What is the diagnosis and recommended treatment for a patient presenting with vomiting, dizziness, and sore throat, who has been absent from work/school and needs a medical certificate to return?

Medical Assessment and Management

Diagnosis

Acute viral pharyngitis (likely viral upper respiratory tract infection)

Clinical Reasoning

Ang pasyenteng ito ay nagpapakita ng mga sintomas na karaniwang viral sa pinagmulan 1, 2:

• Nagsusuka (vomiting) - karaniwan sa viral infections, lalo na sa mga bata 3
• Nahihilo (dizziness) - maaaring dahil sa dehydration mula sa pagsusuka
• Masakit ang lalamunan (sore throat) - pangunahing sintomas ng viral pharyngitis 1

Ang mga sintomas na ito ay mas nagsusuggest ng viral etiology kaysa bacterial (Group A Streptococcus) dahil 3, 1:

• Walang binanggit na mataas na lagnat
• Walang tonsillar exudates na nabanggit
• May kasamang vomiting at dizziness (mas karaniwan sa viral)
• Walang tender anterior cervical lymph nodes na nabanggit

Hindi kailangan ng throat culture o rapid antigen test dahil ang clinical presentation ay clearly viral 3, 1. Ang 65-85% ng acute sore throat cases ay viral 1.

Treatment Plan

Symptomatic Management (Lahat ay nasa PhilHealth Konsulta Formulary):

1. Para sa sore throat at pain relief:

   • Paracetamol 500mg tablet - 1 tablet every 6 hours as needed for pain/fever 2, 1
   • Dispense: 20 tablets (5 days supply)
   • Estimated cost: ₱20-40

2. Para sa nausea/vomiting:

   • Metoclopramide 10mg tablet - 1 tablet 3 times daily before meals 4
   • Dispense: 15 tablets (5 days supply)
   • Estimated cost: ₱30-60

3. Hydration instructions:

   • Maraming tubig at fluids para maiwasan ang dehydration 2
   • Small, frequent meals 4

Total estimated cost: ₱50-100 (well within ₱300 budget)

Important Points:

• HINDI kailangan ng antibiotics dahil viral ang infection 1, 2. Ang antibiotics ay hindi makakatulong at maaaring magdulot ng side effects at antibiotic resistance 3, 1.
• Ang symptoms ay karaniwang gumaling within 7 days kahit walang antibiotics 1, 2

Medical Certificate

This certifies that patient has been seen and examined today with the diagnosis of: Acute viral pharyngitis with associated nausea and vomiting

Recommendation: Symptomatic treatment with analgesics and antiemetics. Rest for 1-2 days. Patient is fit to return to work/school after symptom improvement, typically within 2-3 days if symptoms resolve. Advised to return if symptoms worsen or persist beyond 7 days.

This medical certificate is issued upon the request of the patient for: return to work/school after medical leave due to illness.

Patient Education

Ipaliwanag sa pasyente na 1, 2:

• Ang sakit ay viral infection na kusang gagaling sa loob ng 7 days
• Ang gamot ay para lang sa symptoms (pain, nausea) - hindi para patayin ang virus
• Hindi kailangan ng antibiotics dahil hindi ito bacterial infection
• Bumalik kung: lumala ang symptoms, may difficulty breathing/swallowing, o hindi gumaling after 7-10 days 1
• Iwasan ang pagpapahawa sa iba through proper hand hygiene