PD2 Final Exam Merged
PD2 Final Exam Merged
PD2 Final Exam Merged
This is a case of a 33 year old female who came in at the ER due to chills. Condition started 3
days prior to consult when the patient started to complain of terminal dysuria associated with
hesitancy and incomplete voiding.
2 days prior to consult, patient also noticed “flushed” feeling, associated with headache, nausea
and vomiting. Few hours prior to consult, patient complained of chills that seems “not to go away”.
QUESTIONS:
1. What else in the history would you like to ask the patient that would help you in
narrowing her diagnosis? (4 points each, 20 points total)
1. Sexual history
2. LMP, and if currently pregnant
3. Work: sex worker? Guest relation officer?
4. Personal hygiene
5. Use of birth control? Spermicides?
4. What laboratory and ancillary test would you request? (5 points each, 20 points total)
1. CBC platelet count
2. Urinalysis
3. Urine Culture and Sensitivity
4. KUB Ultrasound
6. Provide health education to the patient to prevent recurrence (4points each, 20 points
total)
a. Drink plenty of water
b. Sexual hygiene (wash genitalia before and after sex, urinate
after sex)
c. Don’t hold your urine
d. Wash your rectum daily and from front to back
e. Proper perineal hygiene (do not use vinegar, or harsh soap)
CASE 2
This is a case of BB 19 year old female who came to you due to hesitancy. Condition started 2
days prior to consult when the patient started to notice incomplete voiding without associated
fever. 1 day prior to consult, patient also experience hesitancy which prompted consult.
QUESTIONS:
1. What else in the history would you like to ask the patient that would help you in
narrowing her diagnosis? (4 points each, 20 points total)
1. Sexual history
2. LMP, and if currently pregnant
3. Work: sex worker? Guest relation officer?
4. Personal hygiene
5. Use of birth control? Spermicides?
4. What empiric first line antibiotic would you prescribe to this patient (10 points)
First line antibiotics for AUC (any 1 of these)
a. Fosfomycin 3gram sachet single dose.
b. Nitrofurantoin 100mg tablet every 6 hours for 7 days
5. After 3 days, patient comes back to you complaining of persistent hesitancy despite
compliance with your prescribed medication. What would be your next course of action?
(10 points each, 20 points total)
a. Request for a urine culture
b. Replace antibiotics with either a quinolone (levofloxacin,
ciprofloxacin or ofloxacin) or beta lactams (coamoxiclav,
cephalosporin)
6. Provide health education to the patient to prevent recurrence
(4points each, 20 points total)
a. Drink plenty of water
b. Sexual hygiene (wash genitalia before and after sex, urinate
after sex)
c. Don’t hold your urine
d. Wash your rectum daily and from front to back
e. Proper perineal hygiene (do not use vinegar, or harsh soap)
CASE 3
This is a case of CC 35 year old male who came in due to hematuria. Condition started 2 weeks
prior to consult when the patient started to notice lower back pain more pronounced on the left,
without associated fever.
1 week prior to consult, patient also noted initial dysuria with decreased force of urine however
he claims that towards the end of voiding, the dysuria and decrease force of urine would usually
go away. Patient did not sought consult and tried to self medicated with sambong capsule once
a day without relief.
1 day prior to consult, patient complained of blood tinged urine, which prompted consult.
6. How would you advise the patient (2 points each,10 points total)
Any five of the following:
1. Increase oral fluids intake
2. Avoid dehydration
3. Eat less salt, including high sodium foods like canned goods.
4. Limit intake high calcium foods like cheese, milk, yogurt
5. Increase citrate in the diet, such as lemonade, oranges.
6. In uric acid stones, avoid foods high in uric acid.
7. Avoid taking too much Vitamin C, Calcium and Vitamin D more
than the RDA.
8. Limit how much protein you eat. Choose lean meats.
CASE 4
This is a case of a 55 year old male who came in due to bipedal edema. Condition started 1
week PTC when the patient started to notice increasing blood pressure from baseline 120/80 to
180/100 mmHg associated with headache and nape pain. Patient took Amlodipine, 5mg
tablet as advised by his friend.
Urinalysis Result:
Color Amber to tea
colored
pH 7.35
Specific Gravity 1.035
Leukocytes 20-30/hpf
Red blood cell 30-40/hpf
Bacteria None
Epithelial Cells 10-20/hpf
Glucose Negative
Protein (+) 4
Ketones Negative
Others RBC Cast (+)
QUESTIONS:
1. Interpret the urinalysis (4 points each, 20 points total)
1. Abnormal color, or blood in the urine.
2. Concentrated urine
3. Sterile Pyuria
4. Hematuria
5. Massive proteinuria
4. Aside from the Urinalysis, what labortary test would you like to
request? (2 points each, 20 points total)
1. Complete blood count
2. Serum Creatinine
3. BUN
4. Complement levels
5. Lipid profile, Cholesterol level
6. ESR, ANA
7. Serum Albumin
8. Serum electrolytes (Potassium)
9. Kidney ultrasound
10. Kidney Biopsy
5. How would you manage this patient? (5 points each, 20 points total)
1. Anti hypertensive medications (Preferably Alpha blocker, followed
by vasodilator and calcium channel blockers: like Clonidine,
Hydralazine, Nifedipine, Diltiazem)
2. Loop Diuretics (Furosemide)
3. Antibiotics (not for UTI) but for sore throat (Co amoxiclav,
Cephalosporins, Quinolones)
4. Calcium supplements
6. What advise can you give to this patient? (2 points each, 10 points
total)
1. Eat less protein
2. Limit salt and potassium in the diet
3. Limit fluid intake
4. Monitor blood pressure regularly
5. Seek prompt consult for sore throat and skin infection
PD: Prelims dynamic,displaced laterally to 6th ICS MCL.
