★ Cardiology:
△ Stable angina pectoris:
Aspirin 0.1 qd; Clopidogrel 75mg qd; Simvastatin 20mg qn; Bisoprolol (Bosu) 2.5mg qd; Isosorbide mononitrate sustained-release tablets (Imdur) 30mg qd.
△ Acute extensive anterior wall myocardial infarction:
Treatment drugs: Aspirin 0.1 qd; Clopidogrel 75mg qd; Atorvastatin (Lipitor) 20mg qn; Low molecular weight heparin calcium 0.6ml subcutaneous injection beside the navel bid; Perindopril (Yasida) 4mg qd; Bisoprolol (Bosu) 1.25mg qd.
Relief drugs: Nitroglycerin 10mg iv-vp 6ml/L (if chest pain cannot be controlled, switch to Corbet).
△ Dilated cardiomyopathy with right heart failure:
Cardiotonic: Digoxin 0.125mg bid (gradually increase dosage); Diuretic: Furosemide 20mg bid, Spironolactone 20mg qd; ACEI: Perindopril 4mg qd; Beta-blocker: Bisoprolol 1.25mg qd; Improve circulation: Ginkgo quinine zinc 320mg ivgtt qd, Kaitai 10mg ivgtt qd, Danshentong II-A 80mg ivgtt qd.
The above are the main drug treatments, other general treatments and symptomatic treatments are not mentioned here. (See surgical medication summary)
△ Wolff-Parkinson-White syndrome and paroxysmal supraventricular tachycardia:
Radical cure: Radiofrequency ablation via catheter, can be discharged after changing medicine on the third day post-operation.
★ Endocrinology:
Neurotrophic: Mecobalamin, Enzhesi 3ml im, Calf blood protein extract (Aiwizhi) 30ml ivgtt.
Improving circulation: Shuxue Ning 20ml, Ginkgo biloba extract injection (Jinnaduo).
Improving brain oxygen supply: Amithiazine-Rubazin (Dukexi) 1 tablet bid.
For hospitalized patients, most have diabetes, among those who come for hospitalization, many also have large vessel, microvascular, and peripheral nerve complications. The treatment mainly focuses on insulin injections, neurotrophic, and improving circulation. Regarding how to use insulin, after two weeks of rotation, I still haven't fully understood it, so I won't elaborate here.
★ Gastroenterology:
Eradication of HP treatment: 1. Rabeprazole sodium capsules (Rui Bei) 0.35g bid A.C; 2. Clarithromycin 0.5g bid; 3. Furazolidone (Litetling) 0.1g bid.
Antiviral treatment for active phase of hepatitis B (big three positive and HBV-DNA greater than 10^5): 1. Entecavir 0.5mg qd; 2. Adefovir dipivoxil 10mg qd; 3. Lamivudine (Hepsera) 100mg qd.
Prevention of upper gastrointestinal bleeding: Bletilla gel 250ml q8h ivgtt; Epsilon aminocaproic acid (an antifibrinolytic agent) 6.0 ivgtt qd.
Adjusting intestinal flora: Zhenchangsheng 2 tablets tid; Compound Lactobacillus acidophilus tablets 2 tablets tid; Trimethobenzamide maleate (Shuliqineng) 0.2 tid.
Liver protection drugs: Polyene phosphatidylcholine (Tianxing) 15ml ivgtt qd; Livgan'an (17-AA) 500ml ivgtt qd; Ornithine aspartate (Yabosi) - preventing hepatic encephalopathy.
Anti-diarrheal drugs: Diphenoxylate 2 tablets tid A.C; Smectite 6.0 tid A.C; Berberine sulfate 0.3 tid.
Treatment for external hemorrhoidal bleeding: Apply anti-inflammatory ointment externally; Airmelang 2 tablets bid; Anluoxue 5mg tid×3; Vitamin B6 20mg tid×3; Apply erythromycin ointment externally.
The treatment for cirrhosis is mostly symptomatic treatment, there isn't much to say about it, currently cirrhosis cannot be cured, and the prognosis is poor.
