General Data C.D. Age/Sex/Status: 81/F/Widow Address: San Miguel, Manila Date of birth: May 19, 1929 Place of birth: Manila Occupation: Unemployed Religion: Roman Catholic

Chief Complaint Difficulty of breathing

History of the Present Illness 7 days PTA Productive cough with yellowish sputum, not accompanied by DOB or fever Temporarily relieved with ambroxol HCl 1tsp Decrease in appetite No consult done 3 days PTA Persistence of cough DOB and low grade fever (38.0°C) Self –medicated with paracetamol 500mg/tab  Lysis of fever 7 hours PTA Choked after swallowing food  Went to the bathroom and came out with gradual decrease in level of sensorium DOB Difficulty in ambulation Admission

Past Medical History Head trauma (May 2009) – UST Neurosurgery (CT Scan unremarkable) (-) HPN, DM, CA (-) Thyroid disorders (-) Asthma, Allergies, PTb (-) Previous blood transfusion

Personal and Social History Mixed Diet Nonsmoker Non-alcoholic beverage drinker No illicit drug use

Family History Gallstone – sister HPN – brother (-) DM (-) CA (-) Asthma, PTB

Review of Systems General: no weight loss Skin: no rashes, no sores, no itching Head: no headache, no dizziness Eyes: no blurring of vision, no redness Ear: no ear pain, no discharge Nose: no epistaxis Throat: no sore throat Neck: no nape pain, no stiffness Cardiovascular: no chest pain, no easy fatigability, no PND Gastrointestinal: no diarrhea, no constipation, no vomiting Genitourinary: no hematuria, no dysuria Musculoskeletal: no joint pain, no swelling Endocrine: no heat and cold intolerance, no excessive sweating, no polyphagia Hematopoetic: no easy bruisability

Physical Examination upon Admission Lethargic, incoherent, stretcher-borne, hyposthenic, in cardiorespiratory distress BP 140/80 PR 105bpm RR 26 T 37.8ºC Weight : 45kg Height : 4’10 ‘’ BMI : 20 Warm, dry skin, no active dermatoses, no rashes Incisional scar on occipital área, no hair thinning Pink palpebral conjunctivae, anicteric sclerae, pupils 1-2mm ERTL No nasoaural discharge, no alar flaring Moist buccal mucosa, (+) food particles in mouth, non-hyperemic posterior pharyngeal wall Rigid neck, no palpable lymphadenopathies, thyroid not enlarged Symmetrical chest expansion, (+) subcostal and intercostal retractions, (+) crackles on both lung fields, vocal fremiti and tactile fremiti cannot be assessed Adynamic precordium, AB 5 th LICs MCL, S1>S2 at the apex, S2>S1 at the base, no murmurs, lifts, thrills, heaves Flabby abdomen, soft, non tender, no masses Pulses were full and equal, no cyanosis, no edema

Neurological Examination Lethargic,(+) spontaneous respiration, refuses to open eyes, no verbal output (intubated), localizes to pain, GCS 9 (E3V1M5) CN: Pupils 1-2 mm ERTL, no visual threat, (+) corneal reflex OU, brisk Motor: no preferential weakness, can maintain both lower extremities against gravity DTRs ++ on all extremities (+) Bilateral Babinski, more consistent on the left Meningeal signs: (-) Nuchal rigidity, (-) Kernig’s Rigidity on all directions of neck movement