1. MELGENE B. TUBAL

2. B. N. 62 Female Capitolyo, Pasig City Married Roman Catholic Right Handed

3. Patient sought consult for the first time regarding her complaint of: Bipedal Edema

4. 2009 2010 20 years PTC: Patient noted gradually enlarging anterior neck mass. Patient did not experience palpitations, nervousness, excessive sweating, headache, dizziness, cold intolerance, lethargy, loss of consiousness and weakness. Patient did not feel anything wrong regarding her condition. Thus, patient did not find any consult nor took any medications

5. 2009 2010 7 months PTC: Patient experienced severe sore throat with accompanied fever Tmax = 38.3 according to neighbor who owned the thermometer. (+)cough and colds. No consult was done. Self medicated with Amoxicillin TID for 2 days. Stopped due to decreased Fever and throat pain. Patient however experienced occasional palpitations and tremors, (-) excessive sweating, resolved spontaneously consult day

6. 2009 2010 7 months PTC: Right after the sore throat, Anterior neck mass at this time was prominent. Patient noted easy fatiguability described as difficulty even when washing clothes (approx 30 min.), walking towards the main street. (-) dyspnea, (-) orthopnea, (-) chest pain, (-) fever, (-) cough and colds. Still no consult done. No medications taken. consult day

7. 2009 2010 5 months PTC: Noted (+) orthopnea due to observed breathlessness when sleeping. Patient still did not consult. After a few days, she noted increased urine output despite increased urination at this time (she associated due to cold weather). Still no consult, No dysuria, pain in flank and abdomen. Edema, resolved spontaneously. Thus no consult. consult day

8. 2009 2010 2 months PTC: Edema at both feet (around ankles) were on and off for the past months. Patient noted edema to be climbing towards her knees eventually reaching her thigh. No consult done. consult day

9. 2009 2010 Day of Consult: Due to patient’s persistent problems, patient consulted at OPD-FMC. consult day

10. Constitutional: (-) anorexia, (-) fever, (-) headache, (-) nausea/vomiting EENT: (-) loss of hearing, (-)BOV, (-) epistaxis, (-) sorethroat, Nervous: (–) insomnia, (-) seizures, (-) loss of consciousness Respiratory: (-) cough (-) colds, (-) dyspnea Circulatory: (-) chest pain, (-) orthopnea, (-) PND (-) palpitations Digestive: (–) diarrhea, (-) abdominal enlargement, (-) dysphagia Urinary System: (-) dysuria, (-) hematuria, Joints: (–) tremors, joint pains Endocrine: (-) polydipsia, (-) polyphagia, (-) palpitations, (-) nervousness Others: (-) weight loss

11. Finished High School never was employed, housewife married to a tricycle driver Denies alcoholic beverage use Denies smoking Denies illicit drug use

12. (+) Anterior neck mass – no check up, no work up, no medication (-) diabetes, hypertension, asthma, allergies, cancer

13. LEGEND DIABETES HYPERTENSION CONGENITAL ANOMALIES CANCER MALE FEMALE BESA FAMILY (April 2010) ? P.B. R.H. T.P. A.P. 68 66 56 64 43 41 R.B. S.B B.B. N.H. R.P. D.P. 61 63 A.B. N.B. 41 38 32 28 27 S.A. N.B.A J.R. N.R. J.B. E.B W.B 18 T.A. 16 15 P.R. R.R.

14. General Survey: Conscious, coherent, ambulatory, not in cardio-respiratory distress, HEENT: Pink conjunctivae, ancteric sclerae, (+) distended neck veins, Jugular venous pulse at 13 cm, (-) tonsillopharyngeal congestion, (+) anterior neck mass measuring approx. 5cm x 6cm x 0.5 cm soft, non- tender, non-nodular, moves with diglutition, no palpable cervical lymphadenopathy, pupils EBRTL, (+) whitish opacity, OU Chest/Lungs: Equal chest expansion, (-) retractions, Clear breath sounds (-) crackles/wheezes CVS: Adynamic precordium, tachycardic, regular rhythm (+) Grade 2 holosystolic murmur Abdomen: flabby, NABS, soft, non-tender, (-) ascites Skin/Extremities: Full and equal pulses, pink nailbeds, (+) grade II bipedal up to below knees Vital signs: BP: 110/70HR: 113 RR: 18 Temp: 36.6 BMI: 19.7

15. Congestive Heat Failure, probably secondary to Thyrotoxic Heart Disease r/o Acute Renal Failure secondary to Post- Streptococcal Infection Goiter, probably Graves Disease, not in storm Cataract, OU

16. 1.T3, T4, TSH 2.Serum Na, K, Cl, BUN, Creatinine, AST, ALT, Alk Phos, Albumin 3.12 Lead ECG w/ Long Lead II 4.Urinalysis 5.ANA Titers

17. 1.Penicillin G – 2 million Units per 21 days – on hold for now 2.Furosemide 20 mg OD x 7 days

18. 1.Endocrinology/Thyroid Clinic 2.Otorhinolaryngology 3.Ophthalmology

19. Will the use of Thyroid Scintigraphy (Radiouptake Iodine) at initial evaluation of goiters give a better prognosis on patients who will not or will later undergo the test?

20. P adults with goiters I Request for Thyroid Scintigraphy in initial evaluation of goiters C 10 year survival rate O Increase survival rate of patients with hyperthyroidism and hypothyroidism M Cross-Sectional Study

21. Will the use of diuretic property of organic supplements such as sambong add to the efficacy of furosemide in the resolution of bipedal edema?

22. P adults with pitting bipedal edema I Organic diuretic use e.g. Sambong (Blumea balsamifera L.) plus Furosemide C Bipedal Edema O Resolution of Bipedal Edema M Cross-Sectional Study