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Treatment protocols
Each protocol puts red flags first, then walks through treatment step by step with the medicines for each step.
Acid Peptic Disease in Pregnancy
Acid peptic disease is more common in pregnancy. Treat with lifestyle changes and pregnancy-safe agents.
Acneچہرے کے دانے
Pimples over the face with multiple small macules, treated with oral antibiotic, a medicated wash, a topical antibiotic gel and, in the sample, isotretinoin.
Acute Cholecystitis
Severe colicky right upper abdominal pain radiating to the right shoulder, with a positive Murphy's sign. Treat with an injectable NSAID and antispasmodic, then refer to a surgeon.
Acute Gastroenteritisدست اور الٹی
Vomiting, loose stools and abdominal cramps from viral or bacterial causes. Assess hydration, correct with IV fluids if needed, and give antibiotics only for the listed indications.
Acute Gastroenteritis in a Child (Sample) and WHO Dehydration Assessmentبچوں میں دست اور الٹی
A worked prescription for a 2.5-year-old, 12 kg child with fever, loose stools and vomiting, followed by the first two columns of the WHO dehydration assessment table.
Acute Hepatitisیرقان
Fever, jaundice and vomiting with right hypochondrial tenderness. Supportive care with IV dextrose, L-ornithine L-aspartate, antipyretic and antiemetic.
Acute Sinusitisسائنس کی سوزش
Sudden headache, usually one-sided and worse on leaning forward, with nasal discharge and sinus tenderness.
Acute Watery Diarrhoea in Childrenبچوں میں اسہال
A leading cause of death in under-5 children in Pakistan, but largely preventable with ORS and zinc. Antibiotics are rarely needed.
Allergic Conjunctivitisآنکھوں کی الرجی
Itching and redness of the eye, especially on exposure to dust; the eye is red but vision is intact.
Allergic Rhinitisالرجک رائنائٹس
Recurrent episodes of sneezing and watery nasal discharge without fever, usually triggered by dust or other allergens.
Anaemiaخون کی کمی
Palpitations, generalised weakness, shortness of breath and body aches with pallor. Treatment is chosen by haemoglobin level: oral iron with B12, then IV iron.
Anal Fissureبادی بواسیر
Painful defecation with bleeding per rectum after a history of constipation. Per rectal examination (PRE) is contraindicated.
Antibiotics and Their Most Common Indications (Reference)
A one-page illustrated summary of antibiotic classes and where each is used. This is a general teaching note, not a Pakistan treatment guideline.
Appetite Stimulants, Multivitamins, Vitamin D and Antiallergics (Reference)
A short list of commonly prescribed supportive products.
Atopic Dermatitis (Hand Eczema)
Itching and lesions on the hands and palms with scratch marks; treated with a steroid-emollient mix, an antihistamine, and avoidance of harsh soaps and detergents.
Backache (including Sciatica)کمر درد
A common complaint of females and the middle-aged group. Differentiate vitamin D deficiency (SLR negative, no tenderness), muscle strain (tender, SLR negative) and sciatica from disc herniation (SLR positive).
Bacterial Conjunctivitisآنکھ کا انفیکشن
Sticky eyes in the morning with purulent discharge for 2 days; the eye is red, vision intact.
Bacterial Vaginosis
Milky vaginal discharge for about 2 weeks with suprapubic pain and backache; examination unremarkable.
Bell's Palsyلقوہ
Deviation of the angle of the mouth and drooping of the eyelid from facial nerve palsy. Treated with physiotherapy, an oral prednisolone taper, B12, a PPI and eye care.
Brand and Generic Names: Analgesics, Antibiotics, Cardiac, CNS, Endocrine, GI, Respiratory (Reference)
Handwritten brand-to-generic lists. All brands and strengths from these lists are merged into the Medicines section, so a brand search finds them.
Bronchial Asthmaدمہ
Recurrent cough, breathlessness and wheeze, worse at night and with seasonal variation. Managed stepwise: counselling, basic drugs, then inhalers and specialist referral.
Burns
Wash with tap water, apply topical silver sulphadiazine, give NSAIDs and, if needed, oral or IV antibiotics. Refer to a consultant for larger, deep or acid burns.
