General medecine Assignment

 

Bimonthly blended assessment - June 2021

25 July 2021

Name: V Dedeepya
Roll no.- 136
Batch: 2019 (3rd sem)
 

I have been given the following assignment to analyze , and review, in an attempt to understand the topic of 'Patient clinical  data analysis' to develop my competency in reading and to comprehending clinical data including history, clinical findings, investigations and diagnosis.

This is the link of questions asked in the bimonthly assignment:

medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1

QUESTION 1

Answer by roll no:135
  • Qualitative insights mentioned were reasonable.
  • the advantages and disadvantages of  description of  the case are listed.
  • studied the cases in detail and gave the necessary feedback.
  • could have mentioned the changes point wise for easy undestanding.

QUESTION 2


haven't got a chance to make elog yet.


QUESTION 3

Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.

AKI :


  • The Elog is well presented.All the necessary history is collected.
  • general and systemic examination findings are mentioned.
  • all the required investigations are mentioned and are provided with dates which helps a lot.
  • treatment plan is well described.

  • Overall, this case has been covered well.
  •  C/C, HOPI, Personal History are all mentioned greatly aiding the cause towards the making of an accurate & timely provisional diagnosis.
  • vitals, general and systemic examination are provided.
  • Treatment plan is discussed on a daily basis.
CKD :


  • the present, past history were given in detail which helps in the correct diagnosis .
  • all the required investigations are mentioned
  • treatment plan should have been discussed further in detail for better understanding.

Patient with coma and renal failure  :

  • The Elog is well presented with correct terminology. 
  • All the required investigations are done and results are shared.
  • All the updates are logged each day.

Patients with acute on CKD :


  • The relevant medical history of the patient has been shared in a comprehensive and systematic manner
  • all the important points are highlighted.
  • the history is taken in detail.


  • The relevant medical history of the patient has been shared.
  • diagnosis should have been discussed in detail.

Patients with AKI :


  • the case is well presented with all the history and investigations done which helps in correct diagnosis.
  • the line of treatment is provided on a daily basis.

QUESTION 4

Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 

AKI :

PROBLEMS:

Acute kidney injury Right HEART FAILURE,With K/C/O - HTN .AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.

  •  lower abdominal pain
  •  burning micturation
  •  low back ache after lifting weights
  • dribbling / decrease of urine out put
  • fever
  • SOB 
  • Patient had sudden onset of pain in abdomen 
  • By burning micturation with high fever : grade associated with chills and rigor 
  • Decrease urine output associated with SOB 


TREATMENT:

DAY 1

  • INJ    TAZAR    4.5gm  IV/TID
  • INJ     PANTOP 40mg  IV/OD
  • INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID
  • INJ     HAI  S/C  ACC  TO   SLIDING SCALE
  •  SYP    LACTULOSE   15ml    PO/TID 

DAY 2

  • IVF : -RL  @ UO+ 30ml/hr
  • INJ    TAZAR     2.25gm IV/ TID
  • INJ     PANTOP 40mg  IV/OD
  • INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID
  • TAB.   PCM   500mg    PO/ SOS
  • INJ     HAI  S/C  ACC  TO   SLIDING SCALE
  •  T. ULTRACET  PO 1/2 TAB  QID


Acute on CKD :

PROBLEMS

Acute renal failure (intrinsic)
Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis
Hyperuricemia 2° to Renal failure 
Uraemia induced tremors
Delerium 2° to septic /Uremic encephalopathy 

• Lower backache 

• dribbling of urine 

• Pedal edema  

• SOB at rest  

• Increased involuntary movements of both upper limbs


TREATMENT:

DAY 1 

• IVF -    NS-0.9%  @100ml/hr
• Inj. Tazar 2.25gm I.V -TID 
• Inj. Lasik 40mg I.V -BD 
•Nebulization Salbutamol -4th hourly 
• Inj. Pantop 40mg I.V -OD 
• Tab. PCM 650mg -TID 
• Foleys catheterization 
• Temperature ,Bp, PR Charting  hourly 
• Strict IO Charting
•GRBS -12th hourly 
• Inj.25% D with 10units of insulin IV -slow for 1hr 

DAY 2
• IVF -NS  0.9% & DNS  -continous infusion @100ml/hr
• Inj.Piptaz 2.25gm I.V -TID
• Inj.Lasix 40mg I.V -BD
• Inj.Pantop 40mg I.V -OD
• Nebulization budecort -8th hourly
• T.PCM 650mg -TID
• INJ. Neomol 1mg -I.V -SOS
• Temperature charting 4th hourly
• Monitor Bp,PR
• Left U/l elevation
• strict I/O charting
• Nebulization Salbutamol 2 repluses -6th hourly
• INJ. MAI 10u in 25% D over 45min I.V

