Consult Training

THINGS TO REMEMBER AS A MEDICAL OUTREACH COMMON CHIEF COMPLAINTS IN THE OPD OR MEDICAL
CONSULTANT MISSIONS
1. Act professionally.
2. Some patients have not seen a doctor or if ever, tired of their own local PE: Skin Lesions
health care workers. Impetigo
3. Most patients are not sick. They just want to be checked, be touched, or
listened to.
4. Most have normal findings.
5. Even if you’re tired, smile. Be patient even if you’re hungry. Be cool.
6. Observe bawal na S
7. Must have instruments
8. On history taking:
• Need not to be detailed
• Ask only related and relevant information to chief complaint
• Ask other problems besides the chief complaint (ROS) Carbuncle
On physical examination
• Attempt to do complete physical examination to discover other
positive diagnoses not related to the chief complaint
• Do ROS and PE at the same time
What to note in doing PE during the COVID-19 pandemic?
• If one has fever, cough, sore throat, body pains, always r/o
COVID-19

REGISTRATION FORM
Always check the following:
• Name Carbuncle vs. Furuncle
Carbuncle:
• Age A red, swollen, and painful cluster of boils that are
• For adults connected to each other under the skin.
o Blood pressure
o Occupation Furuncle:
• For pediatric patients A boil is an infection of a hair follicle that has a small
o Complete age in year and months collection of pus (called abscess) under the skin.
o Height and
weight for Infected
IBW in relation to age wounds
computing Under 10 years old:
IBW in IBW = Age in years x 2 +
relation to 8
age e.g., patient is 7 y/o
IBW = 7 x 2 + 8 = 22kg
• If with fever, take
note of temperature 3-12 months:
and let patient take IBW (in lbs) = age in
Paracetamol months + 10
• Note for allergies to Chicken-
food, drugs, or others pox with
• For females of reproductive age, ask LMP and PMP second-
dary
infection
CONSULTATION
1. Chief complaint (CC)
• Ask if it is an active complaint
• CC will make you think of a differential diagnosis right away
• Do pertinent history taking
• ROS is done together with the PE Infected • Always check interdigital areas
• Perform maneuvers even if findings are normal scabies • Ask family history since it’s common among
• For adults complaining of epigastric pain, always rule out myocardial families
infarction • Can cause rashes due to burrowing of the agent,
Goal in the consultation area: Sarcoptes scabiei
1. To come up with as many diagnoses as you can with your patient
2. To listen to their stories, to examine them and offer something
3. To touch the lives of these people
4. To be a physician to them

2. History of present illness (HPI): always start with OPQRST

• Epigastric pain, 2 days PTC
o Acute - if considering GIT - ask for recently ingested
food? Alcohol? Medication?
• Epigastric pain, 2 months PTC, recurrent
o Chronic - if considering GIT - PUD? Gastric or duodenal
ulcer or cancer? Family affair diseases include scabies and pruritus ani.
• Loose bowel movement (LBM), 250 ml/bout, 10 times a day
o Increased loss of fluid - consider dehydration - in
management, may prescribe IV fluids
3. Past Medical History
4. Social and Environmental history
• Social history includes interpersonal relationships
5. Family History
6. Review of Systems (ROS)
Infected Dengue
insect
bite

For skin lesions commonly caused by Staphylococcus such as impetigo, Insect bites
carbuncles, infected wounds, infected insect bites and infected chicken
pox:
• Cloxacillin 500 mg QID x 1 week
• Cloxacillin 125mg/5ml
• Cloxacillin 250 mg/5ml
**50-100 mg/kg/day: 4 doses
• Wound cleaning

