General Medicine assignment

Bimonthly blended assessment - June 2021

2 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:

https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1

QUESTION 1

1.Answer by roll no. 6

(link:https://aniganikavya06.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html)

PULMONOLOGY CASE

Quantitative assesesment:9/10
 
Qualitative assesment:
This is a case of Acute exacerbation of COPD associated with right heart failure and bronchiectasis.
  • The elog was well presented, with information arranged point wise.
  • All the required investigations are done.
  • Time line of symptoms is aslo mentioned and symptomatology is given in detailed form.
 

An examination of all the systems and required investigations were done and possible right heart failure along with bronchiectasis was diagnosed. Bronchiectasis was  complication of COPD. 

2. Answer by roll no:18


NEUROLOGY CASE

Quantitative assesment:8/10

Qualitative assesment:
This is a case of  Wernicke's encephalopathy secondary to chronic alcohol dependence and  Alcohol Withdrawal delirium.

  • Evolution of symptomatology is well described with flow chart.
  • Point wise manner would have worked better than paragraph format
  • The need for thiamine was explained well in the given review. Kidney failure exacerbated anemia due to reduction of erythropoetin and ulcers for aggravated due to alcoholism.

3. Answer by roll no:23


CARDIOLOGY CASE

Quantitative assesment:8/10
Qualitative:
This is a case of Acute pericarditis with moderate pericardial effusion.
  •  well organised and well presented with pictures and flow charts
  •  symptomalogy could have been presented in Point wise manner rather than paragraph format. 

4.Answer by roll no:46

GASTROENTEROLOGY AND PULMONARY CASE

Quantitative assesment:7/10
Qualitative assesment:
This is a case of pancreatitis,pseudocyst and left brocho-pleural fistula.
  • The evolution of symptomatology is given in detail in a chronological order.
  • But pictures/flow charts/diagrams could have been used for better understanding
  • treatment plan is neatly discussed.

5.Answer by roll no. : 59


NEPHROLOGY CASE

Quantitative assesment:8/10
Qualitative assesment:
This is a case of RENAL AKI secondary to urosepsis with b/l hydroureteronephrosis along with diabetic nephropathy.
  • Development of symptoms is well explained.
  • The concepts are explained clearly.
  • Should have made use of pictures or flowcharts.

6.Answer by roll no:63


CARDIOLOGY CASE

Quantitative assesment:10/10
Qualitative assesment:
  • All the sub-questions have been answered in a detailed and comprehensive manner.
  • Important points have been highlighted
  • very well presented with all the required data along with pictures and charts. 

7.Answer by roli no.:184

 
INFECTIOUS DISEASES

Quantitative assesment:8/10

Qualitative assesment:
  • Symptomatology could have been explained in detail in chronological order.
  • pictures and flowcharts could have been used.

8.Answer by roll no: 151

NEUROLOGY CASE

https://neerajareddysingur.blogspot.com/2021/05/general-medicine-case-discussion.html?m=1

Quantitative assesment:7/10

Qualitative assesment:

This is a case of Recurrent seizures resolved secondary to cortical vein thrombosis with hemorrhagic venous  infarction in right posterior temporal lobe with Iron deficiency anemia.

  • the answers were given in a simple and easily understandable manner.
  • use of pictures and diagrams made it better
  • the information provided it clear and concise.

9.Answer by roll no:186


CARDIOLOGY CASE
(http://bejugamomnivasguptha.blogspot.com/2021/05/a-45-years-old-female-patient-with.html)

Quantitative assesment:(8/10)
Qualitative assesment:
Thia is a case of a female patient with palpitations, pedal edema,chest pain,chest heaviness,radiating pain along left upper arm.
  • evolution of symptomatology is well explained in the chronological order.
  • Could have described the subquestions in detail.

10.Answer by roll no:187


NEUROLOGY CASE

Quantitative assesment:9/10
Qualitative assesment:
This is a case of Cerebellar Ataxia secondary to Acute Cerebrovascular Accident (CVA) with infarct in the right inferior cerebellar hemisphere.
  • The etiology is mentioned and symptomatology is well explained.
  • phamacological intervensions used are well described.

QUESTION 2 


I haven’t gotten a chance to make a case report 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.

Links to the cases: 


ANSWER 3:
MULTISYSTEM:
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.
Diagnosis could have been discussed further.
The complete picture of the case is well framed.

CNS
The symptomatology is discussed in chronological order.
The line treatment could have been discussed in detail.All necessary details like vitals, present and past history are taken.
systemic examination is thorough.

RENAL
Overall, this case has been covered well.  With C/C, HOPI, Personal History greatly aiding the cause towards the making of an accurate & timely provisional diagnosis.
There were no therapuetic uncertainities as all the required information was collected.

CVS
All the required investigations were done.But the question 'how was it diagnosed?' could have been explained in detail.As the patient’s presenting symptoms indicated a cardiac condition ECG and 2D echo were done whose results proved to be very useful. 

ABDOMINAL
The relevant medical history of the patient has been shared in a comprehensive and systematic manner. The reports of all the lab investigations conducted were deidentified and shared. No discussions on diagnostic and therapeutic uncertainties were given.

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. 

MULTISYSTEM

PROBLEMS:
  • gradual loss of weight since 6months
  • polyuria
  • nocturia
  • polydypsia
  • vomitings  and loose stools
  • blood tinged urine 
  • Acute liver failure with ?acute pancreatic failure
  • ?Hepatic encephalopathy 
  • Indirect hyperbilirubinemia-? Criggler najjar syndrome
  • ?hepatic coagulopathy
  • ?porphyria
  • Diabetic ketoacidosis (resolved)
  • ?denovo diabetes type 
TREATMENT

Day 1 - IV fluids, Insulin, Vit K - Insulin is an accepted therapeutic drug for treatment of DKA.

Day 3 -  Syp Lactulose was given for constipation

Day 4 - Inj. Lorazepam was given as absence seizures were suspected. 

Day 5 - Cerebral malaria was suspected and Inj. FALCIGO, Inj. LEVIPIN, and Inj. DOXYCYCLINE was given. 

CNS

PROBLEMS

  •  Weakness of both lower limbs
  •  Loss of hand grip
  •  Bowel and bladder incontinence
  •  Generalised weakness and myalgia
  •  TB 
  •  quadriparesis 
  •  Infection spondylitis

TRAETMENT
1.  Optineuron 
2. Thiamine
3. ATT 

RENAL

PROBLEMS
  •  Hypertension
  •  CKD
  •  edema
  • Shortness of Breath
  • Lethargy
  • Anasarca

TREATMENT

for EDEMA: Lasix has been used to drain out excess fluid
for SOB : NaHCO3 given to stabilize the metabolic acidosis, that caused the SOB. 

CVS

PROBLEMS

  1. Abdominal distension
  2. Shortness of breath
  3. Hypothyroidism
  4. Atrial Fibrillation 

TREATMNET

  •  Inj. Amiodarone
  •  Inj.clexane 
ABDOMINAL

PROBLEMS
  • 1. pedal edema
  • 2. fever 
  • 3. acute kidney injury 
  • 4. Urosepsis

TREATMENT

  •  LASIX 40mg FOR EDEMA

QUESTION 5

 Due to the ongoing pandemic, postings are taking place online which is making it difficult for us to follow.Yet the online clinical postings are the best part of our day where we discuss the cases in detail.Although we are not present in wards physically our professors and interns have been doing their best to show us cases on online platform.I also understood how important history taking is.

 I cant wait enough for the in person postings so that I can go to the and take history myself.

It has also taught me the investigations needed to be done and conclude to a diagnosis.









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