General Medicine Assignment-October

 Bimonthly blended assessment - October 2021

25 october 2021

Name:P.Jahnavi

Roll no.- 183

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:

Didn’t get the chance to make an e-log .

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.