DAY 3
• IVF -NS 0.9% &DNS U.O + 30ml/hr
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Lasix 40mg I.V -BD
• Inj.Pantop 40mg I.V -OD
• Nebulization Salbutamol 2 repluses -6th hourly
• T.PCM 650mg TID-after checking Temp.
• Temperature charting 4th hourly
• Monitor Bp,PR
• strict I/O charting
• Syp. Mucaine gel 10ml -BD


DAY 4
• IVF -NS 0.9% &DNS U.O + 30ml/hr
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Lasix 40mg I.V -BD
• Oral fluids upto 2-3liters/day
• Monitor Bp,PR ,Temperature
• strict I/O charting
• Limb elevation- Crepe bandage
• Syp.mucaine gel 15ml -TID

DAY 5
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Pantop 40mg I.V -OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2%
• Tab.Febuxostat 40mg -OD
• Inj.Optinueron 1 ampule in 100ml NS /I.V/ OD

DAY 6
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Pantop 40mg I.V -OD
• Inj.Optinueron 1 ampule in 100ml NS /I.V/ OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2%
• Tab.Febuxostat 40mg -OD
• Oral fluids upto 2-3L/day

DAY 7 
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Pantop 40mg I.V -OD
• Inj.Optinueron 1 ampule in 100ml NS /I.V/ OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2%
• Tab.Febuxostat 40mg -OD
• Oral fluids upto 2-3L/day
 
DAY 8
• Tab.Pantop 40mg  -OD
• Tab.Febuxostat 80mg -OD
• Tab.Neurobion forte -OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day

DAY 9
• Tab.Pantop 40mg  -OD
• Tab.Febuxostat 80mg -OD
• Tab.Neurobion forte -OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day
• Inj.Ciprofloxacin 500mg-OD

DAY 10
• Inj. Ciprofloxacin 500mg-OD
• Tab.Febuxostat 40mg -OD
• Tab.Neurobion forte -OD
• Tab.pantop 40mg-OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day
•Tab.Ultracet 1/2 tab.-QID


CKD :

PROBLEMS

 CKD ,Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).

  • h/o fever 
  •  generalized weakness

TREATMENT

DAY 1

  •  T. PAN 40mg /PO / OD
  •  oral fluids upto 1.5 - 2 lit / day
  •  T. ZOFER 4mg / PO / SOS
  • TAB NODOSIS  550 BD
DAY 2

  •  oral fluids upto 1.5 - 2 lit / day 
  • T. PAN 40mg /PO / OD 
  • T. ZOFER 4mg / PO /SOS 
  • TAB NODOSIS  550 mg / PO/BD 
DAY 3
  • - oral fluids upto 1.5 - 2 lit / day 
  • - Tab PAN-D  PO/OD ( 8AM)
  • - T. ZOFER 4mg / PO /SOS 
  • - TAB NODOSIS  550 mg / PO/BD 
  • - Protein - x ( plant based ) 2 tablespoon in 1 glass of milk 
  • - Inj ERYTHROPOIETIN 4000IVS/C weekly twice 
  • - T. OROFER - XT PO/BD 
  • - Inj OPTINEORON 1 AMO IN 500ml NS IV/OD 
  • - IVF -NS  UO +30ml/hr
DAY 4
  • -inj.optineuron 1 amp in 500ml NS IV/OD
  • -ivf. NS RL @ uo + 30 ml/hr
  • -inj. erytropoitin 4000 iv s/c weekly twice
  • -tab.pan-d po/od (8 am)
  • -tab.orofer-xt PO/BD
  • -tab.nodosis 500mg PO/BD
  • -protein- x powder 2 tsp in 1 glass of milk PO/TID
  • -tab. zofer 4mg PO/sos
DAY 5
  • - Inj.optineuron 1 amp in 500ml NS SLOW/ IV/OD
  • -tab. pantop 40 mg RO/OD
  • -tab.nodosis 500mg PO/BD
  • - T.OROFER  XT/OD
DAY 6
  • - Inj.optineuron 1 amp in 500ml NS SLOW/ IV/OD
  • -tab. pantop 40 mg RO/OD
  • -tab.nodosis 500mg PO/BD
  • -Protein- x powder 2 tsp in 1 glass of milk PO/TID


