July assessment gm

 

 July assessment 

Q1

1.PULMONOLOGY 

PATIENT DETAILS:

REVIEW:

As patient was having episodes of SOB she was put on BIPAP to increase Spo2 levels . 
    Patient was having electrolyte imbalance like hyponatremia hypokalemia hyperbilirubinemia  . This is because of usage of steroids and diuretics .

2.NEUROLOGY 

PATIENT DETAILS:

Etiology is stated accurately i.e., alcohol withdrawal and symptomatology stands the same [seizures, tremors, restlessness] Thiamine, lorazepam, Kcl are standard medication in my view Alcohol withdrawal symptoms will fit the best It is right decision to give thiamine since it is majorly involved in ATP and NADH production dehydration is the only probable cause for dehydration in my view The mentioned reason is appropriate i.e., alcohol decreases iron absorption and bleeding ulcer is cause for normocytic anaemia yes aggrevated ulcer is due to both combined effect of diabetes and peripheral neuropathy

3.CARDIOLOGY

Patient details :

Review:


It is the case of acute coronary syndrome (acs).
The patient came to the opd with complaints of sob since 30 min and heart burn from past one year which relived without use of any medication and she has been diagnosed with tb for which she completed course of medication a month ago.
Her ecg shown depressed ST wave, no progression to Qwave and partial blockage of coronary artery
Pt was then taken to another hospital, for further treatment but PCI was not done as there were no vacancies in hospitals at that time.


4.NEPHROLOGY AND UROLOGY

PATIENT DETAILS :

REVIEW :


pt came to the opd with the chief complaints of
Fever since 4 days
pus in the urine
He was diagnosed with type 2 diabetes and on treatment Tab GLIMI M1 and goes for regular checkup .
Patient has burning micturition and diagnosed with prostomegaly and TURP. 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.

 

5.Infectious diseases (Mucormycosis, ophthalmology, Otorhinolaryngology)

PATIENT DETAILS :

REVIEW:
Chief complaints of the patient were fever for 10 days facial puffiness and periorbital edema for 4 days and altered sensorium since 2 days as of investigations done the patient is diagnosed with mucormycosis and diabetic ketoacidosis. the patient is suffering from diabetes type2 and hypertension for 2years and radiological investigations revealed mucormycosis.

6.GASTROENTEROLOGY

PATIENT DETAILS:
REVIEW:

This is a case of pancreatitis pseudocyst and left broncho pleural fistula. symptoms include pain in the abdomen, constipation and burning micturiton. Amikacin , metrodinazole and meropenem are given to control the infection. Inj octrotide is given to decrease the secretion of pancreas. TPN is given so Inj thiamine is given as B1 supplement.



7.SEVERE COVID WITH DIABETES

PATIENT DETAILS :
REVIEW: It is the case of viral pneumonia secondary to covid-19 infection .The patient came to the opd with the chief complaints of the following-
fever,drycough,generalised weakness,difficulty in breathing.
 Despite all the above measures, on day 4 of hospital stay the spo2 levels kept falling, pulse was not recordable. ECG has shown a fat line and the patient was declared dead.The i cause of death is cardio pulmonary arrest 


8.INFECTIOUS DISEASE AND HEPATOLOGY 

PATIENT DETAILS :

REVIEW :

As chief complaints of a 55-year-old male patient are pain abdomen for 1week and decreased appetite since 1week and fever for 2days. The patient was diagnosed with a liver abscess and on weekly follow up the patient's symptoms were reduced.
 



9.INFECTIOUS DISEASE( HI Virus, Mycobacteria, Gastroenterology, pulmonology )

PATIENT DETAILS :

REVIEW :

This is a case of tracheoesophagal fistula and oral candidiasis or oesophagal strictures. The patient has chief complaints of difficulty in swallowing, cough on taking food and liquids and had  a weight loss. In the review the chance of patient developing immune reconstitution inflammatory syndrome is very well explained with the help of a flow chart. All examinations were done thoroughly and barium swallow is also done. In this case a very detailed review is not written.



10.CARDIOLOGY 

PATIENT DETAILS :

REVIEW :
Case of atherosclerosis.
Anatomical site is blood vessels,due to arterial
Thrombosis,arteries become harden and narrow,hypertension is observed.cardiorenal syndrome type 4 is observed.
Drugs like tab dytor,tab cardivas,tab digoxin are recommended.The presentation is clear and good.

