STG

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1. GASTROINTESTINAL

What is the most common cause of diarrhoea in children in Ghana?

Viral (usually rotavirus) - antibiotics not routinely needed (STG page 11)

What are the 3 Treatment Plans for dehydration in children?

Plan A (no dehydration - home ORS), Plan B (some dehydration - facility ORS), Plan C (severe dehydration - IV fluids) (page 13-18)

What is the dose of ORS for a child <2 years with no dehydration (Plan A)?

500 ml or more, plus 50-100 ml for each extra stool passed (page 16)

What is the first-line antibiotic for bacterial dysentery in adults?

Ciprofloxacin 500 mg 12 hourly for 5 days (page 14)

What is the treatment for amoebic dysentery?

Metronidazole 800 mg 8 hourly for 5 days (page 14-15)

What is the treatment for cholera?

Tetracycline 500 mg 6 hourly for 3 days OR Doxycycline 100 mg 12 hourly for 3 days (page 15)

What is the zinc supplementation dose for a child >6 months with diarrhoea?

20 mg/day for 10-14 days (page 15)

What drugs should NOT be used for diarrhoea in children?

Anti-diarrhoeals: Kaolin, Loperamide, Codeine, Diphenoxylate/Atropine (page 18)

What is first-line H. pylori eradication therapy?

PPI (Omeprazole/Esomeprazole) + Amoxicillin + Clarithromycin OR Metronidazole for 10-14 days (page 24)

What is first-line treatment for constipation in adults?

Bisacodyl 10-20 mg at night OR Senna 15-30 mg at bedtime OR Lactulose 15-30 ml daily (page 21)

What is first-line treatment for GORD (non-erosive)?

Magnesium trisilicate OR Omeprazole 20 mg daily for 4-8 weeks (page 26)

What is the treatment for oesophageal candidiasis?

Nystatin 400,000-600,000 units 6 hourly for 7 days OR Fluconazole 200 mg stat then 100 mg daily for 14 days (page 29)

2. LIVER DISORDERS

What is first-line treatment for amoebic liver abscess?

Metronidazole 500 mg 8 hourly for 10 days (tissue agent) then Paromomycin (luminal agent) (page 34)

What is the treatment for pruritus in cholestatic jaundice?

Cholestyramine 4 g 12 hourly (max 16 g/day) (page 37)

What is first-line treatment for chronic active Hepatitis B?

Pegylated Interferon alfa-2a OR Tenofovir OR Entecavir (page 40)

What is the first-line drug for hepatic encephalopathy?

Lactulose (oral: 30-45 ml 6-12 hourly OR rectal: 300 ml in 700 ml water 4-6 hourly) (page 44-45)

What is the antibiotic prophylaxis for SBP (spontaneous bacterial peritonitis)?

Ciprofloxacin 400 mg IV 8-12 hourly for 2 days then oral 500 mg 12 hourly for 5 days (page 46)

How is ascites initially managed?

Bed rest + Salt restriction + Spironolactone 100 mg daily + Furosemide 40 mg daily (page 47)

What is the antidote for paracetamol poisoning?

N-Acetylcysteine (NAC) - oral loading dose 140 mg/kg (page 56-57)

3. NUTRITIONAL & HAEMATOLOGICAL

What is the Vitamin A dose for a child >1 year with malnutrition?

200,000 units daily for 2 days (page 60)

What is first-line treatment for iron deficiency anaemia in adults?

Ferrous sulphate 200 mg (65 mg elemental iron) 8 hourly for 3-6 months (page 64)

What is the treatment for Vitamin B12 deficiency?

Hydroxocobalamin 1 mg IM every other day for 6 doses then 1 mg every 3 months for life (page 65)

What is first-line pain relief for vaso-occlusive crisis in sickle cell disease (mild-moderate)?

Paracetamol 500 mg-1 g 6-8 hourly OR Ibuprofen 400 mg 6-8 hourly OR Diclofenac 50 mg 8 hourly (page 70-71)

What should be avoided in sickle cell crisis pain management?

Long-term NSAIDs (>2 weeks) - may cause renal impairment and gastritis. Pethidine no longer recommended (page 71)

What is the dose of Desmopressin for Haemophilia A?

Intranasal: 150 mcg spray into each nostril 12 hourly, may repeat for 3 days (page 67)

4. CARDIOVASCULAR

What is the initial treatment for stable angina?

GTN sublingual 500 mcg + Aspirin 300 mg stat then 75 mg daily + Atenolol 50-100 mg daily (page 116)

What is the initial treatment for acute coronary syndrome (STEMI)?

Oxygen + Aspirin 300 mg chewable + Clopidogrel 300 mg + GTN sublingual + Morphine 5-10 mg IV (page 119)

What is the Well's score for DVT probability?

3 points = high probability; 1-2 points = moderate; -2-0 = low probability (page 124)

What is the first-line anticoagulant for DVT treatment?

