

CARNATION DECORN CORN CAPS (salicylic acid), To be kept in position with the corn for few days. To be reapplied
again till the corn drops out.
 39

Contact Dermatitis
Contact dermatitis is an eczematous dermatitis caused by exposure to substances in the environment. Those substances act
as irritants or allergens and may cause acute, subacute, or chronic eczematous inflammation.

Treatment

Definitive treatment of allergic contact dermatitis is the identification and removal of any potential casual agents;
otherwise, the patient is at increased risk for chronic or recurrent dermatitis.

Wet compresses/ saline soaks

Emollients Emoderm/novasoft or calamine maybe beneficial in chronic cases.
Oral antihistamines like T CPM 4mg 1-0-1
Topical corticosteroids like CLOBETASOL are the mainstay of treatment

Note: When choosing a topical glucocorticosteroid, match the potency to the location of the dermatitis and the vehicle to the
morphology (ointment for dry scaling lesions; lotion or cream for weeping areas of dermatitis).

For severe acute allergic contact dermatitis or widespread and severe chronic dermatitis, systemic glucocorticosteroids
may be required (administered for 2 weeks)

Contact dermatitis
 40

Excessive Sweating
Definition:
I

AETIOLOGY:

Seen in Hypoglycemia,
MI,
Defervescence in fevers,
Hyperthyroidism,
Vasovagal attacks,
Rheumatic fever,
Gout,
Nervous excitement,
Alcohol/drug withdrawal,
Anxiety etc.
DIAGNOSIS:
1. Taking healthy history,
2. Evaluating the symptoms
3. Starch-iodine test,
4. Paper test can be used to confirm the diagnosis.
COMPLICATION:
Infection,
Social and emotional effects
TREATMENT:
PALMOPLANTAR/ axillary sweating: Aldry lotion for LA HS (Aluminium chlorohydrate) or
LOSWEAT powder for LA (miconazole, chlorhexidine).
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