2. CASE-1
• A 25 Years old male presented with a chief complaint of blood in stool
for last 2 weeks, abdominal pain, weakness and myalgia. By occupation
he was a farmer and used to go in the field for passing stool in morning.
On general examination, pallor was noted. On skin examination, an
urticarial dermal reaction was noted because he was complaining of
itching over body. On wet mount examination of stool, eggs of
Anchyostoma duodenale was found. CBC report showed Hb<9gm/dl;
eosinophilia, decrease reticulocyte count.
3.
4.
5.
6. CASE-2
• A 55 Years old women presented with weight loss of 5 kg in 2 months;
weakness and increased appetite. Family h/o for Diabetes, CAD and
hypertension was absent. On routine blood examination, BP=129/80
mmHg, weight-72kg, BMI-30 kg/m2; RBS-200 mg/dl; HbA1C >6.5%.
7.
8. CASE-3
• A 55 years old women p/i emergency with severe vomiting and altered
sensorium. Her relatives give history that patients had 8-9 episodes of
vomiting 4 hr. back. On further history; she was taking her anti-diabetic drug
metformin irregularly. She had raised her doses since last 3 days. Her vitals
are PR-94/min; BP-130/90mmHg; RR-25 breaths/min. On P/E; she was
dehydrated.
• Lab investigations: RBS-760mg/dl, Na+-133 meq/ml; K+-10mmol/l; serum
osmolarity-290mOsm/L. Ketones bodies were strongly present in urine.
• ABG analysis- pH<7.00; HCO3- 7.9m Eq/l anion gap>12; PaCO2-19mmHg.
9.
10. CASE-4/HPI
• Sant ram is a 68-year-old man admitted to the ED complaining of chest
pressure/pain lasting 20– 30 minutes occurring at rest. He describes the
pain as substernal, crushing, and pressure-like that radiates to his jaw
and is accompanied by nausea and diaphoresis. The pain first started
approximately 6 hours ago after he ate breakfast and was unrelieved by
antacids or SL NTG × 3. He also states that he has been experiencing
intermittent chest pain over the past 3–4 weeks with minimal exertion.
11. PMH
• HTN
• Type 2 DM
• Dyslipidaemia
• CAD with PCI with a drug eluting stent (DES) 3 years ago
12. FH
• Father died from heart failure at age 75 and mother is alive at age 88
with HTN and type 2 DM.
13. SH
• (+) Tobacco × 20 years but quit when he received his DES 3 years ago;
drinks beer usually on weekends; denies illicit drug use.
14. Meds
• Aspirin 81 mg PO daily
• Metoprolol tartrate 25 mg PO BID
• Simvastatin 40 mg PO QHS
• Metformin 500 mg PO BID
• SL NTG PRN CP
