GENERAL MEDICINE BIMONTHLY ASSIGNMENT OCTOBER-2021
October 25, 2021
T.KRISHNA HARIKA
ROLL NO:199
OLD BATCH
3RD SEMESTER
"This is online E log platform 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 patients clinical problems with collective current best evidence based inputs"
👉 Medicine paper for Oct 2021 bimonthly blended assignment
https://medicinedepartment.blogspot.com/2021/10/updated-october-2021-weekly-log-and.html?m=0
QUESTION 1:- Testing peer review competency in the active reader of this assignment :
*Please go through the long and short cases in the first link shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyse the diagnostic and therapeutic uncertainties around the cases shared.
GASTROENTEROLOGY ;
https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.htmlc
A 40 YR OLD MAN WITH SHORTNESS OF BREATH , JAUNDICE & REDUCED URINE OUTPUT
*The case has been presented very clearly to the point.
*The data provided is correct
* All the data pertaining to the case has been provided.
*History taking has been thoroughly done. All the questions one might have regarding HOPI, past illness,personal history, family history have been asked and noted well.
* General Examination was detailed & well documented.
*The clinical images and investigation reports are extensive and adequate.
*Diagnostic approach and treatment was also well explained.
https://vamsikrishnarollno16.blogspot.com/2021/10/a-case-of-64yrs-old-male-patient-with.html?m=1
✓A CASE OF 64 YEARS OLD MALE PATIENT WITH OBSTRUCTION JAUNDICE
*History was taken well
*Systemic Examination was detailed
* Reflexes are well described and investigation reports are adequate.
*Overall presentation was good with adequate details and a good connectivity.
CNS ;
A CASE OF 38 YEARS OLD MALE PRESENTED WITH LOWER LIMB WEAKNESS AND BLURRING OF VISION
*Case presentation is complete.
*Present illness is described very well with each and every detail explained properly.All the histories and examinations done are mentioned.
*Systemic examinations are done properly and reflexes testing is also done.
*Investigations are well explained by images of MRI,ECG.
55 YEAR OLD MALE WITH ALTERED SENSORIUM UNDER EVALUATION
*The case is well presented.The data is collected according to the condition.
*Detailed history taking is seen.The capture data is complete and correctly presented.
*Investigations are done and the reports are pinned in the e-log.
*The treatment history is also mentioned accordingly and the drugs are mentioned.
*The case is very well presented and the provided leads are helpful to analyse the diagnostic and therapeutic uncertainties.
http://yashwanthmynenirollno111.blogspot.com/2021/10/a-70yr-old-with-acute-ischemic-stroke.html
A 70yr old with Acute ischemic stroke of left parietal lobe with right sided hemiplegia with right upper limb focal seizures with aphasia with UMN facial palsy
*The history presentation was done in a very commendable manner, each and every detail was paid attention to.
*Step by step explanation was given about the case which include each and every aspect of what is required for a detailed and Crystal clear understanding about the case.
*The examination details are explained very well.
*The investigation reports/pictures were posted along with explaination of each which helps in easy understanding.
*I appreciate the diagnostic approach given in the blog, it paid attention to all the possibilities, ruled out one by one and arrived to a final diagnosis.
HEMATOLOGY :
https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1
PANCYTOPENIA UNDER EVALUATION.
*The overall case presentation is very nice.
*About the completeness and correctness the data is mentioned properly and the history is taken in a very detailed manner.
*Investigation reports are placed accordingly to the day by day analysis.The pictures are also given which is the case a complete look.
*Treatment history is given accordingly.The capture data is nice.
*To analyse the diagnostic and therapeutic uncertainties of the given case useful leads are provided.
PULMONARY, CARDIOLOGY:
The case was beautifully presented in detail,which is almost closely knit with his details, like a step-to-step detailed explanation .
•Past history, family history and family history are missing in this case.
•Evolution of symptomatology was described in a detail.
•General examination was done in a much detailed way ; in different positions with clear documentation .
