1. Update Management in common disease
28/10/59 , 31/10/59
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2. Outline Upper Respiratory tract symptoms Dyspnea Abdominal pain
Urticaria
Pediatric drug
Fever
Update CPG Leptospirosis

3. UPPER RESPIRATORY TRACT INFECTION

4. Upper Respiratory tract infection
Common cold (acute nasopharyngitis)
Pharyngitis
Tonsillitis
Sinusitis
Most common cause is VIRAL.

5. Upper Respiratory tract infection
History taking
fever , cough , runny nose ,nasal discharge , sore throat

6. Upper Respiratory tract infection
Physical examination

7. Upper Respiratory tract infection

8. Upper Respiratory tract infection

9. Upper Respiratory tract infection
Diagnosis : dominant symptoms, examination
Nasal symptoms: Rhinitis, sinusitis ,nasopharyngitis
Nasopharyngeal symptoms: pharyngitis, nasopharyngitis
Pharyngeal symptoms: pharyngitis ,sinusitis
URI?

10. Upper Respiratory tract infection
Management
Advice : Rest, fluid intake, keep warm
Medication : supportive treatment
Avoid transmission.
When to use Antibiotics?

11. Dyspnea

12. Dyspnea
Dyspnea ≠ Tachypnea

13. Dyspnea Physical examination : Vital sign : Temp. ,BP ,PR ,RR
Retraction
Lung sound
Stridor
Wheezing
Crepitation
Secretion sound
Rhonchi

14. Normal Breath sound

15. Wheezing

16. Wheezing

17. Wheezing

18. Rhonchi

19. Stridor

20. Stridor

21. Crackle /Rales /Crepitation

22. Crackle /Rales /Crepitation

23. Test

24. Management in dyspnea Reliable on severity and diagnosis(lung sound)
Maintain airway
O2 supply
Definite treatment

25. Abdominal pain

26. Abdominal pain
Localizing pain
Physical Examination

27. RUQ+Epigastrium pain What organ? Differential diagnosis Dyspepsia
Gastritis
Hepatitis
Billiary colic
Cholecystitis
Cholangitis
Pancreatitis
Peptic ulcer

28. RUQ +Epigastrium pain History taking
Characteristic of pain ,onset ,duration ,timing ,severity ,cause ,factor ,radiation ,associate symptoms
Liver+biliary system : Jaundice , dark urine, pale feces
Stomach : Nausea/vomiting , meal/food,
Pancrease : alcohol
Intestine : diarrhea, constipation

29. RUQ +Epigastrium pain Physical examination
Inspection : distend/scaphoid
Palpation: soft/guard , tender?
Purcussion : tympanic/dullness

30. RUQ +Epigastrium pain Differential diagnosis Dyspepsia Gastritis
Hepatitis
Billiary colic
Cholecystitis
Cholangitis
Pancreatitis
Peptic ulcer
Tender

31. Lt.side Abdominal pain What organ? Differential diagnosis Dyspepsia
Gastritis
Pancreatitis
Peptic ulcer
Enteritis
AGE

32. RLQ Abdominal pain What organ? Differential diagnosis Appendicitis
Enteritis
AGE
Cystitis
KUB stone
PID
Ovarian cyst
Ectopic pregnancy

33. RLQ Abdominal pain History taking associate symptoms
Appendicitis : fever ,Migratory pain, anorexia, N/V(Avarado score)
Intestine : diarrhea, constipation
KUB : hematuria ,dysuria
Gyne : leucorrhea, LMP
PE : Tender?

34. RLQ Abdominal pain Differential diagnosis Enteritis AGE KUB stone
Cystitis
PID
Rupture Ovarian cyst
Ectopic pregnancy
Appendicitis
Tender

35. Avarado’s score

36. URTICARIA

37. Urticaria
Definition : Raised, itchy areas of skin that are usually a sign of an allergic reaction.
DDx : Dermatitis, Anaphylaxis

38. Urticaria History taking :
Duration, Allergen?(contact,eating) ,Hx.of allergy
Rule out anaphylaxis : Shortness of breath ,chest discomfort ,collapse ,nausea/vomitting

39. Anaphylaxis

40. Urticaria Physical examination Vital signs : Temp., BP ,PR ,RR
Heart & Lungs & Abdomen
Skin ,mucosal

41. Urticaria

42. Urticaria

43. Urticaria Management Antihistamine : Chlorpheniramine Steroid?
Topical agent : calamine lotion
Advice for observe allergen
and avoidance

44. Pediatric drug dose

45. Pediatric drug Antibiotics Amoxycillin Supportive drugs Erythromycin
Glyceryl guaiacolate
Co-trimoxazole
Chlorpheniramine
Acetaminophen
Salbutamol
Domperidone
Dicyclomine

46. Pediatric drug 10 Kg/ 1tsp(5ml) 20 Kg/ 1tsp(5ml) Antibiotics
Supportive drugs
Amoxycillin
Glyceryl guaiacolate
Erythromycin
Chlorpheniramine
Co-trimoxazole
Salbutamol
Acetaminophen
Domperidone
Dicyclomine

47. Pediatric drug

48. FEVER

49. Fever Definition : Core Body temperature ≥ 100ºF (37.8ºC)
Grading : Low ºF ( ºC)
Moderate ºF ( ºC)
High > 102ºF (38.9ºC)
Variation by air temp.,location,timing
Caused by inflammation/infection

50. Fever History taking Acute/chronic
Characteristic of fever : timing,grading,duration,response
Specific organ symptoms : Repiration,GI,GU,Soft tissue,CNS
Systemic symptoms : Malaise,fatigue,myalgia,anorexia
Personal history : travel, camping

51. Fever Physical Examination Vital sign Specific organ
Specific sign: Eschar, conjunctivitis, PPE

52. Fever
Diagnosis : up to cause of fever.
Acute Febrile illness (AFI)

53. Fever Management Tepid sponge Advice : Rest , Hydration
Medication : Acetaminophen

54. LEPTOSPIROSIS

55. Leptospirosis
Leptospirosis is a zoonosis, endemic mainly in countries tropical climates.
Caused by Leptospira (long corkscrew-shaped bacteria)

56. Leptospirosis of food/droplet aerosols of fluids contaminated by urine
- Infection occurs through ingestion/inhalation
of food/droplet aerosols of fluids contaminated by urine
- The incubation usually lasts about 10 days (2 to 30 days).

57. Leptospirosis
Clinical manifestation

58. Leptospirosis LAB investigation CBC , UA BUN, Creatinine ,LFT
Confirm diagnosis
1. Culture : gold standart but has no benefit for treatment.
2. Serology : After day 5-7 of symptoms
Microscopic agglutination test (MAT)
indirect hemagglutination test (IHA)
enzyme-linked immunosorbent assay (ELISA)
Lepto dipstick

59. Update CPG Leptospirosis
แนวทางการตรวจวินิจฉัยโรคเลปโตสไปโรซิส.pdf

60. Conclusion Upper Respiratory tract symptoms Dyspnea Abdominal symptoms
Urticaria
Pediatric drug
Fever
Update CPG Leptospirosis

61. References Harrison internal medicine 19th edition.
Symptomatology-student pocket book of symtomps and sign.
med.md.kku.ac.th/site_data/mykku_med/ /Leptosp irosis.pdf

62. THANK YOU