How to compute for dose especially in children Allergy

Pediatric dose computation:
Weight (in kg) x Empiric dose x inverse of Preparation = Total
dose/day (in ml) / 3 or 4 doses = __ml/dose

e.g., you have a 15kg child with impetigo, compute for dose per day
and dose per intake
15 kg x 75 (50-100 mg/kg/day) x 5ml/250mg = 22.5 ml/day / 4
doses = 5.625 ml/dose ~ 5 ml (since it is still within the therapeutic
dose)
Tinea Consider factors that promote growth of Malassezia
How many bottles? versicolor • Hot and humid weather
5ml x 4 doses x 7 days = 140 ml / 60 ml per bottle = 2.3 ~ 3 • Excessive sweating
bottles
*Advice patient to consume all 3 bottles since it is an antibiotic. • Oily skin
• Weakened immune system
Scabies • Hormonal changes
• Benzoyl benzoate lotion apply from neck down then wash after
24 hours, then apply for 3 consecutive days
• Crotamiton cream 10% apply in the evening for 3-5 days
• Sulphur soap
• If infected, wound cleaning and give Cloxacillin
• If with itchiness, give antihistamine such as Cetirizine
• Boil beddings
For tinea versicolor:
Rashes • Tioconazole cream 1% (Trosyd) OD for 2-6 weeks
Ask for history of…
• Clotrimazole cream 1% apply BID-TID
• Exposure
• Terbinafine HCl 1% cream (Lamisil) apply OD or
• Allergies BID for 2 weeks
Inhalants (dust, pollens, perfumes)
Ingestants (food and drugs) • Sulphur soap
Contactants (soap, detergent, metal, rubber)
Injectants (drugs, sting, insect bite) **If lesions are more numerous than normal skin, note as
• For dengue, ask history of insect bites and “normal skin over tinea versicolor”
increased number of similar cases in the Acne Acne occurs when pores are blocked with oil, dead skin or
community bacteria. Four main factors that cause acne include (1) excess
Measles sebum (oil) production, (2) hair follicles clogged by oil or dead
skin cells, (3) bacteria, and (4) bacteria
• Rubella (German measles) vs. Rubeola (plain) Consider the following:
• Risk factors (4)
• Age (teenagers)
• Hormonal change (puberty or pregnancy)
• Family history
• Greasy or oily substances (e.g., lotion)
• Friction

Rubella vs. Rubeola vs. Roseola

Look for the following in the peritonsillar area
Rubella: (or German measles) Forchheimer spots + LAD
Rubeola: (or plain measles) Koplik’s spots
Roseola: Nagayama spots

Impetigo in Ilocano, gad-dil

Carbuncle in Ilocano, pigsa
Tinea versicolor in Tagalog, an-an; in Ilocano, camanao
 cornea
Pingue- Yellowish lesion on the nasal side.
Acne treatment: cula
• Home self-care
• Benzoyl peroxide present in acne cream and gels
are for drying out existing pimples and preventing
new ones. It also kills acne-causing bacteria.
• Sulfur is a natural ingredient with distinctive smell
found in some lotions, cleansers and masks.
• Resorcinol is a less common ingredient used to
remove dead skin cells.
• Salicylic acid is often used in soaps and acne
washes. It helps prevent pores from getting Ptery- A triangular thickening of the bulbar conjunctiva that grows
clogged. gium slowly across the outer surface of the cornea, usually from the
nasal side. Reddening may occur. A pterygium may interfere
• See a dermatologist with vision as it encroaches upon the pupil.
Mass Referred to surgery for excision
• Lipoma

• Sebaceous cyst
Sebaceous cyst on the scalp is called wen

**Write diagnosis as “Pterygium OS/OD/OU”

Arcus A corneal arcus is a thin grayish white arc or circle not quite
senilis at the edge of the cornea. It accompanies normal aging but
may also be seen in younger people, especially African
Atopic • Lesions commonly found in the antecubital fold, Americans. In young people, a corneal arcus suggests possibility
dermatiti back of the knee and neck of hyperlipoproteinemia but does not prove it. Some surveys
s have revealed no relationship.

A gray band in the of opacity in the cornea, 1.o – 1.5 mm wide

Treatment for atopic dermatitis: and is separated from the limbus by a narrow clear zone.
• Antihistamine like Cetirizine 10 mg OD or Loratadine Present is some degree in most persons beyond 60 years old.
10 mg OD x 14 days If before age 40, may be a sign of hyperlipidemia.
• Liberal application of lotion for dry skin Corneal Depending on density, corneal opacity is graded as:
opacities

Pe: head
Pediculosis
Permethrin shampoo
• Pyrethrin (Licealiz)
Wet hair and apply to hair and scalp. Massage gently and leave
shampoo on hair for 10 minutes. Rinse thoroughly. Removes dead
lice and eggs with fine toothcomb. Repeat after 7-1o days if
necessary.

