BIMONTHLY BLENDED ASSIGNMENT JULY 2021

 3rd SEMESTER

NAME : K. SRI HARSHITHA

ROLL NO : 58

"I have been given the following cases to solve in an attempt to understand the topic of 'PATIENT CLINICAL DATA ANALYSIS' to develop my competency in reading and comprehending clinical data including history taking, clinical findings, investigations and diagnosis and come up with a treatment plan."

The Following is a link to the assignment which I have given for a monthly progress evaluation scheme.

LINK TO THE ASSIGNMENT:

http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1

I, Sri Harshitha student from 3rd semester holding roll no.58 was given the following assessment to review and analyze the e-logs and the clinical cases. This system of learning in health care system purely reflects the theme “scholarship of integration in the medical education and research”

QUESTION NO:1

PEER REVIEW: Review the last assignment of the person closest to your no. Roll no. 50 review 49 or 51 give the positive and negative comments on relevancy of the answers.

LINK:http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

LINK: https://vinilabhavani.blogspot.com/

I chose my friend Vinila Bhavani, Roll no.57 as reference for reviewing a blog.

"The cases which was reviewed by my friend were very well explained. The necessary questions were posed and checked, reviewed and assessed appropriately taking into the consideration of patients history, diagnosis and also the treatment part of the diagnosed disease. The pathophysiology of the patients disease, it's symptoms and clinical features are relevantly explained.

She has chosen different systems from different patients and explained the etiologies of each case and she also tried to mention treatment part for most of the cases.

She should have added some pictures and videos for better understanding. In overall I really appreciate her effort in making the e-log.

 

QUESTION NO:2

"Share the link to your own case report of a patient that you connected with and engaged while capturing her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. "

 

I haven’t got a chance to do e-log. I’ll try my best to do the e-log when I get the chance.

 

QUESTION NO:3

PEER REVIEW: BASED ON RENAL FAILURE CASES

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."

1)ACUTE KIDNEY INFECTION:

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

The patient was diagnosed with acute kidney infection secondary to urinary tract infection and presented with chief complaints of lower abdominal pain, burning micturition, low backache and fever since 1week.the clinical presentation was very good and with relevant picture and videos.

But the conclusion of diagnosis is not clearly explained.

2)ACUTE ON CKD

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

The patient came to OPD with complaints of low backache, dribbling of urine, pedal edema an increased involuntary movements of upper and lower limbs.

She was diagnosed with ACUTE RENAL FAILURE. The presentation was clear. All the systemic examinations are done and necessary investigations are done which ruled out the exact cause of disease. MRI Spine screening was done to explain the cause of spondylodiscitis. Symptoms like delirium and cause of seizures are explained. Day wise treatment plan was updated.

 

 

 

3)CKD:

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

A 49 year old female with generalized weakness and vomiting. She was operated previously for haemorroids and was on NSAIDS.


She was diagnosed with chronic interstitial nephritis secondary to plasma cell dysriasis

(multiple myeloma - 70 % plasmacytosis ) .

The case was comprehensive and consise and we'll executed. All the necessary information was provided and even the investigation with reports and histology slides of the plasma cells was also uploaded.

4)ACUTE RENAL FAILURE WITH LOWER BACK PAIN

LINK: casereports.bmj.com/content/2009/bcr.03.2009.1726

A 47 yr old male presented with history of oliguria and uraemic symptoms such as anorexia, nausea, vomiting, lower back pain and altered sensorium. Regular sessions of haemodialysis is done which improved the symptoms. Lower back pain is due to osteolytic lesions due to plasma cell dysriasis. CT findings revealed the altered sensorium. The diagnosis was made in appropriate way by clearly explaining the symptoms.

The case scenario was clearly explained with necessary information. Radiological findings and lab investigations revealed the cause of the disease.

5)PATIENT WITH COMA AND RENAL FAILURE:

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

Patient came to OPD with chief complaints of fever, diarrhea and back and abdominal pain. .She presented with OPD with severe breathlessness and chest pain and gradually became unresponsive. CPR was initiated and kept on ventilator. She was diagnosed with DKA with AKI.2D echo is done to know the cause of the disease. Day wise systemic examinations and lab  investigations are done to know the progression of the disease. The case was well explained with pictorial depictions. Detailed treatment plan was given.

LINK: https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

 

 

 

6)PATIENTS WITH ACUTE ON CKD:

LINK: https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

A 52yr old male who is a known case of diabetes since 5yrs came to routine checkup and complained of burning micturition and not associated with fever or suprapubic pain. He is known case of prostomegaly which was corrected by a surgery TURP.

But complications had developed and he complained of generalized weakness and decreased appetite drowsiness and SOB on his consecutive visits.

He was diagnosed with RENAL AKI SECONDARY TO UROSEPSIS.

