PRINCIPLES OF MEDICINE (8-22-22)
concerned with the non-surgical treatment of a
APPROACH TO THE EVALUATION OF A PATIENT
There are three recurring definitions of what medicine is. Kahit
paiba iba, sa mga entries, common ito.
Sagutin muna natin ‘What is Medicine?’
WHAT IS MEDICINE
● The science and art dealing with the maintenance of
health and the prevention, alleviation, or cure of the
disease
In medicine, it is not only important that we cure sick
patients it is also of equal importance, or sabi nga nila,
mas importante pa nga and prevention of the disease.
Sabi nga, ‘prevention is better than cure. Dun sa
statement na yun, parang mas importante yung
pagprevent kesa dun sa pagcure.ng sickness. So, to us
doctors, it’s an important duty for us to prevent ang
pagiging sick ng patient kesa dun sa pagcure ng
patient. Pero wala tayo magagawa, wala ka na
magagawa, wala na ako magagawa kung dumating
ang pasyente may sakit na.
● As a branch of Medicine: Branch of medicine
disease
So when you say non-surgical, hindi ooperahan. Does
not need any cutting involved. Walang cutting, walang
gagamitan ng instrument na pang cut. Yun yung
non-surgical treatment of disease. Kasi itong medicine,
or more particularly yung internal medicine, it is a
branch of medicine usually involving or involves the
treatment of adult diseases. Ang kaniyang counterpart
ay Pediatrics. So yung medicine na tinutukoy dito is
particularly yung Internal Medicine. Yun yung
counterpart ng Pediatrics. Ang pediatrics, non-surgical
treatment of children’s diseases. Yung internal medicine
naman, treatment of adult diseases non-surgically.
Yung last na common na definition ng medicine ay yung
pinaka practical o yung pinaka common na defition ng
pag nakita mo yung medicine. Yung sinanay mo siya sa
medications, gamot in tagalog. Capsule, tablet, syrup,
yan yung pag sinabing medication o medicine. So sabi
nga, medicine is both a science and an art. Makikita mo
tong info na toh dun sa shinare ko sainyo na Harrison’s.
Nahihirapan kasi akong magshare mismo ng file, pero
nandito naman sa laptop ko, sheshare ko na sana
sainyo para di na kayo mahirapan. Kaso ang problema
masyado siyang malaki. So ang ginawa ko nalang,
shinare ko yung link. Nandun yun sa bandang umpisa.
So medicine is both a science and an art sabi nga nila.
● As a science, it is technology based on science, it is the
foundation based on solutions.
 So medicine ay iba sa mga albularyo, yung mga quack
doctors, mga manghihilot.
So medicine is based on science, may basis siya talaga.
Hindi siya gawa gawa lang sa tradisyon. Hindi siya
based sa word of mouth. Talagang may basis siya.
● Advances in biochemical methodology, biophysical
imaging techniques, and innovation in therapeutic
maneuvers.
So certain therapeutic management of certain diseases
may not be relevant right now. Yung dating alam mo na
panggamot ng certain na sakit dati pwedeng hindi na
ngayon pepwede. Nakadiskubre na sila na nakakasama
yung certain na gamot. So kailangan, as a doctor,
idedevelop niyo rin yung sarili ninyo. Magababasa
parin kayo. Do not stop learning. Medicine and
dentistry is an evolving profession. Kaya nga in one of
your subjects, in jurisprudence (you will take siguro
next sem), imemention sainyo yung requirement na
CPD. Yung Continuing Professional Development. Ito
yung kailangan mong maipon na points bago kayo
makakuha ng license ulit. Sa umpisa hindi pa kayo
irerequire. Pero pag nagrenew kayo ulit, kailangan niyo
magpresent ng mga certificates na magshoshow na
nakaipon kayo ng certain points. Hindi ko sure kung 50
or 45. Ang last kasi na nagrenew ako, binanggit kasi
saking 45 ang kulang ko. Pero sabi nila 50. Pero ngayon
kasi, dahil pandemic pa, naawa pa yung PRC, kaya
hindi pa nirequire yung ganitong points na toh. Pero
next yata, irerequire na. You acquire these points by
attending seminars. Buti nga ngayon, yung seminars is
done pa online at maganda neto, libre pa. Nung
prepandemic, yung mga seminars na nakikita ko, bukod
sa hindi swak sa aking schedule, mahal pa. Ang seminar
may cost as high as 5k-8k. Kaya marami din
nagrereklamong other professions kasi mahal ang
seminars. Yung ibang seminars hindi kukunin sa
Manila. Kailangan mo pa pumunta ng Baguio,Cebu.
Personally, nakaipon naman na ako enough para
makapagrenew ng license.
● It has the ability to extract contradictory physical
signs.
So ibig sabihin, may mga times na nilalagnat ka pero
normal naman ang iyong temperature. Yung isang
female, she's experiencing morning sickness, yung
pagsusuka, yung sakit ng ulo, paghihilo, may cravings.
Pag nag pregnancy test, tapos negative naman,
contradictory. As a doctor, as a clinician, hahanapin mo
yung dahilan. Hindi ka lang magiging kuntento na
nagnegative siya, hanapin mo bakit nangyari yung
symptoms
● Ability to discern and interpret laboratory data.
So ang masasabi ko lang, sa case ninyo, siguro ang
kaparehas ng laboratory data ay katulad nung sa xray.
Gumagamit kayo ng xray to confirm or to help us
diagnose diseases. Lalo na ang contradictory signs.
● To know whether to treat or watch.
Some instances or some diseases na hindi mo kailangan
itreat agad. Yung, hindi naman watch, observe/watch
out for. So sinusulat nga namin sa aming ano, yung
WOF (Watch Out For) or to treat.
● To determine when to pursue a clinical clue or when
to dismiss.
So ano nga eh, meron kaming private term kung
papatulan ba namin o hindi. Yun yung tanungan namin
sa mga doctors.
When we are presented with a group of signs and
symptoms coupled with the laboratory tests,
 magtatanungan kami. Yung yung ginagawa namin sa
clinic. Pag hindi ka sure, ayaw mo magmarunong,
tatanungin ko yung mga kasama ko lalo na mas senior
sakin. ‘Doc, papatulan ko ba toh?’. Hindi naman in a bad
way, may gagawin ba ako dito o oobserve ka
● To decide which is of greater risk: treatment or
disease.
● This combination of medical knowledge, intuition, and
judgment is the art of medicine.
● “Tact, sympathy and understanding are expected of
the physician, for the patient is no mere collection of
symptoms, signs disordered functions, damaged
organs and disturbed emotions. He is human, fearful
and hopeful seeking relief, help, and reassurance” -
Harrison’s Principle of Medicine
Sympathy and understanding are expected of the
physician. He is human. Hindi collection ng signs and
symptoms na kailangan niyo isolve. Pero ang
pinakaimportante ay human siya, tao siya. Yung
implication nun ay respeto. Ano gusto mo gawin sa
kanya, gagawin mo. Hindi. Isipin mo tao din siya na
kailangan ng respeto.
So patient, physician, doctor relationship.
● Individuals whose problems often transcends their
complaints
● Whatever the patient’s attitude, the physician needs to
consider the terrain in which an illness occurs,
including family and social background.
We cannot avoid to have patients, ayun nga, may
attitiude, masungit, maldita. Pero as a physician, as a
dentist, kailangan mo magpractice ng utmost restraint
sa sarili. Kahit inis na inis ka na, pipigilan mo ang sarili
mo kung ayaw mo mapahamak. Baka yung inaalagaan
mong lisensya, biglang mawala dahil lang sa simpleng
pagiinit ng ulo. Intindihin mo nalang, ganun nalang.
Baka naman may dinadamdam talaga. Tanong ka kasi
ng tanong, ang sakit na pala ng ulo o ng tiyan niya. O
may pinagdadaanan siya sa pamilya. May
pinagdadaanan siya sa group of friends o school.
Intindihin nalang
● Approach patients not as “cases” or “diseases”
● Primary objective is to discover the root of the
patient’s concern and do something about it.
Pero don’t be contented of curing or paggalingin yung
symptom lang. Halimbawa, may fever yung patient. It
is not enought that you cure the fever o mawala yung
fever. It is your duty to find the root cause. Hindi ka lang
kuntento na kapag wala na yung lagnat okay na.
Hanapin kung ano yung dahilan in the first place bakit
siya nilagnat. In the first place, bakit masakit ang
ngipin niya. May butas ba? May caries na ba na sobra o
in the likes na nagcacause ng pananakit ng ngipin. Yun
ang isosolve mo. Hindi lang yung bibigyan mo lang siya
ng paracetamol tapos wala na okay na.
Dun na tayo sa pinakatopic. Yung approach to the
evaluation of a patient.
Bakit ka mageevaluate ng patient? Yun yung malaking
tanong. Eto yung reasons.

1. To identify patient with undetected systemic disease
that could be a serious threat to the life of the patient
or that could be complicated by dental treatment
You will encounter patients na, isa, they are not aware
of their physical problem, health problem, at in denial.
May mga patients na in denial na kahit sinabi na sa
kanila o sila mismo nakita na na mataas ang kanilang
BP, in denial pa sila na meron silang hypertension kahit
sinabi na ng doctor. Kasi sasabihin naman nila, “Doc,
okay naman yung pakiramdam ko, di ko na kailangan
maggamot.” So yun yung minsang nangyayari o kaya
talagang… hindi natin maiwasan, may mga kababayan
tayong walang kakayahan. Kahit sa center di sila
makalunta dahil imbis na oumunta sa center,
magnenegosyo, magkakalakal, o magbabasura na lang.
hindi nila alam yung nararamdaman nila kahit pa hilo,
ubo, dinidismiss na lang nila as nothing. Yun yung duty
natin, to detect the undetected sa mga systemic disease.
Lalo na, punta tayo sa inyo, yung mga diseases na to
lalo na hypertension at saka diabetes, makakaaoekto sa
decision making niyo pag kailangan niyo siyang itreat
as a dentist. Diba di niyo naman pwedeng bunutan
agad ang may high blood o diabetes. Detect the
undetected systemic diseases.
2. To identify patients who are taking drugs or
medications that could be potentiated by drugs
prescribed by the dentist that would complicate
dental therapy or may serve as a clue to an underlying
systemic disease that the patient has omitted from the
history.
So balk tayo sa number 1, yung hindi nagsasabi ng
totoo at hindi nila alam kung anong meron sila. Pero by
looking or asking the drug history of the patient, yung
listshan ng gamot nika, magkakaroon ka na ng clue
kung anong sakit nung patient kahit nagsisinungaling
siya, malalaman mo. Halimbawa, meron siyang
ascorbic acid, vitamin B complex, meron ka pang
vitamin D, may ginkobil, tapos makikita mo sa bandang
dulo may losartan, amlodipine, may metformin, so ano
masasabi sayo nun? Meron talaga siyang high blood o
diabetes. Kasi yung iba, minsan kulang din sa
pag-eexplain. Nag-rereseta lang, “inumin mo ‘to ‘nay,
tay” pero di nila ineexplain kung anong meron sila. Ito
namang pobreng pasyente, sobrang busy, hindi na
makakabalik. Swerte kung makakahanap sila ng doktor
na mag-eexplain sa kanila.
Ayun nga, malaman-laman mo meron siyang aspirin
tapos ang plano mo bubunutan siya ng ngipin nung
araw na yun. Pero nung nakita mo yung aspirin,
magbabago yung iyong plano. Ano bang unang
gagawin mo pag nakita mong may blood thinner siya,
hindi lang aspirin? Ihohold mo muna yung procedure.
Sabi nga diba, ihold muna yung aspirin for 1-2 weeks
bago mo siya i-undergo ng procedure lalo na ng tooth
extraction. Kasi, anong mangyayari pag binunutan mo
siya at meron siyang iniinom na aspirin? Magdudugo.
Titigil siya, pero medyo mahihirapan ka. O baka
kailangan mo pa siyang dalhin sa ER. Yun yung
pagiging implication nun.
3.To allow the dentist to modify the treatment plan in
light of any systemic disease the patient may have or
any drugs he may be taking
So pag dumating ang patient mo na, “doc ang sakit ng
ngipin ko kailangan na yatang bunutin”. Pagkita mo, oo
kailangan na nga pero pag interview mo nalaman mo
meron siyang hypertension o diabetes, oops,
magbabago yung treatment plan mo. So imbis na
magbubunot ka, mauuwi muna siya sa cleaning.
Cleaning muna para siguro pag okay na siya, pwede
nang bunutan.
4. To protect the patient and the dentist from any
malpractice (or allegations thereof)
Payo ko sa inyo, when you fill up your dental records,
put as much as possible yung details na pinag-usapan
niyo ng pasyente na sa tingin niyo importante. Yung
mga sinabi mo sa kanya, mga pinagawa mo at mga
ginawa mo sa pasyente. Halimbawa, nilagyan mo siya
ng paste na nilalagay bago magturok ng mismong
anesthesia. Eh yung pasyente nagreklamo, ang sakit mo
raw tumusok ng anesthesia at magdedemanda.
Tandaan niyo pa, natutunan ko to sa mga kakilala kong
lawyer. If it’s not written, hindi mo ginawa. Yun yung
magiging kalaban mo. Kailangan isulat at i-record mo
na nag-apply ka ng ointment, naglagay ka ng
anesthesia. Isulat mo para meron kang proteksyon sa
legalities. Lahat ng details at side notes isama mo.
5. To enable the dentist to select and confer with a
medical consultant about a patient’s possible systemic
problem
As a dentist, minsan wala na kayong time para
mag-manage ng time. So ang gagawin ninyo, irerefer
niyo na lang sa internees, cardiologist, o diabetologist
tapos irerequire mo yung pasyente na mag-present ng
clearance.
6. To help establish a good patient/doctor
relationship by showing the patients that the dentist
is interested in them as individuals and that the
dentist is concerned about their overall well-being
So yun nga, importante na bago ka gumawa ng kahit
ano sa pasyente, isipin niyo munang i-build yung
rapport. Rapport yung good communication, yung gaan
ng loob at trust sayo ng pasyente. Kasi pag yun yung
nakuha mo, lahat ng gusto mo mangyari, magagawa
mo. Pag nagtanong ka, mabibigay niya sayo yung
information na gusto mo. Hindi siya magtatago. Kasi in
the first place, ang pasyente hindi lang mere symptom,
sign, o constellation of signs and symptoms. Tao lang
din siya. First and formoest, respeto lang talaga.
A well-conceived total physical evaluation
involves:
1.Medical history
2.Physical examination
3.Laboratory/ Imaging studies (if indicated)
4.Medical/dental consultation or referral
Key Principles of Patient Assessment
•It is estimated that 80% of diagnoses are based on
history taking alone.
Dito ako humahanga sa mga old timers o retirado na
doktor kasi kahit hindi pa gaano ka-advanced, wala pa
masyadong tests, at hindi pa kumpleto yung gamot,
nakakadiagnose sila ng mga pasyente just basing on
history taking, physical examination, at kinukwento ng
pasyente. Kapag doktor ka, habang nakikinig ka sa
pasyente, may nafoformulate ka nang diagnosis sa utak
mo. Sa physical examination, wala pang laboratory,
Inspection lang at wala ka pang hinahawakan o
minamanipulate. Pagpasok mo pa lang sa room,
inoobserbahan ka na. Baka meron kang finafavor na
paa, pag-sway ng kamay mo, mukha mo, kulay,
symmetry ng mukha, baka may stroke ka na. Tapos
nung tinanong ka na, slurred na yung speech mo. Dun
pa lang may idea ka na ay ito may stroke ito at
kailangan ko na tong i-refer.
•Establish a rapport with the patient.
Kailangan magkaroon kayo ng connection ng pasyente lalo yung ulo ko” Malalaman mo na, baka meron siyang
mo. Mag-reresort ka sa pagtatanong ng kung anong migraine. Masakit pag may ilaw at pagmaingay.
meron kayong common. Napanood mo na ba yung
ganito sa Netflix? Gagamitin mo yung common na
pinanood niyo kagabi o kinain niyo kaninang umaga.
Ay oo dito rin ako nag-aral, nakapunta na ako dito.
Maganda nga dito. Makakatulong yun to establish
rapport with your patient. Initiating the Interview/History Taking
•Ensure the patient is as comfortable as possible.
Besides making him/her comfortable with the way you
speak, kasama na run yung itsura ng room mo. Walang
clutter, maganda ang kulay, hindi madilim, maganda
ang lighting, makakatulong yun. Meron kang mabango,
malamig, humidifier sa corner ng room.
•Ensure consent has been gained.
First and foremost, bago kayo humawak sa pasyente,
● Initial Greeting
magpapaalam kayo.
● Introductions- part of building rapport
•Maintain privacy and dignity.
● Seeking Consent
•Ensure that your documentation (of the assessment)
● Respecting the patient- the patient is not a
is clear, accurate and legible.
meer constellation of signs and symptoms,
Yung pagsulat ng side notes, in the future baka
thus they are human
magamit niyo yun, mas maganda yung nababasa.
Informed Consent
33 min 10 sec
•LISTEN to what the patient says. Tanong ka nga ng •Informed consent is the process in which a health care
tanong pero ang attention mo is hindi sa patient. provider educates a patient about the risks, benefits, and
Nakatutok ka dapat sa pasyente. alternatives of a given procedure or intervention.

Pag may gagawin kang procedure, ieexplain ko yung procedure,

“Always listen to the patient they might be telling you
ano yung procedure, para saan yung procedure, paano gagawin
the diagnosis”
yung procedure. May mga alternatives ba sa procedure? Ano ba
E.g. “Doc, kagabi ang sakit sakit ng ulo ko sobra, sa
yung mga risk? Ano yung mga pwedeng complications?
scale ng 1 to 10, 8 hanggang 10 yung sakit ng ulo.
Kalahati ng mukha ko, paligid ng mukha ko yung sakit. •The patient must be competent to make a voluntary decision
Tapos nagbukas ng ilaw yung kapatid ko, minura ko about whether to undergo the procedure or intervention.
kasi lalong sumakit ang ulo ko. Tapos sinigawan ako ng Legally, may mga implications.Legally ba pwede ka bang
nanay ko, ang ingay ingay niya sa kwarto, napagtaasan magbigay ng consent lalo na kung minor ka. Hindi kami
ko tuloy ng boses kasi sa sobrang ingay niya sumakit pumapayag na magisa lang yung patient lalo na pag minor.
Dapat may kasamang relative, mas maganda yung nagaalaga
mismo sa kanya.
PRINCIPLES OF MEDICINE (8-29-22) Pag nakuha mo ang loob ng patient, gumaan ang loob niya
Part 1 sayo, madali mong makukuha ang information na gusto mo
kahit na yung sensitive questions na related sa kinekwento niya
What is History Taking?
katulad ng sexual history. “Nakailan kanang intercourse?, kelan
ang huling intercourse mo, ano ang naka intercourse mo?”
•Asking questions of patients to obtain information and •Because patients vary considerably in their medical
aid diagnosis. sophistication and ability to recall facts, the reported
medical history should be corroborated whenever
Hindi naman magvovolunteer ang patient na magbigay ng
possible.
information sainyo. You have to ask them

•Gathering data both objective and subjective for the

purpose of generating differential diagnoses, evaluating Piliin mo din. Yung sinasabi ba ng patient kapanipaniwala ba?
progress following a specific treatment/procedure and Hindi ba fake news? Kung yung patient mo matanda na, nasa
evaluating change in the patient’s condition or the impact 80’s na baka nagdedementia na. I-discern mo kung tama ba ang
of a specific disease process. sinasabi ni lolo o ni lola. Tanungin niyo yung kasama. Parang
yung kwinento ko sainyo na bata na may kasama siyang
differential diagnoses, this is the possible diagnosis of a sign and caregiver, ganoon din ang ginagawa ng isang PA. Kung matanda
symptoms. For example, TB, UTI, pwedeng dengue, covid, etc. ang pinapacheck up, kung may kasama siya sa bahay dapat
tapos mamimili kana lang sa list na yon hanggang sa isama din ang kasama niya sa bahay kasi baka kailangan din
makarating ka sa primary diagnosis. tanungin yung kasama sa bahay kung ano talaga ang
nangyayari doon sa matanda.
History Taking

Complete History Taking

•Patients should, at some early point, have the
opportunity to tell their own story of the illness without •Personal Details
frequent interruption and, when appropriate, should What are the data included in the personal details? Unang una
receive expressions of interest, encouragement, and ang name. Pwede mong gamitin ang name for getting a rapport
empathy from the physician. with the patient. Age din dahil may age related diseases.
Pambata, matanda, adult, senior citizen kasi may mga diseases
na ganon. Next is Address. Ang importante dito ay malaman
So pag nagkwento siya, hayaan mo lang muna. So ibig sabihin,
mo kung ano ang location niya, anong klaseng environment
kahit yung simpleng pag tango tango lang “opo, sige po, ah
niya kung malapit ba sa dagat, sa factory, sa city? For example
ganon po?” nakaka encoorage na yon sa pasyente. Mafiifeel niya
yung patient nakatira malapit sa factory na nagrerecycle ng
na may importansya ang snasabi niya hindi yung nakatutok ka
gulong tapos ang kaniyang chief complaint ay palagi siyang
sa laptop, sa cellphone, kausap mo secretary mo. Simpleng
inuubo o hinihingal so that explains kasi nakatira siya factory
tanong lang okay na yon..
ng gulong na nagsusunog.
•Any event related by a patient, however trivial or
seemingly irrelevant, may provide the key to solving the Sex. Male or female kasi may mga diseases na exclusive sa
medical problem. babae o sa lalake katulad ng mga problema sa menstruation
syempre babae yon, erectile dysfunction syempre lalake yon.
Kahit akala mo na chika chika lang ang sinabi ng patient na
may migraine ang nanay at tatay niya, andoon na yung clues eh. Ethnicity. Merong diseases na common sa ethnic groups like
sickle cell disease isang klase ng anemia. Sa europeans like
•In general, patients who feel comfortable with the
hemophilia yung hindi tumitigil ang pagdugo pag nasugatan.
physician will offer more complete information; thus,
putting the patient at ease contributes substantially to Occupation. Katulad ng sinabi ko paano kung hindi lang siya
obtaining an adequate history. nakatira malapit sa factory, nagttrabaho pa siya doon sa
factory meaning nalalanghap niya na talaga kasi andoon na napunta siya sa huling napanood niya sa netflix so dapat ibalik
siya mismo sa loob ng factory. mo siya doon sa gitna. Avoid medical terminology kasi nakaka
intimidate yon sa patient. Dapat alamin kung ano ang anguage
Religion. May religion na may issue sa certain medical
ng patient kung saan siya mas nakakaintindi. Kung sanay sa
conditions katulad ng transfusion of blood. Meron silang
tagalog, tagalugin mo. Pag english, mag english ka.
conservation tungkol doon, anything related with the blood.

Marital status. Ano ba siya? Single, married, widowed, divorce,

separated. Baka kasi yung patient mo si lola depressed hindi So ano ba yung OPQRRSTTA. This is to organized your
kumakain yon pala kamamatay lang pala ng kaniyang asawa thoughts sa HPI. Halimbawa; Pain in the stomach ang chief
nong isang buwan kaya siguro aypn ang cause ng lack of complaint ng patient.
appetite niya.
O stands for onset of disease. Kelan ba yon nagumpisa?
And the Date of examination para malaman mo kung mabilis
nga ba ang pag galing niya, matagal ba ang ineexpect mo na
pag galing niya? Position or site? Saan sa tiyan? Epigastric part ba, epidural?
Birthdate din.
Quality. Burning ba siya? stabbing, crushing? O parang katulad
•Chief complaint
ng sa chest pain? O parang may nakadagan na tao sa dibdib mo
Ito yung main reason kung bakit pumunta ang patuent sainyo
na hindi nawawala katulad ng Angina pectoris ganon ang pain
para magpa check up. This is the record where the patient
describes their complaints on their own words. Usually non.
ginagamit ito sa mga psychiatric. Imbs na isang word lang ang
ilalagay mo, dito yung mismong sinabi ng patient. Always start Relationship to anything or other bodily function/position.
with an open ended question not answerable by yes or no
Mas sumasakit ba siya kung nakatayo, nakahiga?
dapat yung makakapagkwento siya kasi pag tinanong mo ay
hindi open ended question kung hindi madaldal ang patient
mo ay patay tayo dyan. Kahit may listahan ka pa ng questions Radiation. Kumakalat ba yung pain? Halimbawa yung chest
mo, walang continuation kasi putol putol. Pero kung ang
pain ng myocardial infarction kung nagfofocus lang ba siya dito
tanong mo ay “what brings you here? What seems to be the
problem? Mapipilitan siya na maraming sabihin at kung sa gitna na part o gumagapang siya sa left arm or sa left jaw.
nag-follow up question ka, mas madali kang makakakuha ng Usually ganon ang pain ng myocardial infarction kumakalat
pang follow up question.
siya.
Sign and symptoms. Signs are can be observed externally. Yung
nakikita, naaamoy, nahihipo mo sa labas, naririnig mo sa labas.
Relieving or aggravating factors. Mas sumasakit ba yung tiyan
Yung symptoms naman expelled internally. Nararamdaman ng
patient. Subjective to. It may be true to the patient but not to mo pag busog ka o pag gutom ka?
you. Example ng signs ay temperature, moisture pag
nahahawakan mo yung patient o kaya tinitignan mo kung
Severity. Sa sobrang sakit ba ititigil mo na yung trabaho mo,
tumutulo ang pawis niya. Color nakikita mo kung naninilaw,
namumutla and heart rate, pulse rate nakakapa mo to. iuuntog mo nalang ba ang ulo mo sa pader ganon ba kasakit?
Timing - mode of onset (abrupt or gradual) kung sa pain scale
nagsimula ba siya sa 10 or dumaan muna siya sa 1 bago
maging 10 so ito yung gradual. Yung abrupt nagsimula na siya
•History of present illness
sa 10 in pain scale. Progression. Tuloy tuloy ba yung sakit?
Ito yung kwento kung ano ang nangyari doon sa chief Hindi nawawala o pasumpong sumpong.
complain. Kunwari ang pinaguusapan ay liver tapos biglang
PAIN * Narrate in details - Example: By that evening, the footbecame
● Onset of disease swollen and patient was unable to walk. Next day patient
● Position/site attended hospital and they gave him some oral antibiotics. He
● Quality, nature, character - burning sharp, stabbing, doesn't know the name. There is no effect on his condition and
crushing; also explain depth of pain - superficial or two days prior to admission, the foot continued to swell and
deep. started to discharge pus. There is high fever and rigors with
● Relationship to anything or other bodily nausea and vomiting
function/position.
● Radiation: where moved to PAST DENTAL HISTORY
● Relieving or aggravating factors - any activities or * Dental history is one of the most important components of
position the patient history.
● Severity - how it affects daily work/physical activities. - especially for us dental student
Wakes him up at night, cannot sleep/do any work. * The dental history will give an idea of the: past dental visits;
● Timing - mode of onset (abrupt or gradual), previous restorative, periodontic, endodontic, or oral surgical
progression (continuous or intermittent - if treatment; reasons for loss of teeth; untoward complications of
intermittent ask frequency/ nature.) dental treatment; fluoride history; attitudes towards previous
● Treatment received or/and outcome. dental treatment; experience with orthodontic appliances and
- Uminom ka ba ng paracetamol dahil sa sakit ng ulo, dental prostheses; and radiation or other therapy for oral or
nagpahid ka ba ng Katink, naginhawaan ka ba sa facial lesions
ginawa mo - ano mga nagawa sa patient dental wise, nabunutan ba, nag
● Associated symptom ma temporary filling lang ba meron ba siyang brace, pustiso,
- Yung sakit ba ng ulo mo may kasama bang pagsusuko, kasama yan sa past dental history
pagduduwal, seizure loss of consciousness
Maoorganize mo thoughts mo hnd sabog sabog HPI mo. Ang PAST MEDICAL HISTORY
importanta sa HPI gumagamit ka ng time element, time terms * The past medical history includes information about any
tulad ng 1 week , by that evening, the next day, noong isang significant or serious illnesses a patient may have had as a
araw, 1 day prior to admission to consultation, malalaman mo child or as an adult.
nga eh kaagad agad. Bukod sa paragrapgh, malalaman mo na * The patient's present medical problems are also enumerated
HPI dahil sa time element at paragrapgh form eh kasi kwento eh under this category.
pag medo matagal sysptoms ng patient mo, novela magagawa
mo

HISTORY OF PRESENTING ILLNESS The past medical history is usually organized into the
* Always relay story in days before admission e.g. 1 week following subdivisions:
before the admission, the patient fell while gardening& cut his (1) serious or significant illnesses,
foot with a stone. - Past yung nakaraan na, naging mga sakit mo, covid
ba,typhoid ba, dengue ba pati yune mea sakit mo noong
 bata, bulotong, piekas(?) beke yung mga ganun P is parity, kung ilang beses ka nanganak.
Organize iit to a more serious and significant illness, T is term , yung mga pinagbuntis mo ilang beses mo ito nadala
kasali in yung hospitalization. noong 9 months. 37 weeks pataas
(2) hospitalizations, operations (major and minor) P preterm, kung ilan yung mga nabuntis mo na premature or
- Na confine, kasama na rin yung babae ka tas naconfine less than 37 weeks
ka sa hospital dahil sa panganganak, lahat kahit malilit A - Abortion, lahat ng hnd natuloy, nakuknan, mga hnd natuloy
na naoperahansali. kasama na rin, kahit yung naputok less than 20 weeks pababa.
yune kilay tas natahi, kasama na in yun, nagpaayos, ka L- kung ilan yung buhay mo ngayon
ilong kasama na in yon, nagpalipo ka kasama na in yun. e.g. G2 P2 (2 0 0 2)
Basta operation, major and minor kasama na yun So yung nasa example ay 2 beses nabuntis ate , 2 beses
nanganak. 2 beses natapos 0 preterm 0 kunin and 2 buhay
(3) transfusions, ngayon
- Na transfer ng dugo, bakit ka nagpatransfer ng dugo , e.g. G2 P2 (2 0 1 0)
ilang beses, baka kasi may history ka sa transfer ng Pwedeng 1 ito (A) eto pwedeng 0 (L)
dugo , baka may sakit ka sa dugo Ang twins pag kinount mo ang twins isang pagbubuntis lang
(4) allergies, yun. HND dalawa. Pati sa live(L) rin dalawa
- Importante ito, lalo na yung mag rereseta ka, wag
mong kalimutan kasi pagnagreseta tayo ng dugo at FAMILY HISTORY
nag allegeries yan, at hnd natanong lagot tayo diyan - Serious medical problem in immediate family members
(5) medications, and that can be inherited. Basta yung namamana
- Tulad ng kwinento ko yung unang part na number 2 - Eg. High Blood, diabetes, a certain cancer, allergies, and
yung clue para alam mo yung condition ng pasyente Elemira expert for sinda pa kami nakaalis , Asthma
(6) OBGYNE history for females = OB SCORE namamana sa allergies ang mga alpha may mga
G P (T P A L) certain disease na in runs in the family. May certain
e.g. G2 P2 (2 0 0 2) diseases na masasabi mo naman it runs in the family.
- Nice to know lang para alam niyo, example : Meron yung nanay mo tas maipasa sayo. Pwede ting
namnagainaaedtract eh
Obstetrical History- GP P=TPAL - Yung mga rare diseases. Yung mga tinatawag nating
G= gravida; # of pregnancies orphan diseases. Yung disease tulad ng down
P is further broken down & multiple are counted: syndrome, projectya, hunter’s syndrome. Yung
T- # of infants born, ( 37 weeks+) Hunter’s syndrome yun ang mga parang maliliit na
P- #of preterm infants (.20, <37 weeks) magkakamukha, basta parang maliit sila eh. Napapasa
A- # of pregnancies during in spontaneous or therapeutic ng nanay, yung babae hnd affect puro lalaki
abortion (SAB/SAN) naaaepektuhan, nadadala mo siya perio dala lang,
L = # of currently living children. maypapasa lng sa mga lalaking anak and carrier lang.
G is gravidity/gravida which is ilang beses kayo nagbuntis (sa Pagnagkaanak sila ganun din.
mga babae lang ito ahh) Unfortunately, hnd na po kasya dito dent supple.
SOCIAL HISTORY
Different social parameters should be recorded. These include:
● Marital status (married, separated, divorced, single, or
with a “significant other”)
● Place of residence (with family, alone, or in an
institution)
● Educational level
● Occupation
● Religion
● Tobacco use (Pack years);
Pack-Years of Smoking
To calculate smoking pack-years:
- Divide the number of cigarettes smoked per
day by 20 (the number of cigarettes in a pack)
- Then multiply by the number of years smoked.
(70 cigarettes per day / 20 cigarettes per pack x 10
years = 35 pack-years)
(35 cigarettes per day / 20 cigarettes per pack x 20
years = 35 pack-years)
20 cigarettes per day / 20 cigarettes per pack x 35
years = 35 pack-years)
Nagsisigarilyo ka ng 20 sticks per day tas didivide mo sa
20 times 35 years kada nagyoyosi (simula sa year ka
nag start yung pagbilang) so 35 packed years
Ano ba ibig sabihin ng 35 pack-years - ito yung risk na
pwede ka magkaroon ng smoking related diseases. Mas
mataas ang value mas mataas ang risk. Ano ba ang
smoking related? TB, lung cancer, throat cancer, yung
mga nakikita niyo sa pack ng sigarilyo.
REVIEW OF SYSTEMS
● Kasama na yosi tabacco and vaping. Pero kinocompare
siya sa iba.
● Alcohol use (past and present use and amount); anong
klaseng alak Gin Tuba *para sa shadow, isang shot
glass, isang bote, isang lata isang cahon, isang case,
- Araw araw, every other day, pnce a week, once
a month. Tuwing may occasion
● Recreational drug use (past and present use, type, and
amount).
- Shabu, mariwana, ecstasy. Cocaine
● The review of systems is a comprehensive and
systematic review of subjective symptoms
affecting different bodily systems.
● Direct questioning of the patient should be
aimed at collecting additional data to confirm
or rule out those disease processes that have
been identified by the clinician as likely
explanations for the patient’s symptoms.
● This type of questioning may also alert the
clinician to underlying systemic conditions
that were not fully described in the past
medical history.
● A methodical review of systems is important
to elicit features of an underlying disease that
might not be mentioned in thepatient’s
narrative.
Review talaga, eto yung last chance mo para makapag
review o mareview mo pa mga kulang mong HPI so per
system kasi siya ililista mo kasi para talagang check list
siya. Baka may nakalimitan kang itanong ng una dito
mo na makukuha.
Review of Systems
● Central Nervous System / Neurological:
● Headaches
● Head injury
 ● Dizziness Gastrointestinal:
● Vertigo ● Dental / gum problems
● Sensations ● Tongue problems
● Fits / faints ● Difficulty in swallowing
● Weakness ● Nausea
● Visual disturbances ● Vomiting
● Memory and concentration changes ● Heartburn
Eye: ● Colic
● Visual changes ● Abdominal pain
● Redness ● Change of bowel habits
● Weeping ● Colour of stools
● Itching / irritation Genitourinary system:
● Discharge ● Pain on urination
Endocrine: ● Blood in urine
● Excessive thirst ● Sexually transmitted infections
● Tiredness Women:
● Heat intolerance ● Onset of menstruation
● Hair distribution ● Last menstrual period
● Change in appearance of eyes ● Timing and regularity of periods
● Length of periods
Cardiovascular: ● Type of flow
● Chest pain ● Vaginal discharge
● Breathlessness ● Incontinence
● Palpitations ● Pain during sexual intercourse
● Ankle swelling Men:
● Pain in lower legs when walking ● Hesitancy passing urine
Respiratory: ● Frequency of micturition
● Shortness of breath ● Incontinence
● Cough ● Urethral discharge
● Wheeze ● Erectile dysfunction
● Sputum ● Change in libido
● Colour of sputum
● Blood in sputum Gathering Information
● Pain when breathing Systems Review
Ear, Nose and Throat: (often incorporated into the Musculoskeletal:
Respiratory System review) ● Joint pain
● Earache ● Joint stiffness
● Hearing deficit ● Mobility
● Sore throat ● Gait
 ● Falls
● Time of day of pain
Integumentary (Skin):
● General pallor of patient, e.g. pale, flushed,
cyanotic, jaundiced
● Rashes
● Lumps
● Itching
● Bruising
Physical Examination
● The purpose of the physical examination is to
identify physical signs of disease. The
significance of these objective indications of
disease is enhanced when they confirm a
functional or structural change already
suggested by the patient’s history.
● At times, however, physical signs may be the
only evidence of disease and may not have
been suggested by the history.
May mga condition lalo na mga masses mga bukol na
hnd alam ng patient, pero pag inexamine muna siya ni
Doc at pinatingnan, may namamaga daw eh. Kinapa
kapa mo na makukuha mo sya sa medical history
General Statement
● Nutritional status, weight, height and Body
mass index (BMI) kg/m2 - is a measure of
body fat based on height and weight that
applies to adult men and women.
● This is used in pedia
● What is the body Max index ? It is the measure
of body fat based on height and weight that is
applied to adults . it is computed by dividing
your weight in kilograms divided by young
height in meters then squared. 6 meters square
● Vital signs : temperature, pulse rate,
respiratory rate, blood pressure, oxygen
saturation
Instruments na ginagamit
Thermometer para sa temp
Sphygmomanometer para sa blood pressure (tho baka
sa piag aasitan namin yun) mas maganda raw gamitin
Manual
pulse oximeter- mhal dati pero mura na lang sa shopee.
Vital Signs
● Temperature : CDC considers a person to have
a fever when he or she has a measured
temperature of 100.4° F (38° C) or greater, or
feels warm to the touch, or gives a history of
feeling feverish.
Normal Range is 36.5-37.5 ang average 37, but
CDC said 1 temp muna or 140
● Pulse rate : 60 – 100 bpm (adults)
● Respiratory rate : 12-15 cpm
Wag pahalata baka ma sense ang patient , Pag
ginagawa ito ni Doc hinahawakan niya raw iba
para nandoon lang focus para hdn ma
conscious sila Jer. bilangin na lang ng 15 sec
times 4. Pero pag regular lang, if pansin mo
hnd tigidig tigidig pulling 60 second
● Blood pressure : 90/60 – 120/80
● Oxygen saturation : 95 -100%
BMI results those who eats too much food Morbidity has
a bad effect on high blood cholesterol.
Skinn
- Color
- Texture
 - sensitivity - Symmetry and spacing of facial features
EDEMA- pinipindot tas pag tanggal at nakalubogsa - Presence of edema or puffiness
shape ng daliri ko sana that is edema
Iba ang edema iba ang inflammation. . Presence of edema, common to sa bata na may mga
Edema dahil sa extra water ,inflammation, dahil may kidney problem. Usually pag nakahiga, pagkagising
binili si Doc tas inflammation masakit kumawak nila sa umaga puffy dahil kapag diba nakahiga yung
Skin bottle mo yung water pantay kaya yung water aabot
● Color, integrity, texture, temperature, dito sa mukha kapag bumangon na yung bata yung
hydration water by gravity bababa na sa paa niya mawawala na
● Presence of edema, excessive perspiration, yung pamamaga sa face.
unusual odor
● Presence and description of lesions Eyes
● Hair texture and distribution
- Visual acuity, visual fields
● Nail configuration, color, texture,
- Appearance of orbits, conjunctivae, sclerae,
condition, presence of clubbing
eyelids, eyebrows
- Extraocular movements, pupillary shape,
consensual response to light and
accommodation, corneal light reflex
- Ophthalmoscopic findings of cornea, lens,
retina, optic disc, macula, retinal vessel size,
caliber and arteriovenous crossings

Kadalasan gumagamit tayo ng Snellen Chart:

Part 3
Clubbing is yung shape ng daliri mo kapag meron kang
heart disease. Parang stubby siya or mataba. Pag
pinagtabi mo ang iyong pointing finger, pag may butas
Yung mga numbers sa gilid ayan yung Visual Acuity.
sa gitna that’s normal pero kapag nawala yung butas
For example, 20/100 anong ibig sabihin? Yung
na yun may possibility na may heart problem ka or
ineexamine na malabo ang mata makikita niya lang
mababa yung oxygen mo.
yung snellen chart ng malinaw kapag lumapit siya ng
20 feet pero sa taong normal ang vision 20/20 kaya
Head
niyang makita ang snellen chart kahit 100 feet siya yun
- Size and contour of head, scalp appearance
ang ibig sabihin ng 20/100.
 medyo hihilahin mo ng konti papunta sayo para yung
ear canal mag straight. Pag hindi mo hinila yung ears
This is ophthalmoscope:
ng patient ang makikita mo lang skin.