Pe: eyes

1. Nebula
Nebular corneal opacity is a faint opacity which results from
superficial scars involving the Bowman’s layer and superficial
stroma. It is a thin, diffuse nebula covering the pupillary area
interfering more with vision than leukoma which is away from
the pupillary area. It causes discomfort due to blurred image
owing to irregular astigmatism than leukoma which completely
cuts off the light rays.
 2. Macula Xan- Raised yellow plaques, painless and nonpruritic on the upper
It is a semi-dense opacity produced when scarring involves half thelasma and lower lids near inner canthi.
of the corneal stroma. It is visible in goof lighting either as a A form of xanthoma frequently associated with
stain or point form. hypercholesterolemia.
3. Leukoma
It is a dense white opacity which results to scarring of more
than half of the stroma. It involves considerable corneal
cicatrization process.
eyelids
Marginal Lid scaling and redness.
blepharitis Seborrheic inflammation of the lid margins that produce
greasy flakes of dried sections.

Dacryo- Obstruction of the nasolacrimal duct producing acute

cystitis inflammation with tenderness and swelling beside the nose,
near inner canthi.

External Lid pustule from inflamed sebaceous glands near hair follicle
Hordeolu of cilium.
m (Stye)

A swelling between the lower eyelid and nose suggests

inflammation of the lacrimal sac. An acute inflammation is
painful, red, and tender. Chronic inflammation is associated with
obstruction of the nasolacrimal duct. Tearing is prominent, and
pressure on the sac produced regurgitation of material through
the puncta of the eyelids.
Internal Acute inflammation of the Meibomian gland. Clue for diagnosis: s/s of inflammation + tearing of the eyes
Hordeolu due to blocked nasolacrimal duct.
m
Treatment for non-infected Dacryocystitis:
• Advise massaging of duct every AM or PM.
Treatment for dacryocystitis with pus:
• Antibiotics: Cloxacillin 500mg QID for 1 week

Epiphora Epiphora or tearing of the eye may be due to nasolacrimal

duct obstruction (NLDO) or infection (NLDI)
Treatment for NLDO
Stye in Tagalog, kuliti • Irrigation

Treatment for hordeolum or stye: lens

• Antibiotics: Amoxicillin or Cloxacillin 500mg QID Cataract Implies a degree of clouding that interferes with vision.
Can be readily seen by shining a light beam obliquely through
• Warm compress helps accelerate ripening the lens (focal illumination); inspection through ophthalmoscope
with +10 diopter magnification (direct illumination); or slit lamp.
Chalazion A granuloma of the Meibomian gland.
or Running your fingertip on the eyelids will make you feel a
Meibomia bump.
n cyst

A peripheral cataract produces spoke-like shadows that point

inward – gray against black as seen with flashlight, or black
against red with an ophthalmoscope. A dilated pupil facilitates
this observation.
Treatment for chalazion
• Surgical excision

For blurring of vision, do appraisal of visual acuity using

Snellen chart:
Xeroph- Precipitating conditions include: protein-energy malnutrition, XS Corneal scar
thalmia diarrhea, respiratory disease, measles and parasitic infection.

XF Xerophthalmic fundus.
Yellowish white retinal lesions.

Relationship of vitamin A deficiency and Infection

Signs of vitamin A deficiency (xeropthalmia):
WHO classification
XN Night blindness (earliest ocular manifestation of
moderate to severe vitamin A deficiency)
In pediatric patients, ask the parents.
Usually, the child is very active in the
morning and quiet at night due to night
blindness.