COPD (Chronic Obstructive Pulmonary Disease)سی او پی ڈی
Chronic cough, breathlessness and wheeze in a chain smoker or passive smoker, with rhonchi on the chest. Treated with a steroid taper, a PPI, antibiotics when indicated, expectorants and nebulization.
Cardiac Arrhythmias (Note Sheet)
Drugs and measures for common arrhythmias. The sheet is a compact set of student notes and is only partly legible; check against a cardiology source.
Child Weight and Height by Age (Reference Chart)
Quick reference of typical weight and height by age used for weight-based dosing.
Constipationقبض
Passage of hard stools or difficult defecation. Check for red-alert signs before treating with lifestyle changes and laxatives.
Dengue Feverڈینگی بخار
Mosquito-borne viral illness (Aedes aegypti). Outbreaks occur yearly in Pakistan after the monsoon, peaking from September to November.
Depressionڈپریشن
Loss of interest in daily life, low mood and fatigue. Treated with an SSRI plus supportive counselling.
Diabetes Mellitus (Prediabetes and Type 2)شوگر / ذیابیطس
Polyuria, polyphagia, polydipsia and delayed wound healing. The book labels the patient (normal, prediabetic, diabetic) by fasting glucose, post-prandial glucose and HbA1c, then manages stepwise: lifestyle, metformin or a sulfonylurea, combinations, and finally insulin.
Dog Biteکتے کا کاٹنا
Tetanus toxoid, analgesia, anti-rabies vaccine on days 0, 3, 7 (and 14 as shown on the page), wound care and oral antibiotics.
Drugs Safe in Pregnancy (Reference List)حمل میں محفوظ ادویات
A printed list of drug groups considered safe in pregnancy.
Ear Wax (Impacted Cerumen)
Ear blockage, itching or earache with wax in the ear canal. Soften with ear drops, then suction after 4 days.
Enteric Fever (Typhoid)ٹائیفائیڈ بخار
Gradual-onset, step-ladder, continuous fever with non-focal features. Blood culture is the gold standard; Typhidot and Widal have no role per the book.
Epilepsy: Grand Mal (Note Sheet)مرگی
First-line and add-on drugs for generalised (grand mal) epilepsy from a handwritten note sheet.
GERD (Gastro-Oesophageal Reflux Disease)سینے کی جلن
Burning chest pain worse on leaning forward or after food, with excessive salivation and hiccups. Always be vigilant about chest pain and rule out a cardiac cause.
GI and Liver Notes: Vomiting, Oesophagitis, PU, Bleeding, IBD, Cirrhosis, Hepatitis (Note Sheet)
Compact notes on common GI and hepatology conditions with drugs and brands. Only legible content is recorded; verify before use.
Gastric Lavage: Contraindications
When gastric lavage must not be done in poisoning.
Gastritis and Peptic Ulcer Disease (including H. pylori)معدے کی سوزش / السر
Epigastric pain with vomiting. Check hydration, give IV fluids, a prokinetic and a PPI; test for H. pylori in recurrent cases and eradicate if positive.
Generalised Anxiety Disorder (GAD)گھبراہٹ / بے چینی
Palpitations and shortness of breath off and on with loss of sleep and fear of the future; examination is unremarkable. Refer to a consultant psychiatrist.
Gouty Arthritisگاؤٹ / جوڑوں کا درد
Multiple joint pains and inflammation of the small joints of the hands, burning feet sensations, and symptoms worse after taking meat and eggs. Treat the acute attack with NSAIDs, add supplements, then start urate-lowering therapy after 2 weeks.
Haemorrhoids (Piles)خونی بواسیر
Painless bleeding per rectum with a history of constipation; DRE shows a tortuous, dilated venous mass.
Headache: Migraineآدھے سر کا درد
A headache is usually associated with infection (URTI, LRTI, enteric fever, malaria). If isolated, the main causes are migraine and tension-type headache. Migraine is unilateral (female patients), lasts hours to 2–3 days, preceded by aura (zig-zag lines), precipitated by menstruation, flashing light, anxiety, etc.
