Final Practical Examination Short Case
Final practical examination: short case-
Amit sharma
Hall ticket no: 1701006007
A 46 year old male came to casuality with c/c of burning micturation since 10 days, vomiting since 3 days, giddines since 1 day
History of presenting illness:
Patient was apparently asymptomatic 10 yrs back, after which he complained of polyuria and diagnosed with DM type 2 and was started on OHAs, 3 years back he started taking insulin.
20 days back he developed vomiting(3/4 episodes, non billious, non foul smelling)
Later he complained of giddiness and brought to hospital. His GRBS was raised
No history of fever/cough/cold
No significant history of UTIs
Past history:
H/o DM since 10 years.
H/o cataract surgery 3 years back.
1year back he had injury to his right leg, which gradually progressed to non healing ulcer extending upto below knee and ended with undergoing below knee amputation due to developement of wet gangrene.
Not a k/c/o HTN , Epilepsy,TB, Thyroid
Not on any medication
No history of blood transfusion
Personal history:
Diet - Mixed
Appetite- normal
Sleep- Adequate
Bowel and bladder- Regular
Micturition- burning micturition present
Habits/Addiction:
Alcohol- stopped since 1 year
Family history:
Not significant
Vitals on Admission:
BP: 110/80 mmHg
HR: 98 bpm
RR: 18 cpm
TEMP: 101F
SpO2: 98% on RA
GRBS: 124 mg/dL
General Examination:
Pallor present
No- icterus,cyanosis,clubbing,koilonychia, lymphadenopathy
No signs of dehydration
CVS: S1S2 heard, No murmurs
RS: BAE+,NVBS
P/A: Soft, Non tender
CNS:
Reflexes: (Biceps/Triceps/Knee/Ankle/Plantar)Normal
Power: Normal(5/5) in both Upper and Lower limbs
Tone: Normal in both Upper and Lower limbs
No meningeal signs
Investigations:
On admission (19.5.22)
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