★ Pulmonology:
Cough suppression and expectoration: Ambroxol hydrochloride (Enostrum) 120mg ivgtt bid; Expectorant cough suppressant powder; Chlorpheniramine; Compound licorice oral solution.
Bronchodilation and asthma relief: Aminophylline 0.25 iv-vp bid 6ml/h; Provovent hydrochloride (Mupreclear) 25ug bid; Kangkezhi 4ml im bid; Jinotong; Sierping;
Auxiliary anticancer: Xiaoaiping 20ml qd; Polysaccharide peptide from Ganoderma lucidum 4mg qd; Qing capsule 2 tablets tid; Ankaisu 5.0 tid.
★ Nephrology and Rheumatology:
RA drug treatment: 1. NSAID: Inteceqing 50mg bid; 2. DMARD: Methotrexate 10mg qw; Leflunomide (Toushu) 20mg qd; Hydroxychloroquine 0.2 qd.
Appendix: 33% magnesium sulfate wet compress - de-swelling; 50% magnesium sulfate oral - laxative; 25% magnesium sulfate intravenous drip - antispasmodic.
★ Hematology:
There are too many chemotherapy drugs and regimens, which will be organized later when there is time. Here is a summary of common symptomatic treatments within the department:
Nausea prevention: Metoclopramide 10mg im; Nesixia 0.3mg iv (before chemotherapy).
Cough suppression and expectoration: Brown compound 10ml tid; Mucosolvan 60mg iv bid; Fresh bamboo extract 10ml nebulized inhalation bid.
Diuresis: Spironolactone 20mg tid; Furosemide 20mg iv.
Blood pressure reduction: Amlodipine 5mg qd; Captopril 12.5mg sublingual administration.
Headache relief: Rotundine 60mg po.
Calcium supplementation: Calcium gluconate 10% 10ml iv (slow).
★ Neurology:
Neurotrophic: Monosialoganglioside (Shenjie) 40mg ivgtt qd; Cytidine diphosphate choline sodium 0.1 tid; Acetylglutamine 0.75 ivgtt qd.
Improving circulation: Xueshuantong 0.6 ivgtt qd; Dihydroergotoxine mesylate 2.5mg bid; Salvia miltiorrhiza and Ligustrazine injection 10ml ivgtt; Ginkgo flavone 1.0 ivgtt qd.
Myocardial nutrition: Manshuli 20mg tid; FDP (fructose-1,6-diphosphate sodium injection); Trimetazidine; Butyryl cyclic adenosine monophosphate calcium 40mg ivgtt; Beikening 200mg ivgtt.
Free radical scavenging: Edaravone 30mg ivgtt bid.
Fibrinogen reduction: Agkistrodon enzyme 0.75u ivgtt requires skin test.
Antipsychotic drugs: Madopa 0.125 tid; Depakin 0.5 bid.
Antidepressants: Trihexyphenidyl hydrochloride 2mg tid; Alprazolam 0.4 qn; Olanzapine 2.5/5mg qn.
One, ★ Neonatology ★
1. How to judge neonatal crying?
Answer: First judge whether it's physiological or pathological, common reasons include: 1. Nasal obstruction during a cold (PS: NS nasal drops); 2. Skin folds maceration or uncleaned stool on the buttocks; 3. Improper feeding; 4. Lactose intolerance; 5. Milk allergy (exclusive breastfeeding is strongly recommended); 6. Other causes of colic; 7. Pain in other areas.
2. How to judge low responsiveness in newborns?
Answer: Common reasons include: 1. Hypoxic-ischemic encephalopathy (HIE); 2. Septicemia; 3. Respiratory failure; 4. Hypothermia; 5. Hypoglycemia; 6. Central nervous system infection; 7. Drug factors; 8. Others.
3. How to differentiate cyanosis in newborns?
Answer: Main considerations include: 1. Pulmonary lesions, such as neonatal hyaline membrane disease; 2. Congenital heart disease; 3. Methemoglobinemia; 4. Cranial diseases; 5. Septic shock (manifested by shallow rapid breathing, no obvious tricuspid sign, accompanied by generalized weakness, hypotonia, and cold extremities, prolonged capillary refill time at the heel).