The log prepared was clear and precise. Comparison of before and after treatments are done and diagnosis was made clear.

LINK: https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

LINK: https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

 

7)PATIENTS WITH ACUTE AKI:

LINK: https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

LINK: https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

LINK: http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

 

QUESTION NO: 4

"Please analyze the above linked patient data by first preparing a problem list for each patient and then discuss the diagnostic and therapeutic uncertainty around solving those problems include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned for each patient.

 

 

Case-1

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

PROBLEM LIST:

-       Lower abdominal pain

-       Burning micturition

-       Weak back after weight lifting

-       High fever

-       Oliguria associated with SOB

-       Blur vision and black outs

-       Mild hepatomegaly with grade 1 fatty liver

-       Pus cells in urine

-       High blood urea

-       High creatinine

-       Low Na and Cl

DIAGNOSIS:  Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

TREATMENT:  

·         IVF : -RL  @ UO+ 30ml/h -NS

·         SALT RESTRICTION  < 2.4gm/day

·         INJ    TAZAR    4.5gm  IV/TID

 |

         2.25gm IV/ TID

·         INJ     PANTOP 40mg  IV/OD

·         INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID

·         INJ     HAI  S/C  ACC  TO   SLIDING SCALE  8AM  -  2PM  -  8PM

·         SYP    LACTULOSE   15ml    PO/TID [ To maintain stools less than or equal to 2]

 

CASE-2:

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

PROBLEM LIST:

-       Low backache

-       Dribbling of urine

-       Pedal edema

-       SOB at rest

-       Increased involuntary movements of both upper and lower limbs

-       Weakness and tingling of limbs

-       High blood urea, creatinine, uric acid

DIAGNOSIS:  

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)

 

TREATMENT: IVF - NS-0.9% @100ml/hr

·         Inj. Tazar 2.25gm I.V -TID 

·         Inj. Lasik 40mg I.V -BD 

·         Nebulization Salbutamol -4th hourly 

·         Inj. Pantop 40mg I.V -OD 

·         Tab. PCM 650mg -TID 

·         Foleys catheterization 

·         Inj.25% D with 10units of insulin IV -slow for 1hr

 

CASE-3:

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

PROBLEM LIST:

-       Mass per anum with bleeding

-       Muscle aches

-       Fever

-       Generalized weakness

-       Vomitings

-       Low RBC and Hb count

-       Tachycardia

DIAGNOSIS:

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

 

TREATMENT:

·         Tab PAN-D PO/OD ( 8AM)

·         T. ZOFER 4mg / PO /SOS 

·         TAB NODOSIS 550 mg / PO/BD 

·         Protein - x ( plant based ) 2 tablespoon in 1 glass of milk 

·         Inj ERYTHROPOIETIN 4000IVS/C weekly twice

·         Inj OPTINEORON 1 AMO IN 500ml NS IV/OD 

·         IVF -NS UO +30ml/hr - RL 

CASE-4:

LINK: casereports.bmj.com/content/2009/bcr.03.2009.1726

PROBLEM LIST:

-       Oliguria

-       Anorexia

-       Nausea and vomiting

-       Metabolic acidosis

-       Severe backache

-       Altered sensorium with restless twitching of limbs

-       Waldenstroms macrogloubulinaemia

-       High serum creatinine levels

CASE-5 :

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

PROBLEM LIST:

-       Fever

-       Diarrhea

-       Back pain with abdominal and chest pain

-       Severe breathlessness

-       Unconscious

-       speech no response

-       High pO2

-       High urea levels

DIAGNOSIS:

DKA with AKI

Pyelonephritis. 

 

 

TREATMENT:

·         Inj. NORAD 2amp in 50ml NS

·         Inj. PIPTAZ 2.25gm.

·         Inj. DOPAMINE 2amp in 50ml

·         Inj. HAI 1ml in 39ml NS

·         Inj. MEROPENEM

·         Inj. LEVOFLOX

·         Inj. VANCOMYCIN

 

CASE-6:

LINK: https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

PROBLEM LIST:

-       Abdominal distension

-       Constipation

-       Altered sleep patterns

-       Hiccups

-       Pedal edema grade 2

DIAGNOSIS:

Infective endocarditis

Hepatic encephalopathy

 

TREATMENT:

·         Inj. Monocef 1gm IV/BD

·         Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr

·         Proctoclysis enema

·         Inj. Pan 40 mg Iv/OD

·         Inj. Thiamine 200mg in 100ml NS /BD

·         Inj. HAI 6U S/C TID

 

 

 

CASE-7:

LINK: https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

PROBLEM LIST:

-       Drippling of urine

-       Reduced flow of urine

-       Supra pubic pain

-       Prostomegaly

-       Decreased appetite

-       Generalize weakness

-       Drowsiness and excessive sleep

-       Foamy urine

-       Low Hb %

DIAGNOSIS:

Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c of DM-2 since 5 years with diabetic nephropathy with Anemia Secondary to CKD with Grade1 bed sores

TREATMENT:

·         Injection PANTOP 40mg IV/OD

·         Injection PIPTAZ  4.5 stat  and 2.25 gm  IV/ TID

·         Injection LASIX 40mg IV/BD

·         Injection optineuron 1AMP in 100ml NS slow IV/OD

·         Injection NEDMOL 100ml IV/SOS

·         Tab PCM 650mg TID

·         Insulin Human actrapid - 16 IU/TID 

 

CASE-8:  

LINK:https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

PROBLEM LIST:

-       Shortness of breath grade 2

-       Chest pain

-       Orthopnoea

-       Bendopnoea

-       Hypertension

DIAGNOSIS:

HFrEF secondary to CAD; CRF

TREATMENT:

·         TAB. BISOPROLOL 5mg ODTAB.

·          NITROHART 20/37.5mg 1/2 T/D

·         TAB NICARDIA XL 30mg OD

·         TAB. GLICIAZIDE 80mg BD

·         TAB. NODOSIS 500 mg TD

·         Cap. BIO-D3 OD

 

CASE-9:

LINK:https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

PROBLEM LIST:

-       Pedal edema

-       Decreased urine output

-       Vomitings

-       Loose stools

-       Shortness of breath

DIAGNOSIS:

Pneumonitis with Type 1 Respiratory Failite,

Interstial lung disease, 

Right heart failure .

 

TREATMENT:

·         IV fluidsTab.

·         Pan 40 mg po OD 

·         Inj. Lasix 80 mg IV BD

·         Thiamin 200 mg in 100 ml NS IV BD

·         Tab. Levocet 5 mg Po BD

·         Liquid paraffin for LIA

·         Grbs 6 th hrly

·         I/o charting, temp. Charting

 

CASE:-10:

LINK: https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

PROBLEM LIST:

-       Loose stools

-       Pedal edema

-       Abdominal distension

DIAGNOSIS:  

Provisional diagnosis: alcoholic hepatitis

Aki secondary to acute gastroenteritis  

Alcoholic and tobacco dependence syndrome 

 

TREATMENT:

·         INJ THIAMINE 100 mg in 100 ml NS slow IV / TID

·         INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD

·         INJ LASIX 40 mg

·         TAB. ALDACTONE 50 mg PO / BD

·         INJ PANTOP 40 mg IV/ OD

·         ABDOMINAL GIRTH MEASUREMENT DAILY

·         BP /PR/TEMP/ RR -4 hourly 

·         I/O CHARTHING

 

CASE-11:

LINK: https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

 

PROBLEM LIST:

-       Pedal edema

-       Decreased urine output

-       High grade fever

-       Shortness of breath

-       Burning micturition

-       Increased blood urea

DIAGNOSIS:

Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)

With anenmia of chronic disease 

 

TREATMENT:  

·         Inj LASIX 40 mg IV/TID (1 -1 – 1)

·          IVF - NS @ UO + 50 ml/hr

·         Inj MAGNEXFORTE 1.5 gm/IV/BD

·         Tab NODOSIS - XT PO/OD

·          Inj HAI s/c

·         Neb plain Asthalin 4 respules (1 - 1 - 1 - 1)

 

CASE-12:

LINK: http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

PROBLEM LIST:

-       Pain abdomen

-       Vomiting

-       SOB

-       Pedal edema pitting type

-       Distended abdomen

-       Tenderness in epigastric and hypogastric regions

Diagnosis:

Acute pancreatitis with AKI 

Treatment:

·         Iv fluids : NS 40 ml /hr

·         IV lasix 40 mg BD

·         Tab Nodosis

·         IV PIPTAZ 4.5 Gms. BD 

·         Iv 25%Dextrose. 100 ml BD 

·         Tab. Nicardia 10 mg TID

 

QUESTION 5

Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research.

During really a very difficult pandemic situation the learning process has become a hectic problems to both the students and the faculty. But this learning process need to be continued without any interruptions due to this our institution and faculty are putting lots of efforts making online e learning classes to proceed regularly and perfectly, accordingly by which a student can understand and learn the clinical features of the patients. Our faculty, interns and PG’s are all putting lots of efforts to make this possible. Though it is also difficult task for us(students) we are trying our best to understand the subject. These case presentations and e-logs are all difficult to undertake right now for us but, they are also helping us to learn some history taking, diagnosis, causes and clinical features to a little extent. I really thank for all the efforts made by our institution and hoping this pandemic ends soon and we are eagerly willing to have our offline classes.

   

 

 

 

 

 

 


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