X1A Conjunctival xerosis (described as soap suds-

like lesions attached to the conjunctiva)
Cornea with xerosis is likened to a
bangus’ cornea

Prevention: Intake of vitamin A rich foods

Animal sources Plant, vegetable source
Atay Petchay
Alugbati
Gabi, dahoon
Saluyot, Sayote, Sili (talbos)
Malunggay, Mustasa
Ampalaya, dahoon
X1B Bitot’s spots Carrot, Camote (dilaw)
Kalabasa, Kangkong
Plant, fruit source Fats and oils
Mangga Mantika
Tiyesa Margarina
Papaya Gata
proptosis
Ex- Possible causes:
opthalmos • Thyroid disease – hyperthyroidism
• Injury causing bleeding or swelling
X2 Corneal xerosis • Infection
X3A Corneal ulceration/Keratomalacia (cloudiness and • Tumor behind the eyeball
softening) < 1/3 of cornea • Glaucoma

X3B Corneal ulceration/Keratomalacia (cloudiness and

softening) ≥ 1/3 of cornea pe: ears
**Diagnosis written with AD, AS, or AU
Impacted
cerumen
Patient is referred to EENT for “ear cleaning” or “ear
flushing”

Foreign
body
Treatment for foreign body with secondary infection:
• Amoxicillin or Cloxacillin
 Otitis When ear is pulled, straightening out the ear canal, (+) pain and Peri-
Externa (+) red ear canal. odontal
abscess
Treatment for OE:
• Amoxicillin 75-80 mg/kg/day divided into 3 doses
x 2 weeks
• Cotrimoxazole 400 mg or 800 mg BID
Weight (kg) / 2 = ___ ml BID
• (TM 6 mg and SMZ 300 mg/kg BW daily) in BID

Otitis (+) discharge with foul odor

Media (+) pus coming from the tympanic membrane Treatment for periodontal abscess:
• Amoxicillin or Cloxacillin for 1 week
Treatment for OM: • Oral hygiene
• Clean ears with cotton buds with H2O2 • Refer to dental department
• No flushing
gums
Gingivitis
pe: nose
Foreign Paper or seeds.
body Patient often has bad breath.
Foreign body may be removed with paper clip method.
Treatment for foreign body with signs of infection:
• Amoxicillin or cloxacillin
Colds 1. Acute rhinitis
with 2. Chronic rhinitis (r/o nasal septal deviation)
nasal Treatment for gingivitis:
discharge Treatment for chronic rhinitis:
• Decongestant (with PPA) *precaution with HPN • Amoxicillin or Cloxacillin for 1 week
• May give Carbocesteine • Plus, vitamin C
• Increase OFI
tonsils and pharynx
• Refer to Otolaryngologist Acute
tonsillar Treatment for viral ATP
3. Allergic rhinitis pharyn- • Strepsils Dry Cough: dissolve 2 lozenges one
(+) congested (buggy/boggy) turbinates, sneezing, nasal gitis after the other every 4 hours
discharges • If NO Strepsils, you may use ginger lozenges
Treatment for bacterial ATP:
• Amoxicillin or Cephalexin
• Clarithromycin 500 mg BID or 7.5 mg/kg BW BID
• If with exudates: gargle with warm saline BID-TID;
Saline draws out water from edematous tissues

For tonsillopharyngitis, tonsillar size grading scales

Brodsky grading scale
Grade 0 Tonsils within the tonsillar fossa
Grade 1 Tonsils just outside the tonsillar fossa ≤ 25%
Treatment for allergic rhinitis: of the oropharyngeal width
• Antihistamines for at least 2 weeks and avoidance Grade 2 Tonsils occupy 26-50% of the oropharyngeal
of allergens width
o Cetirizine 10 mg OD HS Grade 3 Tonsils occupy 51-75% of the oropharyngeal
o Loratadine 10 mg OD width
o Desloratadine 5mg (Aerius) OD Grade 4 Tonsils occupy > 75% of the oropharyngeal
• Fluticasone nasal spray width
• Mometasone furoate nasal spray, 2 sprays/nostril Diagnosed as: “ATP with enlarged tonsils grade 3”
OD
Bacterial ATP Viral ATP
Erythema (+++) Erythema (+) – not so red
pe: mouth and throat Treated with antibiotics Treated with lozenges
Dental Tooth decay or dental cavities. URTI
caries Treatment for URTI due to irritation:
(DC) • Antihistamine
• Avoidance of source of irritation
Treatment for URTI with post nasal drip or UACS:
• Decongestant
• Antihistamine
• Gargle