★ Hematology ★
1. What tests should be done if an infection is suspected?
Blood culture (bacteria + sensitivity, fungi) T>38.5°C;
Stool culture;
Midstream urine culture;
Sputum smear for pathogenic bacteria;
Sputum culture (bacteria + sensitivity, fungi);
Throat swab pathogenic bacterial culture + sensitivity, fungi + typing.
2. How to handle high white blood cell count?
Hydroxyurea 1.0 bid; Allopurinol 0.1 tid; Sodium bicarbonate 1.0 tid.
★ Pulmonology ★
1. What does sputum pathogen examination include?
Smear: look for bacteria, fungi, tumor cells, acid-fast bacilli;
Culture: pathogenic bacterial culture + sensitivity; fungal culture + typing + fungal count.
★ Cardiology Teaching Rounds ★
☆ ACS ☆
1. Management for individuals with mild coronary artery stenosis:
(1) Stabilize plaque → lower lipid levels (LDL reduced below 2.5, e.g., Lipitor)
(2) Antiplatelet aggregation (e.g., Aspirin initial dose 300mg can be taken lifelong; Clopidogrel; Plavix 300mg 2-month course)
(3) Anticoagulation (low molecular weight heparin 1-2 weeks)
2. Thrombolysis: e.g., Urokinase 22,000 units/kg (1.5 million units 1/3 iv, 2/3 ivgtt within 30 minutes); Streptokinase (less used clinically due to allergy risks)
3. Reperfusion indicators: relief of chest pain; ST-segment depression; reperfusion arrhythmias; early peak enzyme levels.
☆ Wolff-Parkinson-White Syndrome ☆
Three major characteristics of pre-excitation (manifest pathway): short PR interval; delta wave; widened QRS complex.
Types of pre-excitation: Type A delta wave upward → right bundle branch block; Type B delta wave downward → left bundle branch block.
Management during acute pre-excitation episode: narrow QRS complex → transmitted through AV node → Lanatoside C, Verapamil, Propafenone, Amiodarone; wide QRS complex → transmitted through bypass → Lanatoside C, Verapamil contraindicated.
When pre-excitation is not occurring: surgical root treatment, ablate bypass.
★ Gastroenterology ★
How to consider chronic diarrhea with unknown cause clinically? (accompanied by anemia, hypoalbuminemia)
1. Malabsorption syndrome: liver, gallbladder, pancreas solid organ lesions, small intestine lesions → fecal routine, Sudan III staining;
2. Infectious enteritis: e.g., hookworm disease, Giardia lamblia → endoscopy, small intestine mucosa biopsy culture;
3. Gluten-sensitive enteropathy: related to eating wheat-based foods;
4. Ulcerative colitis: abdominal pain, passing mucopurulent bloody stools, relieved after defecation;
5. Crohn’s disease: fever, abdominal pain, abdominal mass;
6. Small intestinal bacterial overgrowth.
★ Endocrinology ★
1. How to calculate diabetic diet?
Total calories (kcal): Ideal body weight (kg) = height - 105; Ideal body weight × (25～30kcal)
Carbohydrates (kcal): Total calories × 60％ / 4
Proteins (kcal): Ideal body weight × (0.8～1.0g)
Fats (kcal): (Total calories - Carbohydrates - Proteins × 4) / 9
2. Insulin treatment:
※ INS dosage: FPG × 2; 24-hour urinary sugar (g) / 2; (blood glucose - 5.6) × weight × 0.6 × 180 / 1000; Use 2/3 of this INS first, adjust remaining 1/3.
※ Choice of INS formulations: 1. Short-acting INS: before each meal + before bedtime subcutaneous injection; 2. Mixed INS: morning and evening subcutaneous injection, slightly less in the morning 2/3 and slightly more in the evening 1/3.
※ Intensive INS treatment: 1. Before breakfast → mixed intermediate- and rapid-acting INS; Before dinner → rapid-acting INS; Before bedtime → intermediate-acting INS. 2. Rapid-acting INS before each meal, intermediate-acting INS before bedtime. 3. INS before each meal, add long-acting INS before breakfast. 4. Mixed short- and intermediate-acting INS, used morning and evening. 5. INS pump or continuous subcutaneous INS infusion.