Heparin SC (250 units/kg 12 hourly) OR Enoxaparin SC (1.5 mg/kg daily) + Warfarin (target INR 2-3) (page 125-126)

What is the target INR for warfarin therapy in DVT/PE?

2 to 3 (page 126, 129)

What is the treatment for acute stroke (infarct)?

Aspirin 300 mg stat (oral/NG) then 75 mg daily after 1 week (page 131, 133)

What are the NYHA classes of heart failure?

Class I: no limitation; II: slight limitation; III: marked limitation; IV: symptoms at rest (page 134)

What is the first-line diuretic for acute heart failure?

Furosemide IV 40-80 mg (page 136)

What is the first-line treatment for hypertension in black patients?

Thiazide diuretics OR Calcium channel blockers (Amlodipine) - ACE inhibitors NOT first-line as monotherapy (page 149)

What is the target BP for diabetics?

What is first-line treatment for hypertensive emergency?

Labetalol IV 20-50 mg over 2 min, repeat at 10 min intervals (max 200 mg) (page 155-156)

What is first-line treatment for acute rheumatic fever?

Benzathine benzylpenicillin (1.2 MU IM if >30kg) + Aspirin/Ibuprofen (page 163)

5. RESPIRATORY

What is the CURB-65 severity score for pneumonia?

Confusion, Urea >7, RR ≥30, BP low, age ≥65 - each 1 point. Score 0-1: home; 2-3: admit; >3: ICU (page 169)

What is first-line outpatient treatment for CAP in adults?

Amoxicillin 1 g 8 hourly for 7 days + Azithromycin 500 mg daily for 6 days (page 172)

What is first-line treatment for severe pneumonia requiring admission?

Amoxicillin+Clavulanic acid IV + Azithromycin IV then oral (page 173)

What is first-line treatment for acute moderate/severe asthma exacerbation?

Oxygen + Nebulised Salbutamol 2.5-5 mg + Nebulised Ipratropium bromide + IV Hydrocortisone 200 mg stat then 100 mg 6 hourly (page 177)

What is first-line maintenance for chronic asthma?

Inhaled Salbutamol PRN + Inhaled Budesonide (or Fluticasone) (page 178-179)

What is first-line treatment for chronic bronchitis with infective exacerbation?

Oxygen + Salbutamol nebulised + Ipratropium bromide + Amoxicillin + Prednisolone (page 185-186)

What is first-line treatment for lung abscess?

Cloxacillin IV + Amoxicillin+Clavulanic acid IV + Ceftriaxone IV + Metronidazole IV for 4 weeks then oral continuation (page 190-191)

6. CENTRAL NERVOUS SYSTEM

What is first-line treatment for status epilepticus?

Lorazepam 4 mg slow IV (over 3-5 min), repeat once after 10 min OR Midazolam 150-300 mcg/kg IV (page 198)

What is the maintenance anticonvulsant for generalised tonic-clonic seizures?

Phenytoin OR Carbamazepine OR Sodium valproate (page 201-202)

What is the initial treatment for the unconscious patient?

Ensure patent airway + cervical spine stabilization + catheters + NG tube if no contraindications (page 204)

7. PSYCHIATRIC

What is first-line treatment for ADHD?

Methylphenidate 2.5-5 mg 12 hourly, increase weekly to max 30 mg 12 hourly (page 208)

What is first-line treatment for acute agitation/psychosis?

Lorazepam 2-4 mg IV/IM OR Haloperidol 2-5 mg IM (page 211)

What is first-line treatment for depression?

Fluoxetine 20 mg once daily OR Sertraline 50 mg once daily (page 218-219)

What is first-line treatment for schizophrenia (acute)?

Olanzapine 5-10 mg daily OR Chlorpromazine 25-50 mg IM 6-8 hourly (page 222-223)

What is the treatment for bipolar disorder (manic phase)?

Risperidone OR Olanzapine OR Haloperidol OR Sodium valproate (page 227)

What is the first-line drug for alcohol withdrawal delirium tremens?

Lorazepam 2-4 mg daily OR Diazepam (Day 1: 10-20 mg 6 hourly, tapering over 5 days) (page 232)

8. SKIN

What is first-line treatment for boils/furunculosis?

Flucloxacillin 250-500 mg 6 hourly for 7 days (page 246)

What is first-line treatment for impetigo (mild)?

Mupirocin ointment 12 hourly for 7 days (page 247)

What is first-line treatment for Buruli ulcer?

Rifampicin 10 mg/kg daily for 8 weeks + Streptomycin 15 mg/kg daily for 8 weeks (page 250)

What is the single-dose treatment for yaws?

Azithromycin 30 mg/kg (max 2 g) as single dose (page 251)

What is first-line treatment for tinea capitis?

Griseofulvin 500 mg daily for 4 weeks (page 252-253)

What is first-line treatment for scabies?