Upper respiratory tract infection or irritation due to smoke, dust,

foreign body, or acid reflux.
UACS Upper airway cough syndrome.
It is characterized by chronic cough (i.e., present ≥ 8 weeks)
related to upper airway abnormalities. (American College of Chest
Physicians)
One study defines UACS as persistent dry cough present for
at least 8 weeks duration associated with sensation of the
presence of mucus in the throat.
 UACS was formerly known as postnasal drip syndrome; however, Pe: chest
the term UACS is now preferred. This is because it is unclear Chest Chest pain for males and females may be due to:
whether the mechanisms of cough are due to the drainage of pain 1. Musculoskeletal: Costochondritis or MSS
secretions from the nose or the paranasal sinuses into the (+) pain on the costochondral junction for costochondritis.
pharynx, or the direct inflammation/irritation of cough receptors
in the upper airway. Treatment for musculoskeletal chest pain:
• Analgesic
Key diagnostic factors are cough, unpleasant sensation in
the throat, postnasal drip, and cobblestone mucosa. Other 2. Cardiac: Coronary artery disease (CAD)
diagnostic factors are nasal abnormalities, symptoms of
rhinitis, posterior pharyngeal mucus and wheeze. Treatment for cardiac chest pain:
• Perform ECG
• Antianginal drugs

Cough 1. Acute
▪ Upper respiratory tract infection (URTI)
If dry and nonproductive cough, may be due to irritation
Treatment for URTI due to irritation:
• Antihistamine
o Cetirizine
o Loratadine
• Fresh ginger candy
Treatment for UACS
• Antibiotics ▪ Lower respiratory tract infection (LRTI): Acute bronchitis
• Allergy medications or Community acquired pneumonia (CAP) – low,
• Nasal irrigation moderate, or high risk/PCAP A, B, C or COVID19
infection

Pe: neck Treatment for LRTI with productive cough:

Nape Cervicomuscular strain (CMS) with or without traction headache. • Mucolytic
pain AKA. Trapezial strain with or without traction headache. • Antibiotics
(+) Tatz sign: tenderness, limitation of movement o Amoxicillin 500 mg 1 cap TID x 1 week
o Cotrimoxazole 800/160 mg 1 tab BID
Treatment for allergic rhinitis: o Clarithromycin 250 mg to 500 mg BID
• Analgesic o Azithromycin 500 mg 1 tab OD x 3 days
o Mefenamic acid 500 mg or
o Ibuprofen 200 mg or 400 mg TID pc 2. Chronic
• AWCOPA ▪ Pulmonary tuberculosis (PTB)
• Vitamin B complex OD ▪ Congestive pulmonary disease (COPD)
• Muscle relaxant: Eperisone (Myonal) 50 mg TID ▪ Fungal infection
▪ Lung carcinoma
Thyroid Diffuse or Nodular. Toxic or Non-toxic. Bronchial
enlarge- If toxic, patient presents with weight loss, tachycardia, insomnia, asthma
ment restlessness and exophthalmos. Treatment for bronchial asthma:
(Goiter) Goiter grading scale • Nebulize with Salbutamol, then re-assess, may
Grade 0 No goiter repeat after 15 minutes
Grade Ia Goiter detectable only by palpation and not • Bronchodilator: Salbutamol 2-4 mg 1 tab TID
visible even when neck is fully extended. • If with infection, antibiotics
Grade Ib Goiter visible when neck is fully extended and • Steroid: Prednisone 1 mg/kg/day for 5 days (Pred
palpable. 10 mg or Pred 30 mg)
Grade II Goiter visible when neck is in natural position.
Grade III Very large goiter visible even from a
considerable distance.
Pe: abdomen
Grade IV Monstrous goiter.
Epigastric
pain
Treatment for epigastric pain:
• Antacids: AlMagOH 1 tablet TID 1 hr pc and HS
• Ranitidine 150 mg 1 cap BID or 300 mg 1 cap OD
• Omeprazole 20 mg or 40 mg 1 cap OD 30
minutes before breakfast
• Small frequent feedings
• Avoidance of GI irritants

Intestinal
parasitism
Treatment for intestinal parasitism:
• Mebendazole 100 mg 1 tab BID x 3 days
Thyroid enlargement may be palpated through anterior or • Mebendazole 100 mg/5ml 5ml BID x 3 days
posterior approach.