Eardrum (tympanic membrane):

Ganito yung nakikita, usually yung retina.

In weber test and rinne test ginagamitan ng tuning

fork.
Weber test- to determine conductive hearing loss.
Ears
Yung tuning fork pinapatong mismo sa taas, mismong
● Configuration, position and alignment of
sa skull.
auricles
Rinne test- detects sensory neural hearing loss (sa air
● Otoscopic findings of canals (cerumen,
papunta sa ating eardrum na nadedetect ng cranial
discharge, foreign body) tympanic
nerve #8)
membranes
● Hearing tests : Weber & Rinne test
Nose
● Gumagamit ng otoscope
● Appearance of external nose, nasal patency
● Presence of discharge, crusting, flaring, polyps
● Appearance of turbinates, alignment of
septum
● Presence of sinus tenderness or swelling
● Discrimination of odors
● To check yung nose kung tabingi ba siya
inagamitan ng Nasal Speculum tsaka penlight
para makita yung loob.
Ang ear canal hindi talag siya straight, medyo paliko ng
konti. Ang gagawin mo pag gumagamit ng otoscope

Mouth and Throat
● Number, occlusion and condition of teeth;
presence of dental appliances
● Appearance of lips, tongue, buccal and oral
mucosa, and floor of mouth (color, moisture,
surface characteristics, symmetry)
● Appearance of pharynx, tonsils, palate
● Symmetry of movement of tongue, soft palate
and uvula; gag reflex
● Discrimation of taste
● Voice quality
Neck
● Mobility, suppleness and strength
● Position of trachea
● Thyroid size, shape, tenderness
● Presence of masses
● Usually chinecheck dito yung thyroid.
● Paano mo malalaman kung yung nakapa mong
mass sa neck ay thyroid in origin or neck lang.
Ang thyroid sumasama sa paglunok.
Chest & Lungs
● Size and shape of chest, anterior posterior
diameter, symmetry of movement with
respiration
● Palpation findings: symmetry, masses
● Auscultation findings (using the stethoscope):
characteristics of breath sounds
● Usually ang ginagamit ay stethoscope.
● Check visually then kapain mo if may mga
masses palpate and auscultate.
Normal Breath Sound
Vesicular Breath Sounds VS Wheezing (Expiratory)
2 VARIANTS OF OUR CHEST: Pectus carinatum vs
Pectus excavatum
PECTUS CARINATUM:
Ang chest mo parang chicken or kalapati. Parang
patusok yung dibdib mo.
PECTUS EXCAVATUM:
It is the opposite. Palubog naman. Anong implication Heart Sounds
niyan? Nakaka affect sa paghinga yan. - Ang normal lub dub

Sa neck may stethoscope din ha, pinapakinggan yung

bruit. Yun yung tunog na dumadaan na blood sa carotid
vessels.
Chest & Lungs
Ang mga in-aauscultate usually abdomen, chest and
neck. Pero kapag nag auscultate ka gawin mo na agad
sa abdomen kasi kapag inuna mo yung pag palpate kesa
yung pag auscultate maiiba eh kasi sensitive yung
intestine kapag ginalaw na eh.

These are the sites kung saan mo ipapatong yung Abdomen

stethoscope kasi icocompare mo yung left tsaka right. ● Shape, contour
● Auscultation findings: bowel sounds in all
Kapag nakaencounter ka ng patient na may tubig sa quadrants (normoactive, hyperactive,
lungs. Usually ang maririnig mo wala (parang hypoactive)
nabibingi). So, pwedeng wala kang naririnig sa isang ● Palpation findings: organs, massess
side pero sa kabila meron kaya kailangan icocompare ● Costovertebral angle tenderness
siya (or bilateral siya).

Heart
● Anatomic location of apical impulse
● Heart rate, rhythm
● Blood pressure
● Auscultation findings: characteristics of S1
and S2 (lub-dub)
● Presence of abnormal heart sounds e.g.
murmur, regurgitation

Bakit ba pinakikinggan?
Pinapakinggan yung bowel sounds. May normal active,
hyperactive and hypoactive. Yung hyperactive yung
tunog ng tiyan mo kapag gutom or kapag nagtatae
(yung malikot). Yung hypoactive is intestinal
obstruction pinaka common diyan.
Costovertebral angle tenderness, ito yung pang
check if may pain yung kidneys mo. Retroperitoneal
yung kidney so medyo malalim, dito sa angle kung
saan nag eend yung ribs at vertebra hanapin mo yun
slightly mo ipound yung kamay mo doon. Kapag
inflamed yung kidney sasakit yun.
REGIONS OF ABDOMINAL AREA
Yung epigastric area kapag masakit ayan yung sa ulcer.
Umbilical ay sa may pusod at hypogastric ay sa puson.
Sa right hypochondriac nandyan yung liver. Sa kabila
ay liver then sa gitna ay pancreas.
Ang appendicitis usually right lower quadrant. Ang
gallbladder stones right upper quadrant.
Lymphatic
● Presence of lymph nodes in head, neck,
clavicular, axillary or inguinal areas
● Size, shape, tenderness, mobility, consistency
of nodes
● Sa female kapag nag breast exam kayo idamay
niyo ang kilikili baka may mga lymph nodes sa
kilikili kasi connected yan sa breast eh.
Musculoskeletal/Extremities
● Posture: alignment of extremities and spine,
symmetry of body parts
● Symmetry of muscle mass, tone and strength
● Range of motion, passive and active; presence
of pain with movement
● Appearance of joints; presence of deformities,
tenderness or crepitus
Neurologic
● Mental status: orientation, reasoning and
calculations, memory, mood and feelings,
speech clarity, comprehension
● Cranial nerves : On Old Olympus Towering
Top A Fin A German Viewed A Hop
 ● Cerebellar and motor function: Gait, balance,
coordination with rapid alternating motions
● Sensory function, symmetry
● Superficial and deep tendon reflexes
DIAGNOSTIC STUDIES
● Physicians rely increasingly on a wide array of
laboratory and imaging tests to make
diagnoses and ultimately to solve clinical
problems; however, such information does not
relieve the physician from the responsibility of
carefully observing and examining the patient.
● Physicians must weigh the expense involved
in laboratory procedures against the value of
the information these procedures are likely to
provide.
Investigations/Ancillary Procedures
● Laboratory tests (fluid, feces, etc)
● Imaging : Xray, CTScan, MRI, Ultrasound, 2D
Echo
● ECG, Stress test
● Difference of CT Scan and MRI:
CT Scan- kamaganak ng xray, radiation ang
ginagamit
MRI- uses magnet
Investigations/Ancillary Procedures
Telemedicine
- Telemedicine is defined by the World Health
Organization (2010) as “the delivery of health
care services, where distance is a critical
factor, by all health care professionals using
information and communication technologies
for the exchange of valid information for
diagnosis, treatment and prevention of
disease and injuries, research and evaluation,
and for the continuing education of health
care providers, all in the interests of
advancing the health of individuals and their
communities”.
- Teleconsultation refers more specifically to
the consultation done using
telecommunications, with the purpose being
diagnosis, or treatment of a patient with the
sites being remote from patient or physician
(Deldar, et al. 2016; Van Dyk, 2014)
Kapag sinabi mong telemedicine, ito ay sharing of ideas
between professionals. Ang teleconsultation ay parang
face to face consultation pero ginawa mo sa internet.
Who can practice telemedicine?
 Any physician with a valid license from the
Philippine Professional Regulation Commission (PRC)
can engage in telemedicine with patients physically
residing in the Philippines.

What are the minimum competencies to practice

telemedicine?
Telemedicine requires proficiency in digital
communication skills, clinical acumen and knowledge
of technology and equipment to be used, while
adhering to ethical practice.

What are the minimum requirements to set up for

telemedicine?
A communication device such as a landline
phone, cellphone with or without camera, and/or
computer will be required. If using video or chat
software, a stable internet connection is vital. A
private, well-lit location is preferred, especially for
video consult.
Principles of Medicine - September 7, 2022
We will talk about the immune system and associated
diseases including allergies. Pag pinag aralang mabuti,
allergy is related to the immune system.
IMMUNE SYSTEM
Immune - hindi natatablan kasi paulit ulit natin syang
naeexperience
- sa kakaexpose mo sa certain trigger or
infection, namememorize na ng immune system
mo yungagent na yun kaya nabbuild up ng
defense for that so the subsequent event na un,
hindi ka na matablan
Immunologic Principles
Immunity - Is the state of having sufficient biological
defenses to avoid infection, disease, or other unwanted
biological invasion.
- It is the capability of the body to resist
harmful microbes from entering it.
- It can be innate or acquired.
Keyword at main focus natin sa immune system,
defense.
Immunologic Principles
● Immunologic reactions are the result of cells
of the immune system recognizing and
responding to foreign stimuli called
ANTIGENS (disease-producing cells).
Kapartner ng antigen ay antibody, Kaya kapag
may sakit, dinedetect mo ung antigen, kasi ung
disease producing cell ng covid ay antigen.
● This system is characterized by two features :
1. Specificity - It means that the immune cells
initiating the reaction recognize and generate
a response against the antigen in question but
none other.
Specific, dun lang mag rereact sa specific
antigen na un.
2. Memory - It is demonstrated by the fact that
on second and subsequent exposure to the
SAME antigen, the immune response is
generated both more quickly and more
vigorously.
Pag paulit ulit mmo syag naeencounter, mas
bumibilis, mas namememeorize ng immune
system mo yung antigen na yun. Yun ang
nangyayari pag nagkaroon tayo ng chicken pox
or measles, nagkakaroon tayo ng memory sa
system natin kaya hindi na tayo natatablan sa
susunod nating mga exposure.
Ganun rin yung nagyayari sa vaccination. Yan
ang principle ng vaccination, memory.
Innate/ Natural Immunity
● It does not require prior exposure to an
Antigen (memory) to be effective.
Pag may dumating, lalaban sya. HIndi need ng
memory.
Components include phagocytic cells that ingest and
destroy invading antigens.
- neutrophils and monocytes in the blood
- Macrophages and dendritic cells in tissues
- Antigen presenting cells
- Natural killer cells
- Certain polymorphonuclear leukocytes
(eosinophils, basophils and mast cells)
Acquired/ Adaptive/Specific Immunity
● Needs memory
● Remembers past exposure
● Antigen specific
● Components incude :
- antibodies
- T and B lymphocytes
Let’s watch this. It will explain adaptive, innate
immunity and vaccination.
Video:
Vaccines: The Immune System and Immunisation weeks however because the body doesn’t produce
30 trillion. That’s the number of cells that make up the memory cells of its own. Emil von Behring used
human body. Beyond that, that man bacteria, fungi, passive immunization to cure children with diphtheria.
viruses and protozoa call each one of us home. Our He was awarded the first Nobel Prize in Physiology or
immune system has the difficult task of distinguishing Medicine (1901) for this work.
between our own cells and foreign cells, and between
healthy and sick ones. The body has 2 different modes Sabi sa video, nag iinject tayo ng trap para magwork
of defense. (1) The Innate immune response triggers ung immune system natin. 2 klase ng vaccination:
immediately once a pathogen is detected in our body. passive at active. Sa active, kailangan munang
It always operates in the same way and fends off about matrigger immune system natin by injecting dead or
95% of infections. By contrast, the adaptive immune weakened particles. Sa passive naman, nag inject mismo
response takes time to come into effect. It operates by ng antibody para labanan ung targeted na antigen.
developing mechanisms to fight off a specific
pathogen. In the process, memory cells are created.
Innate vs Adaptive Immunity
They help to prevent a new outbreak a second
Characteristic Innate Adaptive
infection or further transmission of the disease - a
s Immunity Immunity
highly effective system nevertheless.
Presence something created in
ABout 60 million people die each year and about ¼ of
already present response to
those die of infection even today. Though it’s much less in the body exposure to a
foreign
apparent in what we call the developed world.
substance
Nonetheless, it;s a huge problem everywhere and
Specificity non-specific specific
specifically in places where there isn’t ready access to
antibiotics and where the likelihood of infection is Response rapid slow (1-2
weeks)
greater.
In addition to nutrition and good hygiene, vaccine is a Potency limited and high potency
lower potency
main factor in improving public health. Vaccines, also
known as active immunization, use the adaptive Memory no memory long term
memory
immune response
to arm the body against specific diseases. Sample of Allergic none immediate and
Reaction delay
the pathogen, either dead or alive but in a weakened hypersensitivit
state are injected into the patient. The body then y

reacts to the simulated infection with an actual

immune response that produces memory cells whichin 2 Major Divisions of the Immune System

turn leads to immunity. If an infection is already in Humoral Immunity Cellular Immunity

progress or the patient's immunization history can’t be
Refers to a component of Refers to the other
determined due to injury or time pressure, there’s also the adaptive immunity components of the
an option known as passive immunization. in it, where B cells secrete adaptive immunity,
antibodies which which is mediated by the
antibodies are injected to help the body immediately circulate in the blood as activated
fight the disease agents. Protection only lasts 6-8 a soluble protein antigen-specific T cells
 - These APCs serve dual role in the T-cell
Mediated by B cells Mediated by T cells
response
Acts on extracellular Acts on intracellular
1. They present antigen to T lymphocytes
microbes and their microbes such as
toxins viruses, bacteria, possesing receptors specific for the antigen.
parasites and tumor
2. They produce a substance called interleukin 1
cells
(IL 1) which results to the activation of the
Rapid Delayed type of
T-cells.
hypersensitivity
- Once activated, they produce substances
called lymphokines (interleukin 2 or IL 2)
Elements of the Immune Sytem
which are responsible for the continued
1. Lymphocytic system
proliferation of T-cells
2. Phagocytic system
- In this activation process, T cells differentiate
3. Complement system
into cells which have distinct functions.
1. Cytotoxic T cells
1. Lymphocytic system
2. Helper T cells
- They are derived from the pleuripotent bone
3. T cells that mediate delayed type of
marrow stem cell and develop into two major
hypersensitivity reactions
cell types.
4. Suppresor T cells
1) T cell
2) B cell
● B cell
- pleuripotent means they have the ability to
- kaya daw B cells kasi sa Bone marrow.
transform into other cells. Hindi lang isang
Nadiscover yan sa part ng chicken.
klaseng cell yung kaya nyang i-produce
- Produced in the bone marrow, B cells migrate
to the spleen and other secondary lymphoid
● T cell
tissues where they mature and differentiate
- Mediate cellular immunity which is important
into immunocompetent B cells.
in the defense against mycobacteria (cause tb),
- They are responsible for humoral immunity
viruses and fungi and responsible for tumor
- For B cells to react to antigen, the antigen
immunity and graft rejection (sa transplant)
must be “processed” by APCs that interact
with TH (T helper) cells
- When the lymphokines released by the TH
cells and then interacts with the mature B
cells, they are stimulated to form plasma cells
which in turn produce the ANTIBODIES.
- It is derived from the Bone marrow > Thymus
> T-cell > Disseminates throughout the body
Immunoglobulins
- For T cell activation to occur, antigen
● These are produced by the plasma cells and is
presenting cells (APC) must first interact with
divided into 5 major classes:
the antigen.
1. IgG
 2. IgM
3. IgA
4. IgD
5. IgE
Immunoglobulins
IgG
● Constitues 75% of the serum
immunoglobulins.
● Most abundant with 4 isotypes.
● It is the ONLY immunoglobulin that crosses
the placenta
Di kase lahat ng components nagcocross sa placenta.
Ibis sabahin nattransfer sa bata.
● It is the major defense against invading
organisms by virtue of its opsonizing and
complement fixing activities.
IgM
● Accounts for 10% of the serum
immunoglobulins.
● Membrane bound immunoglobulin on the
surface of immature and mature B cells.
● It is extremely efficient in fixing complement
● Major defense against invading organisms and
is also an important cell surface antigen
receptor on B lymphocytes.
● First antibody produced in primary response
to an antigen.
● First antibody produced by the fetus.
So pag pinagcompare ang IgG at IgM, sabi nga dito first
antibody produced in primary response to an antigen.
Usually may mga tests tayo. So kung natatandaan niyo,
may dengue IgM, dengue IgG, tsaka NS1. Kung maaga
pa yung stage ng dengue kunware within 3-5 days, yung
ginagamit is NS1 test. Meron din yung dual test yung
dengue IgG at dengue IgM. Pag sinabi mo kaseng IgM,
recent lang yung infection, acute infection. Kaya nga
siya yung first antibody produced in primary response
kase it is responsible in acute infection so bago pa less
than 6 months usually. Pag sinabi mo namang IgG,
tapos na pero nadedetect parin pero wala na yung
infection, dumaan na. Nagkaroon ka di mo lang sguro
naramdaman.
IgA
● Constitutes 15% of serum immunoglobulins
● Predominant antibody in secretions (saliva,
tears, breast milk) and the mucosa.
Ito yung immunoglobulin na meron sa colostrum.
● Consist of two 4 chain units and attached to
aprotein called secretory component, which is
produced by epithelial cells.
● First line of defense against microorganisms
IgD
● Found in the serum only in small amounts,
representing 0.2% of immunoglobulins
● This is found on the surface of many immature
B lymphocytes and may be important as an
antigen receptor.
IgE
● Also called Reagin
● Found in the serum only in trace amounts
● It binds to tissue mast cells and basophils
● When mast cell bound IgE combines with an
antigen, the mast cell releases histamine and
other vasoactive substance. This mechanism
explains most of the allergic reactions.
So pag mataas ang IgE mo sa katawan, it is related to
allergies. Meron kasing IgE test, specific IgE test para
malaman kung merong mga tumutubo tubo sayo.
Kunwari bahing ka ng bahing or mga rashes ka kung
allergy siya.
● Involved in the defense against parasitic
infections.
Usually active rin siya sa mga parasitic infections like ● Three main effects:
worms, bulate. 1. Lysis of cells (bacteria, allografts,
tumor cells)
Pagpatay sa cells.
Phagocytic System
2. Generation of mediators of
● It includes polymorphonuclear leukocytes and inflammation
the monocyte-macrophage system. Involve sa pamamaga
● These cells mobilize to the site of injury or 3. Opsonization – enhancement of
microbial invasion, then ingest and degrade or phagocytosis
destroy antigen

So pag sinabing phagocytic system, maiisip mo si Types of Immunologic Responses

pacman. Nag eengulf siya. ● Although the immune system generally is

● Macrophages are major components of the protective, the same immunologic

host defense system both for their nonspecific mechanisms that defend the host at times may

phagocytic ability and for their participation result in severe damage to tissues and,

in specific immune responses. occasionally, may cause death.

● Substances they release are recognized as ● According to Gell and Coombs classification,

important mediators of cell interactions. there are four types of immunologic tissue

○ Interleukin 1 (IL1) – not only actives damage:

T cells; it is also the substance 1. Type 1

formerly known as “endogenous 2. Type 2

pyrogen” induces fever in the host. 3. Type 3

4. Type 4
Ito yung responsible sa pagkakaroon natin ng fever.
Kaya ang fever it is not actually the disease. It is just a
signal. Palatandaan na mayroong nangyayari sa
katawan natin. So as doctors, hindi dapat maging
kampante na gamutin lang yung fever. Ibig sabihin ng
fever, mayroong somthing sa loob na kailangan mong
imbestigahan kung bakit nilalagnat ang patient.

○ Tumor necrosis factor (TNF)

Complement System
Type I
● It is composed of circulating blood proteins
(c1 to c9) that react in a specific sequence, or - IgE-Mediated Hypersensitivity

cascade, when activated. Sa mga allergies

 - Ag induces crosslinking of IgE bound to mast
cells and basophils with release of vasoactive
mediators
- Typical manifestations include systemic
anaphylaxis (grabeng allergies na
nahihirapang huminga na kailangan pang
injection-an ng epinephrine. Need mabilis
action dito kase mahihirpang huminga patient
kase pati airways nya namamaga) and
localized anaphylaxis such as hay fever,
asthma, hives, food, allergies, and eczema
Type II
- IgG-Mediated Cytotoxic Hypersensitivity
- Ab directed against cell surface antigens
mediates cell destruction via complement
activation or ADCC
- Typical manifestations include blood
transfusion reactions (ag sinalinan ka ng dugo,
nagkakaroon ka ng allergic reactions),
erythroblastosis fetalis (pag hindi compatible
yung dugo nung baby at nung tatay, usually
yung tatay, kaya nagkakaroon ng reaction
yung bata), and autoimmune hemolytic
anemia.
Type III
- Immune Complex-Mediated Hypersensitivity
- Ag-Ab complexes deposited in various tissues
induce complement activation and an ensuing
inflammatory response mediated by massive
infiltration of neutrophils
- Typical manifestations include localized
Arthus reaction (nung nainjection kayo for
covid, yung pamumula) and generalized
reactions such as serum sickness, necrotizing
vasculitis, glomerulnephritis, rheumatoid
arthritis, and systemic lupus erythermatosus.
(so sa mga autoimmune diseases itong type III)
Type IV
- Cell-Mediated Hypersensitivity
- Sensitized TH1 cells release cytokines that
activate macrophages or TC cells which
mediate direct cellular damage
- Typical manifestations include contact
dermatitis (kunware nagsuot ka ng gloves eh
allergic ka sa latex. Maya maya may reaction
na namumula na. Kung papano mo sinuot yung
gloves ganon yung shape niya kase contact siya.
Tsaka delayed, after ilang minutes dun palang
lilitaw) , tubercular lesions and graft rejection
Immunodeficiency Diseases
Immunodeficiency Disorders
● Immunodeficiency disorders are associated
with or predispose patients to various
complications, including infections,
autoimmune disorders, and lymphomas and
other cancers.
● Primary immunodeficiencies are genetically
determined and can be hereditary; secondary
immunodeficiencies are acquired and much
more common.
Manifestations of immunodeficiency
● Immunodeficiency typically manifests as
recurrent infections.
Paulit-ulit na infection. Kunware may pigsa ka or sores,
paulit-ulit. Gagaling babalik. Usually sign yan ng
immunodeficiency.
● However, more likely causes of recurrent
infections in children are repeated exposures
to infection at day care or school (infants and
children may normally have up to 10
respiratory infections/year), and more likely
causes in children and adults are inadequate
duration of antibiotic treatment, resistant
organisms, and other disorders that
 predispose to infection (eg, congenital heart
defects, allergic rhinitis, ureteral stenosis or
urethral stenosis, immotile cilia syndrome,
asthma, cystic fibrosis, severe dermatitis).
● Immunodeficiency should be suspected
when recurrent infections are the following:
○ Severe (kunware hindi lang simpleng
pigsa, malala siya kase yung tutulong
na part ng immune system sayo, wala)
○ Complicated
○ In multiple locations
○ Resistant to treatment
○ Caused by unusual organisms
○ Present in family members
● Initially, infections due to immunodeficiency
are typically upper and lower respiratory tract
infections (eg, sinusitis, bronchitis,
pneumonia) and gastroenteritis, but they may
be serious bacterial infections (eg, meningitis,
sepsis).
● Immunodeficiency should also be suspected
in infants or young children with chronic
diarrhea and failure to thrive (hindi lumalaki.
Parang tumatanda by age pero yung size nila
hindi nag-iimprove or nagpprogress),
especially when the diarrhea is caused by
unusual viruses (eg, adenovirus) or fungi (eg,
Cryptosporidium).
● Other signs include skin lesions (eg, eczema,
warts, abscesses, pyoderma (nagcacause ng
mga pigsa), alopecia), oral or esophageal
thrush, oral ulcers, and periodontitis.
● Less common manifestations include severe
viral infection with herpes simplex or varicella
zoster virus and central nervous system
problems (eg, chronic encephalitis, delayed
development, seizure disorder).
● Frequent use of antibiotics may mask many of
the common symptoms and signs.
Immunodeficiency should be considered
particularly in patients with infections and an
autoimmune disorder (eg, hemolytic anemia,
thrombocytopenia).
Evaluation of Suspected Immunodeficiency
● History and physical examination are helpful
but must be supplemented by immune
function testing.
● Prenatal testing is available for many
disorders and is indicated if there is a family
history of immunodeficiency and the mutation
has been identified in family members.
Evaluation of Suspected Immunodeficiency :
History
● Clinicians should determine whether patients
have risk factors for infection or a history of
symptoms of secondary immunodeficiency
disorders and/or risk factors for them. Family
history is very important.
● Age when recurrent infections began is
important:
○ Onset before age 6 months suggests a
T-cell defect because maternal
antibodies are usually protective for
the first 6 to 9 months.
○ Onset between the age of 6 and 12
months may suggest combined B- and
T-cell defects or a B-cell defect, which
becomes evident when maternal
antibodies are disappearing (at about
age 6 months).
○ Onset much later than 12 months
usually suggests a B-cell defect or
secondary immunodeficiency.
● In general, the earlier the age at onset in
children, the more severe the
immunodeficiency. Often, certain other
primary immunodeficiencies (eg, common
 variable immunodeficiency [CVID]) do not siya kaya mas malaki siya kaya meron kondisyon na
manifest until adulthood. sphlenomegaly.

Evaluation of Suspected Immunodeficiency : ● Muscle mass and fat deposits of the buttocks
Physical Examination are decreased.

● Patients with immunodeficiency may or may
not appear chronically ill. Macular rashes,
vesicles, pyoderma, eczema, petechiae,
alopecia, or telangiectasia may be evident.
Pyoderma. Pigsa pigsa
HIV. Sa mga merong HIV, namamayat sila.
● In infants, skin around the anus may break
down because of chronic diarrhea. Neurologic
examination may detect delayed
developmental milestones or ataxia.

Petechiae. Rashes pag nagkadengue. Kulay pula na

parang sulat ng ballpen. Hindi siya nakaangat na
magaspang. Para syang nasa ilalim ng skin na mapula.

Alopecia. Nauubusan ng buhok.

Telangiectasia. Spider veins

● Cervical lymph nodes and adenoid and

tonsillar tissue are typically very small or
absent.
● In certain other immunodeficiencies (eg,
chronic granulomatous disease), lymph nodes
of the head and neck may be enlarged and
suppurative. Evaluation of Suspected Immunodeficiency : Initial
● Tympanic membranes may be scarred or Testing
perforated. The nostrils may be crusted,
● If a specific secondary immunodeficiency
indicating purulent nasal discharge. Chronic
disorder is suspected clinically, testing should
cough is common, as are lung crackles.
focus on that disorder (eg, diabetes, HIV
Purulent nasal discharge. Hindi lang siya sipon–sipon na infection, cystic fibrosis, primary ciliary
may nana. dyskinesia).

Lung crackles. Napapakinggan mo sa likod ng patient ● Tests are needed to confirm a diagnosis of