Heart Failure, Angina, Unstable Angina, MI and Pericarditis (Note Sheet)
Compact notes on drug choices in heart failure, angina, MI, cardiogenic shock and pericarditis. Partly illegible; verify before use.
Hepatitis Cہیپاٹائٹس سی
Blood-borne viral infection causing chronic liver disease. Pakistan has one of the highest burdens worldwide (genotype 3 most common), and modern oral antivirals cure over 95% of patients.
Hiccupsہچکیاں
Hiccups are commonly associated with acid peptic disease (APD). Baclofen is the drug of choice.
Hyperemesis Gravidarumحمل میں الٹیاں
Excessive vomiting in pregnancy, especially in the first trimester.
Hypertension (OPD Approach)ہائی بلڈ پریشر
Hypertension is BP of 140/90 or more on two separate occasions. Treat by stage, age and end-organ damage; hypertensive urgency has no end-organ damage, emergency does.
Hypertension: Drug Selection Notes (Young, Old, IHD, HF, Pregnancy)ہائی بلڈ پریشر: دوا کا انتخاب
A one-page note choosing antihypertensives by age and co-existing disease.
Impetigo
Multiple watery pustular lesions that spread over a few days, treated with a topical antibacterial cream and an antihistamine, with strict separation of towels, soap and clothes.
Intestinal Colic in Infants (with GER and Gastrocolic Reflux)بچوں کے پیٹ کا درد
Excessive crying in an infant. Rule out encephalitis first: fever, refusal to feed and a bulging fontanelle point to encephalitis; no fever, taking orally and a depressed fontanelle point to colic.
Irritable Bowel Syndrome (IBS)آئی بی ایس
Recurrent abdominal pain with constipation-predominant or diarrhoea-predominant bowel habit, triggered by stress and meals, with unremarkable examination.
LRTI in Infants (Viral and Bacterial)بچوں میں سینے کا انفیکشن
Viral LRTI has a low-grade fever; bacterial LRTI has a high-grade fever. Both are graded mild, moderate or severe, and management depends on the grade. Severe cases go to tertiary care for admission.
Laryngitis
Inflammation of the voice box causing hoarseness. Usually viral.
Lower Respiratory Tract Infection (Bacterial)سینے کا انفیکشن
Bacterial chest infection with high fever and productive cough. Management depends on whether the cause is bacterial or viral.
Malariaملیریا
High-grade fever with rigors and chills that subsides with sweating, acute onset, with no focal symptoms (no sore throat, cough, runny nose, loose stool, abdominal cramps or burning micturition).
Mumps (from a sample prescription)
The book has no separate theory page for mumps; it appears in a sample prescription for a child with fever and painful swelling near the ear.
Oral Ulcers (Aphthous Ulcers)منہ کے چھالے
Painful oral cavity, irritation with salty or spicy food, unable to eat or drink; previous history of fever or stress. Round sores, one or multiple, with inflammation of the mucosa.
Organophosphate Poisoning (Spray Intake)سپرے کا زہر
A poisoning emergency managed with gastric lavage, IV access, repeated atropine to atropinisation, pralidoxime (Contrathion), antibiotics and monitoring. The book says poisonings must be dealt with at a government set-up.
Osteoarthritis (Knee)گھٹنوں کا درد
Pain in the knee joint (usually), off and on, exaggerated by activity, with crepitus on examination.
Otitis Externa (Ear Canal Infection after Match-stick Use)
Severe earache with a history of match-stick use, a tender tragus and pinna, and an inflamed ear canal with fever.
Otitis Media (Ear Discharge)کان بہنا
Greenish or yellowish ear discharge with earache or a sense of a foreign body in the ear. Clear the ear, give topical antibiotic-anaesthetic drops if the tympanic membrane is intact, plus oral antibiotic, NSAID and antihistamine.
Otomycosis (Fungal Ear Infection)کان میں فنگس
Itching in the ear and ear blockage with greenish or white discharge. How to tell wax, otitis media and otomycosis apart matters, but the book stresses that examining the ear and experience are what differentiate them.