Permethrin lotion 1% - apply to whole body, wash off after 8-12 hours, repeat after 7 days (page 268-269)

What is first-line treatment for acne vulgaris (mild-moderate)?

Benzoyl peroxide 5% lotion topical + Clindamycin 1% lotion/gel topical (page 278)

9. ENDOCRINE & METABOLIC

What is the diagnostic criteria for diabetes?

FPG >7.0 mmol/L OR 2-hr PG >11.1 mmol/L OR HbA1c >6.5% (page 287)

What is first-line oral antidiabetic for Type 2 DM?

Metformin 500 mg-1 g daily, increase to max 1 g 12 hourly if needed (page 291)

What is first-line treatment for DKA in adults?

0.45% NaCl + Soluble insulin IV (0.1 units/kg hourly) + KCl infusion (page 295)

What is the treatment for severe hypoglycaemia (unconscious)?

Dextrose 50% IV: 25-50 ml in adults, OR Glucagon 1 mg IM (page 299)

What is the LDL-C target for secondary prevention (post-MI/stroke)?

What is first-line treatment for hypothyroidism?

Levothyroxine 25-200 mcg daily (life-long) (page 305)

What is first-line treatment for hyperthyroidism?

Carbimazole 20-40 mg daily (page 306)

10. OBSTETRICS & GYNAECOLOGY

What is the iron and folic acid supplementation in pregnancy?

Ferrous sulphate 200 mg (65 mg elemental) + Folic acid 5 mg daily (page 317)

What is the tetanus toxoid schedule in pregnancy?

TT1 at 1st visit; TT2 at least 4 weeks later; TT3 at least 6 months after TT2 or next pregnancy (page 318)

What is first-line treatment for hyperemesis gravidarum (severe)?

IV fluids (Normal saline or Ringers lactate) + Metoclopramide 5-10 mg IM/IV 8 hourly (page 323)

What is first-line treatment for hypertension in pregnancy?

Methyldopa 250-500 mg 8-12 hourly (max 2g daily) (page 324)

What is the MgSO4 regimen for eclampsia?

Loading: IV 4g (20ml of 20%) over 5-15 min + IM 10g (5g each buttock). Maintenance: IM 5g every 4 hours (page 330)

What is first-line treatment for PPH (uterine atony)?

Oxytocin 10 units IM then 10-40 units in 500ml IV infusion (page 346)

What is the misoprostol dose for PPH?

Sublingual 600-800 mcg stat (page 346, 370)

What is first-line treatment for dysmenorrhoea (severe)?

Ibuprofen 200-400 mg 8 hourly OR Mefenamic acid 500 mg 8 hourly (page 359)

What is the misoprostol dose for incomplete abortion (<12 weeks)?

600 mcg orally stat (page 362-363)

What is first-line treatment for abnormal vaginal discharge with positive risk factors?

Treat for vaginitis (Metronidazole) AND cervicitis (Cefixime + Azithromycin OR Doxycycline) (page 375-376, 446-447)

What is first-line treatment for PID (mild)?

Ciprofloxacin 500 mg 12 hourly for 3 days + Doxycycline 100 mg 12 hourly for 14 days + Metronidazole 400 mg 12 hourly for 14 days (page 380)

11. RENAL & GENITOURINARY

What is first-line treatment for acute cystitis?

Nitrofurantoin 100 mg 6 hourly for 5-7 days (page 407)

What is first-line treatment for complicated UTI?

Ciprofloxacin IV 400 mg 8-12 hourly OR Gentamicin IV 40-80 mg 8 hourly OR Ceftriaxone IV 1-2 g daily (page 402-403)

What is first-line treatment for BPH (small prostate)?

Terazosin 2-10 mg at night OR Tamsulosin 400 mcg daily (page 410)

What is first-line treatment for acute epididymo-orchitis?

Ciprofloxacin 500 mg 12 hourly for 14 days + Doxycycline 100 mg 12 hourly for 4 weeks (page 425)

What is the critical window for testicular torsion surgery?

Within 6 hours of onset to salvage the testis (page 425-426)

12. STIs & HIV

What is first-line treatment for urethral discharge in males?

Ceftriaxone 250 mg IM stat (for gonorrhoea) + Doxycycline 100 mg 12 hourly for 7 days (for chlamydia) (page 443-444)

What is first-line treatment for genital ulcer syndrome?

Treat for Herpes (Aciclovir) + Syphilis (Benzathine penicillin) + Chancroid (Ceftriaxone/Azithromycin) (page 449-450)

What is first-line ART regimen in Ghana?

Tenofovir + Lamivudine (or Emtricitabine) + Efavirenz (page 463)

What is PEP for high-risk exposure in healthcare worker?

Tenofovir 300 mg daily + Emtricitabine 200 mg daily + Lopinavir/r 400/100 mg 12 hourly for 28 days (page 466)