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1. An 18 year old boy is brought to the emergency room with history of unresponsiveness for about 6 hours. He was apparently normal when last seen. There was a history of significant loss of weight with increased appetite for the last three months.
On examination, he is deeply comatose, breathing rapidly and is severely dehydrated.
What is the differential diagnosis?
Justify your diagnosis and explain the pathophysiological basis for his symptoms and signs.
How will you manage this patient? 2. A 68 year old lady is found unconscious in the bed early in the morning. She is a known diabetic and hypertensive, both of which were well controlled. She was on Glibenclamide 5mg BD, Metformin 500mg TDS, Lisinopril 5mg BD, and Metoprolol 50mg BD.
On examination, she is deeply comatose, has tachycardia and there is no evidence of focal neurological deficits.
What is the differential diagnosis?
Justify your diagnosis and explain the pathophysiological basis for his symptoms and signs.
How will you manage this patient? 3. A 35 year old man has presented with malaise, loss of appetite & weight and frequent giddiness on standing up.
On examination he is emaciated. His blood pressure is 110/80mmHg in supine position and 80/60 mmHg in standing position. A recent small wound scar on his right hand is noticeably dark.
What is the differential diagnosis?
Justify your diagnosis and explain the pathophysiological basis for his symptoms and signs.
How will you manage this patient? 4. A 36 year old lady, a known patient of bronchial asthma complains of weight gain and amenorrhoea for the last 3 months. She is on regular treatment for her asthma, which is well controlled now.
On examination she is obese. Her skin is thin and many bruises are seen over her upper limbs and striae are seen over the lower part of her abdomen. Her blood pressure is 180/100 mmHg.
What is the differential diagnosis?
Justify your diagnosis and explain the pathophysiological basis for his symptoms and signs.
How will you manage this patient?
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