Paediatric Injectable Drug Dose Charts (Reference, Unverified)
Two photographed charts of paediatric injectable doses. The photos are skewed and blurry, so rows were matched by position; every figure here must be checked against the original chart before any use.
Pharyngitis
Inflammation of the throat wall causing sore throat and fever; treated with an antibiotic when indicated plus an NSAID and antihistamine.
Pneumonia in Childrenبچوں میں نمونیا
Lung infection and a major killer of children under 5 in Pakistan. Early recognition by fast breathing and prompt antibiotics save lives.
Primary Nocturnal Enuresis (Bed Wetting)بستر گیلا کرنا
Excessive bed wetting in a child. Rule out UTI and anatomical problems first, then counsel, and use an antidiuretic if counselling fails.
Rat Pill Poisoning
The book's protocol for rat-pill (anticoagulant-type) poisoning: gastric lavage, baseline coagulation tests, vitamin K, IV fluid, antibiotic and PPI.
Respiratory Notes: Asthma, COPD, Cor Pulmonale, Pulmonary Embolism and Others
Compact notes on asthma (acute and long term), acute exacerbation of COPD, allergic rhinitis, pulmonary embolism, haemoptysis, aspiration pneumonia, lung abscess, interstitial lung disease, sarcoidosis and pulmonary hypertension.
Road Traffic Accident (Minor Trauma and Abrasions)
A patient who fell from a bike half an hour ago with abrasions on the shin and forearm. Examine vitals, clean the wounds, assess for head, chest, abdominal and bone injury, and give tetanus toxoid and analgesia.
Scabiesخارش / کھجلی
Itching all over the body, especially at the peripheral parts, worse at night and on the genitalia, with a positive family history.
Scorpion Bite
Injectable antihistamine and NSAID, followed by oral NSAID, antihistamine and Danzen DS.
Shingles (Herpes Zoster)شنگلز
Burning, itching, appearance of papules and malaise or fever, with involvement of a dermatome and papules like grapes. Treated with oral acyclovir, topical antiviral and anaesthetic, pregabalin, B12 and an NSAID.
Snake Biteسانپ کا کاٹنا
Treatment protocol (medical unit protocol shown in the book): start as soon as possible, give 5 ampoules of polyvalent anti-snake venom diluted in 500–1000 mL of 5% D/W over 30–60 minutes, and watch for anaphylaxis.
Tinea (Ringworm)دادھ
Itching with well-circumscribed lesions on the face, abdomen, hands or head; usually multiple but may be single.
Tonsillitis
Infection of the tonsils with fever, sore throat and painful swallowing. Medical management is similar to pharyngitis; recurrent cases are referred to ENT for tonsillectomy opinion.
Toothacheدانت کا درد
Very severe toothache with an inflamed mucosal lining and carious tooth. Treated with an antibiotic pair, an NSAID and a PPI, with referral to a dentist.
Tuberculosis (OPD Approach)ٹی بی / تپ دق
Low-grade fever, cough for more than 2 weeks, night sweats, weight loss, loss of appetite and sometimes haemoptysis. Confirm with sputum AFB and chest X-ray, check GeneXpert for MDR-TB, then start ATT by weight and refer to a consultant for further decision.
UTI and Renal Colicپیشاب کی نالی کا انفیکشن / گردے کی پتھری کا درد
Flank pain radiating to the groin (renal colic, more common in renal stone) or burning micturition (more common in UTI). Both are managed the same way except that tamsulosin has no role in UTI.
Vaginal Candidiasis
Per-vaginal itching with a curdy vaginal discharge, off and on.
Vertigoچکر آنا
Approach: exclude pregnancy and anaemia, then treat symptomatically.
Viral Bronchitis (Viral LRTI)وائرل برونکائٹس
Low-grade fever with a painful dry cough and a clear chest; CBC shows lymphocytosis.
Viral Rhinitis (Common Cold)نزلہ زکام
Inflammation of the nasal mucosa from a viral infection. Causes of rhinitis: viral and allergic.
Wasp / Bee Sting
Injectable antihistamine and NSAID, then oral NSAID, antihistamine and Danzen DS. Anaphylaxis (tachycardia, hypotension, wheeze) needs intramuscular adrenaline.