•Clinical images of the patient and investigations were added with de-identification .
•Diagnostic approach and treatment was also well explained .
NEPHROLOGY ;
*A 46 YEAR OLD MALE WITH PEDAL EDEMA
•History taking has been thoroughly done. All the questions one might have regarding HOPI, past illness,personal history, family history have been asked and noted well.
•General Examination was detailed & well documented.
•The clinical images and investigation reports are extensive and adequate.
QUESTION 2:-
Testing scholarship competency of the examinees ( ability to read comprehend, analyse, reflect upon and discuss captured patient centered data):
Please analyse the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems.
GASTROENTEROLOGY ;
40 years old man
PROBLEM LIST:
-10 to15 days history of bilateral pedal edema.
-palpitations
-abdominal distension
-Gradual decrease urinary output since 15 days
-Decreased appetite
TREATMENT APPROACH:-
*Fluid restriction : < 1t / day
* Salt restriction : < 2gm / day
* Tab . Lasix - 40 mg , BD
* Tab . Metalazone 5mg , BD
* Tab . Thiamine 100 mg , OD
* Syrup . Lactulose 15 ml , BD
* Tab . Rifagut 550 mg , BD
* Protein powder with 100 ml milk , 2 times daily
* Abdominal girth & weight measurement daily
* 2-3 egg whites / day.
64 years old man
PROBLEM LIST:-
-Patient has pain in both knees since 6 months.
-Yellowish discoloration of urine since 1 month.
-Passing of clay coloured stools since 1 month.
-itching all over the body since 1 month, decreased appetite, loss of weight and generalised weakness since 1 month.
TREATMENT APPROACH:-
•Antibiotic therapy (if indicated for infection)
•Endoscopic retrograde cholangiopancreatography (ERCP),
•Intravenous fluids and pain medications.
CNS ;
38 year old man
PROBLEM LIST:-
*20 days back he had acute retention of urine and relieved after Foley's catheterization.
*Giddiness and blurring of vision since 4 days
*Generalized weakness since 3 days.
TREATMENT APPROACH:-
*INJ. MANNITOL 100ml IV/ TID
*INJ. ZOFER 4MG IV/ BD
*INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
*INJ. CIGXANE 60MG SC/OD
*INJ. NEOMOL 100ML IV/ SOS
*TAB. VERTIN 16 MG PO/ BD
*TAB. PCM 650 MG PO/ TID
*Strict temperature monitoring 4th hourly
*Strict BP monitoring 2nd hourly.
55 year old male
PROBLEM LIST:-
-Headache which was sudden in onset and radiating to the neck.
-Developed altered sensorium.
TREATMENT APPROACH:-
-head end elevation
-Inj.MANNITOL 100mg IV BD
-tab.ECOSPIRIN
-Inj.OPTINEURON I ampoules one NS IV OD
-tab AMLONG RO /OF at 8:00am
-physio therapy for right upper limb and right lower limb.
70 year old male
PROBLEM LIST:-
*Fever-7 days back,low grade, intermittent and associated with chills
*cough with expectoration, voluminous and mucoid
*Intially c/o inability to lift right upper limb,and after 2 hrs he was unable to talk, identify his family members and unable to lift his left lower limb
*Deviation of mouth to left side.
TREATMENT APPROACH:-
*Ryles tube feeding every 4rth hourly
- 100ml water
- 100 milk with protein powder
*Tab Ecosprin AV /150/40mg PO/H/S
*Tab Amlong 5mg/RT/OD
*Tab Levipil 500mg RT/BD
*Nebulisation with Duolin-8th hourly
With budecort-12th hrly
With mucomist-8th hrly
*INJ HAI S/C TIDTID(acc to Grbs)
8am-2pm-8pm
*Physiotherapy for right UL and RL
HEMATOLOGY ;
70 year old male
PROBLEM LIST:-
*Shortness of breath since 20 days
*Leg pain on walking since 20 days
* Pedal edema since morning
TREATMENT APPROACH:-
-Tab VIT B12 po/od
- Tab PCM 650mg po/sos
-Tepid sponging
-Monitor vitals 4th hrly.
