Kims PG medicine exam-1

CHEIF COMPLAINTS  42year male Supervisor in petrol bunk came with c/o (on 24-4-2023) 1)Vomiting - 3episodes in the night(8pm on 23-4-2023) 2)Pain abdomen-Diffuse(in the morning 4am) HISTORY OF PRESENTING COMPLAINTS  He studied till intermediate,later he left his studies and entered in to family finance business later wine shop business.He started drinking beer, toddy from year 2000 (occasionally during gatherings------>weekly once------->daily(1beer/day). He lost his mother in 1994(his age-13yr),She struggled for 8months with cancer.His father also drinks alcohol around 90-180ml/day,had a CVA(Right hemiplegia) in 2007---->bed ridden for 2years--->died in 2009.He had a elder brother, who went to Bombay,also died due to excess alcohol consumption(?Liver cirrhosis) He got married in 2004(age-21yr).From 2015 patient started taking  beverages with high alcohol content,due to stress from his business loss.From 2020 he gave up all his own business

CHIEF COMPLAINTS  50 year male farmer by occupation came with complaint of Itching in the front and back and both upper arms(since 2 months) Nausea,loss of appetite(since 7days) Decreased urine output(since 1day) HISTORY OF PRESENT ILLNESS He started his career at the age of 13years(1986) as lorry cleaner who used to accompany with driver for the first 2years.At his 15years age started driving the lorry by himself. Till 45years(2019) he continued the same profession.He used to drive 100km to and fro in a day.Depending on his requirement of money he used to work 4-6 days in a week. 5 years back as he was getting tired easily(not able to drive long distance)went to local hospital, diagnosed as having high sugars started on OHA.He stopped driving as it is more stressful and started farming his 3 acre land. He used OHA for 1year,later swithed to insulin as sugars were not in control.From 4years he is on inadequate dose of insulin.He used to take insulin dose (16U/18U) once in a day(against