Case for Internal Medicine Simulation Case

Case 1

45 years old female with BH 150 cm, BW 75 kg came with complaint a wound in her right foot thumb which is looked darker since 2 weeks before. 1 day before, she also felt dyspneu and cough. Patient have had diabetes mellitus since 2 years ago. Her father also had diabetes and died since 1 year ago. On physical examination, BP 100/60, P 108 x / menit, RR 28 x, T: 38 C. Her conjunctiva is pale, sklera is not icteric, crackles heard on her both lung. There is gangren on her right foot. Hb 9.2, L 14000, T 300.000, PBG 285, Ureum 90, creatinine 1,4.

Question :

1. What are the possibilities of this patient problem? (mention!) 2. What are the additional examination needed to determine the problem possibilities in this patient? 3. What are the expected results from those additional examination? 4. How is the pathophysiology from each problem and how is the syntesis from each problems so it became one unity? 5. How to manage the problems comphrehensively?