CASE 1

50 years male, known case of systemic hypertension for past 5 years on irregular treatment came to the ER with c/o headache, blurring of vision and giddiness for past 2 days. Chest pain and breathlessness for past 1 day. No h/o fever/head injury/seizures. O/E patient appears confused, afebrile, diaphoresis +, B/L pitting pedal edema + , vitals: pulse- 102/min ,regular ; BP- 220/140 mm Hg ; RR- 24/min

CVS- S1S2 +, S3 gallop + ; RS- BAE +, B/L basal crepts +;

P/A- soft ; CNS- awake, disoriented, moves all 4 limbs spontaneously, PERL +, B/L plantar extensor.

 

 

1.What is the diagnosis.

2.What are the possible systemic complications of this condition.

3.What are the expected findings in fundus examination by ophthalmoscope in this patient.

4.What are the investigations to be done in this patient.

5.How will you treat this patient.

 

 

 

CASE 2

20 years male, known case of type 1 DM was brought to the ER with c/o diffuse abdominal pain, dull aching type associated with nausea and vomiting for past 1 day, h/o breathlessness for past 3 hours. H/o polyuria, polydipsia present. No h/o constipation/loose stools. On probing him, he revealed that he did not take inj.insulin for past 2 days. O/E conscious, dehydrated, febrile, vitals: pulse- 120/min ,regular ; BP- 90/60 mm Hg ; RR- 28/min ; CVS- S1S2 + ; RS- lungs clear ; P/A- soft, diffuse tenderness ; CNS- No FND

Lab parameters : CBG- 450 mg/dL ; serum urea - 50 mg/dL ; serum creatinine- 1.6 mg/dL ; Na+ - 140 mEq/L ; K + - 3.0 mEq/L ; urine sugar - ++ ; urine ketones - +++ ; ABG : pH- 6.9 ; pCO2- 28 mmHg ; pO2- 90 mmHg ; HCO3- 8 mEq/L

 

 

1.What is the diagnosis.

2.What are risk factors precipitating this condition.

3.What is the criteria for diagnosing this condition and identify the acid-base imbalance present in this scenario.

4.What are the possible complications.

5.What are the 3 primary goals of treatment and how will you treat.

 

CASE 3

58 years female, known case of type 2 DM for past 10 years on irregular treatment was brought to the ER with c/o altered sensorium in the form of decreased responsiveness for past 2 days, h/o lethargy and generalised weakness present for 10 days. H/o polyuria, polydipsia present. No h/o head injury/ fever/headache/nausea and vomiting. O/E drowsy, dehydrated, afebrile, vitals: pulse- 120/min, regular ; BP- 90/60 mm Hg ; RR- 18/min ; CVS- S1S2 + ; RS- BAE +; P/A- soft, non-tender ; CNS- drowsy, responds to oral commands, PERL +, moves all 4 limbs, B/L plantar extensor

Lab parameters : CBG- 700 mg/dL ; serum urea - 45 mg/dL ; serum creatinine - 1.4 mg/dL ; Na+ - 140 mEq/L ; K + - 3.5 mEq/L ; urine sugar - +++ ; urine ketones -absent ; ABG : pH- 7.4 ; pCO2- 41 mmHg ; pO2- 90 mmHg ; HCO3- 23 mEq/L

 

 

1.What is the diagnosis.

2.What are risk factors precipitating this condition.

3.What are the differences between this condition and DKA.

4.What are the possible complications and write the formula for calculating plasma osmolality.

5.How will you treat this patient.

 

CASE 4

45 years female, known case of type 2 DM on regular treatment with glibenclamide 5 mg 1-0-1 and mixed insulin s.c 8U-0-8U  was brought to ER with c/o altered sensorium in the form of confusion, drowsiness, difficulty in speech for past 2 hours. H/o palpitations,tremors and sweating were present before 2 hours. On probing the patient’s attenders, they revealed that she was previously taking glibenclamide 5 mg 1-0-0 and mixed insulin 6U-0-4U s.c and the dose was escalated in view of hyperglycaemia identified during the last check up 2 days back. O/E drowsy, disoriented, afebrile, diaphoresis + ; vitals: pulse- 110/min ,regular ; BP- 110/70 mm Hg ; RR- 18/min ; CVS- S1S2 + ; RS- BAE +; P/A- soft, non-tender ; CNS- drowsy, disoriented, PERL +, moves all 4 limbs in response to pain stimulus, B/L plantar flexor

lab parameters : CBG- 40 mg/dL ;serum urea - 36 mg/dL ; serum creatinine – 0.8 mg/dL ; Na+ - 140 mEq/L ; K + - 3.5 mEq/L

1.What is the diagnosis.

2.What are risk factors/causes precipitating this condition.

3.What are the endogenous compensatory mechanisms for this condition.

4.What are the complications.

5.How will you treat this patient.

6.What is whipple’s triad.

 

 CASE 5

20 years male was brought to ER with h/o scorpion sting in his right little finger two hours back. He c/o severe pain at the site of bite. O/E conscious, oriented, afebrile, vitals: pulse- 140/min ,regular ; BP- 150/80 mm Hg ; RR- 20/min ; CVS- S1S2 + , S3 + ; RS- BAE +; P/A- soft, non-tender ; CNS- No FND

 

 

1.What are the two types of scorpion venom

2.Local manifestations

3.Systemic manifestations

4.Life threatening complication

5.Treatment of scorpion sting