general medicine monthly assignment (june 2021) by Anahita Behara
general medicine monthly assignment (june 2021) by Anahita Behara
QUESTION 1
peer review of 10 randomly selected elogs of 2017 batch
Case 1
Roll number 40
A 52 year old female
patient came to OPD on 19th of may with the chief complaints of
FEVER since 10 days
BREATHLESSNESS since 3 days
INTERMITTENT
COUGH since 3 days
The provisional
diagnosis was : Severe Covid pneumonia
What could have been
done better : there could have been more inclusion
of pictures of the patient’s chest X rays also a through report of the systemic
exam of respiratory system could have been provided for reference , further
investigations were not listed.
What was well done : the general examination and history of the patient was
very concise and easy to understand
Grade: 6/10
Case 2
Roll number 41
A 28 year male who is
electrician and a resident of Nalgonda was admitted to hospital on 25/05/2021 with
chief complaints of
- Fever since 4 days
-Cough since 2 days
-Pain in epigastrium
since morning
Provisional diagnosis
: mild pneumonia secondary to covid infection
What was well done :
diagnostic imaging was shown very clearly , patient history was well written
and easy to comprehend , the use of multiple images of patient and HRCT scan
was very helpful and made the case more interesting to read.
Grade : 9/10
Case 3
Roll no.68
A CASE OF A 45 YEAR
OLD MALE WITH ACUTE KIDNEY INJURY ON CHRONIC KIDNEY DISEASE (HYPERTENSIVE
NEPHROPATHY) WITH URAEMIC ENCEPHALOPATHY.
PROVISIONAL
DIAGNOSIS:
AKI ON
CKD(HYPERTENSIVE NEPHROPATHY) WITH URAEMIC ENCEPHALOPATHY.
PLANNING FOR
HEMODIALYSIS
What was well
done: it was very concise and easy to understand , biochemical reports were
clear.
What needs to be
worked on: chief complaints was not in patients words
(pedal edema was mentioned in chief complaint instead swelling on legs)
Grade:8/10
Case4
Roll no.128
A 55 year old female
patient, a resident of Miryalaguda and farmer by occupation came to the
hospital on 17/5/21 with the chief
complaints of shortness of breath,
pedal edema and facial puffiness.
PROVISIONAL
DIAGNOSIS:
Acute exacerbation of
COPD associated with right heart failure and bronchiectasis.
What was well done
:present history was well explained and easy to understand and diagnostic
images were very clear and many images of the patient made it clear to
understand at first glance.
Grade: 9/10
Case5
Roll no. 172
A
40 year old male presented to the hospital from Yadagirigutta with the chief
complaints of irrelevant talking and decreased food intake since 9 days.
Provisional
diagnosis: wernickes encephalopathy
What was well
done: history taking was easy to comprehend and made it interesting to read
What could have been
done : placement of diagnostic imaging and treatment history coud have been
presented better
Grade:8/10
Case6
Roll no.17
A 58-year-old female
presented with the chief complaints of fever for 6 days, and
shortness of breath for 2 days.
PROVISIONAL DIAGNOSIS
Viral pneumonia secondary to COVID-19 infection, overlapping
Interstitial lung disease.
What was well done :
the chronogological order of the progression was well paced and interesting to
read , treatment plan was easy to comprehend.
Grade:8/10
Case 7
Roll no.169
56 yrs old female came to OPD with epigastric
pain since 1 week.
PROVISIONAL DIAGNOSIS
GERD( Gastroesophageal reflux disease)
What was well done :
the information was well presented and each of the patients individual concerns
were addressed , the added videos of endoscopy and pelvic X-rays help in clear
understanding and visualization.
Grade:10/10
Case 8
Roll no.59
A 52 year old male with Cerebellar Ataxia
PROVISIONAL DIAGNOSIS:
Cerebellar Ataxia secondary to Acute Cerebrovascular Accident
(CVA) with infarct in the right inferior cerebellar hemisphere.
What was well done :
The presence of diagnostic imaging as well as videos os the
patient demonstrating the preence of nystagmus proved to make the elog informative
and an interesting read
Grade: 9/10
Case9
Roll no.
A 40 year
old male presented to the hospital from Yadagirigutta with the chief complaints
of irrelevant talking and decreased food
intake since 9 days.
PROVISIONAL
DIAGNOSIS:
1. Wernicke's encephalopathy secondary to chronic alcohol
dependence.
2. Uraemic
encephalopathy.
3. Alcohol Withdrawal
delirium.
What was well done :
the elog was well organized and the placement of images and videos of the
patient played a key role to understanding this case.
