3 Diseases na lang daw po for orals natin: LEPTO, HPN, DENGUE FEVER. Dito na natin buhos effort natin sa 3.

https://docs.google.com/document/d/1tdBmDazJBYDLEvYrNgp5e6i9rqNW1uuguIGkwRzdxwQ/edit - link ng file nung table natin kanina if want niyo tignan. Thank you po sa mga nag input.

MAIN DIAGNOSIS SALIENT PATHOPHYSIOLOGY DIAGNOSTICS MANAGEMENT

DENGUE WITH WARNING SIGNS S/SX: ● Dengue virus attaches to the ● CBC (Leukopenia, Thrombocytopenia, Management for dengue is largely
● Sudden onset of fever - BIPHASIC OR langerhan cells in the skin. Virus Elevated Hct supportive therapy for symptomatic relief
“Saddleback” fuses with the cell mediated by ● NS1 Antigen (rapid) Test - best during first and adequate fluid therapy to avoid any
Differentials: ● Headache viral envelope 5 days of illness signs of dehydration.
● Chikungunya - r/o severe ● Retro-orbital pain glycoprotein(infectivity). Viral ● Dengue IgM & IgG (ELISA or Rapid test)
joint pains ● Backpain with severe myalgia receptors. ➔ Dengue IgM - after day 5 of illness
(Breakbone fever) ● The main target site of infection for (for acute or recent infection)
● Macular rash dengue is the reticuloendothelial ➔ Dengue IgG - detects past dengue
● Malaria - r/o onset and ● n/v system. Namely the lymph nodes , infection
fever pattern ● Maculopapular rash beginning on the trunk blood and bone marrow ● Tourniquet Test - 5 mins; ≥20 petechiae per
and spread to extremities and face ● The virus inoculated in the skin can square inch
● Leptospirosis - r/o be injected directly into the
negative tourniquet test, WITH WS: bloodstream or will spillover in the
● Clinical: layers resulting in infection of
jaundice. Calf pain, etc. - lives/travel to dengue endemic area immature langerhans cells.
- Fever x 2-7 days + any of the ff: Infected cells then migrate to the
● Typhoid fever - r/o ➔ Abd pain lymph nodes where monocyte and
➔ Persistent vomiting macrophages are recruited which
➔ Clinical fluid accumulation becomes the target of infection.
➔ Mucosal bleed This event Amplifies the infection
➔ Lethargy, restlessness leading to the dissemination of the
➔ Liver enlargement >2cm virus through the lymphatic system
● Laboratory: ● Virus replication leads to viremia
- Increase hct which leads us to the second site
- Rapid decrease in plt count of infection which is the blood
● and formation of Ag-Ab complex
which triggers the complement
cascade and activation of
hageman factor. This leads to
vascular permeability and /shock
● Viremia leads to the increase
production of inflammatory factors,
● These factors cause fever, which
was observed in our patient .
● It also causes increased vascular
permeability which allows protein
and RBC to leak in the
intravascular space .This along
with the depressed levels of
clotting factors and activation of
fibrinolytic system results to
 increase bleeding tendencies
● In the bone marrow, the virus
destroys the precursor cells.
Destruction leads to decreased
blood levels mainly the platelets
and leukocytes. This can be
manifested by the lab results from
our patient presenting with
thrombocytopenia , and
leukopenia. If these are not
maagapan, it leads to bleeding
which may worsen to hypovolemic
shock

LEPTOSPIROSIS ● Myalgia (calf muscle pain) Leptospirosis occurs after direct or indirect● CBC: Neurophilia, Leukocytosis, Mild lepto:
● Conjunctival suffusion (red eyes without contact with bacteria shed in the urine of Eosinophilia, lymphopenia, ● Doxy (1st line) - mild
exudate) reservoir animals, mostly rodents, in which Thrombocytopenia ● Amox
Differentials: ● Chills abdominal pain infection is asymptomatic and results in ● Azith
● Chikungunya - r/o severe ● Headache chronic renal carriage. ● CBC: Leukocytosis, Neutrophilia,
joint pains Thrombocytopenia Moderate to severe:
● Mild: When the organism is shed in the infected● Renal: increased BUN and crea ● Pen G (1st line)
○ Nonspecific symptoms animal's urine, it can survive in freshwater● Liver: AST/ALT, ALkaline, Bilirubin ● Ampi
● Malaria - r/o onset and ○ Maculopapular rash for up to 16 days and in soil for almost 24 elevated ● Ceftr
fever pattern ○ petechiae -like and days. ● Bleeding: Pt/PTT prolonged ● Cefotaxime
pinpoint, reddish purple They can then enter the human host● ABG: Acidosis, Hypoxemia ● Azith
● Dengue fever - r/o fever brown through open wounds, mucous membranes,● CXR: patchy alveolar pattern
pattern, joint pain, ● Moderate to severe - Weil’s or the lungs if infected water is inhaled. It● ECG: cardiac compli
disease can also be transmitted across the placenta● Urinalysis: Proteinuria, Pyuria,
○ Jaundice if an infected human is pregnant, leading to Hematuria, casts present (1st week)
○ Renal failure a miscarriage in the first two trimesters. If● Isolation and Culture - gold standard
○ hemorrhage infected during the third trimester,● Gram stain- gram negative
pregnancy can result in stillbirth or● PCR - detect bacterial dna
intrauterine death. ● Darkfield microscopy with
immunoflourescence
Once within the body, the bacteria goes into● MAT
the lymphatics and then into the● Specific IgM
bloodstream. From the bloodstream, the
infection can spread to the entire body but
tends to settle in the liver and kidneys.