Cervical r/o Primary Koch’s Infection (PKI): perform CXR Gallbladder Request for UTZ of LGBP (liver, gallbladder, bile duct,
Lymph r/o Lymphoma stone or pancreas).
node Chole-
enlarge- cystitis
ment LBM Acute gastroenteritis (AGE) with signs of dehydration.
r/o Amoebiasis
 insomnia
Always observe for signs of dehydration – note latest According to the American Academy of Sleep Medicine, insomnia is defined as
urine output, dry skin and oral mucosa, poor skin turgor. difficulty either falling or staying asleep that is accompanies by daytime
Stool from patient with amoebiasis smell fishy, mucoid and impairments related to those sleep troubles.
sometimes bloody.
American Academy of Sleep Medicine Types of Insomnia
Chronic Chronic insomnia is when a person experience sleeping
Treatment for amoebiasis: insomnia difficulties and daytime symptoms, like fatigue and
• ORESOL as tolerated disorder attention issue, at least 3 days per week for more than
3 months or repeatedly over years.
• Metronidazole 500 mg TID for 7-10 days
It is estimated that about 10% of people have chronic
insomnia disorder.
Short-term Short-term insomnia disorder involves the same sleep
Epigastric For elderly, always rule out ischemic heart disease (IHD) – insomnia difficulties as chronic ID, but those problems are
pain inferior ischemia or inferior myocardial infarction. disorder experienced for less than 3 months and may not occur 3
Perform ECG. times per week.
Acid related Includes It is believed between 15-20% of adults experience short-
disorder • Non-ulcer dyspepsia term insomnia disorder in any given year.
(ARD) • Acute Gastritis or Duodenitis Other insomnia If a person has significant sleeping problems but does not
• GERD disorder meet all the criteria for either chronic or short-term
insomnia disorder. Because of its vague nature, this
• Peptic Ulcer Disease (check color of stool for diagnosis is rarely used.
melena)
Paradoxical Also referred to as sleep state misperception, occurs when
Pe: musculoskeletal insomnia a person feels their sleep is greatly disturbed but no other
Nape pain (CMS) with or without tension headache evidence confirms the presence of sleep difficulties.
Low back pain (LSS) with or without sciatica People with paradoxical insomnia may greatly underestimate
Arthritis how much sleep they actually get.
Sleep-onset Both chronic and short-term insomnia can involve trouble
Treatment: insomnia falling asleep when first lying down for the nigh, which
• Ibuprofen 400 mg 1 tab BID or TID pc may be referred to as sleep-onset insomnia.
• Diclofenac Na 50 mg 1 tab BID pc Sleep- Difficulty staying asleep throughout the night, and this can
• Naproxen 550 mg 1 tab TID pc maintenance affect people with either chronic or short-term insomnia.
• Piroxicam 30 mg 1 cap OD pc insomnia Middle-aged and older adults with insomnia are more likely
to experience issues with maintaining sleep throughout the
• Muscle relaxant: Eperisone 50 mg 1 tab TID night than with falling asleep.
• Carisoprodol 300 mg + Paracetamol 250 mg (Lagaflex) TID Behavioral In the past, a child’s inability to sleep without specific
• Touch (Tatz therapy) insomnia of items or routines was called as behavioral insomnia of
• Refer to Rehab childhood childhood.
For example, a child is unable to sleep without a favorite
stuffed animal might have been described as having this
Gout variant of insomnia.
Fatal insomnia Although, it contains ‘insomnia’ in its name, it is not a
Treatment: sleep disorder. Rather, it is also called fatal familial insomnia
• Colchicine (500 mcg) 2 tabs now then 1 tab every 1 hour up to 6- (FFI), which is a very rare genetic disorder causing
8 tabs/day until there is relief of pain, vomiting, diarrhea, or abdominal progressive brain damage. FFI is a neurological disorder that
pain. Maintenance dose of 1 tab TID x 2 days then OD involves many symptoms, including increasingly severe
sleep difficulties.
• NSAIDS: Indomethacin 100 mg 2 capsules BID pc
A person must have at least one of the several daytime symptoms related to
• Diclofenac 50 mg TID pc x 3 days then BID pc until attack their sleeping problems:
disappears
• Fatigue
• Celecoxib 200 mg OD x 5 days
• Impaired attention or memory
• Trouble with work, school or social performance
Fever • Irritability or disturbed mood
• Sleepiness
Treatment for fever: • Behavioral issues, like hyperactivity or aggressiveness
• Paracetamol 10-15 mg/kg q4 hours for fever > 38°C • Decreased motivation
• Increased accidents or mistakes
Dizziness • Worries about or discomfort with one’s sleep
Anemia
Treatment for insomnia:
Treatment for anemia: • Sleep medication, for significant symptoms to promote sleep,
• FeSO4 + Folic acid OD reduce anxiety about sleep problems and decrease daytime
• EGLV OD impairment.

