Ab-Malik

19/05/2026

Celebrating my 1st year on Facebook. Thank you for your continuing support. I could never have made it without you. 🙏🤗🎉

16/05/2026

Cause of Altered mental Status Remember with AEIOU TIPS

12/05/2026

VOMITING

Definition

Vomiting is the forceful expulsion of gastric contents through the mouth due to contraction of abdominal and diaphragmatic muscles.

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History Taking in Vomiting

1. Quantity / Volume

Small

Moderate

Large amount

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2. Frequency

Number of episodes per day

Intermittent or continuous

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3. Quality / Contents

Contains previous meal

Undigested recognizable food → suggests gastric outlet obstruction

Clear acidic fluid → suggests reflux disease

Mucus-containing vomitus

Watery vomitus

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4. Associated Blood

Fresh Blood (Hematemesis)

Bright red blood in vomitus

Changed Blood

Coffee-ground appearance due to action of acid and pepsin

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5. Color and Taste

Color

Depends on level of obstruction:

Vomitus containing color of previous meals → obstruction proximal to 2nd part of duodenum

Bile-stained vomiting → obstruction distal to 2nd part of duodenum

Feculent vomiting → distal ileal obstruction

F***l vomiting → colonic obstruction

Taste

Sour

Bitter

Foul taste

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6. Character

Projectile vomiting

Self-induced vomiting

Effortless vomiting (regurgitation)

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7. Relation to Pain

Whether vomiting relieves pain or not

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8. Smell

Odorless

Offensive / foul-smelling

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9. Timing

Early morning vomiting:

Pregnancy

Raised intracranial pressure / brain tumors

Postprandial vomiting

Nocturnal vomiting

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10. Preceding Factors / Triggers

Drugs

Alcohol

Surgical procedures

Trauma

Motion sickness

Infection

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11. Associated Symptoms

Nausea

Anorexia

Weight loss

Dyspepsia

Abdominal pain

Fever

Diarrhea

Headache

Vertigo

Dehydration

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Important Clinical Points

Projectile vomiting without nausea may indicate raised intracranial pressure.

Persistent vomiting of undigested food suggests gastric outlet obstruction.

Bilious vomiting usually indicates obstruction distal to the duodenum.

Feculent vomiting suggests intestinal obstruction.

12/05/2026

Questions that must be rule out During History Taking of vomiting

10/05/2026

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

09/05/2026

Shout out to my newest followers! Excited to have you onboard! Abdullah Abdullah, Muhammad Zahid, Rafihudeen Najmzy, Mansoor Ahmad, Ehsanullah Mangall, Usman Kamal, Wafa Wafa, Azizullah Masroor

08/05/2026

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

08/05/2026

SCROTAL PAIN causes, physical examination and management
゚viralシ

07/05/2026

04/05/2026

Ear Wax clinical Features and management