PULMOMARY, CARDIOLOGY ;
26 year male
PROBLEM LIST:-
*intermittent shortness of breath on walking for long distance.
*spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep
*Decreased urine output since 9 months
*Multiple episodes of vomiting since 2 days.
TREATMENT APPROACH:-
-Salt and water restriction
-Inj.augmentin 625mg od
-Tab nicardia10mg tid
-Tab.pantop 40mg od
-Tab.lasix 40mg bd
-Tab.orofer xt od
-Tab shelcal.hs od
-Tab nodosis 550mg od
-Tab zofer 4mg tid
-Nebulisation with budecort and salbutomol 8th hrly
-Bp/pr/temp/spo2 and I/O charting monitoring.
NEPHROLOGY ;
46 year old male
PROBLEM LIST:-
* 3 years ago he was diagnosed with hypertension for which he is taking medication and from then he says he has developed pedal edema.
*He had his first 4 sessions of dialysis of dialysis and has come back for his maintenance rounds.
* Decreased appetite since one month.
*He developed shortness of breath 10 days back and cough and cold since 5 days back.
QUESTION 3:- 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.
GASTROENTEROLOGY ;
*Blood test are done.
*Normocytic nomochromic Anemia with relative eosinophilia and thrombocytopenia
*Coarse echotexture with irregular margins.
* Gall bladder wall thickened.
*B/C grade 1 RPD
*Moderate ascites
*Serum protein : decreased
*Serum creatinine : elevated
*Blood urea : elevated
*LFT : Mild increase in bilirubin
*Tab-UDILIV 300 mg(used to treat liver diseases)
*Protein powder 2 times daily-since serum protein decrease.
LFT
*RFT
*HEMOGRAM
*X-RAY
*ANTIBIOTIC THERAPY (INFECTION)
*INTRAVENOUS FLUIDS AND PAIN MEDICATIONS
CNS ;
CUE
*ULTRASOUND
*MRI
*ECG
*TAB-VERTIN 16mg
*TAB PCM 650 mg
MRI
*ECG
*2D ECHO
*RFT
*TAB-ECOSPIRIN
*HEAD END ELEVATION
CT-SCAN BRAIN PLAIN
*CT-SCAN CHEST HRCT
*ECG
*MDCT SCAN BRAIN- PLAIN
*HB
*TLC
*PCV
*MCV
*MCHC
*RBC
*PLATELETS
*CREATININE
*SERUM ELECTROLYTES
*SERUM URIC ACID
*FBS
*PLBS
*HbA1c
HEMATOLOGY ;
*LFT
*BLOOD GROUPING AND RH TYPING
*SERUM ELECTROLYTES
*SERUM CREATININE
*BLOOD UREA
*T3,T4,TSH
*ECG
*CUE
*BONE MARROW BIOPSY
PULMONARY CARDIOLOGY ;
PT
*ABG
*CBP
*ECG
*2D ECHO
*X-RAY
*LFT
*LIPID PROFILE
*COLOUR DOPPLER 2D ECHO
NEPHROLOGY ;
HEMOGRAM
*RFT
*CUE
QUESTION 4:-
Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :
Share the link to your own case report this month of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case.
QUESTION 5:-
Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month :
ANSWER:-
*Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research.
*Reflective logging enable the student to stay up to date and keep a track of their progress.
*I have had a positive experience this month.
*There were opportunities to attend rounds in the ICU and see, touch and talk to the patients for ourselves and that was an invaluable learning experience in medicine.
*While making elogs we could actually go and ask the patient for more details wherever needed which was great.
*The case discussions in the group are insightful and are a great way to read & comprehend many cases at once in a short span of time, which if done by ourselves would take much longer.
*This helped me to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.
THANK YOU FOR GIVING ME THE OPPORTUNITY
KRISHNA HARIKA.