Case: MYOCARDIAL INFARCT Regular rhythm S1>S2 at the apex. +S4
gallop. No murmurs
Case of a 58 year old female who came at the
ER due to chest pain 2.) What are your working diagnosis? Give
1. What other pertinent questions should at least three?
be asked in the Medical History Stable Angina
CC: Chest Pain Unstable Angina
HPI Acute Myocardial Infarction
▪ Onset of chest pain (3 hours PTA)
▪ Location of chest pain? (retrosternal) 3.) What diagnostic test will you request to
▪ Duration confirm your diagnosis?
Character of chest pain? (heavy, squeezing) • ECG
▪ Radiation (Radiating to left subscapular area) • Cardiac Enzymes
▪ Severity (pain scale of 9/10) • Chest X-ray
▪ Timing • 2DED
▪ Associated s/sx? (Diaphoresis)
PMX 4.) Discuss treatment options
▪ Comorbids PCI
1. Hypertension AMI REGIMEN
2. Diabetes Mellitus for 10 years • ASA (aspirin)
3. Previous hospitalization (none) • Clopidogrel
4. Maintenance medications. (unrecalled anti • Beta blockers (Heart rate and BP)
HIN and anti DM; noncompliant) • ARBs/ACE
FHX • Statins
• 1st degree relative with CV death (Father • Nitrate
deceased - stroke) • Anticoagulants
Personal and Social History • Morphine
▪ Smoking Pack years (40 years smoker) • Lactulose
▪ Alcohol Intake (occasional alcoholic drinker) • Oxygen
▪ Lifestyle (Sedentary)
ROS PD 2: Midterms
• Respiratory Case: Pulmonary
• Cardiovascular
• Endocrine A 55-year-old businesswoman, smoker,
PE presents to the emergency room complaining
of productive cough. fever and chest pain for 7
What focus PE? days. She consulted a nearby clinic and
• CARDIOVASCULAR EXAM claimed she was given antibiotics. Her cough
• JVP was noted to have decreased in quantity.
• AUSCULTATE CHEST FOR CRACKLES However, the lever persisted and she was still
experiencing left-sided chest pain, which is
Verbalize: PE findings to student worse when she coughs or takes a deep
General: Conscious but anxious and restless breath. In addition, she started to have
VS: BP 150/100, CAR 110, RR 28, Temp: 36.8 difficulty breathing especially when she walks
Skin: Cool, Clammy around. On PE, Temperature is 38.5 C Heart
Neck: JVP 3 cms/water rate is 115 bpm. BP 120/70 mmHg. RR 26 and
Lung: Equal Lung Expansion. No retractions. is shallow. Pulse oximetry is 94% saturation on
Clear breath sounds room air. Upon auscultation of the chest,
Heart: Dynamic precordium, with no bulging or decreased breath sounds in the lower hat of
depressions. Apical impulse is 2.5 cms in the left lung fields posteriorly
width,
ROS: Unremarkable.
4. What laboratory and ancillary test would
Physical Examination:
you request?
BP: 110/80 HR: 89 RR: 24 Temp: 38.9
● CBC platelet count
● Urinalysis
Patient is awake, ambulatory, conscious and
● Urine Culture and Sensitivity
coherent, acutely ill looking, not in
● KUB Ultrasound
cardiorespiratory distress.
5. Prescribe an antibiotic for the patient (10
Skin appears flushed, without noticeable
points)
localized lesions. No rashes.
● Antibiotics: any of these
○ Ciprofloxacin 500mg tablet
No cervical lymphadenopathy. Posterior
BID for 7days (or 1000mg
pharyngeal walls appears hyperemic but not
tablet OD for 7 days)
congested. Tonsils are not hyperemic and not
○ Levofloxacin 250mg OD for 7
enlarged.
days (or 750mg OD for 5
Chest expansion is symmetrical without use of
days)
accessory muscles of inspiration. Tactile
○ Ofloxacin 400mg BID for 14
remits are equal. Breath sounds are mostly
days
vesicular. No crackles, no egophony.
○ Cefixime 400mg OD for 14
days
Dynamic precordium, tachycardia with regular
rhythm. Good S1/S2, no murmurs noted.
3. Final Diagnosis
2ND SEM MIDTERMS: THYROID 4. What additional tests would help confirm
the diagnosis? (10 points)
50 y/o housewife complains of progressive ● None. Thyroid autoantibodies are
weight gain of 20 pounds in one year, fatigue, arguably insensitive and the cost does
slight memory loss, slow speech, dry skin, not justify the benefit
constipation, cold intolerance.
5. What are the treatment options?
PE: Vital signs: BP: 140/100 ● Thyroid hormone replacement therapy
Pulse: 58/min, regular with levothyroxine
She is moderately obese and speaks slowly,
has a puffy face with pale, cool, dry, and thick 2ND SEM PRESEMS: MUSCULO
skin
A 35 year old male, no known comorbidity,
Thyroid gland: slightly enlarged, firm, not came in to your clinic due to left ankle pain.
nodular, mobile, and not tender deep tendon
reflex time is delayed
2. What in the Past Medical History would 4. Describe using your own words, the
you like to ask the patient? inspection and palpation findings in acute
● Congestive Heart Failure gouty attack?
● Psoriasis
● History of malignancy and recent Swelling (Tumor)
treatment/chemotherapy Tenderness (Dolor)
● Metabolic syndrome Warmth (Calor)
● Dyslipidemia Redness (Rubor)
Impaired mobility (loss of function)