Lahat ng red, pansinin at kumpletuhin o itama. Sana masagot karamihan, pero feeling ko hindi talaga natin masasagot lahat kase hindi na natin macocontact ulit yung patient. So wag ma-toxic kung hindi lahat masagot. Paki-upload ang bago by Saturday 12 NN.

Big Group Discussion Medicine II – Module IV – C7 Ordoveza M, Pacquing P, Paderna N, Padolina D, Pagkalinawan L, Palacpac K, Palisoc M, Palma S, Pangan C, Panlilio C, Park J, Pelayo B, Phoa T, Panganiban J

Patient 45/M, farmer Chief Complaint Headache Was this present at the time of presentation? Severity, location, character, onset? HISTORY

History of Present Illness 7 days PTA Fever (37.8 C), chills, body malaise Paracetamol 500 mg tab (Biogesic) q4h  lysis of fever, chills Back pain (grade) Ibuprofen + Paracetamol (Alaxan)  relief Bilateral calf pain (5/10) Spontaneously resolved Headache (7/10), frontal, throbbing Did not resolve Experienced a few hours after wading in swamp water di ba ito masyadong mabilis, kase incubation period ng leptospirosis ay 1-2 weeks (range 2-20 days); madalas daw ba siyang mag wade, o minsan lang yun within 20 days na nagkasakit siya?

History of Present Illness 6 days PTA Recurrence of fever (39 C) and chills (how long did this last? pattern? any meds?) Tea-colored urine in the morning (how was this asked? morning only? is this consistent with leptospirosis? can’t find anything in Harrison’s stating presence of tea- colored urine in leptospirosis. delete if we can’t explain this.) This prompted consultation at a local clinic Impression of infection of unknown origin Norfloxacin 100 mg/tab BID Indomethacin 25 mg/cap BID Ranitidine HCl 150 mg/tab BID Compliant (did these medicines lead to any improvement?)

History of Present Illness 5 days PTA No fever, with resolution of tea-colored urine (delete tea-colored urine if we cannot explain it) Headache (8/10), frontal, throbbing Not relieved by paracetamol Vomiting of recently ingested food how recent (3 tbsp), anorexia

History of Present Illness 4 days PTA Fever recurred Headache persisted Vomiting, anorexia persisted Prompted consult at USTH OPD Laboratory workups requested indicate ↑ or ↓ or N BUN 41.6 Creatinine 3.3 Sodium 130 Potassium 3.7 ALP 166 No medications given yet

History of Present Illness 2 days PTA Persistence of symptoms Fever Headache Vomiting, anorexia Jaundice noticed by patient’s wife (skin, or sclerae? yellow ba talaga sinabi, o sabi lang nag-iba kulay?) No oliguria, tea-colored urine, acholic stools This prompted consult at USTH-CD ER Admission

Review of Systems no weight change, no fatigue, no dizziness no pruritus, no petechial rashes new scar/wound on right toes no epistaxis, no nasal discharge no oral lesions, no gum bleeding no deafness, no tinnitus or ear discharge no sore throat or tonsillitis no neck stiffness no PND, no orthopnea no constipation or diarrhea no tremors, no heat or cold intolerance no seizures no easy bruisability no lymphadenopathy

Family History (+) HPN mother and sibling (-) DM

Past Medical History (-) DM (-) HPN (-) asthma (+) pneumonia (2001) (+) enucleation on right eye due to trauma (1970s)

Personal History Smoking 30 pack-years Stopped in 2002 because of pneumonia Alcohol Occasional how occasional? Denies illicit drug use Mixed diet

Salient Features Hx pa lang ito, wala pang galing sa PE, pero ako na maglalagay noon. Fever, chills Recurrent, maximum 39 C Back pain, bilateral calf pain Headache Severe, frontal, throbbing, persistent Vomiting Jaundice No acholic stools, no tea-colored urine Farmer + history of wading in swamp water (check with incubation period) + new wound/scar in right toes