CASE 1

A 22- year-old, male, factory worker, diagnosed previously with Rheumatic Fever and is
receiving Penicillin G 5 Million unit every month since age 17. Two years prior to consultation,
she started to experience shortness of breath while climbing 1 flight of stairs or lifting heavy
objects. No consultation was done. After a year, he was not able to work anymore because of
difficulty of breathing at rest which was accompanied by orthopnea, paroxysmal nocturnal
dyspnea, and pedal edema. She consulted a physician in a community health center and was
prescribed with Furosemide 40 mg BID which she took for about a week. Symptoms abated but
she did not go back for follow up. She took Furosemide 40 mg irregularly whenever he is
symptomatic. One month prior to consultation, she was unable to lie down on bed because of
difficulty of breathing despite taking Furosemide. She still has bipedal edema and easy
fatigability. She was brought to the emergency room by her mother.

1. What is the chief complaint?

2. When was the onset of her manifestation?
3. What information in the history should be placed under Past Medical History

CASE 2

E.B. 49 y/o meat vendor in Nepa Q Mart, Hypertensive for 10 years Highest BP 210/100,
usual BP is 140-150/100 maintained on Amlodipine 10 mg BID and Atenolol 100 mg OD. She is
also on Metformin 500 mg per tab, 1 tab 3x a day.

December 24, 2018; It was a very busy day for her in the market because of so many
costumers buying meat for Christmas. She was not able to have enough sleep the previous nights
and has been missing doses of her medications.

At 8:15 pm last night (February 3), patient was noted to have involuntary movements of
the mouth with jaw rotating in a circular motion while seated. This was then followed by
involuntary movement and stiffening of the body without loss of consciousness but with severe
headache, occasional vomiting and dizziness. After several minutes, she suddenly developed left
sided heaviness progressing to weakness with slurring of speech.

1. What is the most likely chief complaint?

2. When was the onset of her manifestation?
3. What information in the history should be placed under Past Medical History

CASE 3

M.A, 49 y/o female on hormonal replacement due to her polycystic Ovarian syndrome .

1 year prior to admission (PTA), patient noted progressive weight loss with irregularities in
menstruation, and these were attributed to dieting and probable premenopausal syndrome. She
also started to have dysmenorrhea on first 2 days of menses and dysparunea. 8 months PTA, there
was slight abdominal enlargement with 2 months of amenorrhea. Pregnancy test done showed
negative result. 5 months PTA, still with progressive abdominal enlargement, weight loss and
anorexia, she also experience early satiety and bloatedness. This is sometimes accompanied by
epigastic pain, nausea and vomiting. 3 months PTA, still with amenorrhea, she noted a palpable
node in the LUQ of her breast. She consulted an internist and was advised mammography and
breast nodule biopsy. 1 month PTA, she started to experience pain on the RLQ together with
other previous manifestation of progressive abdominal enlargement, wt loss , occasional febrile
episode and dyspnea. She was brought to the emergency room.

1. What is the most likely chief complaint?

2. When was the onset of her manifestation?
3. What information in the history should be placed under Past Medical History
CASE 4

Carmen 54 y/o hypertensive for about 15 yrs now. Highest BP 190/90 usual BP is 140/80. She’s
been complaining of intermittent angina for 1 week now usually aggravated by work. She
experienced claudication in her R foot lasting for 30 minutes relieved by massage. She decided to
see a doctor not for the claudication but for her crushing pain on the chest with episodes of
bloatedness. She was given pantoprazole 40 mg/tab BID for 7 days and then to come back for
follow up.
2 weeks PTA, she lost consciousness for about 30 minutes after experiencing palpitation.
1 week PTA, she again lost consciousness with disorientation. She was brought to the ER
but on examination, aside from BP of 180/90 which gradually decreased to 140/80 and an
irregular heart rate at 112/min,she had essentially normal findings including Neurologic exam.
Assessment then was transient Ischemic attack, hypertension uncontrolled. Atrial fibrillation with
rapid ventricular rate.
2 days PTA, she experienced a sudden crushing anginal pain lasting for 1 hour unrelieved
by rest. She again was rushed to the ER and was advised admission. However due to financial
constraint was not admitted.
Few hours PTA, she was having an argument with her daughter when she again
experienced chest discomfort and sudden loss of consciousness.

1. What is the most likely chief complaint?

2. When was the onset of her manifestation?
3. What information in the history should be placed under Past Medical History

CASE 5

Carlo, 48 y/o jeepney driver for 12 years. He is a chronic smoker since 19, consuming
atleast 1 pack/day. He was previously treated for Tuberculosis and had received Anti-TB
medications for 6 months but without regular follow up from his pulmonologist. He continues to
have chronic cough productive of whitish phlegm and post nasal drip especially in the morning.
About 3 weeks prior to admission, he had slight fever about 38.2 C and he self medicated with
paracetamol 500 mg tid. 3 days prior to admission he developed anorexia, weight loss, muscle
weakness and easy fatigability. The following day he again cough out blood.

1. What is the most likely chief complaint?

2. When was the onset of her manifestation?
3. What information in the history should be placed under Past Medical History