CASE 1: HYPERTHYROIDISM

Patient is 23 years old, female who resides in Ampatuan Maguindanao. Alert, oriented and self- directing.
Patient’s chief complaint is fever. A year ago patient was diagnosed of hyperthyroidism. She was given
PTU but patient didn’t follow it up. One week prior to admission patient had palpitation, tremors, easy
fatigability, and enlargement of anterior neck mass. Three days prior to admission patient had an on an off
fever with body weakness. She took Paracetamol but symptoms still persisted. No past medical history and
family history other than hypertension on paternal side. She is a housewife, non-smoker and not an
alcoholic beverages drinker. According to the patient, her diet would mostly consist of vegetables and
canned goods. She lives in a one storey 2-bedroom house with one comfort room. Their daily source of
water is the deep well while they buy their distilled drinking water per gallon. Garbage disposal is through
burning and garbage tract collection. Upon admission, thorough physical examination was done. There’s a
mass in the anterior neck 2x2 cm. Patient’s vitals were as follows T= 38.7 P= 109 R= 22. And there was
also weight loss because according to the patient her clothes become too loose for her, current weight is
45kg. Diagnosis is hyperthyroidism. Discussed the course of treatment and patient agreed. Infused IVF :
PNSS IL x 80cc/h. Labs requested :CBC,PLT,U/A,S. Na, K, Ca, S.Crea, ECG 12 LEADS, CXR PA view,
TSH, FT4, SGPT. Started Propanolol 10mg/tab OD and PTU 500-1000 mg load, then 250mg every 4
hours. Hydrocort 100mg every 8 hours to prevent impending thyroid storm. On the third day of
hospitalization patient showed no signs of fever, tremors, palpitations and fatigue. Discussed strict
compliance of take home medications and regular outpatient follow- up.
CASE 2: NEPHROLITHIASIS

1-year old patient with chief complaint of vomiting. Patient was conscious and wasn’t on cardio-pulmonary
distress. 2 days prior to admission there was an on and off fever (38c-39c). The night prior to admission,
there was 4 episodes of vomiting and epigastric pain. Patient was previously hospitalized (December 2016)
due to UTI and (May 2017) due to pyelonephritis. According to the parents, patient completed the
immunization. He was born in lying-in. Patient was and still on breastfeeding. Father is a vendor, a non-
smoker and an occasional drinker (alcoholic beverages) while mother is a housewife. They live in a 1-
storey house with one bedroom and one comfort room situated outside. Daily water source is deep well and
distilled water for drinking which they buy per gallon. Waste disposal is through burning and garbage tract
collection. Physical examination done. Vitals were as follows T=37.2, P= 114, R=30, Weight: 10 kg.
Patient had a sunken eyeballs, lips were pinkish and dry, and skin was warm to touch. There was a positive
tenderness in epigastric area. Admitting impressions were acute gastritis with moderate dehydration vs
dengue fever suspect and also urinary tract infection. Venoclysis done as an immediate management in the
ER along with laboratory works (cbc and urinalysis). Results came, for urinalysis -PUS CELLS 40-50, RBC
6-10, CBC- HGB 103, WBC- 9.98, SEGMENTERS 0.81, PLT 251. Medications started (Ampicillin,
Ranitidine and Pracetamol) and patient was admitted. Hydration was closely monitored. On the 2 nd -3rd day
of admission, ampicillin was shifted to cefuroxime. Ordered for serum creatinine to be checked and KUB
ultrasound to be done. Ultrasound result showed hydronephrosis, nephrolithiasis (right). Patient was
referred to urologist. Seen by the urologist on the 5 th day of admission, was diagnosed with obstructed
uropathy right secondary to nephrolithiasis and advised to do elective stone surgery (right) at SPMC. On
7th day of admission, after medications and series of repeated lab tests, patient was afebrile with no
vomiting and no abdominal pain. Advised to go home with home medications and follow-up after one week.
Also advised patient to see the urologist for further management.
. Venoclysis done as an immediate management along with laboratory works (cbc and urinalysis).