Two, Endocrinology:
1. Diabetic foot infections are often caused by Staphylococcus aureus forming furuncles, usually localized due to the release of coagulase by Staphylococcus aureus.
2. The preferred basic treatment for newly diagnosed diabetes is diet + exercise + metformin.
3. When using vancomycin, be cautious of hepatotoxicity and ototoxicity, and monitor serum drug concentration.
4. Thyroid swelling is mainly associated with humoral immunity, while GD infiltrative exophthalmos is mainly related to cellular immunity.
5. T3 (high activity) → rT3 inactive; T4 has low activity.
6. Hyperthyroidism radioiodine treatment uses beta rays, not alpha rays. Beta rays do not penetrate the skin and are limited to the thyroid swelling, whereas alpha rays can penetrate the skin.
7. Patients with diabetic nephropathy with creatinine > 300 umol/L need to consider hemodialysis.
8. For patients with high nighttime blood sugar but normal postprandial blood sugar: decreased hepatic gluconeogenesis, evident peripheral tissue insulin resistance. Metformin and sensitizers (such as Avandia, Actos) can be used.
9. Tangli (Nateglinide) works well only for patients with fasting blood sugar < 9.0 mmol/L. (Statistical results, don't know why?)
10. Metformin should be avoided during perioperative periods for diabetic patients to prevent lactic acidosis induced by surgery.
11. Scleroderma is divided into three types: diffuse type, limited type, and overlapping type. Typical clinical manifestations: thin upper lip, visible radial skin lines; thin nose tip, ears; 95% accompanied by Raynaud's phenomenon; finger lesions develop from distal to proximal; often complicated by pulmonary fibrosis at the lung base; death is commonly due to respiratory failure caused by involvement of type II alveolar epithelial cell lesions. Treatment principle: improve peripheral blood supply, hormone anti-inflammation (subcutaneous tissue autoimmune); dry cough and difficulty breathing indicate involvement of lungs, cyclophosphamide needed.
12. Normal BUN, elevated creatinine suggests chronic renal insufficiency;
Elevated BUN, normal creatinine suggests acute or pre-renal renal insufficiency.
13. Proteinuria + or 0.5g/24h, use metformin cautiously.
14. Fructose chloride sodium is contraindicated in patients with renal insufficiency.
15. Clarify three concepts: hypoglycemia, hypoglycemic disorder, hypoglycemic reaction.
16. Diabetic nephropathy first shows tubular dysfunction, then glomerular lesions appear.
Clinically, tubular dysfunction manifests as: nocturia, increased urine specific gravity, increased osmotic pressure.
17. Hematuria differentiation: 1. Stones; 2. Contusions; 3. Inflammation; 4. Tumor.
18. IgA nephropathy primarily presents with hematuria, lumbar pain is relatively rare.
19. In ENA polypeptide antibody spectrum: ANA may be positive in all rheumatic diseases and infections, non-specific. The following indicators have some specificity.
Anti-dsDNA, anti-Sm antibodies → systemic lupus erythematosus;
Anti-U1RNP → mixed connective tissue disease;
Anti-Scl-70 → scleroderma;
Anti-SSA, SSB → Sjögren's syndrome;
Anti-Jo-1 → dermatomyositis or polymyositis;
20. Massive hemoptysis management: sedation, oxygen therapy; first dose use saline + posterior pituitary extract 6 units (contraindicated in hyperkalemia, coronary heart disease patients); Combet; *********; if internal medicine treatment fails, consult interventional department for bronchial artery embolization.
21. Clinical manifestations of aspergillosis mainly involve chest pain and hemoptysis; cough, sputum production, stringy sputum is mostly due to Candida albicans infection;
22. Early HAP is mostly caused by G+ bacterial infections, such as streptococci;
Late HAP is mostly caused by G- bacterial infections, such as Escherichia coli, Pseudomonas aeruginosa; often complicated by fungal infections.