na maraming plema or parang pumuputok putok. immunodeficiency (see table Initial and
Additional Laboratory Tests for
● The liver and spleen are often enlarged.
Immunodeficiency). Initial screening tests
Spleen. Nageenlarge ang spleen kasi maraming should include
components yung nasisira katulad ng white blood cells ○ Complete blood count (CBC) with
sa case ng immunodeficiency. Ang spleen kasi siya yung manual differential
nagfifilter ng blood kaya mas active siya gawa ng ○ Quantitative immunoglobulin (Ig)
maraming defective white blood cells. Mas gumagana measurements
○ Antibody titers
 ○ Skin testing for delayed Kaya meron tayong mga boosters kasi tuwing meron
hypersensitivity mga developments na yung certain booster na lumabas
ay hindi nagtatagal, nagdedevelop sila ng bagong
Treatment of Suspected Immunodeficiency
booster.
● Avoidance of live vaccines and exposure to
Treatment of Suspected Immunodeficiency :
infection
Management of Acute Infections
Live vaccines. Pag live vaccines, ibig sabihin buhay yun.
● After appropriate cultures are obtained,
Weakened pero buhay. Kung mahina ang immune
antibiotics that target likely causes should be
system mo kahit nanghihina yan, it is sufficient to cause
given promptly. Sometimes surgery (eg, to
a problem. Kahit na mahina na organism, nakakacause
drain abscesses) is needed.
padin ng problems.
● Usually, self-limited viral infections cause
● Antibiotics and sometimes surgery
severe persistent disease in
● Replacement of missing immune components
immunocompromised patients. Antivirals (eg,
Treatment of Suspected Immunodeficiency : oseltamivir, peramivir, or zanamivir for
Infection Prevention influenza; acyclovir for herpes simplex and
varicella-zoster infections; ribavirin for
● Infection can be prevented by advising
respiratory syncytial virus or parainfluenza 3
patients to avoid environmental exposures
infections) may be lifesaving.
and not giving them live-virus vaccines (eg,
varicella, rotavirus, measles, mumps, rubella, Self-limited viral infections cause severe persistent
herpes zoster, yellow fever, oral polio, disease in immunocompromised patients. Yung dating
intranasal influenza vaccines) or BCG (bacille gumagaling na basta basta na viral infections tulad ng
Calmette-Guérin). sipon, hindi na gumagaling agad kasi immunodeficient
● Pneumococcal, meningococcal, and ka. Yung simpleng sipon magiging purulent nasal
Haemophilus influenzae type b (Hib) vaccines discharge dahil nga immunodeficient ka.
are the recommended risk-specific vaccines,
Treatment of Suspected Immunodeficiency :
but their effectiveness varies with the degree
Replacement of missing immune components
of immunodeficiency .
● Such replacement helps prevent infection.
● Messenger RNA-based and adenovirus-based
Therapies used in more than one primary
vaccines for prevention of COVID appear to be
immunodeficiency disorder include the
safe in patients with a primary
following:
immunodeficiency. but it is as yet unclear how
○ IV immune globulin (IVIG)
much these vaccines will raise antibody titers
○ Subcutaneous immune globulin
and how long they will continue to be
(SCIG)
protective. It is likely that patients with
○ Hematopoietic stem cell
humoral and B-cell deficiencies will have a
transplantation
decreased response.
Principles of Medicine - September 12, 2022
Unclear how much these vaccines will raise antibody
We will talk about specific immunodeficiency diseases.
titers and how long they will continue to be protective.
Ataxia Telangiectasia
Ataxia - disease with the manifestation of
uncoordinated movement. Ito ung mga taong pag
naglalakad parang lasing. Pag nagsasalita sya,
nagsusulat, kumakain sya, hindi coordinated yung mga
muscle movement nya. Usually affected yung
cerebellum. Ito ung part ng brain responsible for fine
motor movements
Telangiectasia - ito ung sign, nakikita mong may ugat
ugat or spider veins. Mas prominent ito, color red or
violet, and dun sya sa mga kitang kita na areas kaya
pansin na pansin sya.
● Ataxia-telangiectasia results from a DNA
repair defect that frequently results in
humoral and cellular deficiency.
Exposed kasi tayo sa radiation which can cause breaks
in out DNA pero may mechanism ung katawan natin
pang repair but in the case of ataxia tel, yung repair
mechanism na yun, hindi gumagana so yung DNA sa
mga humoral and cellular elements like b cell and t cell,
hindi narerepair kaya nagreresult sya sa sakit na to.
Yung relult nito ung mga b cell at t cells mo defective, so
defective or mababa rin immune system mo.
● It causes progressive cerebellar ataxia
(frequent stumbling, unsteady gait, trouble
with fine motor movements like eating,
writing and speaking), oculocutaneous
telangiectasias, and recurrent infections due
to a weak immune system like recurrent
sinopulmonary infections.
Manifestations nya, cerebellar ataxia (aging nadadapa,
iba ung lakad mo parang lagi kang nakabukaka, trouble
with fine motor movements like eating, writing and
speaking), oculocutaneous telangiectasias (affected
yung mata, skin), and kaya sya tinawag na immune
disease dahil sa recurrent infections due to a weak
immune system like recurrent sinopulmonary infections
like sinusitis, pag ubong grabe, pneumonia na grabe.
● They have higher risk of developing cancers
like leukemia and lymphomas.
● IgA and serum alpha-1 fetoprotein levels are
measured.
● Genetic testing is needed to confirm the
diagnosis.
Kaya masasabi nating primary immunodeficieny kasi
genetics it runs in the family.
● Treatment is with prophylactic antibiotics or
replacement of immune globulin.
Chédiak-Higashi Syndrome (Albinism, Anak araw)
● Chédiak-Higashi syndrome is a rare,
autosomal recessive syndrome characterized
by impaired lysis of phagocytized bacteria,
resulting in recurrent bacterial respiratory
and other infections and oculocutaneous
albinism.
Kapag binanggit ung autosomal recessive, that term
pertains to genetics. Nakaka-engulf ang mga
macrophage pero hindi napapatay yung mga naisubo
nyang bacteria or microbe. Pinakaimportante sa itsura infections like osteomyelitis and septic
nya, oculocutaneous albinism. Pwede mag iba ung age arthritis) ; multiple granulomatous lesions of
nya pro ung itsura ganito. the lungs, liver, lymph nodes, and
gastrointestinal and genitourinary tracts;
● Genetic testing for LYST mutations can
abscesses; lymphadenitis;
confirm the diagnosis.
hypergammaglobulinemia; elevated
Primary immunodeficieny parin
erythrocyte sedimentation rate; and anemia.
● Treatment includes prophylactic antibiotics,
Kaya pag nakita nyo ung organs nito, either sa xrays,
interferon gamma, and sometimes
biopsy or saan man, puro nodules at granulomas.
corticosteroids. Sometimes stem cell
● Diagnosis is by assessing oxygen radical
transplantation is curative.
production in white blood cells via a flow
cytometric oxidative burst assay.
Chronic Granulomatous Disease (CGD)
Inaassess mo ung killing ability ng WBC, un ung
● A granuloma or nodules is an aggregation of chinecheck mo sa CDG.
macrophages that forms in response to
● Treatment is with antibiotics, antifungal
chronic inflammation. This occurs when the
drugs, and interferon gamma; granulocyte
immune system attempts to isolate foreign
transfusions may be needed.
substances that it is otherwise unable to
… Granulocyte transfusions kasi gusto mong palitan
eliminate. Such substances include infectious
yung mga defective na WBC.
organisms including bacteria and fungi, as
well as other materials such as foreign objects,
keratin, and suture fragments.
Chronic Mucocutaneous Candidiasis
Pag nakakita ng pathogen ung phagocyte, isswallow or
iingest sya pero hindi rin nya mapapatay like sa
Chédiak-Higashi syndrome. Ang gagawin nya i-isolate
nya by trapping thepathogen with large numbers of
macrophage para hindi makakawala and magkalat ung
microbe, kaya nagkakaroon ng granuloma.
Yung main feature dito ung candida. Normally pwede ka
Pero sa CGD, abnormal ang pagform ng mga granuloma
namang magkaroon ng candida kung saan saang parte
● Chronic granulomatous disease is ng katawan, mula ulo hanggang paa. Yung problem sa
characterized by white blood cells that cannot Chronic Mucocutaneous Candidiasis, chronic. Hindi sya
produce activated oxygen compounds and by natataggal agad, actually baka hindi na sya
defects in phagocytic cell microbicidal natatanggal. Deep seated, widespread halos buong bibig
function. may kulay puti. Yung itsura nya mukang natuyong
● Manifestations include recurrent infections gatas. ANd hindi agad nakukutkot or nasscrape. If
(pneumonia, skin or soft tissue infections like nascrape man, baka magdugo kasi deep seated sya.
cellulitis or abscesses, bone and joint
 ● Chronic mucocutaneous candidiasis is
persistent or recurrent candidal infection due
to inherited T-cell defects.
● Autoimmune and endocrine disorders may
develop in its recessive form.
● Diagnosis is based on recurrent, unexplained
candida infections.
May isa pang disease na ganito rin ang manifestations
nya.
● Treatment includes antifungal drugs and
treatment of any endocrine and autoimmune
disorders.
Common Variable Immunodeficiency (CVID;
acquired or adult-onset hypogammaglobulinemia)
● Common variable immunodeficiency
(acquired or adult-onset
hypogammaglobulinemia) is characterized by
low immunoglobulin (Ig) levels with
phenotypically normal B cells that can
proliferate but do not develop into
Ig-producing cells.
● Patients have recurrent sinopulmonary
infections. Diagnosis is based mainly on serum
Ig levels.
● Treatment includes prophylactic IgG
replacement therapy (papalitan ung kulang)
and antibiotics for infection.
DiGeorge Syndrome (22q11.2 Deletion Syndrome)
Hindi lang immunodeficiecy syndrome kundi
chromosomal abnormality rin, genetics ung problema
22q11.2 - about sa chromosme kasi pag
nagdedetect tayo, nagccheck up nung mga possible
na may chromosomal abnormality, ginagawa
usually ng mga geneticist, nag eextract ng
chromosome then nili-line up sa isang film or
pinagdedevelop-an. Kanya kanyang pwesto yan.
Diba we have 46 chromosomes, 23 pairs. Bawat
pair, may pwesto 1-23. Yung pang 23rd, un ung sex
chromosomes (either xx or xy).
22q means pang 22nd na position ng
chromosomes, nandun ung problem. Yung down
syndrome nasa 21st position kasi trisomy 21 sya.
● DiGeorge syndrome is thymic and parathyroid
hypoplasia (nagsshrink or lumiliit) or aplasia
leading to T-cell immunodeficiency and
hypoparathyroidism.
If thymus may problema, damay na yung T cell mo kasi
sa kanya nadedevelop ung T cell
● Infants with DiGeorge syndrome have low-set
ears, midline facial clefts, a small receding
mandible, hypertelorism (eye nila mejo
malayo agwat), a shortened philtrum,
developmental delay, and congenital heart
disorders.
● Diagnosis is based on clinical findings and
includes assessments of immune and
parathyroid function and chromosome
analysis.
● Treatment includes supportive measures and,
if severe, thymus or stem cell transplantation
(to produce new T cell).
Hyper-IgE Syndrome
(Hyperimmunoglobulinemia E Syndrome; Buckley
Syndrome)
 ● Hyper-IgE syndrome is a hereditary combined
B- and T-cell immunodeficiency characterized
by recurrent staphylococcal abscesses of the
skin, sinopulmonary infections, and severe
pruritic eosinophilic dermatitis.
Palagi kang may nana sa skin , mga pigsa pigsa. Parang
pigsang tinubuan ng tao. Talagang kadiri talaga.
● Diagnosis is confirmed by measurement of
serum IgE levels.
Mataas na level ng IgE so minemeasure.
● Treatment consists of supportive measures,
including lifelong prophylactic
antistaphylococcal antibiotics.
PART 2
● Treatment consists of supportive measures,
including lifelong prophylactic
antistaphylococcal antibiotics.
Lifelong kang iinom ng antibiotic panlabaan sa pigsa,
sores…
Severe Combined Immunodeficiency (SCID)
● Severe combined immunodeficiency is
characterized by low to absent T cells and a
low, high, or normal number of B cells and
natural killer cells.
● Most infants develop opportunistic infections
within the first 3 months of life.
Opportunistic infections and causative agent nya ay
nakatira sa katawan. Pero when the time comes na
favorable ang situation sa kanya, like when mahina ang
immune system mo, dun ka nya sasaktan. Saka yan
sasalakay, tatake advantage ka niya kaya opportunistic
● Diagnosis is by detecting lymphopenia,
absence or a very low number of T cells, and
impaired lymphocyte proliferative responses
to mitogens.
● Patients must be kept in a protected
environment; definitive treatment is
hematopoietic stem cell transplantation.
Itong batang to nilagay sa plastic kaya bubble boy
tawag sa kanya. Di sya pwedeng maexpose sa kahit ano
like sa air na may microbes. So sa advancement sa
techonology, hindi na sguro ginagamit ang ganto.
Nilalagay/pwede nalang magpagawa ng clean room.
Yung ang hangin ay controlled, may filter na matindi.
Wiskott-Aldrich Sybdrome
● Wiskott-Aldrich syndrome is a primary
immunodeficiency disorder that involves
combined humoral and cellular immunity
deficiencies.
● Inheritance is X-linked recessive.
Wiskott-Aldrich syndrome is caused by
mutations in the gene that encodes the
Wiskott-Aldrich syndrome protein (WASP), a
cytoplasmic protein necessary for normal B-
and T- cell signaling.
Yung T-cells kailangan ni B-cells para magdevelop
● Because B- and T-cell functions are impaired,
infections with pyogenic bacteria
(pus-forming) and opportunistic organism,
particularly viruses and Pneumocystis jirovecii
(hindi to usual organism na nagccause ng
pneuomonia. So sabi natin sa
immunodeficiency, it is caused by unusually
organisms), develop. Infections with varicella
 zoster virus and herpes simplex virus are sexual intercourse, shared intravenous drug
common. paraphernalia, and mother-to-child
● The first manifestations are often transmission (MTCT), which can occur during
hemorrhagic (usually bloody diarrhea), the birth process or during breastfeeding.
followed by recurrent respiratory infections,
Characteristic ng secondary immunodeficiency is may
eczema, and thrombocytopenia (mababa ang
ginawa ka, inaquire mo siya. Hindi yan dahil sa dugo or
platelet).
dahil sa mana. May ginawa ka kaya nakuha mo siya.
● Cancers, especially B-cell lymphomas (EBV+)
Hindi naman lahat ng sexual intercourse, pwedeng
and acute lymphocytic leukemia, develop in
multiple partners, unprotected sex. Yung
about 10% of patients > 10 years.
mother-to-child transmission ay iba sa genetic. Ito ay
● Diagnosis of Wiskott-Aldrich syndrome is
natrasfer via sa placenta, hindi genetic. Mechanical
based on the following:
siyang natransfer.
○ Decreased T-cell count and function
● HIV disease is caused by infection with HIV-1
○ Elevated IgE and IgA levels
or HIV-2, which are retroviruses in the
○ Low IgM levels
Retroviridae family, Lentivirus genus.
○ Low or normal IgG levels
● HIV produces cellular immune deficiency
○ Decreased natural killer cell
characterized by the depletion of helper T
cytotoxicity
lymphocytes (CD4+ cells). The loss of CD4+
○ Impaired neutrophil chemotaxis
cells results in the development of
● Treatment of Wiskott-Aldrich syndrome is
opportunistic infections and neoplastic
prophylactic and immune globulin to prevent
processes.
recurrent bacterial infections, acyclovir to
prevent severe herpes simplex virus May defect siya sa (CD4+ cells). Hindi ka mamamatay
infections, and platelet transfusions to treat mismo sa HIV/AIDS. Ikamamatay mo ay yung
hemorrhage. If thrombocytopenia is severe, secondary infection na iccause nya
splenectomy can be done, but it is usually
● AIDS is defined as HIV infection that leads to a
avoided because it increases risk of
CD4+ T lymphocyte count of < 200/μL.
septicemia.
Ang HIV kase may stages. 1,2,3,4 yan. Huling stage ay
● The only established cure is hematopoietic
yung AIDS, terminal, ibig sabihin and CD4 count mo ay
stem cell transplantation, but gene therapy is
sobrang baba na, less than 200.
under study.
● Without transplantation, most patients die by HIV-AIDS : Pathogenesis
age 15; however, some patients survive into
● After primary infection with HIV, acute
adulthood.
viraemia develops resulting in widespread
dissemination of HIV, some resemble

HIV - AIDS glandular fever.

● Human immunodeficiency virus (HIV) is a Parang may malalaki kang kulani

blood-borne virus typically transmitted via

 ● Antibodies to HIV develop and appear in the
serum within 6 wks to 6 months from
infection (seroconversion) but some patients
may be sero negative.

Kung maaga mo siya ipatest, pwede pa siyang

magnegative, false negative kase undetectable pa siya.

● After infection of CD4+ cells, there is usually a

long symptomatic period, but as HIV damages
more CD4 cells, the risk of development of
severe immunodeficiency, and symptoms of
disease rise in time.
May weight loss kase nga nahihirapang kumain.
Stages of HIV-AIDS infection
Main manifestations of HIV/AIDS

● Opportunistic infections : mainly fungal and

viral
● Neoplasms : mainly Kaposi sarcoma
(malamang sa hindi, HIV yan) and lymphoma
● Neurological disorders : Mainly dementia
(parang alzheimers. Makakalimutin ka. Yung
mga mental faculties mo bumabagsak.)
● Autoimmune disorders : Mainly purpura

Main Symptoms of AIDS

Stage 1, zero negative ka pa. Andyan na yung virus pero
hindi pa nadedetect kaya yung CD4 count mo nasa
normal pa. Stage 2, andun na yung minor symptoms,
fever sguro adenophathies and bumababa na yung CD4
count. Sa stage 3, mas ramdam mo na sya, di ka na
makakakain. Puro ka na singaw sa bibig at sa
esophagus at bumaba pa lalo yung DC4. Sa stage 4, less
than 200 na yung CD4.

Central

● Encephalitis - namamaga ang brain

● Meningitis - namamaga ang meninges, yung
covering ng brain
Eyes ● Oral signs are common in patients with
T-lymphocyte disorders.
● Retinitis
● The most prominent oral sign in this group of
Lungs patients is chronic oral candidiasis
○ Usually widespread and deep seated
● Pneumocystis pneumonia - malamang HIV
○ Not easily scraped off (kung
kase hindi ito yung usual causative agent ng
masscrape man, baka magdugo)
pneumonia yung pneumocystis
● The dentist should consider the possibility of
● Tuberculosis (multiple organs)
impaired T-lymphocyte function in patients
● Tumors
with chronic oral candidiasis that does not
Skin respond well to treatment.

● Tumors ● In patients with HIV/AIDS

○ The chief occupational risk of
Gastrointestinal acquiring infection is as a result of

● Esophagitis injury by a sharp instrument,

● Chronic diarrhea particularly a LA needle, which

● Tumors contained a considerable amount of

contaminated fluid.
Treatment
○ Though needlestick injuries can
transmit the virus, infections among
dental personnel caring for HIV
infected patients is rare despite
reports of many such injuries.
● Regarding orofacial manifestions, most
patients with HIV disease have some head and
neck and oral manifestations at some time.
● Oral candidiasis is common, often the initial
manifestation and seen in 50% of the patients.
● Oral candidiasis is frequently associated with
esophageal candidiasis, the latter not the
former is an AIDS defining illness.
Antiretroviral Therapy ● Kaposi sarcoma in 50% of the patients is oral
or perioral, presenting as a red or purple
ART uses different kinds of medication to keep HIV
macule or nodule usually on the palate.
from growing and multiplying.
● In children with HIV, chronic parotitis
(pamamaga ng parotids) is common and is
virtually pathognomonic (characteristic nung
Dental Correlations
particular disease na yun).
Immunodeficiency Diseases
 ● Chronic oral candidiasis is seen in 75% of the
patients with HIV and is the single most
common mucocutaneous manifestation.
Allergies
● It is an abnormal immune response (usually
Type I or Type IV hypersensitivity response)
to an antigen – a protein or allergen.
● People who suffer allergies to one type of
substance are more likely to suffer allergies to
others.
● Common allergens are pollen, dust mites,
mould, pet dander, milk and egg proteins but,
in many cases the allergen cannot be reliably
identified.
● The most common allergic Type I
hypersensitivity reactions include allergic
rhinitis (hay fever), some asthma, eczema and
urticaria which affects 10% of the population,
have a strong genetic basis and are related to
IgE
● Type IV reactions (delayed hypersensitivity)
are T-cell–mediated.
● T cells, sensitized after contact with a specific
antigen, are activated by reexposure to the
antigen; they damage tissue by direct toxic
effects or through release of cytokines, which
activate eosinophils, monocytes and
macrophages, neutrophils, or natural killer
cells.
● Antigen binds to IgE that is bound to tissue
mast cells and blood basophils, triggering
release of preformed mediators (eg,
histamine, proteases, chemotactic factors) and
synthesis of other mediators (eg,
prostaglandins, leukotrienes,
platelet-activating factor, cytokines).
● These mediators cause vasodilation, increased
capillary permeability, mucus hypersecretion,
smooth muscle spasm, and tissue infiltration
with eosinophils, type 2 helper T (T H 2) cells,
and other inflammatory cells.
An allergy is an overreaction of the immune system to
a normally harmless substance called an Allergen.
Common Allergens
● Pollen
● Animal dander
● Down feathers
● Mites
● Chemicals
● A variety of food
On first exposure, the inhaled allergen enters the
mucous membrane lining the nasal passages where it
is taken up by the antigen-presenting which presents it
to the T-cells. These T-cells activate the B-cells to
release substances called IgE antibodies against the
allergen. These IgE antibodies sit on the surface of
mast cells. The mast cells have granules containing
chemical mediators like histamine, prostaglandin, and
etc. On exposure, the allergen binds to the IgE
antibodies present on the mast cells cross-linking
them. This results in the release of histamine,
prostaglandin and other mediators into the
surrounding tissue. These mediators cause dilation of
the surrounding blood vessels and increase their
permeability. This results in the nasal stuffiness,
sneezing, and mucous discharge or allergic rhinitis.
Antihistamines work by blocking the action of
histamines at its receptors and thus decreasing the
body’s reaction to the allergen.
Common Features of Allergies
● Nose : sneezing, congested or runny nose and
rhinorrhea (allergic rhinitis)
● Sinuses : post-nasal drip and pain
Post-nasal drip. Parang may sensation na may plema ka
sa lalamunan kahit wala kang ubo.
● Airways : coughing, wheezing and dyspnea
● Eyes : red, itchy, runny eyes
● Skin : eczema and hives
● Gastrointestinal : abdominal pain, bloating,
vomiting and diarrhea
Gastrointestinal. Yung iba hindi kita ang allergies.
Anaphylaxis : Clinical features
Minsan yung gastrointestinal tract nila ang apektado.
Anaphylaxis
Anaphylaxis. Typically allergy siya. Kung ano ang causes
at yung prosesong pinagdaanan sa allergies, ganun din
ang anaphylaxis. Ang pinagkaiba lang nila mas grabe
ang manifestations at meron pang plus.
● It is a severe life threatening type I
Kaya ang tawag sa kanya anaphylactic shock. Kasi
hypersensitivity reaction.
bumababa ang blood pressure mo.
● Anaphylaxis is typically triggered by
○ Drugs (eg, beta-lactam antibiotics,
insulin, streptokinase, allergen
extracts)
○ Foods (eg, nuts, eggs, seafood)
○ Proteins (eg, tetanus antitoxin, blood
transfusions)
○ Animal venoms
○ Latex
○ Peanut and latex allergens may be
airborne. Occasionally, exercise or
cold exposure can trigger or
contribute to an anaphylactic
reaction.
● History of atopy does not increase risk of
anaphylaxis but increases risk of death when
anaphylaxis occurs.
● Interaction of antigen with IgE on basophils
and mast cells triggers release of histamine,
leukotrienes, and other mediators that cause
diffuse smooth muscle contraction (eg,
resulting in bronchoconstriction, vomiting, or
diarrhea) and vasodilation with plasma
leakage (eg, resulting in urticaria or
angioedema).
● Anaphylaxis symptoms usually occur within
minutes of exposure to an allergen.
Sometimes, however, anaphylaxis can occur a
half-hour or longer after exposure. In rare
cases, anaphylaxis may be delayed for hours.
Signs and symptoms include:
○ Skin reactions, including hives and
itching and flushed or pale skin
○ Low blood pressure (hypotension)
○ Constriction of the airways and a
swollen tongue or throat, which can
cause wheezing and trouble
breathing
○ A weak and rapid pulse
○ Nausea, vomiting or diarrhea
○ Dizziness or fainting

Anaphylaxis : Management
● Epinephrine given immediately
● Sometimes intubation
Intubation. Pag nahihirapan na huminga. Nasa ER na.
Kailangan na tubuhin.
● IV fluids and sometimes vasopressors for
persistent hypotension
IV fluid tsaka vasopressors para tumaas ang BP mo.
● Antihistamines
● Inhaled beta-agonists for bronchoconstriction
Mga ventolin o salbutamol pwede gamitin pag walang
epinephrine para makatulong sa paghinga.
● Primary prevention of anaphylaxis is
avoidance of known triggers.
Ito yung pinakamadali at pinakamura yung pag iwas sa
kung saan ka may allergy.
● Desensitization (Immunotherapy) is used for
allergen triggers that cannot reliably be
avoided (eg, insect stings).
Desensitization. Introduce sayo pakunti konti hanggang
sa masanay na yung immune system mo, dedeadmahin
nalang.
Allergic Rhinitis
● Allergic rhinitis is the medical term for hay
fever or nasal allergies.
● By definition, allergic rhinitis is swelling of the
nasal passages caused by allergens.
● It’s important to note that while many people
refer to it as hay fever, it is not caused by hay.
Nor does is cause a fever. Allergic rhinitis is
triggered by having allergies. You have an
allergy when your body overreacts to things
that don’t cause problems for most people.
These things are called allergens.
● There are 2 forms of allergic rhinitis:
○ Seasonal (hay fever): Caused by an
allergy to pollen and/or mold spores
in the air. Pollen is the fine powder
that comes from flowering plants. It
can be carried through the air and is
easily inhaled. Symptoms are
seasonal and usually occur in spring
kasi mas naglalabas ng pollen, late
summer, and fall. This is the most
common form of allergy.
○ Perennial: Caused by other allergens
such as dust mites, pet hair or dander,
or mold. Symptoms occur year-round.
Clinical Manifestations : Allergic Rhinitis
● Characterized by nasal congestion and
rhinorrhea
Rhinorrhea. Tumutulo ang sipon.
● Patients complain of stuffiness or running of
the nose
● May be associated with sneezing, itching of
the nose (allergic salute) sometimes of the
eyes, throat and ears, conjunctivitis usually
mild, postnasal drip and signs and symptoms
of sinusitis.
● Physical findings include swollen nasal
mucosa and increased nasal secretions.
Diagnosis : Allergic Rhinitis
● Diagnosis is based primarily on a detailed
history of the conditions associated with the
symptoms.
 ● Sneezing, conjunctival symptoms and itching
of the nose and throat and eyes occur more
commonly in allergic rhinitis
● Family history of allergies is useful in
diagnosing allergic rhinitis
Ethiology and Pathogenesis
Laboratory Diagnosis : Allergic Rhinitis
● Lab tests are of limited value in confirming the
diagnosis of rhinitis.
● Moderate eosinophilia and abundance of
eosinophils in the nasal secretions suggest an
allergic basis
● Elevated serum IgE levels suggest patient is
atopic and makes an allergic basis for the
rhinitis more likely
Treatment and management : Allergic Rhinitis
● Eliminating or reducing the concentration of
the offending allergen leads to marked
improvement
● Primary treatment is antihistamine
medication
● Corticosteroids are highly effective in
eliminating symptoms of allergic rhinitis
● Immunotherapy also known as
hyposensitization is useful in patients whose
symptoms are severe and cannot be
controlled by antihistamines.
Urticaria and Angioedema
Ito yung mga skin manifestations ng allergy. Urticaria
Clinical manifestation
yung mga pantal tapos angioedema yung namamaga.
● Hives or welts, also known as urticaria, are
itchy, raised, reddish areas on the skin. About
a quarter of the general population can have
hives during their life. Hives often appear
without warning and may start at any age.
● Angioedema is swelling below the surface of
the skin and fatty tissue.
● Allergic urticaria and allergic angioedema are
most commonly produced by foods or drugs
against which the patient has IgE antibodies.
● Eggs, fish, condiments, spices, cheese, pork,
seafoods and nuts are most often implicated
in IgE mediated allergic reactions manifested
as urticaria or angioedema
● Penicillin is the agent most often implicated in
IgE mediated allergic reactions to drugs.
● The combination of circulating antigen with
IgE fixed to mast cells in the skin results to
urticaria (hives) or more extensive
subcutaneous or submucosal edema
(angioedema)
● Interaction of antigen and IgE directed against
the antigen results in the release of mediators
such as histamine, kinins and slow reacting
substances of anaphylaxis from mast cells
● This results capillary leakage, edema and
formation of urticaria or angioedema
● Immune mechanisms are most commonly IgE
mediated type but occasionally associated
with activation of the complement system
● The urticarial lesion is usually a 1 to 5 cm
irregular wheal with a pale center surrounded
by erythema
● Lesions are often intensely pruritic appear
and fade rapidly
 ● Occur at pressure points
● Most often disseminated
Erythema ay redness sa paligid. Itong sa picture maliliit
lang siya kaso nagdikit dikit kaya malaki. Ang
characteristic pa ng urticaria ay makati.
Prevention and management
● Angioedema lesion is a painless, usually non
pruritic swelling of an area (for instance hand,
finger, foot, lip eyelid) that tends to last for
several days
Food Allergy
Namamaga pero hindi makati at masakit.
Urticaria
● Hives
● Involves the superficial dermis
● Characterized by elevated, erythematous
wheals that are intensely pruritic
● Blanching
● Lesions are well circumscribed
Food Allergy : Management
Angioedema
● Involves deeper dermal and subcutaneous
layers
● Allergic swelling of an entire anatomic part,
such as thumb, hand, lip, eyelid or buttocks
● Not painful or pruritic but with deeper and
dull discomfort – burning quality
● Avoidance of the identified etiologic agent is
the key to prevention
● Both urticaria and angioedema is treated with
antihistamines
● Corticosteroids are reserved in severe cases
● True food allergy, primarily mediated by IgE
antibodies to food proteins, is an abnormal
immune response to food.
● The most common food allergens are egg, milk
and peanuts in children; shellfish, fish, nuts
and eggs in adults.
● Food allergens are proteins that usually are
not broken down by the heat of cooking or by
gastric acid or digestive enzymes and, as a
result they enter the bloodstream.
● The symptoms may begin as itching in the
mouth as the person starts to eat the food
responsible, followed by abdominal
symptoms.
● Then as the food allergens enter the
bloodstream, hypotension, urticaria and
bronchospasm may appear.
● A detailed patient history or a diet diary
together with skin tests are needed.
 ● Food allergy is treated by dietary avoidance.
● Symptoms can be relieved by antihistamines
and bronchodilators.
● Adrenaline/Epinephrine pen
Contact Dermititis
● A type IV cell mediated reaction
Type IV sensitivity. Ibig sabihin delayed.
● Specific T cells interact with the antigen and
secrete a series of pharmacologically active
protein mediators like lymphokines that
collectively bring about local changes
Clinical manifestations
characteristic of a chronic inflammatory
reaction.
● This reaction occurs 24 to 48 hours after
contact exposure
● Skin lesions erythematous with vesicles
● Presence of lesions on exposed areas are
characteristic of contact dermatitis
● Lesions limited to clothed areas suggest a
reaction to laundry agents
● Diagnosis is based on a patient’s history and
patch test with common allergens
Drug Allergy
● “Drug allergy” refers to reaction to a drug that
is mediated by immunologic mechanism
● In an allergic reaction, the immune system
mistakenly responds to a drug by creating an
immune response against it.
● The immune system recognizes the drug as a
foreign substance and the body produces
certain chemicals, such as large amounts of
histamine, in an attempt to expel the drug
from the body.
● Generalized anaphylaxis
● A type I reaction
● Shortly after exposure to the allergen : shock,
nasal obstruction, rhinorrhea, laryngeal
edema and bronchospasm.
● Urticaria, angioedema and severe pruritus can
affect the skin
● Gastrointestinal : abdominal pain, vomiting
and diarrhea
● Cardiac arrythmias
● Severe anaphylactic reaction - DEATH

Contact Dermatitis : Management

Diagnosis
● Topical corticosteroids are the mainstay of
● Any unexpected occurrence in a patient
treatment, while a variety of symptomatic
receiving a drug should suggest a drug
treatments can provide short-term relief of
reaction
pruritus.
● Patients must be questioned carefully as to
● However, the definitive treatment of allergic
drug history, this is important for both
contact dermatitis is the identification and
diagnosis and prevention of reactions.
removal of any potential causal agents;
● There is no certain way of proving that a
otherwise, the patient is at increased risk for
reaction is caused by a drug other than
chronic or recurrent dermatitis.
administering the drug and observing the
same reaction.
Treatment and Management

● Discontinuation of the causative agent is the

major approach to treating drug reactions.
● For generalized anaphylaxis – drug of choice is
aqueous epinephrine SQ repeated Q15 mins
as required.
● Saline or volume expanders for hypovolemia
● Steroids and antihistamines
PRINCIPLES OF MEDICINE (09-21-22)
Tuloy-tuloy lang si doc magbibigay ng lectures. Kaya
hindi na niya gagawing separate time yung quizzes so
ioopen na lang ni doc yung quizzes sabay-sabay. You can
answer the quiz on you own time. Bibigyan tayo ni doc
ng enough time to answer the quizzes. Hintayin na lang
yung announcement for the deadline for modules 3 – 6.
RHEUMATIC AND GRANULOMATOUS DISEASES
Ano nga pag sinabing rheumatic diseases? Naririnig
natin to sa mga matatanda na kapag malmig ay “ang
sakit ng balakang ko, yung rheuma ko”. The word
rheuma is non-specific term na ibig sabihin ay affected
ang iyong muscles, joints, ligaments, and tendons basta
tungkol doon. Pero may specific eh kasi may scientific
groups na nagbibigay ng specific na definition kung ano
ang rheumatic diseases at ito yun:
Rheumatic Diseases
● In 2018, the European League Against
Rheumatism (EULAR) and the American College
of Rheumatology (ACR) created a definition of
rheumatic and musculoskeletal diseases (RMDs)
in adults and children (van der Heide et al 2018).
That description is stated to be:
○ Rheumatic and musculoskeletal diseases
(RMDs) are a diverse group of diseases that
commonly affect the joints but can affect
any organ of the body. There are more than
200 different RMDs, affecting both children
and adults.
○ They are usually caused by problems of the
immune system, inflammation, infections or
gradual deterioration of joints, muscles and
bones.
○ Many of these diseases are long term and
worsen over time.
○ They are typically painful and limit function.
○ In severe cases, MDs can result in significant
disability, having a major impact on both
quality of life and life expectancy.
Rheumatoid arthritis (RA)
● Prototype of chronic destructive joint disease
○ Pag sinabing chronic pang matagalan or
matagal na
○ Destructive – nasisisra na ng unti-unti
● Inflammatory process extends not only to the
articular and tendon synovium but to many
organs of the body
● RA Is an autoimmune disease. This means that
certain cells of the immune system do not work
properly and start attacking healthy tissues – the
joints in RA
○ Pag sinabi nating autoimmune ay
kinakalaban niya ang sarili niyang katawan.
Nakatira siya sa host pero kinakalaban niya
ang sarili niyang host
○ In this case, sa RA, ang kinakalaban niya
yung joint or yung articular cartilage. So
nagiging destructive joint disease. This
means that certain cells in the immune
system do not work properly and start
attacking healthy tissues
● The cause of RA is not known
○ Idiopathic or hindi alam kung ano ang cause
● In RA, the focus of the inflammation is in the
synovium, the tissue that lines the joint. Immune
cells release inflammation-causing chemicals.
● These chemicals can damage cartilage (the tissue
that cushions between joints) and bone.

○ Yung pointed part is the synovium.
○ Unti-unti kakainin niya yung cartilage (kasi
yun ang unang maeencounter ng chemicals)
at pag naubos niya yung cartilage ay yung
bone naman.
● Clinical Manifestations of RA
○ RA is a chronic (long-term) disease that
causes pain, stiffness, swelling and limited
motion and function of many joints.
○ While RA can affect any joint, the small
joints in the hands and feet tend to be
involved most often. Inflammation
sometimes can affect organs as well, for
instance, the eyes or lungs.
■ Minsan may mga systemic
manifestations pa siya like fever (kasi
kapag nakadetect ng problema ang
unang niyang manifestation ay fever)
● Morning stiffness, persisting more than one
hour but often lasting several hours, may be a
feature of any inflammatory arthritis but is
especially characteristic of rheumatoid arthritis.
● Its duration is a useful gauge of the inflammatory
activity of the disease
● Similar stiffness can occur after long periods of
sitting or inactivity (gel phenomenon)
○ Ang gel phenomenon ay yung pag matagal
ka na nakaupo tas pagbangon mo ay masakit
na.
○ In contrast, patients with degenerative
arthritis complain of stiffness lasting but a
few minutes.
● Extra-articular manifestations include:
○ Subcutaneous rheumatoid nodules - most
characteristic extra-articular lesion of the
disease
○ Atherosclerosis is the most common
cardiovascular manifestation in rheumatoid
arthritis
■ Anong nangyayari sa atherosclerosis?
Nagkakaron ng blockage ng
pakunti-konti nagnanarrow yung blood
vessels lalo na yung malalaki.
○ Keratoconjunctivitis of Sjogren's syndrome
is the most common ocular manifestation of
rheumatoid arthritis
■ Keratoconjunctivitis ay nagddry eyes to
the point na parang nagkakaroon ng
sore eyes na secondary doon sa
Sjogren’s syndrome.
● Felty’s Syndrome
○ Complex of chronic rheumatoid arthritis,
splenomegaly, anemia, thrombocytopenia
and neutropenia
○ Infectious, leg ulcerations and cutaneous
pigmentation may be present
○ To easily remember this, gamit tayo ng
mnemonic:
 ○ Drugs: Drug therapy combines NSAIDS,
which reduces symptoms and Disease
Modifying Antirheumatic Drugs (DMARDS)
which slow disease progression.
○ Surgery: Surgery must always be considered
in terms of the total disease.
Part 2 17:30-35:00

● Diagnosis of RA
Dental correlation
○ RA can be hard to detect because it may
•Involvement of the TMJ (temporomandibular joint) in
begin with subtle symptoms, such as achy
RA results from granulomatous involvement of the
joints or a little stiffness in the morning.
articular surface of the synovial membrane leading to
Also, many diseases behave like RA early on.
destruction of underlying bone.
○ Diagnosis of RA depends on the symptoms
•Common symptoms of RA of the TMJ
and results of a physical exam, such as
● Bilateral stiffness, crepitus, tenderness and
warmth, swelling and pain in the joints.
swelling over the region of the joint
○ Some blood tests also can help confirm RA.
● Pain appears to be present only in the acute
Telltale signs include:
phase
■ Anemia (a low red blood cell count)
● Destruction of the underlying bone causes
■ Rheumatoid factor (an antibody, or
permanent limitation of opening
blood protein, found in about 80% of
patients with RA in time, but in as few
•Xray changes : narrowed joint space, flattened
as 30% at the start of arthritis)
condyles, erosions, subchondral cysts and
○ Elevated erythrocyte sedimentation rate (a
osteoporosis
blood test that, in most patients with RA,
•Arthritis itself does not interfere with dental
confirms the amount of inflammation in the
treatment unless fibrosis or ankylosis of the TMJ
joints)
decreases oral opening
■ Ang problema dito kay ESR (erythrocyte
•A careful drug history should be taken for some of the
sedimentation rate) ay hindi siya
drugs taken by RA patients may cause complications in
specific. Kahit anong parte ng katawan
the dental treatment (e.g. Aspirin)
na meron inflammation ay mageelevate
•Treatment depends on the severity of the signs and
tong ESR. Kaya ang pinaka magandang
symptoms
lab test ay yung RF (Rheumatoid
•Antiinflammatory medications e.g. NSAIDS
Factor)
● Treatment and Management:
•Soft diet in acute exacerbations
○ Rest and nutrition: complete bed rest is
•Exercise programs once symptoms subside
rarely indicated, even for a short time;
•Intraarticular steroids
however, regular rest should be prescribed.
•Replacement of the posterior teeth to relieve stress
An ordinary nutritious diet is generally
on the joint, because some evidence suggest that
sufficient.
destructive joint changes occur more frequently to
Edentulous (lacking teeth) patient
•TMJ surgery in severe cases
Osteoarthritis
Osteoarthritis
•Sometimes called Degenerative Joint Disease or
Degenerative Arthritis, osteoarthritis (OA) is the most
common chronic condition of the joints.
•OA can affect any joint, but it occurs most often in
knees, hips, lower back and neck, small joints of the
fingers and the bases of the thumb and big toe.
•In normal joints, a firm, rubbery material called
cartilage covers the end of each bone. Cartilage
provides a smooth, gliding surface for joint motion and
acts as a cushion between the bones.
•Some of the common symptoms include:
● Sore or stiff joints – particularly the hips,
knees, and lower back – after inactivity or
overuse.
● Limited range of motion or stiffness that goes
away after movement
● Clicking or cracking sound when a joint bends
● Mild swelling around a joint
● Pain that is worse after activity or toward the
end of the day
Diagnosis
•The diagnosis of osteoarthritis includes a medical
history and a physical examination.
•These may be followed by laboratory tests, X-rays,
and a magnetic resonance imaging (MRI) scan.

