General medicine assignment

 

Bimonthly blended assessment - October 2021

25 october 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://medicinedepartment.blogspot.com/2021/10/oct-2021-formative-bimonthly-blended.html?m=1

QUESTION 1

Critical Appraisal -

GASTROENTEROLOGY -

https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

- The case discussed is of Chronic liver failure and kidney disease.

- The case is very well explained.

- The main abnormalities of patient are highlighted which are easy to grasp. 

- There is a video link kept which is very clear about ascitic tap.


CNS -

 http://keelasreevalli.blogspot.com/2021/09/a-52-yr-old-female-homemaker-by.html

- This case is well presented.

- The day to day investigations and treatment are mentioned clearly.

- The clinical presentation of patient is clear in the pictures.

HAEMATOLOGY -

https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1

- The above case presentation is nice. 

- The case is of Pancytopenia. 

- The vitals of the patients are well updated day to day.

CARDIOLOGY , PULMONOLOGY -

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

- The case is explained good.

- It would be more effective if the main events are highlighted.

NEPHROLOGY -

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

- The case presentation is nice.

- As the case is currently ongoing the investigations and treatment are to be updated.

QUESTION:2

-Long case:

Problems list:

•patient presented with a 3 day history of Anasarca.
•frothy urine.
•gradually decreased urine output.
•10 year history of chronic bilaterally symmetric polyarthritis ,evidenced by severe pain ,edema and limitation of joint movements. 

Diagnosis:

Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.


-Short case:1

Problems list :

 •Patient with a 6 months history of gradually progressive, asymmetric rest tremor with autonomic features.


Diagnosis :

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.
2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

Short case:2

Problems list :

Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .

-Abdominal distension and facial puffiness since 6 months.

- Pedal edema since 3 months.

- Low back ache since 3 months .

- Feeling low , not feeling to talk to anyone.

- Weight gain and decreased libido since 3months.

- Loss of libido and erectile dysfunction since 2 months .


Diagnosis :

  • IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
  • TINEA CORPORIS
  • DENOVO HTN . 


QUESTION 3:

Long case:

Investigations:

  • X-RAY, ECG ,CUE ,ESR .
  • Serum urea ,creatinine. 
  • Electrolytes:Na,K,Cl.
  • 2D echo .
  • USG 
  • Urinary microscopy.

TREATMENT:

•Free water restriction for Hyponatremia.
•Tab. PREDNISOLONE P/O 20 mg OD.
•Tab FEBUXOSTAT P/O 80 mg OD.
•Haemodialysis for worsening renal dysfunction.


Short case:1

  • Investigations:
  • ECG 
  • 2D ECHO. 

Treatment:

1 .Tab. Syndopa Plus 125 mg QID.
2. Tab. Syndopa 125 mg CR OD.
3. Tab. Telma 40 mg OD.


Short case:2 

  • Investigations:
  • CBP ,TLC ,PLT ,ALBUMIN.
  • RFT ,LFT.
  • Serum creatinine, electrolytes (Na,K ,Cl).
  • USG abdomen 
  • ECG and 2D Echo. 

Treatment:

 -Ointment AMLORFINE .

-FUSIDIC ACID CREAM.

-TAB HIZONE 15 mg per day.

QUESTION 4:


Link to my elog:
https://dedeepyavemuri06.blogspot.com/2021/10/general-medicine-elog.html

QUESTION 5:

  • Changing to Competency based medical education and offline classes is very helpful  to know about the clinical scenarios . 
  • In this month we got a chance of history taking and went to the wards.
  • This is very useful for improving our skills in history taking and examination.
 









Comments

Post a Comment

Popular posts from this blog

32 year old male with fever and productive cough.

Image
THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT. 32y male fever since 10 days ,productive cough since 5 days August 03, 2023  A 32 year old male who is a village revenue assistant by occupation came to opd with c/o  Fever since 10 days Productive cough since 5 days HOPI: Patient was apparently asymptomatic 10 days ago then he developed fever which is low grade , intermittent type, Mainly during night time and relived temporarily with medication , associated with chills and rigors. C/o productive cough with mucoid sputum, intermittent type, which is mainly during night time. -Generalised weakness present -Not associated with burning micturition ,cold,rash ,bod
Read more

A 25 year old female with Dengue.

Image
 GM PRE FINAL PRACTICAL.  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those clinical problems with collective current best evidence based inputs. 25 yr old female patient resident of miryalguda,housewife by occupation came to OPD with chief complaints of fever and giddiness since 7 days. History of presenting illness: Patient was apparently asymptomatic 7 days back the she developed fever  which was sudden in onset, continuous ,high grade fever, associated with chills and rigors which was relieved on medication . Fever is associated with headache,retro orbital pain. History of generalized weakness, body pains and joint pains. History of nausea and vomitings(non bilious) 3 to 4 times a day projectile History of cough (non productive)
Read more

OSCE pre final

OSCE   1.Death of patients due to bleeding in dengue fever. Link- https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642057/&ved=2ahUKEwjChuq0g_aCAxWZ8zgGHS5YCAMQFnoECBgQAQ&usg=AOvVaw2FwLuJ3VjRMvxmIYsKWR27 This is a retrospective study conducted in Malaysia to examine dengue deaths due bleeding  from June 2006 to October 2007. There were ten fatal dengue cases between the periods of June 2006 to October 2007.  Nine cases were female.  The age range was between 11 to 59 years with a median age of 32 years. Adults over 18 years old comprised 80% of all the fatal cases. 2. Studies done on IV vs oral paracetamol https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://pubmed.ncbi.nlm.nih.gov/24124372/&ved=2ahUKEwiT2-2HhfaCAxXWwjgGHbCUAgAQFnoECBgQAQ&usg=AOvVaw35HJWCPg95qdO8U8TKXzxl This is a Randomized controlled study of the antipyretic efficacy of oral paracetamol
Read more