Vertigo May be due to: dysmenorrhea

1. Benign Paroxysmal Positional Vertigo (BPPV) or
2. Vertebro-basilar Insufficiency (VBI) Treatment for dysmenorrhea:
• NSAIDS: Ibuprofen 200 mg or 400 mg TID pc prn
Treatment for VBI:
• Bonamine 1 tab TID
• Cinnarizine 25 mg 1 tab TID
hypertension dysuria
UTI 1. Sexually transmitted infection (GU or NGU)
Ask for sexual history (VERY IMPORTANT)
Do GS of the discharge.

Treatment for (+) GS:

• Ceftriaxone 250 mg IM SD, then
• Azithromycin 1 gm SD (500 mg 2 tabs SD)

2. Stones (Nephrolithiasis, Ureterolithiasis, Cystolithiasis)

Treatment for stones:

• Increase oral fluids
• Cotrimoxazole 400/80 or 800/160 BID x 1 week
• Ciprofloxacin 500 mg BID x 1 week (NOT given
to patients below 18 years of age)
• If pregnant: Amoxicillin or Cephalexin TID x 1
week, then do prenatal check-up

Always ask for fluid intake. Decreased fluid intake and output,
increases risk of urinary tract infection.
In patients 60 years or older who do not have diabetes or CKD, the goal Ciprofloxacin is contraindicated for patients less than 18
blood pressure is not <150/90 mmHg. years of age due to manifestation of arthropathy after
In patients 18-59 years of age without major comorbidities and in patients 60 use in pediatric group.
years or older who have diabetes, CKD, or both, the new goal blood pressure
is <140/90 mmHg.
pregnancy
Always ask form LMP, PMP, EDC, and AOG.
Indicate GP (TPAL), PU ___ weeks AOG

• Prenatal MV
• FeSO4 + Folic acid (FA)
First trimester: folic acid is important
20 weeks and above: FeSO4 + Folic acid (FA)

neurocirculatory asthenia (NCA)

NCA is a clinical syndrome characterized by breathing difficulties, heart
palpitations, a shortness of breath or dizziness, and insomnia.
It is also called cardiac neurosis, effort syndrome, irritable heart, soldier’s heart,
Da Costa’s syndrome.

First line and later line treatments should now be limited to 4 classes of
medications:
1. Thiazide-type diuretics,
2. Calcium channel blockers (CCBs),
3. Angiotensin converting enzyme inhibitor (ACEI), and
4. Angiotensin receptor blocker (ARBs)
Treatment for hypertension:
• Stop smoking
• Weight management: maintain BMI of 18.5 – 24.9 kg/m2; for every
10 kg weight loss, BP drops by approximately 5-20 mmHg
• Reduce sodium intake (< 2 gm of sodium or approximately <6 gm
of NaCl
• Healthy diet of fruits, vegetables and low fat
• Regular exercise
• Limit alcohol
• Monitor BP (BP diary)