•In OA, the cartilage breaks down, causing pain,

swelling and problems moving the joint.
•As OA worsens over time, bones may break down and
develop growths called spurs. Bits of bone or cartilage
may chip off and float around in the joint.
• In the body, an inflammatory process occurs and
Treatment and management
cytokines (proteins) and enzymes develop that further
•Osteoarthritis is a chronic (long-term) disease. There
damage the cartilage. In the final stages of OA, the
is no cure, but treatments are available to manage
cartilage wears away and bone rubs against bone
symptoms.
leading to joint damage and more pain.
•Long-term management of the disease will include
several factors:
Clinical Manifestations
•Managing symptoms, such as pain, stiffness and
•Symptoms of osteoarthritis vary, depending on which
swelling
joints are affected and how severely they are affected.
•Improving joint mobility and flexibility
However, the most common symptoms are pain and
•Maintaining a healthy weight
stiffness, particularly first thing in the morning or after
•Getting enough of exercise
resting, lasting for a few minutes.
•Pain and Antiinflammatory medications
• Affected joints may get swollen, especially after
•PT and OT sessions.
extended activity. These symptoms tend to build over
Dental Correlations
time rather than show up suddenly.
•The most common intracapsular disorder of the TMJ
is degenerative joint diseases or OA.
•Symptoms: unilateral pain over the condyles ;
decreased range of motion of the mandible,
particularly limitation of opening; crepitus; feeling of
stiffness after a period of inactivity
•Examination reveals pain on palpation with the
deviation of the jaw toward the affected side
Gout and Pseudogout
Gout
•Also called Podagra when the big toe is involved.
•Gout is a painful and potentially disabling form of
arthritis that has been around since ancient times.
•Known as “Disease of Kings” or “Richman’s Disease”
•The first symptoms usually are intense episodes of
painful swelling in single joints, most often in the feet,
especially the big toe. The swollen site may be red and
warm.
•Gout occurs when excess uric acid (a normal waste
product) collects in the body, and needle‐like urate
crystals deposit in the joints.
•This may happen because either uric acid production
increases or, more often, the kidneys cannot remove
uric acid from the body well enough.
•Certain foods and drugs may raise uric acid levels and
lead to gout attacks. These include the following:
•Foods such as shellfish and red meats
•Alcohol in excess
•Sugary drinks and foods that are high in fructose
•Some medications
● low-dose aspirin (but because it can help
protect against heart attacks and strokes, we
do not recommend that people with gout stop
taking low-dose aspirin)
● certain diuretics (“water pills”) such as
hydrochlorothiazide (Esidrix, Hydro‐D)
● immunosuppressants used in organ
transplants such as cyclosporine (Neoral,
Sandimmune) and tacrolimus (Prograf)
•Over time, increased uric acid levels in the blood may
lead to deposits of urate crystals in and around the
joints.
•These crystals can attract white blood cells, leading to
severe, painful gout attacks and chronic arthritis.
•Uric acid also can deposit in the urinary tract, causing
kidney stones.
Diagnosis
•Some other kinds of arthritis can mimic gout, so
proper diagnosis (detection) is key.
•Diagnosis depends on finding the distinguishing
crystals.
•Crystals also can be found in deposits (called tophi)
that can appear under the skin. These tophi occur in
advanced gout.
•Uric acid levels in the blood are important to measure
but can sometimes be misleading, especially if
measured at the time of an acute attack. Levels may be
normal for a short time or even low during attacks.
Even people who do not have gout can have increased
uric acid levels.
•X-rays may show joint damage in gout of long
duration
Treatment
•Colchicine in acute attacks
•NSAIDS
•Corticosteroids are alternative to patients who cannot ○ May use a needle to take fluid (called
take NSAIDS synovial fluid) from a swollen or painful
•Drugs that lower blood uric acid levels joint, to find out whether calcium
pyrophosphate crystals are present.
Pseudogout ○ An X-ray of the joint may help detect
•Calcium Pyrophosphate Deposition (CPPD) whether calcium-containing deposits are
•Also called Chondrocalcinosis present in the cartilage.
•CPPD is a type of arthritis that, as the old name of
- Pwedeng fluid mula sa joint tapos
pseudogout suggests, can cause symptoms similar to
titignan sa microscope kung ano
gout. Yet in CPPD, a different type of crystal deposit
nandoon. Usually kase sa x-ray hindi
triggers the reaction.
nakikita ang results. So kapag nilagay
•CPPD can cause bouts of severe pain and swelling in
sa slides, doon madedetermine kung
one or more joints, which can limit activity for days or
calcium pyrophosphate crystals ba
weeks. It also can cause a more lasting arthritis that
talaga yun.
mimics OA or RA.
•The condition most often involves the knees, but can
● Treatment
affect wrists, shoulders, ankles, elbows, hands or other
○ No treatment is available to dissolve the
joints.
crystal deposits.
○ NSAIDS
•CPPD develops when calcium pyrophosphate crystals
○ Drainage of synovial fluid
build up in a joint. Crystals deposit first in the cartilage
○ Corticosteroids
(the tissue that cushions inside joints) and can damage
the cartilage. The crystals also can cause inflammation Osteoporosis
that leads to joint pain, warmth and swelling.
•Other factors that can contribute to CPPD include: ● The most common metabolic bone disorder

● Excess iron storage (medical term: and the most common cause of osteopenia in

hemochromatosis) the elderly.

● Low magnesium levels in the blood

- Osteopenia means parang
(hypomagnesemia)
nawawalan na ng sustansya yung
● An overactive parathyroid gland
loob. Alam nyo yung angpao, parang
(hyperparathyroidism)
rice crispies, kapag ginanun mo sya,
● Some causes of excess calcium in the blood
mababali agad.
(hypercalcemia)
● A severely underactive thyroid ● Osteoporosis is a progressive metabolic bone
(hypothyroidism) disease that decreases bone density (bone
mass per unit volume), with deterioration of
Diagnosis.
bone structure.

○ Diagnosis hinges on symptoms and medical ● Skeletal weakness leads to fractures with

test results. minor or inapparent trauma, particularly in

 the thoracic and lumbar spine, wrist, and hip of the abdominal cavity as the rib cage
(called fragility fractures). approaches the pelvis.

- Minsan kahit naglalakad lang yung Diagnosis

matanda, kapag natabig ng konti,
● Bone density should be measured using
pwede ng mabali ang buto.
Dual-energy x-ray absorptiometry (DXA) to
Clinical Manifestation screen people at risk and to follow patients
with documented low bone density, including
● Patients with osteoporosis are asymptomatic
those undergoing treatment.
unless a fracture has occurred.
- Meron yung Anlene, sa may supermarket.
- Hindi moa lam kung may
Tatapak ka sa may machine tapos
osteoposrosis ang matanda dahil
magkakaroon ng estimate kung at risk ka na
walang pain. Unlike sa arthritis,
sa osteoporosis. Peron may mas accurate
malalaman mo agad.
niyan sa hospital to check the bone density.
● Nonvertebral fractures are typically
symptomatic, but about two thirds of Treatment and management
vertebral compression fractures are
● Osteoporosis treatments include the “basic
asymptomatic.
CDE’s” -- calcium(C), vitamin D (D),
● A vertebral compression fracture that is
weight-bearing exercise (E), prevention of
symptomatic begins with acute onset of pain
Falls (F), and bone-friendly medicines.
that usually does not radiate, is aggravated by
- Biphosphonates : Ex : Alendronate
weight bearing, may be accompanied by point
- Itong Alendronate hindi ito iniinom
spinal tenderness, and typically begins to
araw-araw. Once a week lang. Medyo
subside in 1 wk.
mahal lang ito. 1000 plus isa. Pero
- Vertebral compression, so yung mga effective naman siya.
vertebra nagco-collapse na kase
Dental Correlations
marupok na.

● Multiple thoracic compression fractures

eventually cause dorsal kyphosis, with
● The mandible, in addition to the long bones
exaggerated cervical lordosis (dowager’s
and vertebrae, may exhibit changes related to
hump).
osteoporosis.
- Parang kuba na kapag nagkakaosteoporosis so
● Osteoporosis most commonly found in
lumiliit yung matatanda. Sa advance stage
postmenopausal women in whom a decrease
nato.
in estrogen is combined with a decrease in
● Patients may have shortness of breath due to
calcium intake.
the reduced intrathoracic volume and/or
abdominal discomfort due to the compression Osteopetrosis
(Albers-Schonberg disease ; Marble bone disease ;
Osteosclerosis fragilis generalisata)
- Osteopetrosis, kabaliktaran naman
ng osteoporosis.
Osteopetrosis
● Normally, old bone is broken down and new
● Osteopetrosis is a rare disorder that causes
bones to grow abnormally and become overly
dense. When bones become overly dense, they
are brittle and can fracture (break) easily. In
addition, bones may be misshapen and large,
causing other problems in the body. For
example, changes to the bone size and density
of the skull can cause pressure on nerves
leading to vision loss, hearing loss, and
paralysis of the facial muscles.
● The types of osteopetrosis are broken into
- Kung sa osteoporosis nagiging
briitle siya, sa osteopetrosis nagiging
brittle din sya pero kumakapal. Hindi
siya nagiging angpao pero in the long
run fragile din siya.
● As bone increases in size, the amount of space
for the bone marrow (soft, sponge-like tissue
in the center of most bones that produces
blood cells) becomes crowded. Decreases in
the amount of space for bone marrow can lead
to low levels of cells in the body that fight
infection, carry oxygen to the body’s cells, or
control bleeding.
- So magkakaroon ka ng anemia kase
mababa white blood cells mo, mababa
red blood cells mo. So kung may
anemia ka, manghihina ka,
mahihirapan kang huminga.
● Osteopetrosis is a genetic disease that a child
inherits from their parents. The disorder may
be mild to severe, and symptoms may appear
early in infancy or later in adulthood. The
treatment options depend on the type of
osteopetrosis the person has.
bone is formed. However, this process does
not work properly in people with
osteopetrosis. Instead, old bone is not broken
down as new bone is formed. This causes the
bone to develop incorrectly, leading to dense,
thick bones that can fracture easily.
- Dito sa case nato, hindi por que
makapal, matibay. Hindi. Mas
makapal, mas makunat, mas brittle.
categories based on inheritance pattern, age
the disease develops, and the severity of the
disease. The types include:
➢ Autosomal recessive osteopetrosis
is the severe infantile form of the
disorder. The symptoms of this type
develop at or shortly after birth and
shorten life expectancy.
➢ Autosomal dominant osteopetrosis
is the noninfantile form of the
disorder and is also known as
Albers-Schönberg disease. The
symptoms of this type develop later
than the infantile form and have a
wide range of disease severity. Even
within the same family, some people
have little or no impact from the
disease, while others are severely
affected by the disease and have
significant disability and shortened
life expectancy. People with this type
 of osteopetrosis may not be
diagnosed until adolescence or
adulthood.
➢ X-linked osteopetrosis is a rare
form of the disease and can affect
many areas of the body.
● The severity of symptoms can vary depending
on the type of osteopetrosis. They include:
➢ Bone fractures from brittle, dense
bones.
➢ Nasal congestion from narrowing
sinus cavities.
➢ Vision and hearing changes from
enlarged bones pressing on nerves.
➢ Dental problems due to bone changes
in the skull and jaw and because teeth
come in later than normal.
➢ Low blood cell levels due to smaller
amounts of bone marrow because of
crowding in the center of bones can
lead to anemia and infection.
➢ Infections in the bone (osteomyelitis).
➢ Chronic bone pain.
Treatment
● At present, the only established cure for
autosomal recessive malignant infantile
osteopetrosis is hematopoietic stem cell
transplantation (HSCT) for specific cases.
● Good nutrition is very important for patients
with osteopetrosis, including the use of
calcium and vitamin D supplements if there
are low levels of calcium in the blood.
● Other treatments are symptomatic and
supportive.
● Genetic counseling is recommended for
families in which this disorder occurs.
Paget’s Disease (Osteitis deformans)
● It is a chronic disorder that can result in
enlarged and misshapen bones.
● It is caused by the excessive breakdown and
formation of bone, followed by disorganized
bone remodeling.
- Di tulad sa osteopetrosis na
nagbrebreakdown pero may certain
shape pa rin ang bone. Sa paget’s
disease, kapag nagremodel na,
bara-bara na. Parang nagkaroon na ng
deformity.
● This causes affected bone to weaken, resulting
in pain, misshapen bones, fractures and
arthritis in the joints near the affected bones.
● Rarely, it can develop into a primary bone
cancer known as Paget's sarcoma.
Clinical Manifestations
● Most people with the condition have no
symptoms. Paget's disease is often diagnosed
when an x-ray is done for another reason. It
may also be discovered when trying to find
the cause of high blood calcium levels.
- Accidental, for example nauntog ka,
nagx-ray ka then doon mo lang sya
makikita. So accidental lang mo sya
malalaman.
● If they do occur, symptoms may include:
● Bone pain, joint pain or stiffness, and neck
pain (the pain may be severe and present
most of the time)
● Bowing of the legs and other visible
deformities
- Bowing is sakang yung legs.
○ Enlarged head and skull deformities
 ○ Fracture ● This osseous enlargement in the edentulous
○ Headache patient often causes an inability to wear
○ Hearing loss existing dentures.
○ Reduced height
- So magpapagawa ka ng bago kung
○ Warm skin over the affected bone
kaya pa niya.
- Yang paget’s disease, nung ancient
times palang meron na nyan.
● In patients with teeth jaw expansion causes
spreading and flaring of the dentition and an
Diagnosis
abnormal occlusal pattern.
● X-ray images of your bones can show areas of ● Teeth may be moderately mobile in early
bone reabsorption, enlargement of the bone phases of the disease and become ankylosed
and deformities that are characteristic of in later stages.
Paget's disease, such as bowing of your long
- ankylosed so mahirap na syang tanggalin.
bones.
● Typical xray findings and elevated serum
● It may gradually encroach on the teeth.
alkaline phosphatase are usually sufficient for
● Bleeding is the most important complication
diagnosis.
encountered in performing oral surgery in
patients with Paget’s disease.
Treatment and management

● Only patients with symptomatic disease

require treatment.
Next meeting: No quiz
● Osteoporosis drugs (bisphosphonates) are the
most common treatment for Paget's disease of
bone.
● In rare cases, you may require surgery to:
○ Help fractures heal
○ Replace joints damaged by severe
arthritis
○ Realign deformed bones
○ Reduce pressure on nerves

Dental Correlations

● Jaw involvement is common in Paget’s disease.

● The primary oral manifestation of Paget’s
disease of the jaws is a gradual enlargement of
the maxilla, the mandible, or both.
PRINCIPLES OF MEDICINE (09-26-22) ● Clinical Manifestations:
This morning we will discuss rheumatic diseases that ○ Skin changes :
affects the muscles ■ Periorbital edema with a purplish
appearance (heliotrope rash) is relatively
Polymyositis - Dermatomyositis specific for dermatomyositis.
● Uncommon systemic rheumatic diseases ■ Gottron's sign (red purple keratotic,
characterized by inflammatory and degenerative atrophic erythema, or macules on the
changes in the muscles (polymyositis) and in the extensor surface of finger joints)
skin and muscles (dermatomyositis).
● The cause appears to be an autoimmune reaction
to muscle tissue in genetically susceptible people.
○ Your immune system attacks your muscles
● Pathologic changes include cellular damage and
atrophy, with variable degrees of inflammation.
● Muscles in the hand, feet and face are affected less
than other skeletal muscles.
● Involvement of visceral muscles in the pharynx
● Treatment and Management:
and upper esophagus and occasionally the heart,
○ Physical activities should be curtailed until
stomach or intestines can impair functions of
inflammation subsides.
those organs.
○ Corticosteroids
● High blood levels of myoglobin from
○ Immunosuppressants
rhabdomyolysis can damage the kidneys.
○ Rhabdomyolysis is the breakdown of muscle
Polymyalgia Rheumatica (PMR)
tissue because of trauma. When you have
● Polymyalgia Rheumatica is an inflammatory
trauma in the muscles. It will release myoglobin
rheumatic disorder characterized by aching or
that is quite toxic to the kidneys.
stiffness of primarily the shoulders, hips and neck.
● Muscle weakness may progress over weeks to
● These symptoms are commonly present in the
months. However, it takes destruction of 50% of
morning or after long periods of inactivity.
muscle fibers to cause symptomatic weakness (ie,
● Polymyalgia rheumatica may develop rapidly
muscle weakness indicates advanced myositis.
(literally "overnight") or may have a gradual
Involvement of pharyngeal and upper esophageal
development over weeks to months.
muscles may impair swallowing and predispose to
● The cause of polymyalgia rheumatica is unknown,
aspiration.
but is associated with immune system dysfunction
● Joint manifestations include polyarthralgia (joint
that may be triggered by genetic factors,
pain) or polyarthritis (joint inflammation).
environmental factors, or by an infection.
● Visceral involvement (except that of the pharynx
● The disorder almost always occurs in patients
and upper esophagus) is less common in
over the age of 50 and occurs two times more
polymyositis than in some other rheumatic
often in women than men.
disorders (eg, SL.E, systemic sclerosis).
● Symptoms:
○ Polymyalgia rheumatica is characterized by
bilateral proximal aching of the shoulder and
hip girdle muscles and the back (upper and
lower) and neck muscles.
○ Stiffness in the morning is typical and lasts >
60 minutes.
○ Shoulder symptoms reflect proximal bursitis
(eg, subdeltoid, subacromial) and less often
bicipital tenosynovitis or joint synovitis.
○ Discomfort may awaken patients from sleep
and is worse in the morning; occasionally it is
severe enough to prevent patients from
getting out of bed and from doing simple
activities.
● Diagnosis:
○ A diagnosis of polymyalgia rheumatica is
made based primarily on the history of
symptoms, physical examination and
laboratory testing.
○ The typical laboratory findings are an elevated
sedimentation rate and elevated C-reactive
protein.
○ Both of these blood tests indirectly measure
inflammation in the body.
○ These tests are not necessarily specific for
polymyalgia rheumatica and may be elevated
in other conditions such as cancer and
infection.
○ However, they are usually elevated in
polymyalgia rheumatica and if they are
normal there is usually a lower suspicion that
the patient has polymyalgia rheumatica.
○ A complete blood count may also reveal
anemia and high platelet count.
● Treatment:
○ 'The goal of treatment is to reduce pain and
stiffness and other symptoms.
○ Typically polymyalgia rheumatica responds to
low doses of prednisone ranging from 1o to
20 mg daily.
■ Some doctors give prednisone as an
diagnostic indicator if the condition is PMR
○ Most people feel better a few days after
beginning medication.
AUTOIMMUNE DISEASES
● These are due to antibodies and I cells directed
against self, produced when immune system fails
or malfunctions.
● They may be initiated by viruses, drugs, chemicals
or other factors and affect the immune system at
several levels.
● Despite the varying types of autoimmune disease,
many of them share similar symptoms. Common
symptoms of autoimmune disease include:
○ Fatigue
○ Joint pain and swelling
○ Skin problems
○ Abdominal pain or digestive issues
○ Recurring fever
○ Swollen glands
Systemic Lupus Erythematosus (SLE)
● A typical autoimmune disease
● A chronic, multisystem, inflammatory disorder of
probable autoimmune etiology, occurring
predominantly in young women.
● Archetypal autoimmune disease
● Characterized by autoantibodies to DNA, which
may initiate immune complex reactions
● Clinical Manifestations:
○ It may develop abruptly with fever associated
with arthralgias and malaise.
○ Joint symptoms, ranging from arthralgias to
acute polyarthritis.
 ○ Skin lesions include malar butterfly erythema
(flat or raised) that generally spares the
nasolabial folds.
○ Cardiopulmonary symptoms commonly
include pleurisy, with or without pleural
effusion.
○ Generalized adenopathy is common.
■ Adenopathy is the enlargement of your
lymph nodes

Part 2 14:30-29:00
Clinical manifestation
•Neurologic symptoms can result from involvement of
any part of the central or peripheral nervous system or
meninges. Mild cognitive impairment is common.
- So you have neuropathies, maybe psychosis pa
nga, dementia
•Renal involvement includes protenuria associated
with hypertension and edema.
- Usually when you have kidney problems, you
may also have hypertension
You can use SOAP BRAIN as your mnemonic
•Hematologic manifestations include anemia,
Serositis (pleuritis, pericarditis- presence of fluid
leukopenia and thrombocytopenia.
around heart)
Oral ulcers
Diagnosis
Arthritis
•The American College of Rheumatology diagnostic
Photosensitivity-silaw ka sa ilaw
criteria for diagnosis of SLE are based on the presence
Malar Rash
if at least four of the following:
Blood- all are low (anemia, leukopenia,
● malar rash, discoid rash, photosensitivity, oral
thrombocytopenia)
ulcers, arthritis, serositis, renal disorders
Renal- protein, In the kidneys you have proteinuria or
(persistent proteinuria), neurological
excessive excretion of protein in your urine.
disorders (seizures and psychosis),
ANA- A positive ANA test/ antibody test
hematological disorders (anemia, leukopenia
Immunologic- Positive DS, DNA, etc
on two or more occasions,
Neurologic- psychosis, seizures, neuropathies
thrombocytopenia), immunological disorders
Discoid Rash
(positive LE cell preparation, anti-DNA or
You must have at least 4 of these for you to be diagnosed
anti-Sm, false positive VDRL)
with SLE.
 tumagal. She died eventually. She was less
than 20 yrs old
•SLE has a 5 year survival rate if more than 90%

Systemic Sclerosis
•Also known as Scleroderma
•It is a disease of unknown origin characterized by
excessive deposition of collagen and other connective
tissue components in skin and multiple internal
Notice the concentration of the erythema or the redness
organs.
of your malar bones or cheekbones. And this is discoid
- If you will imagine what will happen to your
rash, meaning parang siyang round.
skin with scleroderma, may thickening
because of the excess deposition of collagen.
Treatment & Management
- And internal organs composed of snooth
•Most patients appear to do well in the long term
muscle and skeletal muscle. Those organs are
either with NSAIDS or steriods.
replaced with fibrous tissue. Parang may
•Antimalarials such as chloroquine appear to be
peklat.
effective for skin and joint lesions.
•It is associated with prominent and often severe
- You may use other drugs that is used in other
alterations in the microvasculature and the autonomic
ailments to cure other elements also. For
nervous system.
example, yung COVID, we used antiparasitic.
•It is considered an autoimmune disease because of
To resolve COVID.
the immune system involvement.
•Immunosupressive drugs are used for potentially
- So it also involves the skin.
fatal complications such as renal involvement.
Clinical manifestations
- It’s like curing cancer, you do chemotherapy
•The most impressive of the clinical features of
when you have SLE
systemic sclerosis are generalized thickening and
- One time a patient came to our house together
fibrosis of the skin, but some degree of multiple
with her parents. She presented chicken
organ involvement almost always is present.
pox-like symptoms. When I gave her
•Musculoskeletal symptoms are often the initial
medications it did not respond. And she has
manifestation.
other problems like in the kidney. I told the
•Musculoskeletal symptoms vary from mild
parents to bring the patient to the hospital.
polyarthralgias to severe arthritis.
They advised them to confine the patient
•Flexion contractures result from thickening and
because the patient has a very elevated
induration of periarticular tissues.
creatinine. The result came out that the
- Flexion contractures means it’s like you are
patient has SLE affecting the kidneys. She was
being burned. Burn victims after a while, if not
stable.
managed properly, they will develop
- They have to go to Manila every month for
contractures. Their skin will stick together.
chemotherapy. But unfortunately, hindi siya
 - It’s like being burned but you don't have a
history of burn trauma
•Gastrointestinal tract is the most common internal
organ system involved. For instance when the
Esophagus is affected, dysphagia is felt because of its
stricture.
- Imagine your esophagus being composed of
skeletal and smooth muscle,it will be replaced
by fibrosis. If it is replaced by fibrous tissue, it
will become useless already. It will be difficult
for you to swallow.
•Most prominent pulmonary symptoms are tachypnea
and exertional dyspnea due to pulmonary fibrosis
- In the lungs naman, imagine your lungs being
normally spongy tissue, being replaced by
fibrosis. Halos wala na ring silbi.
•Renal disease is the most serious internal organ
involvement in systemic sclerosis and is responsible
for most deaths
- You might resort to kidney transplant.
C.R.E.S.T. Syndrome (Limited Scleroderma)
Calcinosis- calcium deposits in the skin
Raynaud’a phenomenon- spasm of blood vessels in
response to cold or stress
- Example if the vessel of your hand is affected
by your scleroderma, it narrows the vessels of
your hands. Then when you expose it to cold,
it will get pale because of the constriction of
blood vessels. May constriction na nga dahil sa
scleroderma, mas naconstrict p dahil sa cold
water. Pero pag tinaggal mo, it will go back to
normal naman.
Esophageal dysfunction- acid reflux and decrease in
motility of esophagus
Sclerodactyly- thickening and tightening of the skin
on fingers and hands
- Like flexure contractures kanina
Telangiectasias- dilation of capillaries causing red
marks on the surface of the skin
Treatment and management
•No specific treatment exists for systemic sclerosis.
•Because excessive collagen deposition causes many of
the clinical manifestations, drugs capable of inhibiting
collagen accumulation hold the best promise of
halting the progression of fibrosis in cases of early
scleroderma like Penicillamine.
•For Raynaud’s phenomenon : vasodilating agents
like calcium channel blockers; patients should be
advised to avoid exposure to cold and to dress warmly
Dental Correlations
•The most common dental findings in systemic
sclerosis are rigidity and thinness of the lips
•The collagenization of the lips may lead to
microstomia
•The patient’s inability to open his mouth may hinder
oral hygiene, mastication, speech and placement of
prostheses.
•The most common complication encountered in
attempting to perform routine dentistry on patients
with systemic sclerosis is the lack of access to the
oral cavity because of microstomia
•Therefore an attempt should be made to improve
patient’s oral hygiene to prevent oral problems.
This is an example of a mouth having microstomia
PRINCIPLES OF MEDICINE (9-28-22) BIOLOGIC CHARACTERISTICS OF INFECTIOUS
AGENTS

Part 1 2:50-18:03
MICROBIAL DISEASES 1. Infectivity – the ability to infect a host
When we say microbial diseases ito yung numerous 2. Pathogenicity – the ability to cause disease in
the host
cosmic agents tulad ng bacteria, virus, fungi, parasites
at yung medyo bago bago na prions. Ito yung pagcause ng disease sa katawan ng tao
3. Virulence – the ability to cause severe disease
in the host
Introduction
Ito yung ginawa ng covid eh masyado siyang virulent.
4. Immmunogenicity –the ability to induce an
1. Disease is a disturbance in the state of health
immune response in the host
2. Microbes cause disease in the course of
Ito naman yung ginagawa ng mga vaccines.
stealing space, nutrients,and/or living tissue
from their symbiotic hosts (e.g., us)
MODES OF TRANSMISSION
Pag sinabing symbiotic ibig sabihin kasalo, kashare
1. Direct
natin sa katawan natin yung mga microbes.

– Droplet (mga laway)

3. To do this, microbes do most of the following:

– Aerosol (airborne)
– Gain access to the host (contamination)

– Skin to skin (pagdikit like sa kamay, braso)

Halimbawa pag uminom tayo ng tubig na hindi
ganon kalinis o kumain ng mga street foods at pinasok
2. Indirect
natin sa katawan natin so ito na yung to the host.
– Adhere to the host (adherence)
– Fomites
refers to inanimate objects that can carry and spread
Didikit sila katulad ng ginagawa ng mga virus
disease and infectious agents like
clothes, blankets, door handles etc.
– Replicate on the host (colonization)
Katulad pag ikaw ay may covid, may ubo tapos tinakpan
mo ang bibig mo gamit ang kamay tapos maghahawak
Katulad ng virus na nagrereplicate pinapasok niya
ng ballpen. Ang formites dito yung ballpen.
sa genetic material sa loob ng cell at itong cell
iiincorporate niya sa kaniyang DNA para pagka
– Vectors
nagproduce ulit ang ating cell madadamay yung genetic
are living organisms that can transmit infectious
material nong virus satin yung nagreplicate.
pathogens between humans, or from animals to
humans. (e.g. mosquitoes)
– Invade tissues (invasion)
Tapos pag invade ng microbes sa ating host tuald
– Food and water
ng mga parasites na nagiinvade ng ating tissues

– Intermediate hosts
– Produce toxins or other agents that cause host
is normally used by a parasite in the course of its life
harm (damage)
cycle and in which it may multiply asexually but not
sexually (e.g. snails)
at yung pag produce ng toxins like bacterias para
magcreate ng damage.
Yung mga snails may mga parasitic infections na yung
isang parte ng kanilang life cycle ay sa snails sila
tumutubo. Halimbawa mahilig kang kumain ng snail na
yon makukuha mo siya pwede kang mainfect pag
nagkataon naharvest mo siya, nakain mo siya kaya
maiinfect ka.
CLINICAL RESPONSES TO INFECTION
BY AN AGENT
1. Inapparent infection – no clinical symptoms
generated
2. Carrier state – usually no clinical symptoms
but host can transmit infection for long
periods
3. Clinical symptoms
– Mild disease
– Severe disease
– Residual impairment
– Death
Introduction
1. Manifestations may be local (eg, cellulitis,
abscess) or systemic, most often fever.
Halimbawa sa balat pag natusok ka ng matulis na
bagay doon na magsisimula ang cellulitis or abscess
kung saan ka natusok so yan ang local or systemic most
often fever so kumakalat.
2. Manifestations may develop in multiple organ
systems.
Doon siya nakaka create ng problema sa mga
organs natin.
3. Severe, generalized infections may have
life-threatening manifestations (eg, sepsis,
septic shock.
4. Most manifestations resolve with successful
treatment of the underlying infection.
Halimbawa fever sa UTI yung manifestation mo so ano
ang gagawin mo para mawala ang fever? So gagamutin
mo yung infection (UTI).
1. The oral cavity harbors a diverse microbial
flora that under normal conditions resides in
homeostasis.
2. The imbalance of this flora or the colonization
with new microorganisms from a viral, fungal,
or bacterial origin can infect the oral cavity
and its mucosa.
Hindi siya nagccreate ng mga microbes sa bibig
natin mga nagrereside lang sa oral cavity natin
na hindi naman talaga nagccreate ng problema
but the imbalance of this flora, the colonization
of microorganisms from viral to bacterial if will
affect the oral microflora. Tandaan niyo yung
opportunistic bacteria na sa loob ng katawan
natin yung mga microbes na yon. Pag
nakakuha sila ng tyempo pag humina ang
katawan natin yung immune system doon sila
magtetake advantage sa katawan.
Bacteria
1. Bacteria are microorganisms that have
circular double-stranded DNA and (except for
mycoplasmas) cell walls.
2. Most bacteria live extracellularly (sa labas ng
cell ng host), but some preferentially reside
and replicate intracellularly.
3. Obligate intracellular pathogens are able to
grow, reproduce, and cause disease only
within the cells of the host.
4. Facultative intracellular pathogens are able to
live and reproduce either inside or outside of
host cells. (pwede siya mag adjust)
.
5. Many bacteria are present in humans as
normal microbiota, often in large numbers
and in many areas (eg, in the gastrointestinal
tract and skin). Only a few bacterial species
are human pathogens.
Hindi lahat ng bacteria masama katulad ng sa
yakult yung lactobacilli
 1. Bacteria are classified by their Gram stain
characteristics.

2. Gram staining is the application of a crystal

violet dye to a culture of bacteria.

a. Bacteria that retain the color of the dye are

called Gram positive; bacteria that don't are
Gram negative.

Usually ang nangyayari dyan kino culture siya, kukuha

ng sample sa katawan tulad sa throat tapos patutubuin
sa mga petri dish para siyang gelatin. Pag tumubo
makikita mo parang amag ang itsura niyan tapos
kukuha ng ng konti don sa colony na yon tapos ilalagay Yung plasmid dito nagrereside yung DNA na
sa slide i-stir tapos lalagyan ng dye tapos yung bacteria dinedescribe natin as circular double-stranded DNA.
na magccreate sa color of the dye, hinuhugasan yon sa
ilalim ng gripo, tapos titignan sa microscope. The Flagellum ay ginagamit panggalaw
bacteria that pertain to the color of the dye are the
gram positive violet yan and bacteria that don’t color Pilli ay pangdikit, adhere niya sa cell para hindi siya
are gram negative. mahulog or bumitaw.

1. Primary bacterial infections of the oral

mucosa seldom arise because of the oral
epithelium's protective role over the
underlying tissues, the saliva's antibacterial
characteristics, and the immune responses of
the phagocytes.

2. However, if the oral mucosa is disrupted due

to poor oral hygiene, trauma, smoking, alcohol
misuse, or any other stimuli, the risk of
primary bacterial infections goes up.

3. Immunocompromised patients such as those

with HIV, cancer, or undergoing prolonged
corticosteroid therapy are also at increased
risk.

