Patient 1 – The parents of an 11 year old girl bring her for an office visit. She has been developing normally and has been healthy and active. Her parents report that for the past several weeks, she has been feeling tired and weak, drinking more fluids than normal, and has been urinating so much she has wet the bed at night. Two days ago, they noticed that her breath smelled “like fruit” and she lost 8 pounds these last weeks. Yesterday she began breathing fast and deep.
a. Present your initial diagnosis.
b. Describe the pathophysiologic explanation(s) to support your diagnosis and the clinical symptoms presented.
c. List the test(s) you would perform to confirm your diagnosis, the rationale for each test ordered, and the results you would expect if your diagnosis is correct.
d. Describe your recommended treatment(s) and the rationale to support your recommendation(s).
Patient 2– A 45 year old man is being seen because he has been experiencing vision changes, a burning sensation in his feet, and decreasing amounts of urine when he uses the bathroom. He has a long-standing history of hypertension and hyperlipidemia. Your physical exam reveals retinal hemorrhages in both eyes, and decreased sensation to moderate touch in the soles of his feet. A spot urinalysis shows microalbuminuria and a stat Basic Metabolic Profile (BMP) shows decreased Glomerular Filtration Rate (GFR).
a. Present your initial diagnosis.
b. Describe the pathophysiologic processes related to your diagnosis that explain the signs/symptoms, and lab results obtained.
c. State the effect of his symptoms on his life expectancy and the rationale for your answer.
