Question 21

25 year old nurse complaints of dizziness and sweating in the ER. A few days ago she had similar complaints and was adviced to go home from work after stabilizing. She joined work yesterday after leave. This is her third episode of similar complaints. She usually have such complaints whenever she is stressed due to patient overload, and feels better with rest and some juice. Today, her BP is 124/88 mm Hg, pulse is 102/min. She is sweating profusely. The doctor requests for blood chemistry, glucose level, and C- peptide level. The electrolytes levels are as follows, Na 134, K 3.4, Cl 98, Ca 9.2, Mg 2.4, BUN 20, Creat 0.9. Her Glucose level is 54 mg %, and C peptide levels are high. The doctor orders her 5 % Dextrose 100 cc, and she is stabilized subsequently. What is the most likely diagnosis?

A) Factitious disorder
B) Insulinoma
C) Glucagonoma
D) Manchausen Syndrome
E) Hypochondriasis

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Question 3

35 year old female salesperson comes to the ER with dypsnoea and palpitations. She is sure that this an asthmatic attack and she is going to die. These symptoms began while a bus ride to work. She has had similar symptoms earlier twice in last 2 weeks, and this is her third visit to ER for such a cause. She gives no history of chest pain. She says that there is a lot of stress at work due to the new management. She has no history of asthma or any other medical illnesses in the past. She is sexually active with a male partner and is taking OCPs to prevent pregnancy. Her physical examination is normal except for an increased pulse rate which is regular. What is the best possible diagnosis?

A) Hypochondriasis
B) Hyperthyroidism
C) Panic Attack
D) Pulmonary embolism
E) Generalised anxiety disorder
F) Acute Stress disorder
G) Pneumonia

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