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65 M with BPH and DM2

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THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT’S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT. A 65 year old male resident of chandur came with chief complaints of decreased urine volume, increased frequency of urination and poor stream since 3 months  . History of Presenting illness - Patient was apparently asymptomatic 3 months back he then noticed decreased urine volume, poor stream which is not associated with pain, burning micturition, blood in urine, fever. Frequency of urination is increased.  Past history- No similar complaints in the past.                               He is a known case of diabetes since 20years. Since then he is on medication:  Sitagliptin 100mg  Metformin 500m Dapagliflozin 10 mg 
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OSCE QUESTIONS

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1) Having history of BPH and DM 2,if he develops renal failure what will be the cause. Pre renal or post renal?  2)How to divide the insulin dosage?  3) How adipokines causes insulin deficiency?  4) How furosemide causes tetany and muscle cramps ?  5) How to furosemide causes weakness ?  6) In case of liver cirrhosis and heart failure , how to differentiate the edema is caused due to liver failure or heart failure ?  7) How do anemia cause hypopitutarism?  8) Why in IVC obstruction there are dilated veins ?? And why their fillings occurs from bottom to top ?  9) What are the causes of vertebro basillar insufficiency?  10) What is the efficacy of vertin ?  11) What is the effectiveness of promethazine / ondencetron / vertin in cases of relieveing vestibular vertigo ?
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43 M with abdominal distension

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A 48 years old male , bus driver by occupation presented to opd with chief complains of huge abdominal distension.  CHIEF COMPLAINTS  Abdomen distension since 4months Swelling  of both legs since 2 months  Decreased urine since 1 month  DAILY ROUTINE 5 AM : wakes up  5:30 AM: haves green tea with two biscuits and beetle nut 6AM : starts from his house on bicycle and covers about 5kms in 15 minutes  6:30 AM : He starts from silguri to tinsukia which is around (1000) kms  9am:- He halts his bus for breakfast where he takes rice and dal with two pieces of fish and starts again 1pm :- He stops the bus for lunch (rice and dal with two pieces of small fish)  1-5pm :- Rest(his codriver takes over)  5pm:- Cup of milk with biscuits and starts his journey 10pm:- Stops for dinner, has rice and dal with fish and starts driving up to 6am 6am:- Halts and takes biscuits with tea and beetle nuts Afternoon:- He reaches tinsukia and sleeps 8pm:- 600ml of desi beer with fishes 10pm:- sleeps 5am:- He star
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Internal assessment-3

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