It usually takes between 1 to 2 weeks for the

HYPERTENSION ● Nose bleed An average of 2 to 3 BP measurements What is the blood pressure goal in
● Blurry vision The underlying causes of secondary obtained at 2 to 3 separate occasions hypertensive patients with
● Dizziness and headaches hypertension include: provides an accurate basis for estimation (JNC7) (JNC8)
Differentials: (causes of ● Chest pain of BP • no comorbidities?
secondary HPN)
 ● Palpitations ● narrowing of the arteries that At least once, BP should be measured on < 140/90 • <150/90
● Hyperaldosteronism, ● Nausea and vomiting supply blood to your kidneys both arms, and differences in SBP > 20 • diabetes mellitus?
● SOB, easy fatigability ● adrenal gland disease mmHg and/or in DBP >10mmHg should < 130/80 • <140/90
● coarctation of the aorta, ● Lower extremity edema ● side effects of some medications, initiate investigations of vascular • chronic kidney disease?
● renal artery stenosis, including birth control pills, diet abnormalities < 130/80 • <140/90
● chronic kidney disease Suspecting secondary hypertension: aids, stimulants, antidepressants,
● aortic valve disease ● Abrupt onset of HPN or and some over-the-counter BP should be measured in both sitting and Non-pharmacologic:
exacerbation of previously medications standing positions to rule out orthostatic Lifestyle changes -
controlled hypertension ● obstructive sleep apnea hypotension. Particularly in the elderly. - Weight reduction
● Onset: <20 or >50 years old ● hormone abnormalities - Less salad in diet
● No family Hx of HPN ● thyroid abnormalities Chronic Hypertension - Long term Blood - DASH (dietary approach to stop
● Diastolic BP >110-120mmHg ● constriction of the aorta Pressure (BP) ≥ 135/85 (on ambulatory or home HPN) plan:
● Poor BP control or malignant HPN blood pressure measurement) in patients without - Fruits, vegetables, low-fat
● Significant weight change diabetes, or BP ≥ 130/80 in patients with dairy, whole foods,
● hematuria diabetes - Low in sweets, red meat,
and saturated fat
JNC 7 Routine tests - Less alcohol consumption
Normal: systolic BP <120 and diastolic BP ● Hemoglobin and haematocrit - - Regular physical activity
<80 increased. There is an increase in blood
Prehypertension: SBP 120-139 or DBP 80- viscosity Drug regimen for HPN according to JNC
89 ● Fasting plasma glucose - increased 7:
Stage 1 hypertension: SBP 140-159 or levels (≥100 mg/dl) increase risk for Normal: no antihypertensive indicated
DBP 90-99 hypertension Prehypertension: advise lifestyle
Stage 2 hypertension: SBP ≥160 or DBP ● Lipid Profile - elevated TC, LDL, TG, modification and recheck status after 1
≥100 and reduced HDL cholesterol levels. year
Dyslipidemia is more frequent in patients Stage 1 HPN: thiazide diuretics or
AHA 2017 with hypertension consider ACE-I, ARBS, beta blockers, CCBs
Normal: systolic less than 120 mm Hg and ● Serum potassium and sodium - low monotherapy or combination then recheck
diastolic less than 80 mm Hg potassium and high sodium. (water after 2 months
Elevated: systolic between 120-129 mm Hg retention > high blood volume > high Stage 2 HPN: 2-drug combination
and diastolic less than 80 mm Hg central venous pressure > HPN) (thiazide diuretic + ACE-I/ARB/beta-
Stage 1: systolic between 130-139 mm Hg ● Serum uric acid blocker/CCB) and re-evaluation within a
or diastolic between 80-89 mm Hg ● Serum creatinine and Estimated month
Stage 2: systolic at least 140 mm Hg or glomerular filtration rate (eGFR) -
diastolic at least 90 mm Hg elevated Management in HPN of pregnancy:
● Urine analysis including a test for oral antihypertensive agents in pregnant
microalbuminuria women:
● 12-lead EKG - o Methyldopa - DOC
- o Labetalol
- o Nifedipine
Oral HYDRALAZINE is effective as
monotherapy or as add-on
to methyldopa in chronic hypertension in
pregnancy

Management for HPN emergency