Pag Cocci bilog

Coccus pag magisa lang siya. Cocci pag dalawa. 4 ay
tetrad. Pag madami sarcina. Pag clusters staphylococci.
Parang chain ay streptococci.
Bacilli- rods, mahahaba
Pag isa tawag ay bacillus, pag dalawa diplobacillli,
chain ay streptobacilli
Meron namang mga bacteria na spiral tulad ng
Spirochetes, spirilla at vibrio.
CHOLERA
1. Caused by Vibrio cholera
2. Transmitted by ingestion of food and water
contaminated directly or indirectly by feces or
vomitus of infected persons.
3. It is an acute enteric diseases varying in
severity.
Enteric meaning sa mga intestines like GI
4. It can cause massive diarrhea with depletion
of water and electrolytes.
Hindi talaga diarrhea ang makakasama sa
taong may cholera kundi ang effect nito which
is the dehydration
5. Diarrhea due to cholera often has a pale, milky
appearance that resembles water in which
rice has been rinsed (rice-water stool).
Part 2 18:04-34:07
6. It can be fatal.
7. Diagnosis : stool culture
8. Treatment is with electrolyte-containing
solutions (ORESOL); Ciprofloxacin
Eto yung primary hnd yung antibiotics yung primary
mo talaga yung ORESOL (ORAL REHYDRATION SALTS)
iba pa yung gatorade, alternative lang yung gatorade,
pero yung mga gamit na dapat mo talaga ibigay sa mga
dehydrated either through the IV yung ating IV fluid or
Yung Oral eto, yung Oral Rehydration Salts. Alternative
lang ang Gatorade o Pocari Sweats kasi yun yung para
sa mga hnd gusto yung lasa ng ORESOL kasi yung laso
kasi ng ORESOL parang buko na maalat yung ano, at
dahil bacteria siya, antibacterial like ciprofloxacin ang
bibigay
Leprosy (Hansen’s Disease)
● Caused by Mycobacterium leprae.
Kamag-anak siya ng TB kasi parehas silang
mycobacterium pero syempre yung leprae naman yung
leprosy. Para siya yung pinag usapan natin na gout siy
yung paget’s disease na nag-eexist noong pa noong
nagbabasa kayo ng bible nababanggit na yung leprosy
sa time ni Jesus so yun yung similarities nila. Noong
unang panahon meron ng leprosy
● Humans are the main natural reservoir for M.
leprae.
● Armadillos are the only confirmed source
other than humans, although other animal
and environmental sources may exist.
Yung mga paa ng armadillos, yung foot pads nila,
ginagamit ito pang culture ng leprosy, ng
mycobacterium leprae, kasi dun siya tutubo
● Leprosy is thought to be spread by passage
from person to person through nasal droplets
and secretions.
● Symptoms usually do not begin until > 1 yr
after infection (average 5 to 7 yr). Once
symptoms begin, they progress slowly.
● Leprosy affects mainly the skin and peripheral
nerves. Nerve involvement causes numbness
and weakness in areas controlled by the
affected nerves.
Magmamanhid siya sa lesion
● The most severe complications result from the
peripheral neuropathy, which causes
deterioration of the sense of touch and a
corresponding inability to feel pain and
temperature.
So manhid talaga wala ka talagang mararamdaman
● Patients may unknowingly burn, cut, or
otherwise harm themselves. Repeated damage
may lead to loss of digits.
Patients may unknowingly burn kasi hindi
nakakaramdam eh. So makikita mo yung mga dating
meron ng leprosy putol putol na daliri. Kaso bukod sa
epekto ng leprosy kasi parang kinakain siya, pero dahil
siguro sa frustration mo na hnd ka nakakaramdam, i
attempt mo siya i putol para subukan kung hnd ka
talaga nakakaramdam
● Muscle weakness can result in deformities (eg,
clawing of the 4th and 5th fingers caused by
ulnar nerve involvement, foot drop caused by
peroneal nerve involvement)
Yan yung epekto lng leprosy. Noong dati yung early
history ng Pilipinas, meron ng Leprosy. Ang leprosy ay
regarded as napaka nakakahawang sakit. May stigma
na nga siya. Ang pamilya mo or isa sa pamilya mo ay
may leprosy kakahiya ka or iseseperate ka sa
community. Kaya noong panahon ng mga Americans,
dinadali nila yung mga leprosy patient na ito sa
malayong lugar. Yung Mahilig pumunta ng Palawan
dito, yung Culion dati ay leprosy community or
leprosarium ito. Yung mga may leprosy doon dinadala
kasi isolated sila pero ngayon hindi na, nagagamot na
kasi yung leprosy wala yung stigma ng pagkakaroon ng
leprosy
Leprosy
● Diagnosed by skin biopsy
● Long-term, multidrug regimens with dapsone,
rifampin, and sometimes clofazimine
● Sometimes lifelong maintenance antibiotics
Leptospirosis
● Caused by Sprirochetes of the genus
Leptospira.
Nag-uulan nanaman uso nananman ito. Cause by yung
parang spiral na bacteria na nakita natin kanina
● Human infections are acquired by direct
contact with infected urine or tissue or
indirectly by contact with contaminated water
or soil.
Hindi naman kailangan dahil sa baha lang, pwede yung
nagtratrabaho ka sa farm may contact ka ng may ihi ng
daga pwede yun, hnd laging sa baha
● Outbreaks frequently follow exposure to
contaminated flood water.
Noong ondoy na doctor na ako nun tas ang daming
pasyente, bukod sa pasyenteng nag exhibit na talaga ng
symptoms at mga pasyente na medyo na naprapraning
meron na kilang leptopirosis
● Abraded skin and exposed mucous
membranes (conjunctival, nasal, oral) are the
usual entry portals.
Hindi naman pwede lagi sa sugat, pwede rin sa Mata sa
bibig, pwede pumasok yung Leptospira sa usual entry
portals pero common na sinasabi sa sugat kaya wag ka
raw maglulublub sa baha pag meron kang sulat sa paa
● Leptospirosis can be an occupational disease
(eg, of farmers or sewer workers)
Hindi kailangan lagi sa baha, lalo na sa mga sewers.
Talagang maraming ihi dun at dumi ng daga
● The incubation period ranges from 2 to 20
(usually 7 to 13) days. The disease is
characteristically biphasic.
Pag sinabi mong incubation period, eto yung time kung
saan nagsimula yung disease. Mula sa pagka contact mo
doon sa causative agent hanggang sa lumabas ang sign
and symptoms. Yun ang incubation period.
● The septicemic phase starts abruptly, with
headache, severe muscular aches, chills, fever,
cough, pharyngitis, chest pain, and, in some
patients, hemoptysis. Conjunctival suffusion
 usually appears on the 3rd or 4th day.
Defervescence (abatement of fever) follows.
The septicemic phase yung pumasok na yung leptospira
sa dugo nag cacause na ng septicemia. Ang pinaka
characteristic niyan ay yung masakit na yung muscles
sa paa, yungcalf muscles mo pag sumakit na yan tapos
nilagnat ka tapos meron kang namumula ang mala
para kang meron sore eyes. Yan isang clue yan para sa
Doctor. Tapos may past history ka na waving(?) in flood
water malamang sa hindi pwede sa leptospirosis
● The 2nd, or immune, phase occurs between
the 6th and 12th day of illness, correlating
with appearance of antibodies in serum. Fever
and earlier symptoms recur.
● Weil syndrome (icteric leptospirosis) is a
severe form with jaundice and usually
azotemia, anemia, diminished consciousness,
and continued fever.
Eto yung malalang klase. Nakakasurvive naman ang
leptospirosis, pero kung medyo nahuli ka na ng konti,
kasi nga signs and symptoms ng leptospirosis prang
trangkaso lang eh,so didismiss mo na as trangkaso
tapos leptospirosis na pala kaya may possibilidad siyang
lalala ng hnd niyo nalalaman. So eto yung malalang
klase ng Leptospirosis na tinatawag na weils syndrome.
So apektado na liver mo. Pag sinabi Azotemia renal
failure eto na yung hnd nagwowork. Nakaconfine ka
namgingilaw ka, namamanas ka na tas mwdyo delikado
na chances mo mag recover. Yung iba namamatay
● Diagnosis : Blood cultures and serologic
testing
● Prevention :
○ Avoid flood waters
Mga tubig na may possibly may ihi/dumi ng daga
○ Use PPE
Hnd yung mismong hazmat. Kasama na yung googles,
face shield. PPE talaga hnd lang hazmat, yung damit
pangprotect, pag sinabi mo PPE marami yun
○ Prophylaxis : The recommended
regimen for pre‐exposure prophylaxis
for non‐pregnant, non‐lactating
adults is: Doxycycline (hydrochloride
and hyclate) 200 mg once weekly, to
begin 1 to 2 days before exposure and
continued throughout the period of
exposure.
If hindi talaga maiwasan lumusob sa bahaa, halimbawa
goverment embolyee ka tas need mo talagang lumusob
sa baha pwede mo gawin ang Prophylaxis for non
pregnant, non lactating adult.
So halimbawa kalulusub mo lang sa baha. 1-2 days
before iinom ka na hanggang sa may exposure ka pa sa
baha
● Treatment : Penicillin or Doxycycline
Weils Syndrome
● Icterus(jaundice)
○ Yellowing of the eye globes
○ Yellow epidermis
○ Dark Urine
Dark Urine kasi nga sira na kidneys mo kailangan mo
na magpadialysis
Typhoid fever
● A systemic disease caused by Salmonella
serotype Typhi.
● Typhoid bacilli are shed in stool of
asymptomatic carriers or in stool or urine of
people with active disease.
● Inadequate hygiene after defecation may
spread S. Typhi to community food or water
supplies.
Dati alam mo nagkaroon ng typhoid outbreak dito sa
may UST. UST SA UST kasi ako nakatira kasi raw yung
mga tubo ng tubig at tubo ng nga sewers medyo
nagkalawang na so nag agas agas sila sobyung tubo ng
sewers ,syempre alam na natin laman nun ng posi negro
natin, nagakalusot nakapasok sa may inuman ng tubig
so ang raming mga tao nagkaroon ng typhoid
● Signs and symptoms include fever, rash,
splenomegaly and leukopenia, and sometimes
intestinal bleeding or perforation.
Pero usually yung mga characteristics ng nga may
typhoid fever masakit na masakit ang ulo, may lagnat
at masakit na masakit ang ulo tas hnd ka gumagaling
agad
● Cultures of blood, stool, and urine should be
obtained.
● Treatment : Ceftriaxone; sometimes a
fluoroquinolone or azithromycin.
Yung ceftriaxone iniinject yan
Diphtheria
● Diphtheria is an acute pharyngeal or
cutaneous infection caused mainly by
toxigenic strains of Corynebacterium
diphtheriae and rarely by other, less common
Corynebacterium sp.
● Symptoms are either nonspecific skin
infections or pseudomembranous pharyngitis.
Eto yung pinakacharacteristics niya
pseudomembranous pharyngitis
● If a toxigenic strain is involved, the
characteristic membrane appears in the
tonsillar area. It may initially appear as a
white, glossy exudate but typically becomes
dirty gray, tough, fibrinous, and adherent so
that removal causes bleeding.
Parang tonsillitis.
● Local edema may cause a visibly swollen neck
(bull neck), hoarseness, stridor, and dyspnea.
The membrane may extend to the larynx,
trachea, and bronchi and may partially
obstruct the airway or suddenly detach,
causing complete obstruction.
Dahil nga sa pagmamaga ngbibig mo or throat mo,
medyo mahihirapan kang huminga. Namamaos ka tas
sa paghinga mo labored na nahihirapan kang huminga
Pseudomembranous Pharyngitis
Left pic (bull neck) right pic (Pseudomembranous
Pharyngitis makikita mo saan mo easily maoobserve
tonsillitis eto yung may puting exowing(?) parang nana
ayan tas nag stistirde(?) yan nagcacause ng signa and
symptoms ng Pseudomembranous Pharyngitis )
● Diagnosis is clinical and confirmed by culture.
● Treatment is with antitoxin and penicillin or
erythromycin.
● Childhood vaccination should be routine.
Actually etong Diphtheria ay isa sa mga component na
vaccine na DPT (Diphtheria, Pertussis, Tetanus)
Pertussis (WHOOPING COUGH)
Characteristics niya ay inuubo pero hnd yung normal na
inuubo, may hagot ng ubo
● Pertussis is a highly communicable disease
occurring mostly in children and adolescents
and caused by Bordetella pertussis.
● Symptoms are initially those of nonspecific
URI followed by paroxysmal or spasmodic
coughing that usually ends in a prolonged,
high-pitched, crowing inspiration (the
whoop).
● Diagnosis is by nasopharyngeal culture, PCR,
and serologic assays.
● Treatment is with macrolide antibiotics.
Tetanus (Lockjaw) TREATMENT OF TETANUS
· Tetanus is acute poisoning from a - Human tetanus immune globulin and
neurotoxin produced by Clostridium intensive support.
tetani.
· May follow trivial or even inapparent Syphilis
wounds. - Madaming sexually transmitted disease
· Infection may also develop postpartum in pero ito ang napili kong representative.
the uterus (maternal tetanus) and in Tsaka, may oral manifestation kasi itong
neonate’s umbilicus (tetanus syphilis.
neonatorum). - Syphilis is caused by a spirochete known
· C. tetani spores usually enter through as Treponema Pallidum that can be
contaminated wounds. Manifestations of sexually transmitted (vaginal, anal or oral
tetanus are caused by an exotoxin contact) or passed through the placenta,
(tetanospasmin) produced by the causing congenital syphilis.
germinating spores. - It has an incubation period of
· The toxin may enter the CNS along the approximately 20 to 40 days.
peripheral motor nerves or may be - The host for T. pallidum is humans, and it
bloodborne to nervous tissue. has no animal reservoir.
· Most often, tetanus is generalized, - Approximately 4 to 12% of syphilis
affecting skeletal muscles throughout the patients will present with oral
body. However, tetanus is sometimes manifestations and are usually diagnosed
localized to muscles near an entry wound. in the secondary phase of the disease.
- The mean age of syphilis diagnosis is
1. The incubation period ranges from 2 to 50 around 34 years old, of which 51% are
days (average, 5 to 10 days). Symptoms men.
include: - The oral manifestation of syphilis is
- Jaw stiffness (most frequent) usually the first sign of the disease.
- Restlessness - The initial oral lesion characteristic of
- Difficulty swallowing primary syphilis, known as chancre,
- Irritability appears at the site of inoculation around 2
- Stiff neck, arms or legs weeks after the exposure
- Sore throat - The most common locations are the
- Headache buccal mucosa, tongue and lips
- Tonic spasms (Risus Sardonicus)
- Usually ang unang manifestation ay sa Secondary Syphilis
kamay, naninigas ang mga daliri. - Secondary syphilis is a highly contagious
2. Later, patients have difficulty opening stage that appears 2 to 8 weeks after the
their jaw (trismus). primary chancre emerges.
 - In this period, oral lesions can be
maculopapular or mucosal patches
- The mucosal patches are more common,
appearing as lightly raised or shallow oval
ulcers surrounded by an erythematous
border with gray pseudomembrane.
- Lesions on the tongue may appear as
irregular fissures or pronounced
ulcerations
- Unlike the primary syphilis, oral lesions in
the secondary stage of the disease are
multiple and painful. Patients also report
sore throats
- Systemic symptoms include fever and
lymphadenopathy
- In the skin, a maculopapular rash
involving the palms and soles and
alopecia may be found.
- Condylomata lata, a painless, smooth
wart-like lesion, can be observed on the
genitals during this period.
Tertiary Lesions
- Tertiary syphilis is a destructive stage that
manifests months or years after the initial
lesion infection in patients who have not
received effective treatment during the
primary or secondary stages of the
disease
- Oral manifestations of this phase include
a chronic granulomatous gumma usually
located on the hard palate, which may
perforate into the nasal septum
- The tongue may present with leukoplakia
dorsally or appear atrophic and fissured.
Diagnosis
- Syphilis can be screened via
nontreponemal serological tests, such as
the venereal disease research laboratory
(VDRL) and rapid plasma reagin (RPR)
tests.
- If these are positive, then further testing
is mandatory/
- Additional specific treponemal tests are
required to rule out or confirm the
diagnosis of syphilis, like the fluorescent
treponemal antibody absorption
(FTA-ABS) test or treponema pallidum
microhemagglutination assay (TP-MHA)
TREATMENT
- The chancre and oral lesions in primary
syphilis are self-limiting and heal without
scar in three to six weeks.
- A single dose of long-acting benzathine
penicillin (2.4 million units)
intramuscular is the drug of choice if
primary lesions persist and for secondary
syphilis.
- Tertiary syphilis is also treated with
intramuscular benzathine penicillin G
once weekly for 3 to 4 weeks
- The duration of treatment depends on the
stage of the disease and its manifestations
- Patients who are allergic to penicillin are
alternatively treated with doxycycline,
tetracycline or ceftriaxone.
- Patients diagnosed with syphilis, even if
receiving treatment, should abstain from
any sexual activity to prevent the spread
of the disease.
- In addition, the sexual partners of a
syphilis patient should be notified, tested
and treated accordingly
COMPLICATIONS
 - Untreated syphilis can lead to
cardiovascular and neurological syphilis.
- These complications are irreversible, as
the treatment of syphilis can prevent
further damage but not repair the one
that is already done.
- Patients with a high titer of secondary
syphilis, who are being treated
with penicillin, can develop a fever higher in children.
Jarisch-Herxheimer reaction.
- Jarisch Herxheimer reaction (JHR) is a
transient clinical phenomenon that occurs
in patients infected by spirochetes who
undergo antibiotic treatment.
- The reaction occurs within 24 hours of
antibiotic treatment of spirochete
infections, including syphilis,
leptospirosis, Lyme disease, and relapsing
fever.
- JHR usually manifests as fever, chills,
rigors, nausea and vomiting, headache,
tachycardia, hypotension,
hyperventilation, flushing, myalgia, and
exacerbation of skin lesions.
Scarlet Fever
- Scarlet fever is a bacterial infection that develops in
patients suffering from bacterial pharyngitis - strep
throat - and occasionally from streptococcal skin or
wound infections.
- The causative agent is Streptococcus pyogenes, which
belongs to the gram-positive A beta-hemolytic
streptococci group (GABHS).
- Humans are the primary reservoir for this bacterium,
with approximately 2 to 5 days of incubation.
- Scarlet fever, also known as scarlatina, can spread
directly from person to person via infected saliva or
nasal secretions.
- There is a higher risk of transmission in crowded
conditions such as daycare centers and schools.
- Scarlet fever can occur in all age groups,
but it is more prevalent amongst children
between 5 to 15 years old.
- Strep throat is responsible for 15 to 30%
of all pharyngitis in children and 5 to 15%
in adults, making the prevalence of scarlet
- Scarlet fever is seen more in
underdeveloped countries due to
crowded living circumstances.
- Scarlet fever is typically associated with
acute pharyngitis with accompanying
symptoms such as sore throat, fever, odynophagia,
cervical adenopathy.
- The skin presents with a papular-blanching rash,
covering most of the body.
- This rash is described as a "sandpaper rash" because
of the lesions' lack of
confluence.
- It develops on the face, trunk, underarms, and groin
first, spreading to the
extremities later, sparing the palms and soles.
- Scarlet fever has a common oral manifestation known
as "strawberry tongue"
because of the hyperplastic fungiform papillae and
white coating; as the white
coating resolves, the remaining papules give the
tongue a red, bumpy appearance.
- The throat may also appear erythematous along with
white or yellowish patches
making swallowing painful.
- Scarlet fever is sometimes clinically
diagnosed through history and physical
examination, although this may be
challenging because of its earlier stages'
wide variety in severity.
- Throat cultures and rapid strep tests can Part 3
be performed to identify group A strep
This is an example of a mouth having microstomia.
(GAS).
- The first-line treatment for GAS infections
is beta-lactam antibiotics due to their
clinical efficacy and low cost.
- Penicillins usually outperform
cephalosporins and macrolides.
- If the patient is allergic to penicillin, the
first-generation cephalosporin is effective
in reducing morbidity and mortality.
- Penicillin (V) is typically prescribed four
times a day for ten days, and other
systemic symptoms may be treated with
acetaminophen or ibuprofen and fluid
replenishment. Sjogren Syndrome

- The oral manifestations tend to resolve

● It is the association of dry mouth
within two weeks.
(xerostomia) with dry eyes.
- Untreated scarlet fever can lead to
● Primary Sjogren’s or “Sicca syndrome” is
rheumatic fever, which affects the heart,
the association of dry mouth with dry eyes
joints, skin, and brain.
(keratoconjunctivitis sicca) in the absence of
- The risk of having these complications is
any connective tissue disease.
higher in children, and they usually
● Secondary Sjogren’s refers to the association
develop 2 to 3 weeks after the initial
of dry mouth and dry eyes, with another
infection.
connective tissue disease usually RA, less
- Scarlet fever can also lead to renal
frequently SLE, Scleroderma or Polymyositis.
complications, such as post-streptococcal
● It is an autoimmune exocrinopathy –
glomerulonephritis; this is also more
lacrimal, salivary and other exocrine glands
common in children than adults and can
are infiltrated by lymphocytes and plasma
occur within a few weeks of throat
cells, causing progressive acinar destruction
infection or 3 to 6 weeks after GAS skin
and often multisystem disease.
infection.

- This is all about dryness.

Clinical Manifestations
 ● Denture hygiene is important because of
susceptibility to candidiasis.

Granulomatous Diseases

● Granulomatous diseases are those that often

associated with granuloma formation that
affects certain parts of the body.
● A granuloma or nodules is an aggregation of
macrophages that forms in response to
chronic inflammation. This occurs when the
Treatment and management immune system attempts to isolate foreign
substances that it is otherwise unable to
● Management is largely symptomatic though
eliminate.
there have been attempts at
● Type IV hypersensitivity reactions seems to be
immunosuppression to control the disease
involved in its pathogenesis.
process.

Chronic Granulomatous Disease (CGD)

Dental Correlations

● Chronic granulomatous disease is

● Oral involvement results in the discomfort
characterized by white blood cells that
caused by poor salivary flow, obvious dryness
cannot produce activated oxygen compounds
of the mucosa in severe cases, and erythema
and by defects in phagocytic cell
and lobulation of the tongue.
microbicidal function.
● Persistent dryness of the mouth can cause
● Manifestations include recurrent infections
difficulty in speaking, swallowing, or
(pneumonia, skin or soft tissue infections like
managing dentures, disturbed taste sensation
cellulitis or abscesses, bone and joint
and accelerated caries and susceptibility to
infections like osteomyelitis and septic
oral candidiasis and to bacterial sialadenitis.
arthritis) ; multiple granulomatous lesions of
● Swelling of the parotid glands have been
the lungs, liver, lymph nodes, and
observed.
gastrointestinal and genitourinary tracts;
● Dry mouth can be helped symptomatically by
abscesses; lymphadenitis;
frequent sipping of water or sugar free drinks
hypergammaglobulinemia; elevated
or sucking ice.
erythrocyte sedimentation rate; and anemia.
● Salivation may be induced by sialogogues like
● Diagnosis is by assessing oxygen radical
Pilocarpine.
production in white blood cells via a flow
● Chewing sugar free gum or sucking citrus
cytometric oxidative burst assay.
lozenges may help salivation.
● Treatment is with antibiotics, antifungal
● Preventive dental care is important because
drugs, and interferon gamma; granulocyte
patients have the tendency to consume a
transfusions may be needed.
cariogenic diet because of impaired taste.
Wegener’s Granulomatosis ● Eye problems develop in many people with
GPA. The eye problems range from mild
● It is an uncommon disorder that causes
conjunctivitis to severe swelling of the eye.
inflammation of your blood vessels. This
inflammation restricts blood flow to various Diagnosis
organs.
● A more specific blood test used to diagnose
● It is also called granulomatosis with
and monitor Wegener's granulomatosis is the
polyangiitis (GPA), often affects your
antineutrophil cytoplasmic antibody
kidneys, lungs and upper respiratory tract.
(ANCA test), which is commonly elevated
The restricted blood flow to these organs can
when the disease is active.
damage them.
● The diagnosis of Wegener's granulomatosis is
● It also produces a type of inflammatory tissue
confirmed by detecting both abnormal cellular
known as a granuloma that's found around
formations, called granulomas, and vasculitis
the blood vessels.
in a biopsy of tissue involved with the
● Its cause is unknown
inflammatory process. For examples, an open
● It appears to develop after an initial
lung biopsy or a kidney biopsy are commonly
inflammation-causing event triggers an
used in making a diagnosis of Wegener's
abnormal reaction from your immune system.
granulomatosis.
The combination of these events can lead to
inflamed, constricted blood vessels and
Treatment and management
harmful inflammatory tissue masses
(granulomas). The triggering event may be an ● Corticosteroids
infection, but no specific infection has been ● Immunosuppresant drugs
identified as the cause. ● Plasmapheresis.

Clinical Manifestations - Also known as plasma exchange, this

treatment removes the liquid portion of your
● Frequent sinusitis is the most common
blood (plasma) and separates it from the
symptom. Other early symptoms include a
blood cells. The blood cells are then put back
fever that has no clear cause, night sweats,
into your body, and your body produces new
fatigue, and a general ill feeling (malaise).
plasma to make up for what was removed. In
● Chronic ear infections are common. Other
people who have very serious Wegener's
upper respiratory symptoms include nose
granulomatosis, plasmapheresis can help the
bleeds, pain, and sores around the opening of
kidneys recover.
the nose.
● Loss of appetite and weight loss are common. The problem in Wegener’s relies on the liquid
Skin changes are also common, but can take part of your blood --- the plasma.
several forms.
● There may be symptoms of kidney disease. - You will literally clean the plasma.

The urine may be bloody. You can get rid of the dirty plasma
 through plasmapheresis. Your whole inflammatory cells (granulomas) that can
blood is brought out of your body, form as nodules in multiple organs. The
clean by the dialysis, then brought granulomas are most often located in the
back to your body. lungs or its associated lymph nodes, but any
organ can be affected.
● Surgery – Kidney transplant
● Sarcoidosis seems to be caused by an immune
reaction to an infection or some other trigger
Dental Correlations
that continues even after the initial infection
● The oral lesions commonly associated with or other antigen is cleared from the body.
Wegener’s may be the initial of the disorder
Clinical Manifestations
before several organs become involved.
● The most characteristic oral complication is a
● Abortive or acute sarcoidosis
hyperplastic gingivitis often referred to as
“strawberry gums”. - Most commonly manifest itself as the
● The gingiva appears red to purplish in color so-called Lofgren’s syndrome,
with granular surface texture. characterized by polyarthritis,
● Extensive inflammation and ulceration of the erythema nodosum and bilateral
oral mucosa also have been associated with hilar adenopathy.
Wegener’s.
- Hilar adenopathy is the
● The dentist may play an important role in the
enlargement of the lymph nodes in
early detection of Wegener’s by associating
the higher part of your lungs.
oral manifestations with the systemic changes
of mild anemia, leukocytosis, thrombocytosis
- Articular manifestations of acute
and elevated ESR.
sarcoidosis may be profound,
characterized by stiffness and pain in
Strawberry Gums
several joints.

- The most dramatic articular finding

is inflammation, predominantly in
tissues surrounding the ankle –
periarthritis.

● Chronic sarcoidosis

- Characterized by pulmonary
smptoms, manifestations of
extrathoracic involvement and
Sarcoidosis
constitutional symptoms of fever,
● Sarcoidosis, also called sarcoid, is a disease malaise and weight loss
involving abnormal collections of
 - It may be seen as asymptomatic
bilateral hilar adenopathy detected
on Xray.

- Hemoptysis – coughing out of blood.

- Granulomatous lesions of the nose,

nasopharynx and larynx occasionally
develop

- Sarcoid skin lesions like

macupapular rashes, plaques,
subcutaneous nodules and scars.

- Uveitis

- Hepatosplenomegaly

- Pain in the hands and feet caused by

“punched-out” bony lesions or
destruction of bone surfaces.

Diagnosis

● The diagnosis can be established by histologic

examination of the affected tissue notably the
skin, lymph nodes and liver.
● To be certain of the diagnosis, it is useful to
demonstrate sarcoid lesions in at least two
separate organs.
● — It is the most common cause of hepatic
granulomata.
● Xray findings: bilateral hilar adenopathy

- Notice is the group of whites, that is

your hilar adenopathy.
Treatment and management

● There’s no cure for it.

● It often goes away on its own.
● If organ function is threatened, you will likely
be treated with a medication.
○ Corticosteroids.
 ○ Anti-rejection medications.
○ Anti-malarial medications.
○ Tumor necrosis factor-alpha
(TNF-alpha) inhibitors.
● Organ transplant may be considered if
sarcoidosis has severely damaged your lungs
or liver.

Dental Correlations

● The most commonly reported involvement of

structures associated with the oral cavity in
patients with the oral cavity in patients with
sarcoidosis are asymptomatic
lymphadenopathy and parotid gland
enlargement.
● The granulomatous lesions affecting the
salivary glands may cause xerostomia.
● Sarcoid involvement of the maxilla and
mandible have been reported
● Increased tooth mobility and failure of
extraction sites to heal have been attributed to
intrabony sarcoid lesions.
● Dental management is usually unremarkable.
● Sialogogues may be used such as Pilocarpine
in cases of xerostomia.
PRINCIPLES OF MEDICINE (10-03-22)

Midterm on Oct. 21 and is open the whole day.

VIRUSES

● Viruses are the smallest parasites, typically

ranging from 0.02 to 0.3 micrometer, although
several very large viruses up to 1 micrometer
long (megavirus, pandoravirus) have recently
been discovered.
● Viruses are not living things. Viruses are
complicated assemblies of molecules, Ito yung typical na structure ng isang virus.
including proteins, nucleic acids, lipids, and
carbohydrates, but on their own they can do
nothing until they enter a living cell. Without
cells,viruses would not be able to multiply.
● Viruses depend completely on cells (bacterial,
plant, or animal) to reproduce. Viruses have
an outer cover of protein and sometimes lipid,
an RNA or DNA core, and sometimes enzymes
needed for the first steps of viral replication.
● Viruses are classified principally according to
the nature and structure of their genome and
their method of replication, not according to
the diseases they cause.
● Viral infections are often readily transmitted Nakikita niyo yung phage, nagaadhere siya don sa host
in saliva and other body fluids, and where cell and will inject his genetic material. Yung genetic
general hygiene is low and there is close material ng virus will try corporate to the genetic
contact with other persons or their secretions, material ng host cell. Pagkasama na nung cell yung
infections are common. genetic material ng virus, imbis na magrereplicate yung
○ Dito na pumapasok yung mga sexually host cell, yung virus ang dadami.
transmitted disease
● The consequences of viral infection vary
considerably.
● Many infections cause acute illness after a
brief incubation period.
○ So yung range ng mga sakit involving
viral diseases mula sa pinakasimple
hanggang sa pinakamalala.
○ Ex. yung simpleng sipon up to yung
COVID
● Some remain in a latent state, and some cause
chronic disease.
● In latent infection, viral RNA or DNA remains Summary of the difference between your bacteria and
in host cells but does not replicate or cause virus
disease for a long time, sometimes for many
years. Sometimes a trigger (particularly Fever is a common systemic infection indication
immunosuppression) causes reactivation.
○ Latent infection ay wala ka nang sakit
pero yung virus ay magpapaiwan so
nakatago lang siya. DENGUE (BREAKBONE FEVER)

● Dengue is a mosquito-borne disease (Aedes

mosquito) caused by a flavivirus.
● Dengue fever usually results in abrupt onset of
high fever, headache, myalgias, arthralgias,
and lymphadenopathy, followed by a rash that
 ● appears with a 2nd temperature rise after Maglalabas ka ng 1x1 inch na square and kapag meron
afebrile period. kang 20 and above na petechial rashes ay positive yun
○ Yung rash ng dengue maviolet parang pero di siya specific kasi di porke positive ay dengue ka
pasa na. Kasi pwede magmimick yung ibang sakit tulad ng
● Respiratory symptoms, such as cough, sore trangkaso. Madalas tong ginagawa sa health centers.
throat, and rhinorrhea, can occur. Kung malayo ka sa mga hospital at least may idea ka
○ May dalawang klase ang dengue: kahit papano
■ Dengue fever syndrome - it
yung usual na may fever, sakit Part 2: 17:30-35
ng ulo at katawan; sa
laboratory ay mababa yung Herpes simplex virus (HSV)
platelet tapos positive sa
serologic test pero walang 2 subtypes of HSV:
signs ng pagdudugo or rash
■ Dengue hemorrhagic fever - a.HSV-1 – more frequently causes oral lesions
ito na yung may signs ng
bleeding (ilong, gilagid, etc) b.HSV-2 – usually isolated from the genital area
● Dengue can also cause potentially fatal
hemorrhagic fever with a bleeding tendency 2.Both subtypes can cause both oral and genital
and shock. lesions
● Diagnosis involves serologic testing and PCR.
○ Wag kumain ng maiitim like dinuguan,
chocolate. Wag din iinom ng iron kasi
iitim ang poopoo mo. Bakit? Kasi
imimick niya ang bleeding kasi isa sa
mga pwedeng panggalingan ng
dengue ng patient ay sa pwet (rectal HSV
bleeding) pero not in the form of fresh
blood, yun ay patay na dugo (kulay 1.Acute Gingivostomatitis is the most common
itim dahil nag-oxidize na yung blood) manifestation in childhood.
● Treatment is symptomatic and, for dengue
hemorrhagic fever, includes meticulously 2.The illness begins with fever and inflammation of the
adjusted intravascular volume replacement. oral mucosa.
○ Wala talagang eksaktong treatment
nito pero main sa managment ng 3.Regional lymph nodes become tender.
dengue ay yung hydration na either
oral or IV kasi nakakatulong sa
pagtataas ng platelet

