Ab-Malik

Cause of Altered mental Status Remember with AEIOU TIPS

Questions that must be rule out During History Taking of vomiting

Treatment Regimen for Bacterial Urinary Tract Infections
1. Acute Cystitis in Women (Uncomplicated)
Characteristic Pathogens:
E. coli
P. mirabilis
S. saprophyticus
K. pneumoniae
Recommended Empirical Treatment
a. No Mitigating Circumstances
3-day oral regimen:
TMP-SMZ 160/800 mg BD
TMP 100 mg BD
Norfloxacin 400 mg BD
Ofloxacin 200 mg BD
Ciprofloxacin 500 mg BD
b. Mitigating Circumstances
Diabetes
Symptoms for >7 days
Recent UTI
Use of diaphragm
Age >65 years
Recommended:
Consider 7-day regimen with oral TMP-SMZ, TMP, or Quinolone
c. Pregnancy
Recommended 7-day regimen:
Oral Amoxicillin 250 mg TDS
Cefpodoxime 100 mg BD
2. Acute Uncomplicated Pyelonephritis in Women
Characteristic Pathogens:
E. coli
P. mirabilis
S. saprophyticus
Recommended Empirical Treatment
a. Mild to Moderate Illness (Outpatient Therapy)
Oral Ciprofloxacin 500 mg BD
Ofloxacin 400 mg BD
Amoxicillin 500 mg TDS
Cefpodoxime 100 mg BD
b. Severe Illness (Hospitalization Required)
Parenteral therapy:
Ciprofloxacin 200–400 mg BD
Ofloxacin 1 mg/kg TDS
Ampicillin 1 g QID
Ceftriaxone 1–2 g/day for 14 days
Followed by:
Oral Quinolone for 10–14 days (doses as above)
3. Complicated UTI in Men and Women
Characteristic Pathogens:
E. coli
Proteus
Klebsiella
Pseudomonas
Staphylococci
Recommended Empirical Treatment
a. Mild to Moderate Illness
Outpatient oral antimicrobial therapy according to severity and culture sensitivity
b. Severe Illness / Hospitalization Required
Parenteral therapy:
Ampicillin with Gentamicin
Quinolone
Ceftriaxone
(Doses as above) until defervescence.
Abbreviations
TMP = Trimethoprim
SMZ = Sulfamethoxazole
BD = Twice daily
TDS = Three times daily
QID = Four times daily
UTI = Urinary Tract Infection
IV = Intravenous

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SCROTAL PAIN causes, physical examination, management
SCROTAL PAIN
Incarcerated Inguinal Hernia
History
Infants:
Irritable
Crying
Poor feeding
Previously reducible mass
Vomiting
Abdominal distension
Constipation/obstipation if intestinal obstruction has occurred
Physical Examination
Firm, discrete, tender inguinal mass extending to sc***um
Scrotal erythema and edema
Investigations
Labs and imaging of limited use
Ultrasound occasionally helpful to confirm etiology
Management
Emergent reduction
Most manually reducible
To OR if impossible in ER
Definitive surgical repair depending upon age and degree of illness
Testicular Torsion
History
CANNOT MISS!
Peak incidence: peri-pubertal
Sudden onset unilateral pain
Moderate to severe pain
Occasional history of trauma
Previous episodes of pain
Nausea/vomiting common
TWIST score
Physical Examination
High-riding testicle
Horizontal lie
Absent cremasteric reflex
Scrotal erythema and edema
Testicular tenderness
Reactive hydrocele may be present
Investigations
Colour doppler ultrasound if low risk (low TWIST score)
Contraindicated if high likelihood and causes delay
U/A generally not indicated
Management
Immediate surgical exploration if high likelihood
Surgical detorsion and orchiopexy if viable
97% salvage if

Ear Wax clinical Features and management