23. Imidazole antimicrobial agents: target site is the fungal cell membrane (ergosterol), affecting fungal cholesterol metabolism, thereby inhibiting fungal growth. Generally effective within 1-2 hours.
For example: Micafungin, 50mg for candidiasis; 150mg for aspergillosis.
24. Aspergillosis is divided into three types: 1. Saprophytic type (aspergilloma); 2. Allergic type: mainly involving alveolar exudation; 3. Chronic invasive type (most common).
25. Amikacin, moxifloxacin, rifampicin have anti-tuberculosis effects.
26. In community-acquired pneumonia anti-infective treatment, clinicians often combine: Levofloxacin (targeting G-, some G+, atypical bacteria) + Rifampin (G+, anti-tuberculosis).
27. Within 3 months after kidney transplantation, pneumonia is prone to occur as a complication.
28. Long-term use of carbapenems (meropenem) easily leads to the emergence of Stenotrophomonas maltophilia. (This part was involved in my undergraduate graduation thesis statistical analysis, but I didn't understand why at that time. Now recalling it, everything becomes clear!)
29. For segment-level bronchial lesions, flexible bronchoscopy biopsy is preferred; for subsegment-level bronchial lesions, CT-guided lung biopsy is preferred.
30. The most common metastatic sites for primary lung cancer are: skull, prostate, bone.
31. Ca antagonists can reduce pulmonary artery hypertension and decrease right heart load.
32. Inspiratory breathing difficulties are mainly due to large airway obstruction; expiratory breathing difficulties are mainly due to distal small airway obstruction, wheezing can be heard.
33. Tiotropium bromide is more effective for COPD patients than for asthma patients.
34. Beta-lactams: time-dependent, thus dosing frequency is often 2/day or 3/day.
Quinolones: concentration-dependent, once daily dosing is sufficient.
35. Arterial blood gas analysis, details omitted here, see specialized analysis.
36. For atypical bacterial infections, quinolones or macrolides are often chosen.
37. Fungal infections tend to cause dyspnea.
38. Elderly patients using sitafloxacin need to be cautious of neurological side effects, clinical cases have shown induction of epilepsy and mental abnormalities.
39. Areas damaged by hypoglycemia start from the brain, developing downwards. If not promptly treated, involvement of the pons or even the medulla oblongata can lead to respiratory inhibition and immediate death.
40. Clinically, encountering hypertension with hypokalemia should prompt consideration of primary aldosteronism.
41. Potassium: more intake more excretion, less intake less excretion;
Sodium: more intake more excretion, less intake less excretion, no intake no excretion.
42. Breast development in elderly males should consider possible use of spironolactone.
43. NSAIDs as pain-relieving drugs: more important for spondyloarthritis than for RA.
44. Lupus: hyperactivity of humoral immunity.
45. Differences between post-hepatitis cirrhosis and schistosomiasis-related cirrhosis:
The former mainly involves liver function damage, the latter mainly involves portal hypertension. Because the tubular area is the most frequently attacked by autoimmunity.
46. Lupus patients: fast sedimentation rate, CRP normal.
47. Commonly affected parts in rheumatic diseases: SKLEN. S: skin; K: kidneys; L: lungs; E: eyes; N: nervous system. If multiple involvements occur, consider the possibility of rheumatic diseases.
48. Hypophosphatemic bone disease: pseudofracture lines may be seen. Neurofibromatosis can induce this disease.
49. Three classes of drugs for acute gout treatment: Colchicine (two methods of use, one according to the sixth edition textbook, but rather cumbersome, few people know; the departmental method is 1mg 3/day on the first day; 1mg 2/day on the second day; 1mg 1/day on the third day, continue this dosage for one week, then stop); NSAID pain-relieving drugs; hormones.
50. Selection of antihypertensive drugs for hypertension combined with other diseases:
Combined with bronchial asthma: choose Ca antagonists, ACEI class contraindicated.
Combined with stones: choose Ca antagonists.
Combined with heart failure with reduced ejection fraction: choose ACEI, ARB.
Combined with diabetes: choose ACEI, ARB.
Combined