HSV
1. Persistence should prompt an investigation for
immunodeficiency.
2.Gingivostomatitis can lead to dehydration as a result
of limitation of oral intake because of the painful
mouth lesions.
3.Treatment of HSV infections like gingivostomatitis is
supportive
*Nawawala na sa part na to yung record* Ano ibig
4.Topical anesthetics and systemic analgesics provide
sabihi ng ng 100? Doon mo iinflate ulit yung cuff
some relief from the pain.
hanggang sa 100 tas ipapastay-in mo siya for 5-10 mins.
5.Young children occasionally require intravenous
After 5-10 mins and observe mo siya kung san
hydration.
nagbebend yung elbow mo (cubital area) kasi doon
Varicella-Zoster Virus
typically lumalabas yung rash ng dengue.
 ● Herpes virus Varicellae, the cause of both
zoster (shingles) and varicella (chickenpox)
has a worldwide distribution.
● 2.Transmission is by airborne droplets and
direct contact with infectious lesions.
● 3.The individual is considered contagious
from 1 to 2 days before the eruption until all
lesions are crusted usually 6 to 7 days after
eruption.
● In contrast to varicella, zoster occurs
predominantly in adults.
● 2.Since reactivation of latent virus is the
antecedent of the eruption in zoster, an
individual does not acquire the disease from
an exogenous source.
Varicella
1.A mild 1 to 3 day prodrome of fever and malaise
frequently precedes the exanthem
2.The presence of the rash is often the first sign of
illness.
3.The lesions become pustular and then crust.
4.Lesions initially develop on the face and trunk and
erupt in successive crops; some macules appear just as
earlier crops begin to crust.
5. The eruption may be generalized (in severe cases)
or more limited but almost always involves the upper
trunk.
6.Oral lesions are characterized by small blister-like
manifestations that involve various areas of oral
mucosa. Oral lesions resemble vesicles of primary HSV,
but these lesions are not particularly an important
symptomatic, diagnostic, or management problem.
Zoster
1.In Zoster infection (shingles) fever may or may not
be present.
2.The infection is often preceded by neuralgia, which is
generally more sever in adults.
3.Lesions are confined to single dermatomal area
4.The appearance and evolution of lesions are the
same with varicella infection.
.
Varicella-Zoster Virus
1.The typical case of varicella or zoster is diagnosed on
the basis of clinical features.
2.Symptomatic treatment is provided in the form of
analgesics and antipruritics
3.Ocular involvement in cases of zoster needs the
attention of an Ophthalmologist.
4.Aciclovir is considered by some the treatment of
choice.
Herpangina
1.It is characterized by sudden onset of fever with sore
throat, headache, anorexia, and frequently neck pain.
2.Infants may vomit.
3.Within 2 days after onset, up to 20 (mean, 4 to 5) 1-
to 2-mm diameter grayish papules develop and
become vesicles with erythematous areolae.
4.They occur most frequently on the tonsillar pillars
but also on the soft palate, tonsils, uvula, or tongue.
5.During the next 24 h, the lesions become shallow
ulcers, seldom > 5 mm in diameter, and heal in 1 to 7
days.
Herpangina
1.Diagnosis is based on symptoms and characteristic
oral lesions.
2.Treatment is symptomatic.
Hand-Foot-and-Mouth Disease
1.The disease is most common among young children.
The course is similar to that of herpangina.
2.Hand, foot, and mouth disease is caused by viruses
that belong to the Enterovirus genus (group),
including polioviruses, coxsackieviruses, echoviruses,
and enteroviruses.
Hand-Foot-and-Mouth Disease
1.Children have a sore throat or mouth pain and may
refuse to eat.
2.Fever is common.
3.Vesicles are distributed over the buccal mucosa and
tongue, the hands and feet, and, occasionally, the
buttocks or genitals; usually, the vesicles are benign
and short-lived.
4.The diagnosis of hand-foot-and-mouth disease is
usually made clinically.
5.Treatment is symptomatic.
Mumps
1.Paramyxovirus
2.Transmission is by direct contact or by contact with
droplets of saliva that contains several virus several
days before and up to 1 week after the swelling of the
Parotids appears.
Mumps
1.After a 12- to 24-day incubation period, most people
develop headache, anorexia, malaise, and a low- to
moderate-grade fever.
2.The salivary glands become involved 12 to 24 h later,
with fever up to 39.5 to 40° C.
3.Fever persists 24 to 72 h.
4.Parotitis is usually bilateral but may be unilateral,
especially at the onset.
5.Pain while chewing or swallowing, especially while
swallowing acidic liquids such as vinegar or citrus
juice, is its earliest symptom.
6.It later causes swelling beyond the parotid in front of
and below the ear.
Mumps
1.About 20% of postpubertal male patients develop
orchitis (testicular inflammation), usually unilateral,
with pain, tenderness, edema, erythema, and warmth
of the scrotum.
2.Some testicular atrophy may ensue, but testosterone
production and fertility are usually preserved.
3.In females, oophoritis (gonadal involvement) is less
commonly recognized, is less painful, and does not
impair fertility.
Mumps
1.Treatment of mumps and its complications is
supportive. The patient is isolated until glandular
swelling subsides.
2.A soft diet reduces pain caused by chewing.
3.Acidic substances (eg, citrus fruit juices) that cause
discomfort should be avoided.
4.For orchitis, bed rest and support of the scrotum in
cotton on an adhesive-tape bridge between the thighs
to minimize tension or use of ice packs often relieves
pain.
- Ang beke ay hindi cause ng pagblow ng balloon.
Tina nilalagay lang yan para malaman nila na
may beke ka. Para layuan ka nila kase
nakakahawa ka.
Measles (Rubeola)
1. Paramyxovirus
2. Measles is spread mainly by secretions from
the nose, throat, and mouth during the
prodromal or early eruptive stage.
3. Communicability begins several days before
and continues until several days after the rash
appears.
4. Measles is not communicable once the rash
begins to desquamate.
1. After a 7- to 14-day incubation period,
measles begins with a prodrome of fever,
coryza, hacking cough, and tarsal
conjunctivitis.
2. Pathognomonic Koplik spots (white spots)
appear during the prodrome, before the onset
of rash, usually on the oral mucosa opposite
the 1st and 2nd upper molars.
3. The spots resemble grains of white sand
surrounded by red areolae. They may be
extensive, producing diffuse mottled
erythema of the oral mucosa.
1. The rash appears 3 to 5 days after symptom
onset, usually 1 to 2 days after Koplik spots
appear.
2. It begins on the face in front of and below the
ears and on the side of the neck as irregular
macules, soon mixed with papules.
3. Within 24 to 48 h, lesions spread to the trunk
and extremities (including the palms and
soles) as they begin to fade on the face.
4. Petechiae or ecchymoses may occur with
severe rashes.
5. During peak disease severity, a patient’s
temperature may exceed 40° C, with
periorbital edema, conjunctivitis,
photophobia, a hacking cough, extensive rash,
prostration, and mild itching.
 6. In 3 to 5 days, the fever falls, the patient feels
more comfortable, and the rash fades rapidly,
leaving a coppery brown discoloration
followed by desquamation.
- Kinakakatakutan dati ng mga
magulang is kapag may measles, baka
magka pneumonia din. Yun ang
kinakamatayan.
- Tigdas hangin di totoo na hindi
kailanganang mahanginan. Pwedeng
maligo.
1. Diagnosis is by identifying the clinical
manifestations.
2. Treatment is supportive.
German measles (rubella)
1. Rubella is caused by an RNA virus, rubella
virus, which is spread by respiratory droplets
through close contact or through the air.
2. Immunity appears to be lifelong after natural
infection.
- German measles, may lagnat lang.
Hindi gaya ng measles na may ubo’t
sipon. Usually ito ay common sa
malalaking bata at adults. Ang
characteristic nito ay may kulani siya
na kapag pinindot mo ay masakit.
1. Many cases are mild. After a 14- to 21-day
incubation period, a 1- to 5-day prodrome,
usually consisting of low-grade fever, malaise,
conjunctivitis, and lymphadenopathy, occurs
in adults but may be minimal or absent in
children.
2. Tender swelling of the suboccipital,
postauricular, and posterior cervical nodes is
characteristic.
3. The rash is similar to that of measles but is
less extensive and more evanescent; it is often
the first sign in children.
1. It begins on the face and neck and quickly
spreads to the trunk and extremities.
2. On the 2nd day, the rash often becomes more
scarlatiniform (pinpoint) with a reddish flush.
3. Petechiae form on the soft palate
(Forschheimer spots), later coalescing into a
red blush.
4. The rash lasts 3 to 5 days.
5. Constitutional symptoms in children are
absent or mild and may include malaise and
occasional arthralgias.
6. Adults usually have few or no constitutional
symptoms but occasionally have fever,
malaise, headache, stiff joints, transient
arthritis, and mild rhinitis.
7. Fever typically resolves by the 2nd day of the
rash.
Forschheimer spots
1. Rubella is suspected in patients with
characteristic adenopathy and rash.
2. Treatment is symptomatic.
Monkeypox
1. Monkeypox is a rare disease caused by
infection with the monkeypox virus.
Monkeypox virus is part of the same family of
 viruses as variola virus, the virus that causes
smallpox. Monkeypox symptoms are similar
to smallpox symptoms, but milder, and
monkeypox is rarely fatal. Monkeypox is not
related to chickenpox.
2. Monkeypox was discovered in 1958 when two
outbreaks of a pox-like disease occurred in
colonies of monkeys kept for research. Despite
being named “monkeypox,” the source of the
disease remains unknown. However, African
rodents and non-human primates (like
monkeys) might harbor the virus and infect
people.
3. The first human case of monkeypox was
recorded in 1970.
- Hindi ito kamag-anak ng chicken pox..
Kamag-anak ito ni smallpox. Smallpox is fatal
pero ang monkeypox ay mild lang naman.
- Stage of development of lesions is sabay-sabay.
Monkeypox : Symptoms
1. Symptoms of monkeypox can include:
1. Fever
2. Headache
3. Muscle aches and backache
4. Swollen lymph nodes
5. Chills
6. Exhaustion
2. A rash that can look like pimples or blisters
that appears on the face, inside the mouth,
and on other parts of the body, like the hands,
feet, chest, genitals, or anus.
3. The rash goes through different stages before
healing completely. The illness typically lasts
2-4 weeks. Sometimes, people get a rash first,
followed by other symptoms. Others only
experience a rash.
Monkeypox : Transmission
1. Monkeypox spreads in different ways. The
virus can spread from person-to-person
through:
1. direct contact with the infectious
rash, scabs, or body fluids
2. respiratory secretions during
prolonged, face-to-face contact, or
during intimate physical contact, such
as kissing, cuddling, or sex
3. touching items (such as clothing or
linens) that previously touched the
infectious rash or body fluids
4. pregnant people can spread the virus
to their fetus through the placenta
2. It’s also possible for people to get monkeypox
from infected animals, either by being
scratched or bitten by the animal or by
preparing or eating meat or using products
from an infected animal.
3. Monkeypox can spread from the time
symptoms start until the rash has fully healed
and a fresh layer of skin has formed. The
illness typically lasts 2-4 weeks. People who
do not have monkeypox symptoms cannot
spread the virus to others.
Monkeypox : Prevention
1. Take the following steps to prevent getting
monkeypox:
1. Avoid close, skin-to-skin contact with
people who have a rash that looks like
monkeypox.
2. Do not touch the rash or scabs of a
person with monkeypox.
3. Do not kiss, hug, cuddle or have sex
with someone with monkeypox.
4. Do not share eating utensils or cups
with a person with monkeypox.
5. Do not handle or touch the bedding,
towels, or clothing of a person with
monkeypox.
6. Wash your hands often with soap and
water or use an alcohol-based hand
sanitizer.
7. Vaccination
2. If you are sick with monkeypox:
1. Isolate at home
2. If you have an active rash or other
symptoms, stay in a separate room or
area away from people or pets you
live with, when possible.
Monkeypox : Treatment
1. There are no treatments specifically for
monkeypox virus infections.
2. However, monkeypox and smallpox viruses
are genetically similar, which means that
antiviral drugs and vaccines developed to
protect against smallpox may be used to
prevent and treat monkeypox virus infections.
COVID-19 Disease
1. COVID-19 is the disease caused by a new
coronavirus called SARS-CoV-2.
2. WHO first learned of this new virus on 31
December 2019, following a report of a cluster
of cases of ‘viral pneumonia’ in Wuhan,
People’s Republic of China.
1. Anyone with symptoms should be tested,
wherever possible.
2. People who do not have symptoms but have
had close contact with someone who is, or
may be, infected may also consider testing –
contact your local health guidelines and follow
their guidance.
3. While a person is waiting for test results, they
should remain isolated from others.

COVID-19 Disease : Symptoms

1. In most situations, a molecular test is used to
1. The most common symptoms of COVID-19 are detect SARS-CoV-2 and confirm infection.
1. Fever 2. Polymerase chain reaction (PCR) is the most
2. Dry cough commonly used molecular test. Samples are
3. Fatigue collected from the nose and/or throat with a
2. Other symptoms that are less common and swab.
may affect some patients include: 3. Molecular tests detect virus in the sample by
1. Loss of taste (ageusia) or smell amplifying viral genetic material to detectable
(anosmia), levels. For this reason, a molecular test is used
2. Nasal congestion, to confirm an active infection, usually within a
3. Conjunctivitis (also known as red few days of exposure and around the time that
eyes) symptoms may begin.
4. Sore throat, 1. Rapid antigen tests (sometimes known as a
5. Headache, rapid diagnostic test – RDT) detect viral
6. Muscle or joint pain, proteins (known as antigens).
7. Different types of skin rash, 2. Samples are collected from the nose and/or
8. Nausea or vomiting, throat with a swab.
9. Diarrhea, 3. These tests are cheaper than PCR and will
10. Chills or dizziness. offer results more quickly, although they are
generally less accurate.
4. These tests perform best when there is more
virus circulating in the community and when
1. Symptoms of severe COVID‐19 disease sampled from an individual during the time
include: they are most infectious.
1. Shortness of breath,
2. Loss of appetite,
3. Confusion,
4. Persistent pain or pressure in the Quarantine vs Isolation
chest,
5. High temperature (above 38 °C). 1. Quarantine is used for anyone who is a
2. Other less common symptoms are: contact of someone infected with the
1. Irritability, SARS-CoV-2 virus, which causes COVID-19,
2. Confusion, whether the infected person has symptoms or
3. Reduced consciousness (sometimes not.
associated with seizures), 2. Quarantine means that you remain separated
4. Anxiety, from others because you have been exposed
5. Depression, to the virus and you may be infected and can
6. Sleep disorders, take place in a designated facility or at home.
7. More severe and rare neurological For COVID-19, this means staying in the
complications such as strokes, brain facility or at home for 14 days.
inflammation, delirium and nerve
damage.

1. Isolation is used for people with COVID-19

symptoms or who have tested positive for the
COVID-19 Disease : Testing virus.
 2. Being in isolation means being separated from
other people, ideally in a medically facility
where you can receive clinical care.
3. If isolation in a medical facility is not possible
and you are not in a high risk group of
developing severe disease, isolation can take
place at home.
4. If you have symptoms, you should remain in
isolation for at least 10 days plus an additional
3 days without symptoms.
5. If you are infected and do not develop
symptoms, you should remain in isolation for
10 days from the time you test positive.

COVID-19 Disease : Prevention

1. To prevent the spread of COVID-19:

1. Maintain a safe distance from others
(at least 1 metre), even if they don’t
appear to be sick.
2. Wear a mask in public, especially
indoors or when physical distancing
is not possible.
3. Choose open, well-ventilated spaces
over closed ones. Open a window if
indoors.
4. Clean your hands often. Use soap and
water, or an alcohol-based hand rub.
5. Get vaccinated when it’s your turn.
Follow local guidance about
vaccination.
6. Cover your nose and mouth with your
bent elbow or a tissue when you
cough or sneeze.
7. Stay home if you feel unwell.

10/05/2022
Part 1
Fungal Infections
1.Fungal infections are often classified as
opportunistic or primary.
When we say opportunistic , they will just stay within
the area without causing any problem. But when the
time is right for them to control or to harm.
2.Opportunistic infections are those that develop
mainly in immunocompromised hosts; primary
infections can develop in immunocompetent hosts.
When you say immunocompetent there immune system
are working.
3.Fungal infections can be systemic or local.
4.Local fungal infections typically involve the skin,
mouth, and/or vagina and may occur in normal or
immunocompromised hosts.
Fungal infections are transmitted by:
1.Direct contact with infected host (human or
animal).
2.Indirect contact with infected exfoliated skin or hair
in combs, hair brushes, clothing, furniture, theatre
seats, caps, bed linens, towels, hotel rugs, and locker
room floors.
Fungal Infections
1.The majority of oral fungal infections (oral mycosis)
are resultant of opportunistic conditions.
2.Host resistance impairment allows for the initiation
and progression of pathogenic conditions through
local colonization in the oral cavity.
When they take over of that particular fungal element
takes over.
3.The frequency of oral mycosis has remarkably
increased globally with the increased use of
immunosuppressive drugs and immunodeficiency
viral infections.
Like your HIV
4.Oral mycological conditions range from superficial to
deep fungal infections of the oral tissues.
5.The most frequently diagnosed and reported oral
fungal infections are the superficial type and
candidiasis.
Dermatophytoses
1.Dermatophytes are molds (amag) that require
keratin for nutrition and must live on stratum
corneum, hair, or nails to survive.
2.Human infections are caused by Epidermophyton,
Microsporum, and Trichophyton spp.
3.These infections differ from candidiasis in that they
are rarely if ever invasive.
So local sila usually
4.Transmission is person-to-person, animal-to-person,
and, rarely, soil-to-person.
5.Common dermatophytoses include tinea barbae,
tinea capitis, tinea corporis, tinea cruris and tinea
pedis,.
1.Symptoms and signs vary by site (skin, hair, nails).
2.Most often, there is little or no inflammation;
asymptomatic or mildly itching lesions with a scaling,
slightly raised border remit and recur intermittently.
1.Tinea barbae (Barber’s itch) is a dermatophyte
infection of the beard area most often caused by
Trichophyton mentagrophytes or T. verrucosum.
Diagnosis is by examination of plucked hairs on
potassium hydroxide wet mount. Treatment is with
oral antifungals and sometimes prednisone.
How do you do potassium hydroxide wet mount?
Get the sample and put it on the slide and put potassium
hydroxide and if there’s a characteristic of fungal
elements present in that sample, you are quite sure that
is fungal infections.
2.Tinea capitis (Scalp Ringworm) is a dermatophyte
infection of the scalp. Diagnosis is by clinical
appearance and by examination of plucked hairs or
hairs and scale on potassium hydroxide wet mount.
Treatment involves oral antifungals.
Capitis is head.
3.Tinea corporis (Body Ringworm) is a
dermatophyte infection of the face, trunk, and
extremities. Diagnosis is by clinical appearance and by
examination of skin scrapings on potassium hydroxide
wet mount. Treatment involves topical or oral
antifungals.
1.Tinea cruris (Jock itch) is a dermatophyte infection
of the groin. Diagnosis is by clinical appearance and by
potassium hydroxide wet mount. Treatment is with
topical antifungals.
2.Tinea pedis is a dermatophyte infection of the feet.
Diagnosis is by clinical appearance and sometimes by
potassium hydroxide wet mount, particularly if the
infection manifests as hyperkeratotic, ulcerative, or
vesiculobullous or is not interdigital. Treatment is with
topical antifungals, occasionally oral antifungals,
moisture reduction, and drying agents.
Do not let your feet wet esp when you wear your shoes,
socks patuyuin niyo muna because the cold inside your
shoe is very favorable for the growth of fungus.
.
3.Tinea versicolor is skin infection with Malassezia
furfur that manifests as multiple asymptomatic scaly
patches varying in color from white to tan to brown to
pink. Diagnosis is based on clinical appearance and
potassium hydroxide wet mount of skin scrapings.
Treatment is with topical or sometimes oral
antifungals. Recurrence is common.
Dermatophytoses
1.Diagnosis is by clinical appearance and Potassium
hydroxide (KOH)wet mount.
2.Treatment:
a.Topical or oral antifungals
b.Sometimes corticosteroids
Candidiasis
1.Candida sp are commensal organisms that inhabit
the GI tract and sometimes the skin.
Commensal is they live inside the host or exist with the
host but do not harm the host.
2.Several drugs are associated with the development
of Candidal infection.
3.The pharmacological action of these drugs may have
a suppressive effect on the normal gastrointestinal and
oral bacterial flora that naturally keeps the Candidal
population at check.
4.This means that there could be Candidal overgrowth
as a result of such drug effects.
1.Superficial invasion of the mucous membranes and
skin by Candida sp. is called thrush.
2.Mouth thrush most commonly occurs as white,
adherent plaque on the buccal mucosa.
3.Oral thrush is relatively painless except for fissuring
at the corners of the mouth (angular cheilitis), which is
usually painful.
4.Oral thrush can be treated with either Nystatin
suspension or Clotrimazole.
Infestations/Parasites
1.Human parasites are organisms that live on or in a
person and derive nutrients from that person (its
host).
2.There are 3 types of parasites: protozoa, helminths
(worms), and ectoparasites such as scabies and lice.
3.Many parasitic infections are spread through fecal
contamination of food or water. They are most
frequent in areas where sanitation and hygiene are
poor.
Part 2
Amoebiasis
● Caused by Entamoeba histolytica.
● Exist in 2 forms : Trophozoite and cyst
● The motile trophozoites feed on bacteria and
tissue, reproduce, colonize the lumen and the
mucosa of the large intestine, and sometimes
invade tissues and organs.
Which causes nga the typical characteristic ng
amoebiasis which is diarrhea
● Cysts predominate in formed stools and resist
destruction in the external environment. They
may spread directly from person to person or
indirectly via food or water. Amebiasis can
also be sexually transmitted by oral-anal
contact.
● Most infected people are asymptomatic but
chronically pass cysts in stools.
You can be a carrier
● Symptoms that occur with tissue invasion
include intermittent diarrhea and
constipation, flatulence, and cramping
abdominal pain
Pero the main characteristic here is your
diarrhea
 ● Diagnosed by microscopic examination.
Yung stool exam with identification of the cyst
yung Entamoeba histolytica cyst usually
● Treatment :
○ Metronidazole or tinidazole initially
○ Iodoquinol, paromomycin, or
diloxanide furoate subsequently for
cyst eradication
Usually the clue you will entertain will possible
amoebiasis infection are those diarrheal
diseases/attacks that does not relieve by your
usual medication, yung diatabs yung imodium,
when it lats for like 3-4 days even 1 week, you
will have already a clue that the diarrhetic
episodes is not your usual diarrhetic episodes ut
amore serious condition like your Amoebiasis
that needs investigation
Giardiasis
● Giardiasis is infection with the flagellated
protozoan Giardia intestinalis (lamblia).
Flagellated means it has a flagellum. It renders
in motile or it can move
● Waterborne transmission is the major source
of giardiasis.
So fecal-oral route rin
● Transmission can also occur by ingestion of
contaminated food and by direct
person-to-person contact, especially in mental
institutions and day care centers or between
sex partners.
● Giardia cysts remain viable in surface water
and are resistant to routine levels of
chlorination.
● Symptoms of acute giardiasis usually appear 1
to 14 days (average 7 days) after infection.
● They are usually mild and include watery
malodorous diarrhea, abdominal cramps and
distention, flatulence, eructation, intermittent
nausea, epigastric discomfort, and sometimes
low-grade malaise and anorexia.
When you say malodorous iba yung amoy niya
● Acute giardiasis usually lasts 1 to 3 wk.
● Malabsorption of fat and sugars can lead to
significant weight loss in severe cases.
In your diuretic stools but usually giardiasis is
quite not common compare to amoebiasis
(which is quite common talaga)
● Diagnosis is by microscopic examination of
stool.
● Treatment : Tinidazole, metronidazole, or
nitazoxanide
Malaria
This is also a protozoon parasitic infection.
Maybe you’ve heard this malariawhen you go to
isolated aces, usually mountain, you may get
malaria
● Caused by Plasmodium sp.
● The Plasmodium species that infect humans
are
● P. falciparum
● P. vivax
● P. ovale
● P. malariae
● P. knowlesi
● Concurrent infection with more than one
Plasmodium species is uncommon.
● Manifestations common to all forms of
malaria include
○ Fever and rigor—the malarial
paroxysm
When you have an on and off episode
of fever and you get chills and you get
well and get chills again and you have
a history of going to malaria infested
places, there will be a big chance of
you having malaria
○ Anemia
○ Jaundice
○ Splenomegaly
○ Hepatomegaly
● Diagnosis is by Light microscopy of blood
(thin and thick smears)
When you say thick or thin smear, literally you
will smear blood on a glass slides and you
identify the malarian parasite on that glass
slides
● Treatment : Antimalarial drugs
Helminths/Worms
- That causes infestations
Bancroftian and Brugian Lymphatic Filariasis
- It affects your lymphatic system. It affects how
you manage your fluid inside of your body
● Lymphatic filariasis is caused by threadlike
adult filarial worms Wuchereria bancrofti,
Brugia malayi, and B. timori.
● Bancroftian filariasis is present in tropical and
subtropical areas of Africa, Asia, the Pacific,
and the Americas, including Haiti.
● Brugian filariasis is endemic in South and
Southeast Asia. Current estimates suggest that
about 120 million people are infected.
Esp. yung mare poor sanitations,
● Although the parasite damages the lymph
system, most infected people have no
symptoms and will never develop clinical
symptoms.
● These people do not know they have
lymphatic filariasis unless tested. A small
percentage of persons will develop
lymphedema.
Lymphedema or called elephantiasis
 ● This is caused by fluid collection because of
improper functioning of the lymph system
resulting in swelling.
Because this involved worms will clogged the
lymph vessels causing the lyphedema
● This mostly affects the legs, but can also occur
in the arms, breasts, and genitalia. Most
people develop these symptoms years after
being infected.
● Treatment : Diethylcarbamazine (DEC) kills
microfilariae and a variable proportion of
adult worms.
Eto yung mga anti parasitic medications
Filariasis
- iIIf it will affect your leg it will cause
elephantiasis is deprived from the appearance
of the limb that resembles literally an elephant.
Usually when it affects the leg usually pati yung
scrotum. There will be an enlargement also of
the males and their scrotum.
Pinworm Infestation
(Enterobiasis; Oxyuriasis)
● Enterobiasis is an intestinal infestation by the
pinworm Enterobius vermicularis, usually in
children.
● Its major symptom is perianal itching.
Itching around your anus
● Diagnosis is by visual inspection for threadlike
worms in the perianal area or the cellophane
tape test for ova.
● Treatment is with mebendazole or
albendazole.
- You will use your usual scotch tape and stick
that tape to the anus of the patient. You will
not know it but some ova or adult worm will
stick to that scotch tape and that scotch tape
be stick on a glass slide and be examine under
the microscope or the adult worm are present
even if you do not have your microscope, you
will see the adult worms, even if your did not
use the cellophane method, in the stool of
adults with pinworm infection, you can see
that nag wriwriggling wiggling sila
Part 3
22:10 – END
Ascariasis
- There is difference between the male and the
female ascariasis worm, usually the female is
much larger than your male
· Ascariasis is an infection with the
roundworm. Ascaris lumbricoides
· Light infections may be asymptomatic
· Early symptoms are pulmonary (cough,
wheezing)
Wheezing because the adult worm has lodge
down to your respiratory tract kaya
nagkakaroon ka ng cough or nagkakaroon
ka ng wheezing
· Later symptoms are GI, with cramps or
abdominal pain from obstruction of GI
lumina (intestines or biliary or pancreatic
ducts) by adult worms.
This is quite common in areas with poor
sanitation and you get this when you do
not where sandals, slippers or slip on.
Usually children are affected This will sit
in sa sole ng bata or talampakan pag
naglalaro sila sa labas ng nakapaa.
· Chronically infected children may develop
malnutrition because they are parasites
(they will share with your nutrition).
· Diagnosis is by identifying eggs or adult
worms in stool, adult worms that migrate
from the nose of mouth, or larvae in
sputum during the pulmonary migration
phase.
· Treatment is with albendazole,
mebendazole or pyrantel pamoate
(combantrin and also antiox). If you use
these medications for wrong reasons and
at the wrong time; usually you don’t give
this medications when the patient is
suffering for abdominal pain because
there is a big possibility that the worms
(ascariasis adult worms) may be irritate
 and may get out of the gastrointestinal
tract and pass through the other openings
of your body like the nose and mouth.
Schistosomiasis
● Schistosomiasis is infection with blood flukes
of the genus Schistosoma, which are acquired
transcutaneously (they invade your skin) by
swimming or wading in contaminated
freshwater.
● The organisms infect the vasculature of the GI
or GU (genitourinary) system.
● Acute symptoms are dermatitis, followed
several weeks later by fever, chills, nausea,
abdominal pain, diarrhea, malaise, and
myalgia.
● Chronic Symptoms vary with species but
include bloody diarrhea (eg. With S. Mansoni
and S. Japonicum) or hematuria (eg. With S.
haematobium).
● Diagnosis is by identifying eggs in stool, urine
or biopsy specimens.
● Serologic tests may be sensitive and specific
but do not provide information about the
worm burden or clinical status.
● Treatment is with praziquantel.
Life Cycle of Schistosoma parasite
● Here, it will develop as an intermediate
parasite inside a snail. And that snail may be
eaten as food by people (magkakaroon ng
ingestion) but it is not always the case, usually
schistosoma it affects transdermally.
● Adult Schistosoma parasite
ECTOPARASITES:
Scabies
- Human scabies is caused by an infestation of
the skin by the human itch mite (Sarcoptes
scabiei var. hominis).
- The microscopic scabies mite burrows into
the upper layer of the skin where it lives and
lays its eggs.
- The most common symptoms of scabies are
intense itching and a pimple-like skin rash
- You can detect scabies by using the Pentel Pen
Test (literal na pentel pen or pen). You can
trace where the scabies mite traveled sa skin
mo, you will trace sa skin mo; that will reveal a
possible case of scabies.
- The scabies mite usually is spread by direct,
prolonged, skin-to-skin contact with a person
who has scabies.
- Products used to treat scabies are called
scabicides because they kill scabies mites:
some also kill mite eggs.
- Scabicides used to treat human scabies are
available only with a doctor’s prescription.
- Scabicide lotion or cream should be applied to
all areas of the body from the neck down to
the feet and toes (Usually applied once, in the
evening for the whole body except the head
AND also all the other persons with you in the
house will be advised to apply that)
- Bedding, clothing, and towels used by infected
persons or their household, sexual, and close
contacts (as defined above) anytime during
the three days before treatment should be
decontaminated by washing in hot water and
drying in a hot dryer, by dry-cleaning, or by
sealing in a plastic bag for at least 72 hours to
suffocate the scabies mites.
Lice (Pediculous)
- Lice are parasitic insects that can be found on
people’s heads and bodies, including the pubic
area.
- Human lice survive by feeding on human
blood. Lice found on each area of the body are
different from each other.
 - The three types of lice that live on humans - CJD symptoms include dementia, myoclonus
are:
and other CNS deficits; death occurs in 1 to 2
1. Pediculus humanus capitis (head
louse) years
2. Pediculus humanus corporis (body
- Transmission can be prevented by taking
louse, clothes louse), and
3. Pthirus pubis (crab louse, pubic precautions when handling infected tissues
louse)
and using appropriate techniques to clean
- Only the body louse is known to spread
disease contaminated instruments
- Lice infestations (pediculosis and phthiriasis)
- Treatment is supportive
are spread most commonly by close
person-to-person contact.
- Dogs, cats and other pets do not play a role in
the transmission of human lice.
- Lice move by crawling; they cannot hop or fly.
- Both over the counter and prescription
medications are available for treatment of lice
infestations

Prions
- Prion diseases are progressive, fatal and
untreatable degenerative brain disorders.
- All prion diseases result from misfolding of
normal cell-surface brain protein called prion
protein (PrP), whose exact function is
unknown.
- Accompanying pathologic changes include
gliosis and characteristic histologic vacuolar
(spongiform) changes, resulting in dementia
and other neurologic deficits.
- Symptoms and signs develop months to years
after exposure.
- Prion diseases can be hereditary (familial)
- Can be acquired from person to person (eg, as
- Brain shrinkage and deterioration occurs
in kuru) or from animals to humans (eg, as in
variant Creutzfeldt-Jakob disease). rapidly
- Should be considered in all patients with
- Brain section showing spongiform pathology
dementia, especially if it progresses rapidly
- Treatment is symptomatic. Prions resist characteristic of Creutzfeldt-Jakob
standard disinfection techniques and pose
risks to surgeons, pathologists and technicians
who handle contaminated tissues and
instruments. Steam autoclaving of materials at
132 degrees Celsius for 1 h or immersion in
4% Na hydroxide or 10% Na hypochlorite
solution for 1 h is recommended.

Creutzfeldt-Jakob Disease (CJD)

- CJD is a sporadic, familial or acquired
(iatrogenically) prion disease.
- Variant CJD (vCJD) is the form acquired by
eating meat from cattle with bovine
spongiform encephalopathy (mad cow
disease)
PRINCIPLES OF MEDICINE (10-10-22)
HEMATOLOGIC DISORDERS
Blood
● the fluid that circulates in the heart, arteries,
capillaries, and veins of a vertebrate animal
carrying nourishment and oxygen to and bringing
away waste products from all parts of the body.
● Hematology
○ is the branch of medicine concerned with the
study of the cause, prognosis, treatment, and
prevention of diseases related to blood
○ It involves treating diseases that affect the
production of blood and its components, such
as blood cells, hemoglobin, blood proteins,
bone marrow, platelets, blood vessels, spleen,
and the mechanism of coagulation
● most abundant cell in the blood, accounting for
○ Doon sa body weight natin, approximately 8%
bumibigat tayo sahil sa blood. 8% of our
weight is our blood. Kapag yung blood ay
dinevide mo pa sa different components, may
liquid tayong component which is yung
plasma ano laman non? Proteins, water and
other solutes. Yung solid formed elements
naandyan yung red blood cells, white blood
cells at yung platelets. Yung pinaka marami sa
kanila ay yung rbc at susunod yung platelets
and pinaka konti ay wbc. White blood cells
dinedevide pa sa iba’t ibang components. Wbc
components are neutrophils, lymphocytes,
monocytes, eosinophils and basophils.
Mapapansin niyo sa pic na may percentages
pa yan.
Blood Components: Plasma
● The liquid component of blood is called plasma, a
mixture of water, sugar, fat, protein, and salts.
● The main job of the plasma is to transport blood
cells throughout your body along with nutrients,
waste products, antibodies, clotting proteins,
chemical messengers such as hormones, and
proteins that help maintain the body's fluid
balance.
●
○ How to get the plasma? Dalawa sa laboratory.
Una ilalagay mo lang yung tube sa centrifuge
tas iikot yan for ilang mins tas lalabas siya sa
tas magiging result ay yung nasa right ng pic.
Yung pangalawa naman ay pinapastay lang sa
test tube rack tas mamaya maghihiwalay na
yan kasi mas mabibigat yung mga formed
elements kaya babagsak sa baba at maiiwan sa
ilalim.
Blood Components: Blood
● Also known as erythrocytes
● Known for their bright red color, red cells are the
about 40 to 45 percent of its volume. The shape of
a red blood cell is a biconcave disk with a flattened
center - in other words, both faces of the disc have
shallow bowl-like indentations (a red blood cell
looks like a donut).
● Production of red blood cells is controlled by
erythropoietin, a hormone produced primarily by
the kidneys.
○ Kapag nagkaroon ka ng renal failure?
Maaapektuhan din ang production ng
erythropoietin mo which affect the
production of RBC.
● Red blood cells start as immature cells in the bone
marrow and after approximately seven days of
maturation are released into the bloodstream.
● Unlike many other cells, red blood cells have no
nucleus and can easily change shape, helping them
fit through the various blood vessels in your body.
● However, while the lack of a nucleus makes a red
blood cell more flexible, it also limits the life of the
cell as it travels through the smallest blood
vessels, damaging the cell's membranes and
depleting its energy supplies.
● The red blood cell survives on average only 120 Functions of Blood
days
● Red cells contain a special protein called
hemoglobin, (may kasama pa yung hemoglobin na
iron) which helps carry oxygen from the lungs to
the rest of the body and then returns carbon
dioxide from the body to the lungs so it can be
exhaled.
● Blood appears red because of the large number of
red blood cells, which get their color from the
hemoglobin (ito ang kapulahan or kaputlahan ng
● Transportation
dugo).
○ Respiration
● The percentage of whole blood volume that is
○ Nutrient carrier from GIT
made up of red blood cells is called the hematocrit
○ Transportation of hormones from endocrine
(yung kalabnawan or kalaputan ng rbc; the more
glands
rbc ay mas malapot; the lesser the rbc mas
○ Transports metabolic wastes
malabnaw) and is a common measure of red blood
■ Waste like creatinine
cell levels.
● Regulation
○ Regulates pH
Blood Components: WBC
○ Adjusts and maintains body temperature
● Also called leukocytes
○ Maintains water content of cells
● White blood cells protect the body from infection.
● Protection
● They are much fewer in number than red blood
○ WBC protects against disease by phagocytosis
cells, accounting for about 1 percent of your blood.
○ Reservoir for substances like water, electroly
● Differential count: yung sa ibat ibang type ng WBC
etc.
sa cbc
○ Performes haemostasis
○ Neutrophils: kapag sumobra ka is either may
bacterial or fungal infection (ex. UTI)
○ Lymphocytes: kapag marami viral infection
○ Eosinophils and basophils: parasitic infection
or allergies

Blood Components: Platelets

● Also called thrombocytes
● Unlike red and white blood cells, platelets are not
actually cells but rather small fragments of cells.
○ WBC for immune system, si platelets ay para sa
hemostasis.
● Platelets help the blood clotting process (or
coagulation) by gathering at the site of an injury,
sticking to the lining of the injured blood vessel,
and forming a platform on which blood
coagulation can occur.
● This results in the formation of a fibrin clot, which
covers the wound and prevents blood from leaking
out.
● Fibrin also forms the initial scaffolding upon
which new tissue forms, thus promoting healing.
○ To form a fibrin clot para gumaling yung sugat
PRINCIPLES OF MEDICINE (10-12-22)
Part 1 00:40-15:20 ● Alterations in membrane proteins cause the
Part 2 15:21-30:40 RBC abnormalities.
Part 3 30:41-46:40
Ang stable niyang form ay parang doughnut pero pag
HEMOLYTIC ANEMIAS
naiba na ang shape niya hindi na siya stable medyo
marupok na siya madali na masira.
Hemolytic pertains to fragility o yung pagiging
marupok ng RBC natin. Madali na siyang
● The cell membrane surface area is decreased
nadidisintegrate. Hindi na siya umaabot sa 120 days na
disproportionately to the intracellular
life cycle niya nasisira na siya bukod sa maaga siya
content. The decreased surface area of the cell
nasisira, hindi na siya na napapalitan. Diba dapat after
impairs the flexibility needed for the cell to
120 days nagpapalit lang siya. Pag nasira na siya wala
traverse the spleen’s microcirculation, causing
na siyang kapalit kaya nagkakaroon ng anemia, kaya
intrasplenic hemolysis.
kumokonti.

● At the end of their normal life span (about 120

days), RBCs are removed from the circulation.
Hemolysis involves premature destruction
and
hence a shortened RBC life span (< 120 days).

