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GENERAL MEDICINE WARD

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Kashaf Sheikh

on 7 October 2012

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Transcript of GENERAL MEDICINE WARD

a major ward in the hospital that deals with the diagnosis and (nonsurgical) treatment
of diseases of the internal organs (especially in adults) General
Medicine
Ward chest
medicine gastroenterology endo
crinology neurology asthma pneumonia meningitis peptic
ulceration diabetes mellitus gout tuberculosis typhoid malaria tetanus rabies AIDS rheumatology infectious
diseases Meningitis is an inflammation
of the membranes (meninges)
surrounding your brain and
spinal cord, usually due to the
spread of an infection. Most cases of meningitis are caused
by a viral infection, but bacterial and fungal infections also can lead to meningitis. Fever
Severe,unrelentingheadache
Confusion
Vomiting
Stiff neck medical history,physical exam&certain diagnostic tests:Blood cultures,Imaging, Spinal tap (lumbar puncture) Age 0-4 weeks:
Ampicillin plus cefotaxime or an aminoglycoside
Age 1-3 months:
Ampicillin plus cefotaxime plus vancomycin*
Age 3 months to 50 years:
Ceftriaxone or cefotaxime plus vancomycin*
Older than 50 years:
Ampicillin plus ceftriaxone or cefotaxime plus vancomycin*
Impaired cellular immunity:
Ampicillin plus ceftazidime plus vancomycin*
Neurosurgery, head trauma, or CSF shunt:
Vancomycin plus ceftazidime Overview Etiology Symptoms Tests & Diagnosis Treatment AIDS is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV destroys CD4 cells — a specific type of white blood cell that plays a large role in helping your body fight disease. Your immune system weakens as more CD4 cells are killed. You can have an HIV infection for years before it progresses to AIDS. Soaking night sweats
Shaking chills or fever higher than 100 F (38 C) for several weeks
Cough and shortness of breath
Chronic diarrhea
Persistent white spots or unusual lesions on your tongue or in your mouth
Headaches
Persistent, unexplained fatigue
Blurred and distorted vision
Weight loss
Skin rashes or bumps HIV is most commonly diagnosed by testing your blood or saliva for the presence of antibodies to the virus. A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection.
Tests to tailor treatment: CD4 count, Viral load, Drug resistance There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid creating strains of HIV that are immune to single drugs.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)nevirapine200mg/day
Nucleoside reverse transcriptase inhibitors (NRTIs)zidovudine250-300mg/12h,lamivudine
Protease inhibitors (PIs)indinavir800mg/8h Treatment Tests & Diagnosis Symptoms Etiology & pathogenesis Overview Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint
at the base of the big toe. breakdown of purines

production of uric acid uric acid dissolves in your blood and passes through your kidneys into your urine. sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling. The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
Intense joint pain.
Lingering discomfort.
Inflammation and redness. joint fluid test
blood test Medications to treat gout attacks Nonsteroidal anti-inflammatory drugs (NSAIDs). ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin). Colchicine 0.5mg/2-3h until pain goes
Corticosteroids. prednisone Overview Symptoms Tests & Diagnosis Etiology & Pathogenesis Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia. Chills, Fever, Sweating, Headache, Nausea, Vomiting, Muscle pain, Anemia, Stools, bloody, Jaundice Plasmodium falciparum, malariae, ovale, vivax, Thick and thin blood smears
Liver function tests
Complete blood count (CBC)Blood glucose test Uncomplicated P. falciparum malaria
Tab Artem DS Artemether + lumefantrine, 1+1 (a 6-dose regimen over a 3-day period given twice a day)b.d. 20mg/120mg
Treatment of malaria caused by P. vivax, P. ovale and P. malariae
Tab Nivaquine Chloroquine sulphate25 mg base/kg body weightdivided over 3 days,200mg
Tab Primaquine Primaquine (0.25 mg base /kg body weight)O.D., taken with food for 14 days. 0.25mg/kg Overview Symptoms Causative agent Tests & Diagnosis Treatment Rabies is a deadly virus spread to people from the saliva of infected animals. The rabies virus is usually transmitted through a bite. Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For that reason, anyone who may have a risk of contracting rabies should receive rabies vaccines for protection. Rabies doesn't cause any signs or symptoms until late in the disease, often just days before death.
Fever,Headache
Agitation
Anxiety
Confusion
Difficulty swallowing
Excessive salivation
(hydrophobia)because of the difficulty in swallowing
Hallucinations
Insomnia
Partial paralysis Rabies infection is caused by the rabies virus. The virus is spread through the saliva of infected animals. Infected animals can spread the virus by biting another animal or a person. Blood and tissue tests are used to diagnose rabies in people who have signs and symptoms of the infection. A fast-acting shot (rabies immune globulin) to prevent the virus from infecting you. Part of this injection is given near the area where the animal bit you if possible, as soon as possible after the bite.
A series of rabies vaccines to help your body learn to identify and fight the rabies virus. Rabies vaccines are given as injections in your arm. You receive five injections over 14 days. Pneumonia is an inflammation of the lungs caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. persistent cough, shortness of breath, chest pain, and fever — especially a lasting fever of 102 F (39 C) or higher with chills and sweating. Also contact your doctor if you suddenly feel worse after a cold or the flu. Physical exam
Chest X-rays
Blood and mucus tests The best approach to treating pneumonia depends on a number of factors, including your age and general health, the organism or organisms involved, and the setting — community or health care — where the infection developed. Treatment may include: Overview Etiology Symptoms Tests & Diagnosis Treatment hepatitis Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw." Spasms and stiffness in your jaw muscles
Stiffness of your neck muscles
Difficulty swallowing
Stiffness of your abdominal muscles
Painful body spasms, lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light
Fever
Sweating
Elevated blood pressure
Rapid heart rate The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus. Doctors diagnose tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus. Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.
Wound care
Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.