Q2-4

Patient centered data around the theme of renal failure patients with AKI, CKD and acute on CKD, 

captured by students from 2016 and 2019 batch in the links below

Patients with low back ache and renal failure

Q2) Share the link to your own case report 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 

https://siddarth43.blogspot.com/2021/07/aki-on-ckd.html?m=1

Q3) (Testing peer review competency of the examinees) :

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 

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

Over view 

A 58 year old male patient came to casualty with chief complaints of-

lower abdominal pain 1 week

burning micturation 1week

low back ache after lifting weights

dribbling / decrease of urine out put  1week

fever 1 week

SOB , rest  1week  

  Apprisal

Case history was taken well and examination was very well done. Sequential evaluation of case is apprisiable 

Negative points 

It would be better if fever chart is added as it was treated with strict temp and IO monitoring as it would be better understood improvement of the case was not well mentioned

My Analysis

 This is a case of Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

With ? Right HEART FAILURE,With K/C/O - HTN ( Not on Rx)

-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 bodyand return of creatinine to the base line and symptoms less then 3 months indicating it to be a AKI

Acute on CKD :

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

Over view 

A 75yr old male patient ,labourer by occupation ,came to casuality with Cheif complaints of 

 Lower backache since 10days

 dribbling of urine since 10days

 Pedal edema since 3days 

 SOB at rest since 3days 

 Increased involuntary movements of both upper limbs since 10days .

Apprisal

I would not find any points to be highlighted . History was taken well 

Negative points

There are no clinical pics of the symptoms like pedal edema.

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitored

My Analysis

This is case of 

Acute renal failure (intrinsic)

 Grade 1 L4-L5 Spondylodiscitis, Multifocal infectious Spondylodiscitis

Hyperuricemia 2° to Renal failure 

Uraemia induced tremors( resolved)

Delerium 2° to septic /Uremic encephalopathy (resolving)

CKD :

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

Over view

A 49 yr old female , mother of 2 children, who is a house wife, apparently asymptomatic 13 yrs ago and then she noticed mass per anum with bleeding , went to hospital and diagnosed as haemorrhoids and got operated.

 Since 3 yrs she has history of muscle aches, for which she is using NSAIDs.

  She has h/o fever 20 days back, got treated in the local hospital, and 

  Since 20 days she has generalized weakness.

  She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.

Appraisal

History was taken well.

Good lab work clear evaluation was done 

Negative points

There are no clinical pics of the symptoms like pedal edema.

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitoredit would have been better if urine was sent for eosinophils for interatial disease

My Analysis

This is  case of CKD ?

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

Patient with coma and renal failure 

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

Overview

A 35 yr old female with Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).

Back pain( 5 days ago) with abdominal pain and chest pain


appraisal

Very well presented 

With good fever charting with all the necessary information.

History was taken detailed way 

Follow up was good 

All the tests were properly done 

Negative

I could not find the negative data in the elog 

Analysis

It could be the hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . 

Subjectively she was told better but objectively no improvement was Seen. Hospitalisation has increased the infection to the bed sore it would have been better if discharged early as it was permanent damage and was impossible to treat anyway.

Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):


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. 

Analysis the data

 https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html 

Analysis of  A 35 yr old female with Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).

Back pain( 5 days ago) with abdominal pain and chest pain

Vegetative state of the patient could be due to  hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen.

https://pubmed.ncbi.nlm.nih.gov/19362767/

Link supporting the data 


Intermittent Fever spikes can be explained due to the bed sores clearly explained through culture of the sores 


Sepsis might be the reason for encephalopathy by altering the blood brain barrier 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779311/#:~:text=Sepsis%20is%20typically%20regarded%20as,16%5D%2C%20and%20other%20factors.


Q 5) Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 


The elog /online learning from the hospital has been a new experience and we  learnt quite lot of things through reflective observation during lockdown.  

it's a bit challenging as we have just entered internship ,We have learnt elogging of the cases in a very short span of time and made juniors do so.

 I could answer the questions from juniors easily as I have been part of many discussion in ICU and wards 

Managing juniours has been a new experience  challenging my managing  skills.

By doing this assignment I could view many cases and many case scenarios through which I learned many  things 



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