● Anemia results when bone marrow

production
can no longer compensate for the shortened May pale center na palubog na part yan ang normal
RBC survival; this condition is termed may palubog. Sa spherocytosis walang pale center,
hemolytic anemia. pulang pula siya kasi ang shape niya ay bilog na bilog.
Hindi na siya makacompensate for survival. Kung
macocompensate niya ang kaniyang survival,
makakabuo pa din siya ng panibagong RBC pero sa case ● Symptoms and signs of hereditary
ni hemolytic anemia hindi na. spherocytosis are usually mild, and
the anemia may be so well
● If the marrow can compensate, the condition
compensated that it is not recognized
termed compensated hemolytic anemia.
until an intercurrent viral illness
transiently decreases RBC
HEREDITARY SPHEROCYTOSIS
production, simulating an aplastic
crisis.
Pag sinabing spherocytosis ang shape ng RBC
ay bilog. Diba ang RBC ay paflat na parang
Ang common presenting symptoms nito
doughnut na walang butas sa gitna pero
palubog. Dito ang shape ng RBC ay bilog. ay yung Cholelithiasis which is gall
bladder stones.
● Hereditary SPHEROcytosis (chronic familial ● However, these episodes are
icterus; congenital hemolytic jaundice; self-limited, resolving with resolution of
familial spherocytosis; spherocytic anemia) is the infection.
an autosomal dominant disease with variable
gene penetrance. ● Moderate jaundice and symptoms of
anemia are present in severe cases.
autosomal meaning genetic yan.
● It is characterized by hemolysis of spheroidal
RBCs and anemia.
 ● Splenomegaly is almost invariable but
only rarely causes abdominal
discomfort.
● Hepatomegaly may be present.
● Cholelithiasis (pigment stones) is
common and may be the presenting
symptom.
● Congenital skeletal abnormalities (eg,
tower-shaped skull, polydactylism)
occasionally occur.
Diagnosis
RBC fragility assay, RBC autohemolysis assay,
and direct antiglobulin (Coombs) test
Splenectomy (review function of spleen) is the
only specific treatment for the disorder but is
rarely needed.
Tanggalin ang spleen mo pag may
spherocytosis
GLUCOSE-6-PHOSPHATE
DEHYDROGENASE (G6PD) DEFICIENCY
● This enzyme, which is active in virtually
all types of cells, is involved in the
normal processing of carbohydrates. It
plays a critical role in red blood cells,
which carry oxygen from the lungs to
tissues throughout the body. This
enzyme helps protect red
blood cells from damage and
premature destruction.
● G6PD deficiency reduces energy
available to maintain the integrity of the
red cell membrane, which shortens RBC
survival.
● Hemolysis occurs commonly after fever,
acute viral or bacterial infections, and
diabetic acidosis.
● Less commonly, hemolysis occurs after
exposure to drugs or to other
substances that produce peroxide and
cause oxidation of
Hb and RBC membranes.
● These drugs and substances include
primaquine, salicylates, sulfonamides,
nitrofurans, phenacetin, naphthalene,
some vitamin K derivatives, dapsone,
phenazopyridine, nalidixic acid,
methylene blue.
Ang RBC dito ay fragile kasi wala siyang
G6PD kaya irerender niya ang RBC as
fragile na madaling masira. Pag ang
bata usually sa mga bata pag may
G6PD binibigyan yan ng listahan ng
mga gamot na hindi pwedeng itake ng
bata kasi pag tinake ng bata magkaka
anemia siya. Yan ang kinatatakutan kasi
magkakaroon ng problema. Hindi mosila
pwedeng bigyan ng aspiraan. Marami
rami yan
Diagnosis:
G6PD assay (Newborn screening)
Within to 24-48hrs mapatest dapat ang bata.
During acute hemolysis, treatment is
supportive; transfusions are rarely needed.
Patients are advised to avoid drugs or
substances that initiate hemolysis.
Ang pinaka key lang dito ay iwasan ang mga
bawal
SICKLE CELL DISEASE
● Sickle cell anemia is an inherited form of
anemia.
● Normally, your red blood cells are
flexible and round, moving easily
through your blood vessels.
● In sickle cell anemia, the red blood cells
become rigid and sticky and are shaped
like sickles or crescent moons.
● These irregularly shaped cells can get
stuck in small blood vessels, which can
slow or block blood flow and oxygen to
parts of the body.
Iba na yung shape niya eh so mahihirapan siya
pumasok sa mga blood vessels. Kung
makapasok man siya maistruck lang siya sa
loob which can slow blood flow througout parts
of the body.
● Anemia. Sickle cells are fragile. They
break apart easily and die, leaving you
without a good supply of red blood cells.
● Episodes of pain. Periodic episodes
of pain, called crises, are a major
symptom of sickle cell Anemia. Pain
develops when sickle-shaped red blood
cells block blood flow through tiny blood
vessels to your chest, abdomen and
joints. Pain can also occur in your bones
● Hand-foot syndrome. Swollen hands
and feet may be the first signs of
sickle cell anemia in babies. The
swelling is caused by sickle-shaped red
blood cells blocking blood flow out of
their hands and feet.
Ano ang mga pwedeng mangyari?
● Frequent infections. Sickle cells can
damage your spleen, an organ that
fights infection. This may make you
more vulnerable to infections
● Delayed growth. Red blood cells
provide your body with the oxygen and
nutrients you need for growth. A
shortage of healthy red blood cells can
slow growth in infants and children and
delay puberty in teenagers.
● Vision problems. Some people with
sickle cell anemia experience vision
problems. Tiny blood vessels that supply
your eyes may become plugged with
sickle cells. This can damage the
retina — the portion of the eye that
processes visual images.
● Mandibular osteomyelitis is an oral
complication commonly observed in
patients with sickle cell anemia. Various
other changes includes anesthesia or
paraesthesia of the mental nerve,
asymptomatic pulpal necrosis, orofacial
pain, enamel hypomineralization,
delayed eruption, hypoplasia of teeth
and diastema.
Diagnosis
DNA testing (prenatal diagnosis)
Kasi genetic siya
 Peripheral smear
Solubility testing
Hb electrophoresis (or thin-layer
isoelectric focusing)
Treatment
Broad-spectrum antibiotics (for infection)
Analgesics and IV hydration (for
vaso-occlusive pain crisis)
Sometimes transfusions
Immunizations, folate supplementation,
and Hydroxyurea (for health
maintenance)
THALASSEMIA
● These are groups of inherited
microcytic, hemolytic anemias
characterized by defective hemoglobin
synthesis.
Pag sinabi natin microcytic, maliliit ito na
cells and hemolytic . hemoglobin yung
tiga carry ng oxygen and Iron
● It results from unbalanced Hb synthesis
caused by decreased production of at
least one globin polypeptide chain.
So sa component ng hemoglobin may
defect, kaya sa resulting na hemoglobin,
defective rin
● In Beta thalassemia, decreased
production of the Beta chain is
observed; autosomal inheritance
● Alpha thalassemia which results from
decreased production of alpha chains.
● Clinical features of thalassemias are
similar but vary in severity.
● Beta thalassemia major presents by age
1 to 2 with symptoms of severe anemia
and transfusional and absorptive iron
overload.
Usually ang mga bata affected dito,
● Patients are jaundiced and leg ulcers
and cholelithiasis occurs.
● Splenomegaly probably due to splenic
sequestration may develop, accelerating
destruction of transfused normal RBCs.
Splenomegaly , paglaki ng spleen, due
to splenic sequestration, maraming
defective na blood cell. Pag may mga
defective na RBW or blood elements,
ang tapunin niyan ay spleen so
paglumalaki marami ang defective na
rbc or blood components
● Bone marrow hyperactivity causes
thickening of the cranial bones and
malar eminences.
● Long bone involvement predisposes to
pathologic fractures and impairs growth
possibly delaying or preventing puberty.
● Iron deposits in heart muscle may cause
heart failure.
● The oral manifestations includes
excessive overgrowth of maxilla leads to
excessive lacrimation and nasal
stiffiness, pallor oral mucosa
● Diagnosis is based on quantitative Hb analysis.
Kasi ang problema talaga niyan ay nasa hemoglobin
● Treatment for severe forms may include
transfusion, splenectomy, chelation and stem
cell transplantation.
Splenectomy kasi malaki na nga spleen mo
WHITE BLOOD CELL DISORDERS
CHRONIC GRANULOMATOUS DISEASE
● Chronic granulomatous disease (CGD) is a
primary immunodeficiency that affects
phagocytes of the innate immune system and
leads to recurrent or persistent intracellular
bacterial and fungal infections and to
granuloma formation.
● The disease becomes apparent during the first
2 years of life in most patients, but the onset is
occasionally delayed into the second decade of
life.
○ The earliest manifestations often
involve the skin. Recurrent
pyodermas are common, and they
often appear as perianal, axillary, or
scalp abscesses.
○ Systemic findings include
osteomyelitis, pulmonary abscesses
and granulomas, spleen and/or liver
abscesses, and hepatosplenomegaly.
○ Pyrexia may be noted.
○ Diarrhea may occur.

COAGULATION DISORDERS
DISSEMINATED INTRAVASCULAR COAGULATION
(DIC)
Nagphapahagosytosis kaso hnd niya napapatay lahat
kaya ginagawa niya lang, magkukumpol na lang yun
phagocytes para makaform ng granuloma
Diagnosis
● Flow cytometric oxidative (respiratory) burst
assay
● Treatment
Prophylactic antibiotics and usually antifungals
● Usually interferon gamma
● For severe infections, granulocyte
transfusions
● Bone marrow transplantation
HEMOSTATIC DISORDERS
- Problema sa pagdudugo
THE THREE STAGES OF HEMOSTASIS
● In the primary hemostasis a platelet plug is
formed within 5 minutes to seal the site of
injury.
Pupunta agad si platelet
● In the secondary hemostasis fibrin is formed
(coagulation) and a fibrin mesh reinforces the
frail platelet plug (timescale hours).
Patitibayatin pa yung unang platelet plug,
thereby, producing yung fibrin plug(?)
● The third part is (secondary) fibrinolysis
which dissolves the clot but takes place first
after tissue repair (timescale days).
Fibrinolysis yung okay na.
Kasama na yung pagdissolve yung cloth, pero
pag nagdissolve na yung cloth dapat okay na
yung tissue pala na yung possibilidad na mag
dugo uli
Primary-platelet makikita
Secondary- mga clotting factor ang makikita
leading to fibrin formation
Pangatlo - fibrinolysis, yung madidissolve yung
fibrin pero mangyayari lang yun pag okay na
tissue nasugatan
● Disseminated intravascular coagulation
(DIC), also known as disseminated
intravascular coagulopathy or less
commonly as consumptive coagulopathy, is
a pathological process characterized by the
widespread activation of the clotting cascade
that results in the formation of blood clots in
the small blood vessels throughout the body.
Consumptive Coagulopathy yung
pinakanakakaexplain sa disease na ito
● This leads to compromise of tissue blood flow
and can ultimately lead to multiple organ
damage. In addition, as the coagulation
process consumes clotting factors and
platelets, normal clotting is disrupted and
severe bleeding can occur from various sites.
Kasi consumptive kasi CONSUMES, yung hnd pa
dapat nagagamit yung clotting factor pero
nagamit na kaya normal clotting is disrupted.
Pag kailangan mo na siya hnd na siya
magagamit.
● DIC does not occur by itself but only as a
complicating factor from another underlying
condition, usually in those with a critical
illness.
● The combination of widespread loss of tissue
blood flow and simultaneous bleeding leads to
an increased risk of death in addition to that
posed by the underlying disease.
● DIC usually results from exposure of tissue
factor to blood, initiating the coagulation
cascade.
● DIC occurs most often in the following clinical
circumstances:
○ Complications of obstetrics (eg,
abruptio placentae, saline-induced
therapeutic abortion, retained dead
fetus or products of conception,
amniotic fluid embolism): Placental
tissue with tissue factor activity
enters or is exposed to the maternal
circulation.
Complication sa panganganak,
○ Infection, particularly with
gram-negative organisms:
Gram-negative endotoxin causes
 generation or exposure of tissue
factor activity in phagocytic,
endothelial, and tissue cells.
Mga nag tritrigger ng DIC
○ Cancer, particularly mucin-secreting
adenocarcinomas of the pancreas and
prostate and acute promyelocytic
leukemia: Tumor cells express or
release tissue factor.
○ Shock due to any condition that
causes ischemic tissue injury and
release of tissue factor.
● If DIC is suspected, platelet count, PT, PTT,
plasma fibrinogen level, and plasma d-dimer
level (an indication of in vivo fibrin deposition
and degradation) are obtained.
Treatment
● Treatment of cause
● Possibly replacement therapy (eg, platelets,
cryoprecipitate, fresh frozen plasma, natural
anticoagulants)
● Sometimes heparin
Yung mga patient na may DIC, lalo na yung
mga nasa hospital lalo na yung mga
natutudsok, nagdudugo sila doon sa mga
natusukat
HEMOPHILIA
- Involves 2 coagulation factors: Factor VIII,
Antihemophilic, and IX Christmas Factor.
Pinaguusapan na factor pagdating sa
hemophilia
COAGULATION FACTORS
● Hemophilia A (factor VIII deficiency), which
affects about 80% of patients with
hemophilia, and Hemophilia B (factor IX
deficiency) have identical clinical
manifestations and screening test
abnormalities.
● Hemophilia is an inherited disorder that
results from mutations, deletions, or
inversions affecting a factor VIII or factor IX
gene. Because these genes are located on the X
chromosome, hemophilia affects males almost
exclusively.
● Normal hemostasis requires > 30% of normal
factor VIII and IX levels. Most patients with
hemophilia have levels < 5%; some have
extremely low levels (< 1%). The functional
level (activity) of factor VIII or IX in
hemophilia A and B, and thus bleeding
severity, varies depending on the specific
mutation in the factor VIII or IX gene.
Injury occurs:
1)Injury to the blood vessel results in bleeding
2) the vessel constricts and clotting factors are
activated, parang tumigil ang dumudugo
Normally
3) Along with other substances, clotting factor VIII
causes a strong platelet plug to form.
Bukod sa platelet yung clotting cascade gagana lalo na
yung factor 8 tapos magkakaroon na ng
4) A stable fibrin clot forms over the platelet lug as a
final seal on the injury and the bleeding stops
Hemophilia A
3) Lack of clotting factor VIII causes a weak platelet
pulg to form
Due to the lack of clotting factor VIII, magiging weak,
magkarron man ng isang prblema sa clotting factor,
hnd ka makakabuo ng stable fibrin clot kaya kailangan
nla isa’t isa
4) Incomplete and/or delayed fibrin clot allows
bleeding to continue
● Patients with hemophilia bleed into tissues
(eg, hemarthroses, muscle hematomas,
retroperitoneal hemorrhage). The bleeding
may be immediate or occur slowly, depending
on the extent of trauma and plasma level of
factor VIII or IX.
Ang importante dugo siya ng dugo, titigil
naman siya pero kailanagn may gawin ka
● Pain often occurs as bleeding commences,
sometimes before other signs of bleeding
develop.
● Chronic or recurrent hemarthroses, bleeding extraction or other oropharyngeal mucosal
between the joints, can lead to synovitis and trauma (eg, tongue laceration).
arthropathy.
● Even a trivial blow to the head can cause
intracranial bleeding.
● Bleeding into the base of the tongue can cause
life-threatening airway compression.
● Severe hemophilia (factor VIII or IX level < 1%
of normal) causes severe bleeding throughout
life, usually beginning soon after birth (eg,
scalp hematoma after delivery or excessive
bleeding after circumcision).
Namatay bata kasi hnd nila alma na may
hemophilia after matuli
● Moderate hemophilia (factor levels 1 to 5% of
normal) usually causes bleeding after minimal Paaano pinapasa
trauma. In mild hemophilia (factor levels 5 to
25% of normal), excessive bleeding may occur
after surgery or dental extraction.
Galingan niyo history taking, kahit yung
simpleng “pagnasugatan ba kayo, tumitigil
naman po ba ang dumudugo” kahit yung mga
ganun tanong magkaka idea na kayo
● Hemophilia is suspected in patients with
recurrent bleeding, unexplained
hemarthroses, or a prolongation of the PTT.
Kasi nga bakit PPT, yung Factor VIII and Factor
IX ay intrinsic. Ano yung pang measure ng
intrinsic pathway, PPT kaya may prolong runs in the Royal Family ng UK
● If hemophilia is suspected, PTT, PT, platelet Yung mga may hemophilia, yun ang mabilis na maidugo
count, and factor VIII and IX assays are kaya yung mga may hemophilia na mga bata
obtained. pinagbabawalan sila mag laro, gadgets lang iwas sa
● In hemophilia, the PTT is prolonged, but the sharp kasi nga masusugatan kaya need mag ingat
PT and platelet count are normal. Factor VIII PLATELET DISORDERS
and IX assays determine the type and severity
of the hemophilia. IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)
● Patients with bleeding or in whom bleeding is ● Idiopathic (immunologic) thrombocytopenic
anticipated (eg, before surgery or dental purpura is a bleeding disorder caused by
extraction) are given replacement factor, thrombocytopenia not associated with a
preferably using a recombinant product; dose systemic disease.
depends on the circumstances. Idiopathic you do not know the cause
● Replacement of the deficient factor is the ● ITP usually results from development of an
primary treatment. In hemophilia A, the factor autoantibody directed against a structural
VIII level should be raised transiently to platelet antigen.
○ About 30% of normal to prevent pero usually, it results from an autoantibody so
bleeding after dental extraction or to parang considered siyang autoimmune
abort an incipient joint hemorrhage ● In childhood ITP, the autoantibody may be
○ 50% of normal if severe joint or IM triggered by viral antigens.
bleeding is already evident ● The trigger in adults is unknown.
○ 100% of normal before major surgery ● ITP tends to worsen during pregnancy and
or if bleeding is intracranial, increases the risk of maternal morbidity.
intracardiac, or otherwise life ● The symptoms and signs are petechiae,
threatening purpura, and mucosal bleeding.
● An antifibrinolytic agent (ε-aminocaproic acid Due to the platelet defect
2.5 to 4 g po qid for 1 wk or tranexamic acid ● Gross GI bleeding and hematuria are less
1.0 to 1.5 g po tid or qid for 1 wk) should be common.
given to prevent late bleeding after dental
 ● The spleen is of normal size unless it is
enlarged by a coexisting viral infection or
autoimmune hemolytic anemia.
● Like the other disorders of increased platelet
destruction, ITP is also associated with an
increased risk of thrombosis.
PATHWAYS OF COAGULATION : EXTRINSIC VS
INTRINSIC PATHWAY
•Extrinsic Pathway – needs a substance from outside
of the blood to make it work ; trigerred by tissue
trauma/injury
- substance needed is found outside blood
•Intrinsic Pathway – the substances that need to
make it work is already within the blood ; trigerred by
trauma to the blood cells and inside the vessel
- Substance needed inside blood
COAGULATION FACTORS

Functions of blood
1. Transportation
- Respiration
- Nutrient carrier from GIT Factor Name Pathway
- Transportation of hormones from endocrine
glands I Fibrinogen Both
- Transports metabolic wastes
2. Regulation II Prothrombin Both
- Regulates pH
- Adjusts and maintain body temperature III Tissue Factor Extrinsic
- Maintains water content of cells
3. Protection IV Calcium Both
- WBC protects against disease by phagocytosis
- Reservoir for substances like water, V Proaccelerin Both
electrolyte, etc
- Performs haemostasis VI Accelerin Both

- pag nagkaroon ka ng sugat, papupuntahin na VII Proconvertin Extrinsic

doon si platelet to create initial platelet plug.
- Ang 2nd na maactivaye ay coagulation cascade VIII Antihemophilia Intrinsic
c
COAGULATION CASCADE
•The coagulation cascade, or secondary hemostasis, is IX Christmas Intrinsic
a series of steps in response to bleeding caused by factor
tissue injury, where each step activates the next and
ultimately produces a blood clot. X Stuart-Prower Both
•The term hemostasis is derived from “hem-”, which Factor
means “blood”, and “-stasis”, which means “to stop.”
Therefore, hemostasis means to stop bleeding. XI Plasmathromb Intrinsic
•There are two phases of hemostasis. First, primary oplastin
hemostasis forms an unstable platelet plug at the site Antecedent
of injury. (PTA)
•Then, the coagulation cascade is activated to stabilize
the plug, stopping blood flow and allowing increased XII Hageman Intrinsic
time to make necessary repairs. This process Factor
minimizes blood loss after injuries
- No need to memorize coagulation factors XIII Protransglutam Both
- These factors activate each other to create inase
fibrin clot
They need each other para makarating sa dulo
LABORATORY TESTS - Nirerequest kapag gumagamit ka ng warfarin.
1.Complete Blood Count includes Actual Platelet It is an ingredient of rat poison
Count
- kailangan kasama si APC, dapat sabihin mo •When is it ordered?
para ilagay nila. Need siya sa may dengue •Used to monitor anticoagulant therapy
2.Peripheral Blood Smear Warfarin(Coumadin)
- different from cbc becs cbc is quantitative, PBS •When a patient not taking anti-coagulants has signs
is in a form of paragraph of bleeding disorder.
3.Bone marrow aspiration and biopsy •When a patient is to undergo invasive medical/dental
- Inaaspirate ang bone marrow in leukemia procedure such as surgery to ensure normal clotting
4.Tests of the Vascular Platelet Phase of Hemostasis: ability.
•Bleeding Time (BT)
- tutuskin ka ang may tissue tas blot. and An elevated PT may indicate:
irerecord ang time. It tests the function of your •Vitamin K deficiency
platelet. •Disseminated Intravascular Coagulation
5.Tests of the Coagulation Cascade: •Liver disease
•Clotting Time ( CT) or Coagulation time •Deficiency in Factors I, II, V, VII, IX
- magpapatak ng vlood sa glass slide using •On anticoagulant (Warfarin) therapy
needle iikutin mo tas aangat ng konti. Pag - vit k is a partisipant in hemostasis.
nagkaroon ng parang sinulid it means nag clot - Liver disease, few vit k
ang blood - Newborn babies, injected with vit k. Because
•Activated Partial Thromboplastin Time (APTT). immature pa organs nila
Intrinsic factor INTERNATIONAL NORMALIZED RATIO (INR)
•Prothrombin Time (PT). – Extrinsic factor •A PT test may also be called an INR test.
- Needed before surgery. To test if you can • INR (international normalized ratio) stands for a way
control bleeding of the patient of standardizing the results of prothrombin time tests,
6.Tests of Fibrinolysis and the Mechanisms That no matter the testing method.
Control Hemostasis: •So your doctor can understand results in the same
● Fibrin Degradation Products (FDP) way even when they come from different labs and
different test methods.
NORMAL VALUES : HGB, HCT, WBC • Using the INR system, treatment with (anticoagulant
•Hemoglobin (Hgb) therapy) will be the same. In some labs, only the INR is
•Male : 14 – 17.4 g/dL reported and the PT is not reported
•Female : 12.0 – 16.0 g/ •An INR of 1.0 means that the patient PT is normal.
•Hematocrit (Hct) •An INR greater than 1.0 means the clotting time is
•Male : 45 – 52% elevated.
•Female : 36 – 46% •INR of greater than 5 or 5.5 = unacceptable high risk
•White Blood Cells : 4.5 – 11 of bleeding,whereas if the INR=0.5 then there is a high
chance of having a clot.
PLATELET COUNT • Normal range for a healthy person is 0.9–1.3, and for
•100,000-400,000 NORMAL people on warfarin therapy, 2.0–3.0, although the
target INR may be higher in particular situations, such
•< 100,000 Thrombocytopenia as for those with a mechanical heart valve.
- Like PT. But serves to standardize the lab test
•50,000 - 100,000 Mild Thrombocytopenia maiintidihan pa rin ng dr na babasa.

•< 50,000 Severe Thrombocytopenia PARTIAL THROMBOPLASTIN TIME

PROTHROMBIN TIME
•Measures the effectiveness of the Extrinsic Pathway
•Normal value : 10 – 15 secs
•The time required for the plasma to clot after an
excess of thromboplastin and an optimal
concentration of calcium have been added.
•Sensitive to Factors I, II, V, VII, X.
•The PT evaluates patients suspected of having an
inherited or acquired deficiency in these pathways.
•Measures effectiveness of the Intrinsic Pathway
•Normal value : 25-40 secs
•The partial thromboplastin time (PTT) or activated
partial thromboplastin time (aPTT or APTT( is a
performance indicator measuring the efficacy of both
the "intrinsic" and the common coagulation pathways.
•It is also used to monitor the treatment effects with
heparin a major anticoagulant.
•Normal PTT times require the presence of the
following coagulation factors:
I, II, III, IV, V, VI, VIII, IX, X, XI, & XII
 - Ngayon minomonitor heparin
SYMPTOMS OF BLEEDING DISORDERS
•When is it ordered? •The symptoms can vary depending on the specific
type of bleeding disorder. However, the main signs
•When a patient presents with unexplained bleeding include:
or bruising, •unexplained and easy bruising
•It may be ordered as part of a pre-surgical evaluation •pallor
for bleeding tendencies, •heavy menstrual bleeding
•When a patient is on intravenous (IV) or injection •frequent nosebleeds
heparin therapy, the APTT is ordered at regular •excessive bleeding from small cuts or an injury
intervals to monitor the degree of anticoagulation. •bleeding into joints
- Pag may problema sa kidney, bleeding
Prolonged PTT may indicate:
•Use of heparin. DISORDERS OF RED BLOOD CELL PRODUCTION
•antiphospholipid antibody:especially lupus AND IRON METABOLISM
anticoagulant, which paradoxically increases
propensity to thrombosis •ANEMIAS
•coagulation factor deficiency ,
e.g hemophilia INTRODUCTION TO ANEMIA AND APPROACH TO
•Disseminated Intravascular Coagulation PATIENTS WITH ANEMIA
•Liver disease
•Anemia is defined as a significant decrease in red
corpuscles or hemoglobin.
•Anemia is usually discovered accidentally, since this
clinical condition has vague, nonspecific symptoms
and commonly occurs in such a slow, chronic fashion
that the patient may not realize that he or she is
unwell.
•Once the anemia is discovered the health professional
should determine the underlying disease process.
•In anemia due to deficiency of iron, folate, or
vitamin B12, the oral findings may be the initial
summary of what i’ve said earlier presentation resulting in a decreased hemoglobin level
or change in mean corpuscular volume.
•The lab measurements that are generally used to
determine the presence or the absence of anemia are
the packed red blood cell (RBC) volume or the
hematocrit and the hemoglobin concentration of the
peripheral blood.
•Hemoglobin :
•Male : 140-180 g/L ; Female : 120-160 g/L
•Hematocrit :
•Male : 0.40-0.54 ; Female : 0.37-0.47
- Sa anemia, maputla, malabnaw, at konti rbc
Normal RBC Production and Pathology

INTRODUCTION TO HEMATOLOGIC DISORDERS

•The cardinal symptoms and signs associated with
hematologic disease are those resulting from:
1.Underproduction or overproduction of :
• RBCs (anemia or erythrocytosis)
•Leukocytes (leukocytosis or leukopenia)
•Platelets (thrombocytopenia or thrombocytosis)
2.Defective hemostasis (hemorrhage or intravascular
coagulation)
3.Neoplasia of the lymphoreticular system
(lymphomas, reticuloendothelioses or plasma cell
dyscrasias)
Sa medullary cavities nanggagaling ang red bone
marrow, yellow marrow. So any disease that will affect
the red bone marrow will also affect the stem cell, yung
magbubuo ng rbc, wbc, and platelets.
Normal rbc production and pathology
Anemias caused by deficient erythropoiesis
Iron deficiency anemia
- Anemia, may be due to blood loss. Can have an
impared production dahil kulang ingredient ng
blood. Pwedeng kulang sa iron, b12 or folic
acid. Or increase destruction.
Acute posthemorrhagic anemia
● Results from the rapid loss of whole blood.
- For ex. Naglalakad ka tapos
sinasaksak ka sa tagiliran, nagripuhan
ka, may tendency na dugo mo sa
katawan.
● It may occur from trauma (including surgery),
rupture or erosion of blood vessels, or defects
in hemostasis.
● Clinical manifestations vary with the amount,
rate and location of the hemorrhage, as
well as the patient’s general state of health
and the presence of disease in critical
organ systems.
● In the healthy young adult the rapid loss of
500 to 1000ml of blood (10% to 20% of blood
volume) is usually tolerated without
symptoms. Some have weakness, sweating,
nausea, bradycardia, hypotension and
syncope.
- Kapag healthy ka, mabilis lang
makarecover. Pero kung may sakit ka,
pwedeng mahirapan ka makarecover.
- Kapag nawalan ka ng 1 liter of blood,
wala ka masyadong mararamdaman.
Pero kung meron ka mang
mararamdaman, yan yung weakness,
sweating, etc.
● The rapid loss of 1000 to 1500ml of blood
(20% to 30% of blood volume) may cause
symptoms only in the upright position or with
exertion.
● The rapid loss of 1500 to 2000ml (30% to
40% of blood volume) usually results in
hypovolemic shock, which may be irreversible
if the blood loss extends 2000 to 2500ml
(40% to 50% of blood volume)
-
● It is the most common cause of anemia
encountered in epidemiologic studies and
clinical practice.
● The most important cause of iron deficiency
anemia in adults is blood loss.
● In women menstrual blood loss accounts for
most instances of iron deficiency anemia.
- Lalo na sa mga babae dahil may
monthly period, literal na nauubos ang
dugo kada buwan. Ang mga
malalakas ang mens, minsan umiinom
yan ng mga iron supplement.
● Dietary lack of iron is an important cause of
iron deficiency anemia only in children under
3 years of age.
● DA results, ultimately, from an inadequate
supply of iron for normal hemoglobin
synthesis in developing erythroid cells in the
bone marrow.
● Most symptoms of iron deficiency are due to
anemia. Such symptoms include fatigue, loss
of stamina, shortness of breath, weakness,
dizziness, and pallor.
- Kase kulang ang hemoglobin mo kaya
kakapusin ka ng hininga.
● Fatigue also may result from dysfunction of
iron-containing cellular enzymes.
● In addition to the usual manifestations of
anemia, some uncommon symptoms occur in
severe iron deficiency.
● Patients may have pica, an abnormal craving
to eat substances (eg, ice, dirt, paint).
● Other symptoms of severe deficiency include
glossitis, cheilosis, concave nails (koilonychia),
and, rarely, dysphagia caused by a postcricoid
esophageal web (Plummer-Vinson syndrome).
● The most common oral manifestation of iron
deficiency anemia is mucosal pallor on the
gingivae and vermilion lips. Angular cheilitis
and atrophic glossitis can also be seen in iron
defieciency anaemia
● The most common oral manifestation of iron
deficiency anemia is mucosal pallor on the
gingivae and vermilion lips.
 ● Angular cheilitis and atrophic glossitis
(smooth tongue) can also be seen in iron
defieciency anaemia
Diagnosis
● CBC, serum iron, iron-binding
capacity, and serum ferritin
● Rarely bone marrow examination
Treatment
● Oral supplemental iron
● Rarely parenteral iron
Megaloblastic anemia
● Results most often from deficiencies of
vitamin B 12 and folate.
- Usually kapag namamanhid, yung
inininom ng parents natin is yung B
complex.
- Folate naman or folic acid usually
tinetake ng mga buntis para maform
daw ang fetal head.
● Ineffective hematopoiesis affects all cell lines
but particularly RBCs.
● Anemia develops insidiously and may not
cause symptoms until it is severe.
● Deficiencies of vitamin B 12 may cause
neurologic manifestations, including
peripheral neuropathy, dementia, and
subacute combined degeneration.
● Folate deficiency may also cause diarrhea and
glossitis.
● Many patients with folate deficiency appear
wasted, particularly with temporal wasting.
● Megaloblastic anemia causes stomatitis,
mucosal ulceration, atrophy of oral mucosa
exhibited by glossitis and angular cheilitis
- Yung red, yan ang usual rbc. Yung blue
yung megaloblastic anemia, so malaki
talaga siya.
Diagnosis
● CBC, RBC indices, reticulocyte count,
and peripheral smear
● Sometimes bone marrow
examination
Treatment is directed at the underlying
disorder.
Aplastic anemia
● Aplastic anaemia is a rare disease in which the
bone marrow and the hematopoietic stem
cells that reside there are damaged.
● This causes a deficiency of all three blood
cell types (pancytopenia): red blood cells
(anemia), white blood cells (leukopenia),
and platelets (thrombocytopenia).
● Aplastic refers to the inability of stem cells to
generate mature blood cells.
● It is more frequent in people in their teens and
twenties, but is also common among the
elderly.
● It can be caused by heredity, immune disease,
or exposure to chemicals, drugs, or radiation.
● However, in about half the cases, the cause is
unknown.
 ● Symptoms include fatigue, weakness,
dizziness, and shortness of breath. It can
cause heart problems such as an irregular
heartbeat, an enlarged heart, and heart
failure. You may also have frequent infections
and bleeding.
- Mas malala ang mararamdaman mo
compared to bleeding disorders.
● The oral manifestations includes pallor of oral
mucosa, petechiae, submucosal echymosis,
gingival hyperplasia, gingival bleeding, oral
candidiasis, herpetic lesion, ulcers covered
with black or gray necrotic membrane
● The definitive diagnosis is by bone marrow
biopsy; normal bone marrow has 30–70%
blood stem cells, but in aplastic anemia, these
cells are mostly
● gone and replaced by fat.
- Makikita mo ang red bone marrow ay
napapalitan ng fats.
● First line treatment for aplastic anemia
consists of immunosuppressive drugs,
typically either anti-lymphocyte globulin or
anti-thymocyte globulin, combined with
corticosteroids and ciclosporin.
Hematopoietic stem cell transplantation is
also used, especially for patients under 30
years of age with a related matched marrow
donor.
Next meeting: Continue discussion
Midterms: October 21 (Open until evening)
10-12-22 WEDNESDAY
PART 3
Idiopathic Thrombocytopenic Purpura
- The symptoms are signs are petechiae,
purpura, and mucosal bleeding.
- Gross GI bleeding and hematuria are less
common
- The spleen is of normal size unless it is
enlarged by a coexisting viral infection or
autoimmune hemolytic anemia (maraming
sira na RBC na tinatapos sa spleen).
- Mas active na spleen mas madaming defective
ne blood component.
- Like the other disorders of increased platelet
destruction, ITP is also associated with an
increased risk of thrombosis.
DIAGNOSIS
- CBC with platelets, peripheral blood smear
- Rarely bone marrow aspiration
- Exclusion of other thrombocytopenic
disorders
TREATMENT
- Oral corticosteroids
- IV immunoglobulin(IVIG)
- Splenectomy
- Thrombopoletin receptor agonist drugs
- Rituximab
- Other immunosuppressants
- For severe bleeding, IVIG, IV anti-D immune
globulin, IV corticosteroids and/or platelet
transfusions
VON WILLEBRAND DISEASE
- Von Willebrand Factor (VWF) is synthesized
and secreted by vascular endothelium to form
part of the perivascular matrix.
- VWF promotes the platelet adhesion phase of
hemostasis by binding with a receptor on the
platelet surface membrane (glycoprotein
Ib/IX), thus connecting the platelets to the
vessel wall.
- VWF is also required to maintain normal
plasma factor VIII levels. Levels of VWF can
temporarily increase in response to stress,
exercise, pregnancy, inflammation, or
infection.
- Von Willebrand disease (VWD) is a hereditary
deficiency of von Willebrand factor (VWF),
which causes platelet dysfunction.
- Bleeding manifestations are mild to moderate
and include easy bruising, mucosal bleeding,
bleeding from small skin cuts that may stop
and start over hours, sometimes increased
menstrual bleeding and abnormal bleeding
after surgical, procedures (eg. tooth
extraction, tonsillectomy).
- Platelets function well enough that petechiae
and purpura do not occur.
- Diagnosis requires measuring total plasma
VWF antigen, VWF function as determined by
the ability of plasma to support agglutination
of normal platelets by ristocetin (ristocetin
cofactor activity) and plasma factor VIII Level.
- Patients are treated only if they are actively
bleeding or are undergoing an invasive
procedure (eg. surgery, dental extraction).
- Desmopressin is an analog of vasopressin
(antidiuretic hormone) that stimulates release
of VWF into the plasma and may increase
levels of factor VIII.
MALIGNANCIES:
LEUKEMIAS
- Cancers of the hematopoietic tissues
characteriuzed by infiltration of the
peripheral blood, bone marrow and other
 tissues by cells of a particular line, usually
lymphoid or myeloid
- The involved cells may be immature in
appearance, in which case the process is
called “acute”, or they may be mature looking
in which case the process is “chronic”.
- Patients may reveal mucosal pallor due to
anemia or bleeding and petechiae of the
palate, tongue or lips.
- Painful and deep oral ulcerations are common
resulting from either neutropenia or direct
infiltration by malignant cells.
- Viral, fungal and bacterial oral infections
develops as a consequence of
immunosuppression.
- Gingival hyperplasia resulting from leukemic
infiltration is most common in the acute
leukemias.
ACUTE LEUKEMIA
- Characterized by rapid increase in the number
of immature blood cells called blasts or
leukemia cells.
- Crowding due to such cells makes the bone
marrow unable to produce healthy blood cells
- Immediate treatment is required in acute
leukemia due to the rapid progression and
accumulation of the malignant cells, which
then spill over into the bloodstream and
spread to other organs of the body.
- Acute forms of leukemia are the most
common forms of leukemia in children.
CHRONIC LEUKEMIA
- Characterized by the excessive buildup of
relatively mature but still abnormal white
blood cells.
- Typically taking months or years to progress,
the cells are produced at a much higher rate
than normal, resulting in many abnormal
white blood cells.
- Whereas acute leukemia must be treated
immediately, chronic forms are sometimes
monitored for some time before treatment to
ensure maximum effectiveness of therapy.
- Chronic leukemia mostly occurs in older
people, but can theoretically occur in any age
group.
Lymphocytic leukemia
- The cancerous change takes place to a type of
marrow cell that normally goes on to form
lymphocytes, which are infection-fighting
immune system cells.
- Most lymphocytic leukemias involve a specific
subtype of lymphocyte, the B cell.
Myeloid leukemia
- The cancerous change takes place in a group
of white blood cells called the myeloid cells,
which normally develop into the various types
of mature blood cells, such as red blood cells,
white blood cells and platelets.
Major classification of leukemias
Acute lymphocytic leukemia
- Acute lymphocytic leukemia (ALL) is the most
common pediatric cancer; it also strikes
adults of all ages.
- Develops when abnormal white blood cells
accumulate in the bone marrow. These cells
divide rapidly, replacing healthy cells and, in
some cases, invade healthy organs. Also
known as acute lymphoblastic leukemia and
acute lymphoid leukemia
Acute myeloid leukemia
- (AML) occurs in both adults and children. This
type of leukemia is sometimes called acute
nonlymphocytic leukemia (ANLL).
- The most common type of acute leukemia in
adults, occurs when the bone marrow makes
immature blood cells called myeloblasts.
Chronic lymphocytic leukemia
 - (CLL) most often affects adults over the age of
55. It sometimes occurs in younger adults, but
it almost never affects children.
- It is a slow-growing cancer that begins in
immune cells called lymphocytes.
- These cells develop in bone marrow, but
eventually travel into the blood.
- CLL develops when too many abnormal
lymphocytes grow, crowding out normal blood
cells.
Chronic myeloid leukemia
- (CML) occurs mainly in adults. A very small
number of children also develop this disease.
- Chronic myelogenous (or myeloid or
myelocytic) leukemia (CML), also known as
chronic granulocytic leukemia (CGL), is a
cancer of the white blood cells.
- It is a form of leukemia characterized by the
increased and unregulated growth of
predominantly myeloid cells in the bone
marrow and the accumulation of these cells in
the blood.
Treatment
Some of the common treatment options for ALL
include:
- Chemotherapy
- Radiation therapy
- Stem cell transplant
- Targeted therapy - does its work by using
drugs that are designed to seek out features
unique to specific cancer cells or ones that
influence their behavior.
MULTIPLE MYELOMA
- Also known as plasma cell myeloma,
myelomatosis, or Kahler's disease (after
Otto Kahler), is a cancer of plasma cells, a
type of white blood cell normally
responsible for producing antibodies.
- In multiple myeloma, collections of
abnormal plasma cells accumulate in the
bone marrow, where they interfere with
the production of normal blood cells.
- Most cases of multiple myeloma also feature
the production of a paraprotein—an abnormal
antibody which can cause kidney problems.
- Bone lesions and hypercalcemia (high blood
calcium levels) are also often encountered.
- Ito ang problem Sa multiple myeloma, walang
cell death.
- Yung dapat na namamatay na plasma cell,
hindi namamatay but dumadami pa.
MULTIPLE MYELOMA
- Persistent bone pain (especially in the back
or thorax), renal failure, and recurring
bacterial infections are the most common
problems on presentation, but many patients
are identified when routine laboratory tests
show an elevated total protein level in the
blood or show proteinuria.
- Pathologic fractures are common, and
vertebral collapse may lead to spinal cord
compression and paraplegia.
- Symptoms of anemia predominate or may
be the sole reason for evaluation in some
patients, and a few patients have
manifestations of hyperviscosity
syndrome.
- Peripheral neuropathy, carpal tunnel
syndrome, abnormal bleeding, and symptoms
of hypercalcemia (eg, polydipsia, dehydration)
are common.
- Patients may also present with renal failure.
- Lymphadenopathy and hepatosplenomegaly
are unusual.
- Oral lesions can be seen in up to 70% of MM
cases, with the jawbone being involved in up
to 30% of cases.
- Common manifestations include toothache,
loose teeth, paraesthesia and gingival masses .
- Dental practitioners play an important role in
the multidisciplinary care of myeloma
patients including the potential diagnosis of
MM, the management patients undergoing
systemic chemotherapy, and surveillance of
the oral cavity for suspicious lesions
 Non-Hodgkin Lymphoma
- Characteristic bone lesion ng MM: SALT AND
PEPPER APPEARANCE ng bones lalo na sa
skull
Hodgkin Lymphoma & Non-Hodgkin Lymphoma
- Non-Hodgkin lymphomas (NHL) are a
heterogeneous group of disorders involving
malignant monoclonal proliferation of
lymphoid cells in lymphoreticular sites,
including lymph nodes, bone marrow, the
spleen, the liver, and the GI tract.
- Presenting symptoms usually include
peripheral lymphadenopathy. However, some
patients present without lymphadenopathy
but with abnormal lymphocytes in circulation.
- Diagnosis is usually based on lymph nodes or
bone marrow biopsy or both.
- Treatment involves radiation therapy,
chemotherapy, or both.
- Stem cell transplantation is usually reserved
for salvage therapy after incomplete remission
or relapse.
- Kapag walang reed-sternberg cells pero may
cancer formation non-hodgkin lymphoma yun

HODGKIN LYMPHOMA
- Hodgkin lymphoma is a localized or
disseminated malignant proliferation of cells
of the lymphoreticular system, primarily
involving lymph node tissue, spleen, liver, and
bone marrow.
- Hodgkin lymphoma results from the clonal
transformation of cells of B-cell origin, giving
rise to pathognomic binucleated
Reed-Sternberg cells.
- Symptoms include painless lymphadenopathy,
sometimes with fever, night sweats,
unintentional weight loss, pruritus,
splenomegaly, and hepatomegaly.
- Painless, soft masses, with or without
traumatic ulceration, may occur in palate,
buccal mucosa, and gingivae. 10-17-2022
- Diagnosis is based on lymph node biopsy.
- Treatment is curative in about 75% of cases Part 1
and consists of chemotherapy with or without
radiation therapy. Neoplastic diseases
Ito ay tungkol sa neoplasm at sa cancer. Yung cancer at
malignancy. Since yung neoplasm at sa cancer nasa
cellular level lang nangyayari.
 •In this final stage, the duplicated
DNA and RNA split and move to
separate ends of the cell, and the
cell actually divides into two
identical, functional cells.