PROBLEMS

  • Fever and Diarrhea 
  • Back pain)with abdominal pain and chest pain.
  • Patient is in a persistent vegetative state. 
TREATMENT:
Day 1
  • Inj. NORAD 2amp in 50ml NS
  • Inj. PIPTAZ 2.25gm.
  • Inj. DOPAMINE 2amp in 50ml
  • Inj. HAI 1ml in 39ml NS 
Day 2 
  • Inj.HAI 1ml in 39mlNS
  • Inj. PIPTAZ 2.25gm.
  • Inj. CLEXANE 40gm. 
  • Iv infusion NS RL @100ml/hr.
Day 3 
  • Inj.HAI 1ml + 34ml NS
  • Inj. PIPTAZ 2.25gm
  • Iv infusion NS (urine output + 40ml/hr)
  • Inj. NORADRENALINE(2 amp+46ml NS) 
Day 4,5 same as day 3
Day 6
  • Inj. PIPTAZ
  • Inj. LEVOFLOX
  • Inj. VANCOMYCIN
Day 7 and 8 same as day 6.
Day 9
  • Inj. MEROPENEM
  • Inj. LEVOFLOX
  • Inj.VANCOMYCIN
Day 10 and 11 same as day 9
Day 12
  • Inj. MEROPENEM
  • Inj. FOSFOMYCIN
  • Inj. CLEXANE



PROBLEMS:

Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore

  • Fever since 4 days
  •  Pus in the Urine

TREATMENT:

  • Injection PANTOP 40mg IV/OD
  • Injection PIPTAZ  4.5 stat  and 2.25 gm  IV/ TID
  • Injection LASIX 40mg IV/BD
  • Injection optineuron 1AMP in 100ml NS slow IV/OD
  • Injection NEDMOL 100ml IV/SOS
  • Tab PCM 650mg TID
  • Insulin Human actrapid - 16 IU/TID


PROBLEMS:

HFrEF secondary to CAD; CRF
  • Shortness of Breath grade -II which converted into grade -III-IV 
  • Diabetes Mellitus 
  • Hypertension
TREATMENT:


1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml



Patients with AKI :

 
PROBLEMS:

Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease 
  • Now presented with history of fever not associated with vomiting and loose stools . 
  • Patient complaints pedal edema bilateral and pitting type
  •  decreased urine output and burning micturition.
TREATMENT:

DAY 1
  • Inj LASIX 40mg (8am- 2pm -8pm)
  • IVF - NS @ UO + 50 ml/hR
  • Inj LASIX 40mg (8am -2pm -8pm)
  • IVF - NS @ UO + 50 ml/hr

DAY 2

  •  Inj LASIX 40 mg IV/TID          1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 4 respules    [ 1 - 1 - 1 - 1 ]


DAY 3
  •  Inj LASIX 40 mg IV/TID    1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT  PO/OD
  •  Tab OROFEA - XT  PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules

DAY 4
  •  Inj LASIX 40 mg IV/TID   1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT  PO/OD
  •  Tab OROFEA - XT  PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules  QID
  • Tab ULTRACET 1/2 tab QID [ 1/2 - 1/2 - 1/2 - 1/2 ]
DAY 5
  •  Inj LASIX 40 mg IV/TID    1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - 500 mg  PO/OD
  •  Tab OROFEA - XT  PO/OD
  •  Inj HAI s/c
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]

DAY 6
  • Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - 500 mg PO/OD
  •  Tab OROFEA - XT PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules QID
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
DAY 7
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - 500 mg PO/OD
  •  Tab OROFEA - XT PO/OD
  •  Inj HAI s/c TID  [ 10U - 8U - 8U ]
  •  Neb plain Asthalin 2 respules QID
  •  Tab Norflox 200 mg PO/BD
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
DAY 8
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  IVF - NS @ UO + 50 ml/hr
  •  Tab Norflox 200 mg PO/BD
  •  Ing OPTINEURON 1amp in 100 ml  NS IV/OD
  •  Tab OROFEA - XT PO/OD
  •  Tab SHELCAL-CT PO/OD
  •  Inj HAI s/c TID [ 10U - 8U - 8U ]
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
DAY 9
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  Tab Norflox 200 mg PO/BD
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
  •  Tab OROFEA - XT PO/OD
  •  Tab SHELCAL-CT PO/OD
  •  Inj HAI s/c TID [ 10U - 8U - 8U ]


QUESTION 5
Please reflect on and share  your telemedical learning experiences from the  hospital as well as community  patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.

Due to ongoing pandemic posting are taking place online which is making it difficult to follow. But our general medicine department has really made efforts for all that they can do to make us understand better in online classes.
They help in making us students understand the cases and doing e-logs. The interactive sessions are also being conducted so that whatever the cases shown in the hospital during online sessions are discussed and are made sure they are understood by us .










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