Medications
Antitoxin. tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue.
Antibiotics. orally or by injection, to fight tetanus bacteria.
Vaccine. you'll need to receive a tetanus vaccine in order to prevent future tetanus infection.
Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may be used to help regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine may be used for this purpose as well as sedation.

Supportive therapies
Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, you may need to be supported temporarily by a ventilator. Overview Symptoms Etiology & Pathogenesis Tests & Diagnosis Treatment Hepatitis is swelling and inflammation of the liver. It is not a condition, but is often used to refer to a viral infection of the liver. Immune cells in the body attacking the liver and causing autoimmune hepatitis
Infections from viruses (such as hepatitis A, B, or C), bacteria, or parasite
Liver damage from alcohol, poisonous mushrooms, or other poisons
Medications, such as an overdose of acetaminophen, which can be deadly Abdominal pain or distention
Breast development in males
Dark urine and pale or clay-colored stools
Fatigue
Fever, usually low-grade
General itching
Jaundice (yellowing of the skin or eyes)
Loss of appetite
Nausea and vomiting
Weight loss
Enlarged and tender liver
Fluid in the abdomen (ascites) that can become infected
Yellowing of the skin Abdominal ultrasound
Autoimmune blood markers
Hepatitis virus serologies
Liver function tests
Liver biopsy to check for liver damage
Paracentesis if fluid is in your abdomen Treatment to prevent hepatitis B infection after exposure hepatitis B immune globulin within 24 hours of coming in contact with the virus Treatment for acute hepatitis B infection you may not need treatment. Spread blood products Treatment for chronic hepatitis B infection Antiviral medications interferon@,lamivudine, Liver transplant No specific treatment exists.Your body will clear the hepatitis A virus on its own.In most cases of hepatitis A, the liver heals completely in a month or two with no lasting damage. Spread faecal-oral. Treatment for hepatitis A infection Overview Etiology Symptoms Tests & Diagnosis Treatment Treatment for hepatitis C infection A combination of two antiviral drugs —
peginterferon and ribavirin Alcoholic hepatitis corticosteroids or pentoxifylline Treatment of toxic hepatitis liver damage caused by an overdose of acetaminophen, receive a chemical called acetylcysteine. Autoimmune hepatitis
Medications to control your immune system (immunosuppressants) Prednisone
Azathioprine (Azasan, Imuran) Overview Symptoms Etiology Tests & Diagnosis Treatment Asthma is a disorder that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing. Overview Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight&lining of
the air passages swells.This reduces amount of air that can pass by. In sensitive people, asthma symptoms can be triggered by breathing in allergy-causing substances (called allergens or triggers).
Common asthma triggers include: Animals (pet hair or dander)
Dust
Changes in weather (most often cold weather)
Chemicals in the air or in food
Exercise
Mold
Pollen
Respiratory infections, such as the common cold
Strong emotions (stress)
Tobacco smoke
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) provoke asthma in some patients.
Personal or family history of allergies, Cough with or without sputum (phlegm) production

Pulling in of the skin between the ribs when breathing (intercostal retractions)

Shortness of breath that gets worse with exercise or activity

Wheezing,

Emergency symptoms:
Bluish color to the lips and face

Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack

Extreme difficulty breathing

Rapid pulse

Severe anxiety due to shortness of breath

Sweating Allergy testing

Arterial blood gas low PaO2 & PaCO2

Blood tests to measure eosinophil count & IgE

Chest x-ray

Lung function tests

Peak flow measurements Control drugs to prevent attacks
Inhaled steroids(beclometasone)
Long-acting beta-agonist inhalers(salmeterol)

Quick-relief (rescue) drugs for use during attacks
Short-acting bronchodilators (inhalers),such as Ventolin,
During a hospital stay,the patient also needs oxygen, breathing assistance, and medications given through
a vein (IV). Pathogenesis Etiology Symptoms Tests & Diagnosis Treatment Allopurinol 100-300mg/24h to reduce serum urate.
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