The product of mitosis is 2 exact copies of mother cell.

Pag pinagsama sama mo ang cell makakabuo ka ng
tissue. Pag pinagsama sama ang tissue makakabuo ka
ng organ. Pag pinagsama sama ang organ makakabuo
ka ng organ system at pag pinagsama ang organ
system makakabuo ng organism o tao. Mula cell
hanggang tao it involves the process of replication
pero controlled yan may balance, may lumalaki, may
namamatay, may bumabawas so regulated siya pero
pagdating kay cancer ibang usapan na yan.
Yung isang mother cell makakabuo ng one is to one
katulad ng mother cell. Yung meiosis naman involves
gametes, mga sex cells usually egg at sperm pagdating
sa tao. Ang mabubuo doon ay ½ at 1/2 . So kaya tayo
produkto tayo ng sperm at egg cell, kalahati galing sa
tatay natin at kalahati naman sa nanay natin kaya may
trait ka na makukuha sa dalawa kasi pinaghalo. Di
katulad pag somatic cells mga cells ng balat, buhok,
parehas yon ang regulated pero pag unregulated na
siya, mapupunta na tayo sa cancer, uncontrollable na
yan, divide lang sila ng divide wala na silang pinapansin
kaya kita mo nakakabuo tayo ng abnormal amount ng
mga cells.

Growth regulation

•Each cell goes through a four

phase cycle in order to replicate
itself.

•The first phase called G1, is when

the cell prepares to replicate its
Chromosomes.

So naghahanda palang ang chromosomes kung saan

nagrereside ang ating genes.
Growth regulation
•The second stage is called S, and
•The number of cells in a normal tissue is tightly
in this phase DNA synthesis
regulated by a balance between cell proliferation and
occurs and the DNA is duplicated.
death.
•The next phase is the G2 phase,
•The final common pathway for cell division
when the RNA and protein
involves distinct molecular switches that control
Duplicate.
cell cycle progression from G1 to S phase of DNA
synthesis.
RNA is the building blocks of protein

•Dysregulation of cellular proliferation is the

•The final stage is the M stage,
main hallmark of neoplasms/cancer.
which is the stage of actual cell
division.
Neoplasia
Definition:

•NEO means new; plasia means formation

•“An abnormal mass of tissue, the growth of which is

uncoordinated with that of normal tissues, and that
persists in the same excessive manner after the
cessation of the stimulus which evoked the change”

Usually pag sinabi nating neoplasia, mass yan o bukol

pero hindi naman palagi. Meron namang considered na Classification
cancer pero wala kang makikitang bukol. Yung
pinagusapan natin na leukemia , wala ka namang •Benign
makikitang bukol don pero cancer siya kasi abnormal •Malignant
ang proliferation ng cells. Blood cancer siya.
Benign Malignant
Kahit wala siyang stimulus, tuloy tuloy na siya.
Well differentiated Poorly differentiated
•“Cell division without control”
Slow growth Rapid growth
Neoplasia
Cohesive Non cohesive

•All tumors have two basic components: Encapsulated Not Encapsulated

•Parechyma: made up of neoplastic cells No invasion/ With invasion/

infiltration/ metastasis infiltration/ metastasis
•Stroma: made up of non-neoplastic, host-derived
Not fatal Causes death (if not
connective tissue and treated)
blood vessels

Pag slice mo yung suha, yung laman yung nakakain
yon ang parenchyma, yung puti puti naman yon ang
stroma.
The parenchyma:
•Determines the biological behavior of the
tumor
•From which the tumor derives its name
The stroma:
•Carries the blood supply
•Provides support for the growth of the
parenchyma
Well differentiated meaning mas nakikita pero pag
malignant parang labo labo siya, parang may chaos.
Pagdating sa paglaki mas mabagal ang benign. Yung
malignant mabilis. Cohesive yung benign meaning
dikit dikit sila
Sa benign encapsulated may barikada yan walang
makakawala. Si malignant wala kaya free silang
gumalaw.
Sa malignant ang characteristic niya yung metastasis
ibig sabihin lilipat yung ibang cell sa kabilang site,
kumakalat. Pag benign walang metastasis walang
invasion. Invasion sa katabi lang , infiltration sa
malapit lang ang metastasis malayo. Pero the same din
lumilipat ka ng pwesto. Ano yung nakakacontribute
don? As compared to benign, non-cohesive hindi sila
magkakakapit kapit, wala silang pakealam sa isat isa
kaya pwede kang umalis, hindi mo naman dala ang isa
mong kasama so pwede kang lumipat. Pag dating
naman sa fatal, ang benign pag sinabing non fatal ang
tumor mo makakahinga ka ng maluwag pero
pagsinabing malignant, kakabahan kana. Pero hindi
lahat ng benign ay hindi delikado. May mga benign na
tumor na yon ang part na napuntahan (sa katawan) ay
delikado. Saan yon? Sa utak. Sa loob ng skull. Lumalaki
pa din yan eh e alam natin ang skull hindi na
nageexpand yan hindi tulad nong baby tayo. Pag
lumalaki yan sisikip, magbubuild ang pressure sa ulo,
maiipit ang mga structures na kailangan sa ating
functioning. Pwede mabulag, mabingi, increased
intracranial, pwede mo siyang ikamatay kahit benign
siya.
Cancer/malignancy
•Cancer is an unregulated proliferation of cells.
•Its prominent properties are a lack of
differentiation of cells, local invasion of
adjoining tissue, and, often, metastasis (spread
to distant sites through the bloodstream or the
lymphatic system).
Evolution of cancer:
morphologic changes
•As mutations accumulate in a given cell,
there is a progressive loss of regulation of the
cell cycle, differentiation, and cell-to-cell
adhesion and interaction.
•These changes are accompanied by
progressive abnormalities in morphology
(appearance) of the cells. At times, changes
in cellular appearance or number are normal
responses to physiologic stresses.
•For example, failure to exercise a muscle will
result in ATROPHY- reduction in cell, while repeated
exercise produces HYPERTROPHY- enlargement in cell
sze.
•Atrophy – reduction in cell size
San mo siya mapapansin? Yung mga taong naka wheel
chair na hindi na ginagalaw the more na liliit siya. Yung
mga nakawheel chair yung binti ang liit na.
•Hypertrophy – enlargement of cell size
Yung mga kargador, body building
•Hyperplasia - An increase in the number of cells in a
tissue with normal cell morphology and normal cell to
cell interaction.
Ex: pagbuo ng kalyo sa paa, kamay
•Dysplasia - A pre-cancerous state characterized by
increased cell proliferation with highly abnormal and
variable appearance to the cells. Cell to cell
interactions are diminished, and the architecture of
the tissue is less organized. Dysplasia is potentially
reversible, and it doesn't always progress to cancer,
but it indicates a pre-cancerous state with a high
probabability of progressing to cancer.
Pag nakita mo magiiba ang mood mo, medyo pangit.
PART 2
Cancer/malignancy
In 2000 cancer biologists Robert Weinberg and
Douglas Hanahan published an article entitled "The
Hallmarks of Cancer.“ They listed six essential
alterations in cell physiology that characterized
malignancy.
● Self-sufficiency in growth signals: cancer
cells acquire an autonomous drive to
proliferate - pathological mitosis - by virtue of
the activation of oncogenes such as ras or myc.
● Insensitivity to growth-inhibitory
(antigrowth) signals: cancer cells inactivate
tumor suppressor genes, such as Rb, that
normally inhibit growth.
● Evasion of programmed cell death
(apoptosis): cancer cells suppress and
inactivate genes and pathways that normally
enable cells to die.
● Limitless replication potential: cancer cells
activate specific gene pathways that render
them immortal even after generations of
growth.
● Sustained angiogenesis: cancer cells acquire
the capacity to draw out their own supply of
blood and blood vessels - tumor angiogenesis.
Meron siyang sariling paraan para mabuhay
siya, eto na nga yung mga new blood vessels.
Hiwalay yan sa buong katawan yung blood
vessels na yan, hnd yan part sa normal
 anatomy sa cell lang yan para makakuha siya - Sa ating lymph vessels
nh nutrients sa katawan ng tao 3. Haematogenous spread
● Tissue invasion and metastasis: cancer cells a. This is typical route of metastasis for
acquire the capacity to migrate to other
sarcomas, but it is also the utroma,
organs, invade other tissues, and colonize
these organs, resulting in their spread such as those originating in the
throughout the body. kidney (renal cell carcinoma).
Doon nsiya nakikila pag meron talagang - Sa dugo, tamang tama madaling makalipat sa
metastasis cancer talaga yan. dugo
4. Transplantation or implantation
Metastasis a. Cancer cells may spread to lymp
● Metastatic tumors are very common in the
nodes (regional lymph nodes) near
late stages of cancer.
the primary tumor.
Usually makikita mo siya sa late stages
b. This is called nodal involvement,
● Metastasis is a complex series of steps in
positive nodes, or regional disease.
which cancer cells leave the original tumor
- Doon sa katabi pwede sa katabi
site and migrate to other parts of the body via
- Halimbawa sa mga babae na may breast
the bloodstream, the lymphatic system, or by
cancer, pag nagcheck kayo ng breast ninyo sa
direct extension.
self breast exam, idadamay niyo kilikili ninyo sa
● To do so, malignant cells break away from the
breast exam baka may lumalaki yung lymp
primary tumor and attach to and degrade
nodes niyo kasi pwedeng lumapit yung cancer
proteins that make up the surrounding
cells kung may cancer cells man nakapa ninyo
extracellular matrix (ECM), which separates
doon a katabing malapit lang, doon sa
the tumor from adjoining tissues.
katabing lymph nodes.
● By degrading these proteins, cancer cells are
- Pwede rin sa may cancer surgeons, ingat na
able to breach the ECM and escape.
ingat sila na pag gumamit sila ng scalpel blade
na pinanghiwa nila sa bukol na may cancer,
pagkatapos nila gamitin yun,, itatapo na nila.
Hindi na nila gagamitin yun ulit kasi, pwede
Routes of metastasis
dumakit yung cells ng cancer doon sa blade
kaya pagginamit mo yan, hiniwa sa ibang parts
1. Transcoelomic
ng katawan mo, pwede kang mag lipat or
a. The spread of a malignancy into body
IMPLANT or TRANSPLANT sa ibang parte ng
cavities can occur via penetrating the
katawan.
surface of the peritoneal, pleural,
pericardial, or subarachnoid spaces.
Organ specific targets
b. For example, ovarian tumors can
● There is a propensity for certain tumors to
spread transperitoneally to the
seed in particular organs.
surface of the liver.
- eto na nga yung dinidiscuss ni Stephen
- Pagsinabi niya transcoelomic, gagamitin niya
Paget na nakadiscover ng paget's
ibang cavities sa katawan tulad ng peritoneal,
diseases na “seed and soil” theory
pleural, pericardial, or subarachnoid spaces.
● This was first discussed as the "seed and soil"
- For example, magkasama sa isang cavity ang
theory by Stephen Paget over a century ago in
ovaries at liver kaya ang cancer ng ovary
1889. The propensity for a metastatic cell to
madali lang makapunta sa liver
spread to a particular organ is termed
2. Lymphatic spread
'organotropism'.
a. Lymphatic spread allows the
- May mga cel na doon lang talaga hilig
transport of tumor cells to lymph
nilang pumunta. Wala talagang
nodes and ultimately, to other parts of
explanation. Katulad ng prostate , gu
the body.
sto nila magsprespread sila sa bone,
b. This is the most common route of
ang colon cancer mahilig sila sa livera,
metastasis for carcinomas.
 ng stomach cancer mahilig sia
ovaries
● For example, prostate cancer usually
metastasizes to the bones. In a similar
manner, colon cancer has a tendency to
metastasize to the liver. Stomach cancer often
metastasises to the ovary in women, then it is
called a Krukenberg tumor.
● According to the "seed and soil" theory, it is
difficult for cancer cells to survive outside
their region of origin (comfort zone), so in
order to metastasize they must find a location
with similar characteristics.
● For example, breast tumor cells, which gather
calcium ions from breast milk, metastasize to
bone tissue, where they can gather calcium
ions from bone. Malignant melanoma spreads
to the brain, presumably because neural tissue
and melanocytes arise from the same cell line
in the embryo.
- Si breast tumor cells mahilig siya sa
calcium which gathers calcium ions
from breast milk, so may affinity siya
sa Calcium, kung ako breast canver
cell, saan ako lilipat na marami ring
calsiumsi , edi sa bone kasi may
calcium ang bone, doon ako
compatible eh doon may calcium
- Pwede rin si melanoma, usually nag
sprespread daw sa brain. Kasi
presumably because neural tissue ng
brain at yung skin cells nation,
melanocytes, pigment cells,, noong
nag develop sila noong embryo pa lang
tayo iisa pinanggalingan nila
kumbaga parang magkababata sla,
kasi may special connection. Syempre
if lilipat ka gusto mo doon sa may
kilalla ka so pupunta ka roon sa may
brain cells pupunta ako kay brain.
- Kaya yung iba pagnagmetastasis, may
dahilan
- -diba pagnaglipat ka sa Manila para
mag aral. Ano coconsider mo doon
para mag aral ka doon. yung familiar,
may familya ka doon may kamag-anak
ka doon, may kakilala ka doon kaya
don ka lilipat.
Examples of cancer okung saan sila lumilipat
Etiology of Malignant Neoplasia (Cancer)
Ano mga triggers bakit ka nagkakacancer
● Chemicals Used in industry food,
cosmetics, and plastics
- Chemicals: mandalas yan nababanggi.
Dia yung mga naghihinto ang
production or narerecall ang mga
producto kasi nga cancerous daw na
yung sa pancit canton, nirecall sa (
same country) nag exceed sa product
na yun kaya binalik ang producto
● Environmental Agents- Air and/o water
pollution
- Usok to form ung cancer
● Radiation
● Hormones
● Virus
- Kaya kayong mga babae meron
kayong pa HPV vaccination
● Genetic Predisposition
- It runs in the family, nabalitaan niyo
na si Angelina Jolie nasa lahi nila ang
breast cancer kay nag pa prophylactic
mastectomy so pinatangal niya na
yung boobs niya so common sense, hnd
kana tutubuan ng breast cab=ncer
kasi wla na breast niya
● Smoking
- Yung oack years nagdiidictate kung
may malaki kang chance na
 magkaroon ng lung smoking related
diseases tulad ng cancer
Nomenclature
● -oma = tumor (benign)
● -carcinoma = hard tumor (malignant)
● -sarcoma = soft tumor (malignant)
Pagnagnaname naman ng cancer, may rule yan eh.
Basically pag dulo
-oma = tumor (benign)
-carcinoma = hard tumor (malignant)
-sarcoma = soft tumor (malignant)
Tulad nilo
Tulad neto, pag epithelial cell ang source niya , ang
benign may -oma, and malignant may -carcinoma
Kaya meron tayong: adenoma, papilloma.. Benign yun
Adenocarcinoma, squamous cell carcinoma- malignant
naman yan
Pag mesenchymal naman origin ganun rin omo and
carcinoma din
Pag Benign: osteoma, Haemongioma, Leiomyoma,
Rhabdomyoma
Palitan mo lang yung oma, gawin mong sarcoma
malignant na siya : Osteosarcoma, Angiosarcoma,
Leiomyosarcoma
Pero hnd lahat ganyan
Meron may Oma ang dulo pero malignant. Lalo na itong
teratoma
● Teratoma – germ cell tumor; mature (benign)
● Immature (malignant)
- Pag immature yng teratoma
malignant na agad yun
● Melanoma/melanocarcinoma – malignancy of
melanocytes
- Automatic malignant yan skin cancer.
● Seminoma/seminal carcinoma – carcinoma of
testes
● Leukemia – malignancy of hematopoetic stem
cells (WBCs)
● Lymphoma – malignancy of lymphocytes
Meron din yung mga hnd dumusunod walang oma,
carcinoma, sarcoma tulad ng leukemia, pagnabasa mo
leukemia, malignant na siya agad. Walang benign na
leukemia, malignanat na yan agad
Detection, diagnosis and staging of cancer
- Paano dinedetect paano scinescreen
Detection

Sa screening naman, sa screening method, hnd ibig
sabihin meron ka na , nag -iingat ka lang,
pinapaunahan mo lang katulad ni Angelina Jolie.
Iscrineen niya sarili niya for breast cancer kaya ang
ginawa niya prinevent na niya, pinatanggal niya na
yung boobs niya para sa breast cancer.
Ganun rin sa ibang parte ng katawan. Katulad sa
cervix, pwede ka magpapopsmear pero depende kung
gaano kadalas mo siya gagawin, mag hnd ka pa sa age
na madalas magkaroon ng cervical cancer. Mga 59
below, pwedeng yearly lalo na sexually active ka na.
Pero pagdumating ka na sa age na 60 and below, mas
madalas na every 6 months na lalo na pagmaynakitang
dysplasia, mga finding abangan na ng doctor yun
Sa mga lalaki naman, prostate, ang gold standard and
advice ng mga urologist ay yung digital rectal exam.
Yung gagamit talaga ng daliri para i examin yung
prostate, pero yung iba ilang may mga ganun ganun, so
magpapaultrasound na lang sila, paparequest ka nga
ng ultrasound pero pina recommend transrectal pero
ganun din, masmalaki pa kasi mas malaki probe nun
kesa daliri sa prostate may specific antigen, siguro
naririning niyo yun sa mga kamaganak niyong lalaki.
Yung lab exam nila may BSA (?) minomonitor lang yan
lalo na paglaki ng prostate kahit hnd naman cancerous
Yung ovaries naman,, ultrasound, ginagamit rin ng
flower markers(?) blood yun eh yung CA-125 tsaka
yung physical exam, kinakapa yan sa tiyan.
Pag may nakikita kayo ng mga malalaki na tiyan,, na
hnd namna bunti, may ga ovarian cancer diyan.
Tinawag yan ONG Ovarian New Growth. Sa sobrang laki
ng new growth ng ova, dinadaganan or iniipit niya na
yung blood vessels yung extrang tubig lumalabas, kaya
lumalaki yung tiyan ng mga may ovarian cancer.
Sa Lung naman, chest xray or kaya CT scan,
Sa Breast naman, dati mammography pero dati yung
mga babae ayaw magpamammography kasi masakit
raw dahil literal na iniipit pero dahil sa advancement
ng technology, hnd na kailangan nakaipit basta may
contact lang doon sa breast makakaread na ng
accurate yung machine, at tsaka syempre physical exam.
Either doctor gagawa or sarili ninyo
Sa Colon naman, ang colonoscopy yan ang counterpart
ng endoscopy sa bunganga pinapasok, sa endoscopy sa
pwet , sa endoscopy e malambot pa yun eh
nagagagalaw mo pa, sa colonoscopy maligas yun eh
kaya maraming natatakot, parang tubo yun eh tube na
rigid. Tsaka gumagamit ng Fecal Occult Blood Test.
Parang lang ito . Para itong routine stool exam or fecalis
pero merong pero meron prinoprocess na ibang
paraan, na occult bleeding sa ibang parte ng katawan .
Pag ito nag positive may malaking chance na
magkaroon ito ng colon cancer
Diagnosis
● A diagnosis of cancer may be suspected based
on history and physical examination but
requires confirmation by tumor biopsy and
histopathologic examination. Sometimes the
first indication is an abnormal laboratory test
result (eg, anemia resulting from colon
cancer).
-meron kasi mga PE finding na baka sa tingin
niyo benign pero malignant na pala kaya
gagamit na kayo ng biopsy , yun ang ibig kong
sabihinkasi meron rin yung kala mo malignant
pero ngayon pala benign.
Katulad ng mga babae . yung mga nagcheck ng
breast yun biglang nagkabreast exam within
your period, Pag nad breast exam kayo ng
within your period, talagang may makakapa
kayo diyan, matatanranta kayo, kaya
suggestion mag self check kayo 1 week after ng
menstration kasi minsandahil sa hormone may
matigas kayong makakapa talaga.
● A complete history and physical examination
may reveal unexpected clues to early cancer.
Tulad sa colon cancer, yung simpleng
pagmonitor mo lang gaano ka kadalas dumumi
sign yan. Pag biglang dumalang ang pagdumi
mo 1 beses ka lang sa isang linngoo, isang
beses ka lang sa isang buwan, isang beses ka
lang every 2 month baka meron na . Tapos
yung sa itsura ng dui. Usually ang dumi ng mya
colon cancer…, dibayung tawag sa normal ay
 scybalous stool, yung bou formed siya, pero sa
taong may colon cancer, usually parang ribbon,
manipis. Parang string, o kaya yung goat-stool
like parang dumi ng kambing, parang putol
putol,, tsaka nag dudugo sa prerectom, fresh
blood kasi kagagaling lang sa rectum
● Physicians must be aware of predisposing
factors and must specifically ask about :
○ familial cancer,
- May cancer sa family basta
cancer alamin mo
○ environmental exposure (including
smoking history), and
○ prior or present illnesses (eg,
autoimmune disorders, previous
immunosuppressive therapy,
hepatitis B or hepatitis C, HIV
infection, abnormal Papanicolaou test
(PAP’s smear), human papillomavirus
infection).
Part 3
Diagnosis
Physicians must be aware of predisposing factors and
must specifically ask about:
● familial cancer,
● environmental exposure (including smoking
history), and
● prior or present illnesses (eg, autoimmune
disorders, previous immunosuppressive
therapy, hepatitis B or hepatitis C, HIV
infection, abnormal Papanicolaou test (PAP’s
smear), human papillomavirus infection).
● HPV infection may lead to cervical cancer
Symptoms suggesting occult cancer can include:
● Fatigue
● Weight loss
● Fevers
● Night sweats
● Cough
● Hemoptysis
● Hematemesis
● Hematochezia
● Change in bowel habits
● Persistent pain
Staging
● Cancer stage has a lot of influence on survival
rate, since higher survival rates are usually
associated with earlier stages of the disease.
● To describe one's cancer stage physicians use
the TNM Staging System which uses criteria
that are similar for different types of cancer
except malignancies in the brain and blood.
● TNM means T for tumor size, N for nodal
involvement, M for metastasis
● Cancer staging is a helpful tool for physicians
in advising their patients about their options
for treatment.
● A patient with Stage I may need less
aggressive treatment than a patient with Stage
II cancer, but a patient with Stage IV cancer
may choose to have supportive therapy rather
than radical procedures.
● It is the duty of the doctor to give palliative
care, yung comfortable yung patient sa last
days niya at hindi siya in pain.
TNM Staging
● The TNM classification system of cancer
describes the tumor size (T) and degree of
invasion, the involvement of regional lymph
nodes (N) and the presence of spread or
metastasis (M) to distant parts of the body.
● Different degrees of tumor size or invasion,
involvement of lymph nodes and spread to
other organs are further specified in numbers
to describe in more detail the stage of
malignancy.
● For instance, a tumor described as T1 is much
smaller and confined than a tumor that is
described as T4.
● Sa T designated yan sa T1 hanggang T4. T1
being the smallest and T4 being the biggest.
● Pag sa N (nodal involvement), kapag N1 may
nodal involvement and kapag N0 wala.
● Kapag M1 may metastasis, kapag M0 wala.
● Cancer staging depends on a combination of
the three parameters (tumor size, lymph node
involvement and spread of disease).
● A Stage I cancer therefore is a localized stage
of malignancy, where a tumor is relatively
small, has not invaded surrounding tissues or
spread to other organs.
● On the other hand, cancer which is in Stage IV
may have a tumor of any size, may have
affected the lymph nodes and has definitely
spread to other distant organs such as the
brain, liver or bones.
Staging Some potentially malignant (pre-cancerous) oral
● Stage 0. Also known as carcinoma in situ (CIS), clinical lesions which can progress to OSCC include the
this is an early form of cancer where there is a following:
flat lesion with no invasion of malignant cells ● Erythroplasia - a clinical term to describe any
into the surrounding tissue. Although this can erythematous (red) area on a mucous
develop into full blown cancer some doctors membrane that cannot be attributed to any
do not consider this as cancer but other pathology (namumula)
"pre-cancer." ● Leukoplakia - a condition where areas of
● Stage I. Tumors in this stage are usually keratosis appear as firmly attached white
smaller than 2 centimeters (cm) and are patches on the mucous membranes of the oral
localized to the part of the body where it cavity (namumuti)
originated. Lymph nodes are not affected and ● Lichen planus - a disease of the skin and/or
there is no sign of spread elsewhere. mucous membranes that resembles lichen
● Stage II. Tumors in this stage measure 2-5 cm (parang amag sa trees na flat)
but are still localized since they have not ● Oral submucous fibrosis
invaded other tissues or spread to distant
sites. Local lymph nodes may be affected. They
are considered to be locally advanced tumors.
● Stage III. Tumors in this stage are fairly large,
measuring more than 5 cm. This late, locally
advanced stage affects lymph nodes nearby
and it may be difficult to differentiate from
stage II cancer.
● Stage IV. Tumors in this stage may be of any
size, affecting nearby lymph nodes and
showing evidence of spread (metastasis) to Lichen Planus
other organs or regions of the body. A
secondary cancer may develop during this
stage. The overall physical and mental health
of the patient may be affected and survival
rate is very low.

Oral cancer
● Oral cancer is usually squamous cell
carcinoma (OSCC) and is mainly a disease of
older males. Erythroplasia
● It is the predominant cancer in the head and
neck region.
Risk factors of oral cancer:
● Tobacco
● Betel quid (nganga)
● Alcohol-containing beverages
● Charcoal grilled meats and fried foods
● Micro-organisms e.g. Candida, HPV, Herpes
Leukoplasia
virus
● Poor oral hygiene
Oral cancer
● Common sites for OSCC are the lips, the lateral
Oral cancer
border of the tongue and the floor of the
● There is a highly significant increase in the
mouth.
incidence of OSCC in systemic diseases like
● Many OSCCs can be detected visually but early
Systemic Sclerosis
OSCC can be asymptomatic, may appear
● There is an increase in the risk of having
innocuous and can be overlooked especially if
potentially malignant lesions in transplant
the examination is not thorough.
recipients
● Cancer must be suspected, especially when
● There is a putative association of DM with oral
there is a single oral lesion persisting for more
cancer.
than 3 weeks

Warning features of oral carcinoma


● Staging of OSCC should be made according to
the TNM classification of the International
Union Against Cancer (UICC)
● Any lesion of a potentially malignant or
dubious nature persisting for more than 3
weeks should be biopsied.
● The reliable differentiation of malignant
lesions from benign lesions by clinical
inspection alone is not possible.
● The only method currently available to
determine the diagnosis and give an
indication of prognosis reliably is the
laboratory histopathologic examination of a
biopsy tissue sample.
The golden rule is therefore to biopsy any persistent
mucosal lesion where there is not absolute confidence
that the diagnosis is of a benign lesion.
Cancer treatment:
❖ Surgery
❖ Radiotherapy
❖ Chemotherapy (cytotoxic drugs)
❖ Targetted therapy stem cell transplantation
❖ Immunotherapy
❖ Gene therapy
Complications of treatment
● The likelihood is high that aggressive cancer
treatment will have toxic effects on normal
cells as well as cancer cells.
● Most patients being treated for head and neck
cancer will experience some oral
complications, and while most of these are
manageable, complications can sometimes
become severe enough that treatment must be
completely stopped.
● Surgical solutions to tumor removal may lead
to oral and nutritional problems as well.
Mucositis
● Mucositis occurs when cancer treatments
break down the rapidly divided epithelial cells
lining the gastro-intestinal tract (which goes
from the mouth to the anus), leaving the
mucosal tissue open to ulceration and
infection.
● The part of this lining that covers the mouth,
called the oral mucosa, is one of the most
sensitive parts of the body and is particularly
vulnerable to chemotherapy and radiation.
● The oral cavity is the most common location
for mucositis.
● Oral mucositis is probably the most common,
debilitating complication of cancer
treatments, particularly chemotherapy and
radiation.
● It can lead to several problems, including pain,
nutritional problems as a result of inability to
eat, and increased risk of infection due to
open sores in the mucosa.
● It has a significant effect on the patient’s
quality of life and can be dose-limiting (i.e.,
requiring a reduction in subsequent
chemotherapy doses).
Signs and symptoms of mucositis include:
● -Red, shiny, or swollen mouth and gums
● -Blood in the mouth
● -Sores in the mouth or on the gums or tongue
● -Soreness or pain in the mouth or throat
● -Difficulty swallowing or talking
● -Feeling of dryness, mild burning, or pain
when eating food
● -Soft, whitish patches or pus in the mouth or
on the tongue
● -Increased mucus or thicker saliva in the
mouth

Dysphagia
● Dysphagia, derived from the Greek phagein,
meaning "to eat," is a common symptom of
head and neck cancer and can be an
unfortunate sequelae of its treatment.
● Dysphagia is any disruption in the swallowing
process during bolus transport from the oral
cavity to the stomach.
● In head and neck cancer patients, dysphagia
may be caused by surgical ablation of
muscular, bony, cartilaginous, or nervous
structures or may be attributable to the
effects of antineoplastic agents including
radiation and/or chemotherapy.
Xerostomia
● Xerostomia is defined as dry mouth resulting
from reduced or absent saliva flow.
● Xerostomia is not a disease, but it may be a
symptom of various medical conditions, a side
effect of radiation to the head and neck, or a
side effect of a wide variety of medications.
● It may or may not be associated with
decreased salivary gland function.
● Xerostomia is the most common toxicity
associated with standard fractionated
radiation therapy to the head and neck.
Trismus
● Trismus is defined as a tonic contraction of
the muscles of mastication.
● More recently, the term 'trismus' has been
used to describe any restriction to mouth
opening, including restrictions caused by
trauma, surgery or radiation.
● May result from replacement fibrosis of the
masticatory muscles.
Other complications:
● Infections are predisposed to by xerostomia
● Loss of taste (hypoguesia) follows radiation
damage to the taste buds but xerostomia may
contribute to disturb taste sensation.
● Radiation caries
● Osteoradionecrosis
● Radiation therapy induces endarteritis
obliterans, which leads to progressive tissue
fibrosis and capillary loss, leaving bone
susceptible to avascular necrosis.
● Craniofacial defects, tooth hypoplasia and
retarded eruption can follow irradiation of
developing teeth and growth centers in
children.
● Drug-induced thrombocytopenia may cause
gingival bleeding, mucosal petechiae or
ecchymoses.
Metastatic tumors to the oral cavity
● Metastatic tumors (MT) to the oral region are
uncommon, comprising only 1-3% of all
malignant oral neoplasms.
● Metastatic lesions may occur in the oral soft
tissues, in the jawbones or in both osseous
and soft tissues.
● The common primary sources of tumors
metastatic to the oral region are the breast,
lung and kidney.
● Mandible is the most common location for
metastases, with the molar area being the
most frequently involved site
● Frequently, they show non-aggressive clinical
findings mimicking a reactive or benign
lesions or even simple odontogenic infections.
Steps in the metastatic cascade
1. Primary tumor - Metastasis involves
sequential progression of the primary tumor
towards invasion and dispersion/spreading of
cancer cells through the lymphatic or blood
vessels.
2. Systemic circulation - Circulating cancer cells
survive and settle in the microvasculature of
 the target organ and extravasate through the
vessel wall.
3. Final metastatic destination - These cancer
cells gain access, advance towards evident
metastasis with or without an intervening
period of latency.

Clinical Presentation:
● Oral metastasis is considered as a late
complication and frequently associated with
multiple organ metastases.
● Oral metastases can grow rapidly causing
pain, difficulty in chewing, dysphagia,
disfigurement and intermittent bleeding,
leading to poor quality of life.

Treatment and Prognosis

● The treatment and prognosis is primarily
based on the site of origin and the degree of
metastatic spread.
● Unfortunately, the identification of a
metastatic tumor usually represents a poor
overall prognosis.
● The time from the appearance of the
metastasis to death is several months.
● If the primary tumor was successfully treated
and the patient's medical condition permits,
the metastatic lesion should be aggressively
treated.
● Management may involve surgical resection,
radiation, chemotherapy or a combination of
these techniques.

-end-