Grade:9/10
Case 10
Roll no.63
A CASE DISCUSSION ON PANCREATITIS, PSEUDOCYST
AND LEFT BRONCHO PLEURAL FISTULA
DIAGNOSIS:
* ACUTE ON CHRONIC
PANCREATITIS WITH PSEUDOCYST & ACUTE INFECTIVE PERI PANCREATIC FLUID
COLLECTIONS
* MODERATE LEFT PLEURAL
EFFUSION WITH BASAL ATELECTASIS.
* LEFT PNEUMOTHORAX
SECONDARY TO BRONCHO PLEURAL FISTULA
What was well done :
the placement of images and the concise history as well as well organized case
file made it interesting to read
Grade: 9/10
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QUESTION2 : link of elog
https://anahitabehara.blogspot.com/2021/07/general-medicine-elog.html
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QUESTION 3 : a critical review of an elog along with my understanding of the case.
CVS
A 70 year old female
presented to casuality with complaints of Distension of abdomen and shortness of breath Grade-3 since 5days
This case was well written
and presented with clear images and good placement of diagnostic imaging
History of present illness
The patient was apparently asymptomatic 5 days ago then
presented with
Abdominal distension since 5 days
Onset - gradual and progressive
Distension is generalized
SOB - Grade 3 ; since
5days incidious in onset gradual in progeression
GRADES OF SOB
History of past illness ;
Hypothyroidism since 5 years
No history of hypertension,diabetes asthma tuberculosis.
Treatment history ;
she was on Thyronorm100mg OD for
hypothyroidism .
After viewing the diagnostic imaging and the blood work a
provisional diagnosis was achieved
Diagnosis;
HFrEF with Atrial
fibrillation 2 to ?IHD
Heart failure with reduced ejection
fration
Treatment plan
Amiodarone is more effective than sotalol or propafenone for
the prevention of recurrences of atrial fibrillation.
Amiodarone is an iodine based drug , and is the chief choice
for atrial fibrillation. However amiodarone can cause fluctuations in thyroid
hormone levels when taken for a long duration of time.
//the patients biochemical reports show that she was
suffering from severe hyperthyroidism
On further research on the internet I came across a similar
case in which chronic hypothyroidism was followed by hyperthyroidism.
During this project of referring an elog and making a summary
of my understanding of this case, has helped me a lot . I had to refer some
books and scientific journals thus expanding my view point and it has helped
move away from one track thinking to trying to relate all the symptoms , just
like how detective solve cases by correlating clues.
Thank you Dr.Biswas and all the interns who helped me and
guided me .
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QUESTION 4 : ELABORATE ON THE EFFICACY AND EFFICIANCY OF THE DRUGS SUGGESTED TO THE FOLLOWING PATIENTS
Cns
Quadreparesis secondary to
infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 -
C6 level.
Drug of choice
. Inj. Optineuron 1Amp
in 100ml NS IV/OD
2. Inj. Thiamine 200mg
in 100ml NS IV/TID
3. ATT - according to
body weight 2 tab PO/OD
4. Bp/ PR/ Spo2/ Temp
charting
Optineuron Injection is a combination of nutritional supplements
that is prescribed to treat nutritional deficiencies as well as vitamin B12
deficiency. It ensures the proper growth and functioning of the body.
Case 3
PROVISIONAL
DIAGNOSIS:
AKI
ON CKD(HYPERTENSIVE NEPHROPATHY) WITH URAEMIC ENCEPHALOPATHY.
PLANNING
FOR HEMODIALYSIS
Drug of
choice
Treatment:
IVF-NS(0.0+30ml/hr)
INJ.LASIX(40mg/IV/TID)
INJ.NaHCO3(100meq in
100ml NS/IV/Stat)
T.NODOSIS
550mg/P.O/TID
BP/PR/Strict I/O
Charting
Lasix is a prescription medicine used to treat the
symptoms of fluid retention (edema) in individuals with congestive heart
failure, liver disease or kidney disorder.
Sodium Bicarbonate (sodium bicarbonate 5% injection) Injection may be indicated in the treatment of
metabolic acidosis which can occur in severe renal disease, uncontrolled
diabetes, circulatory insufficiency due to shock, anoxia or severe dehydration,
Case3
Diagnosis:
Acute kidney injury
secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of
chronic disease
Drug of choices
- Inj LASIX 40mg
(8am- 2pm -8pm)
- IVF - NS @ UO
+ 50 ml/hr
Lasix is a prescription medicine used to treat the symptoms of fluid retention (edema) in individuals with congestive heart failure, liver disease or kidney disorder.
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answer 5
Amidst the global pandemic , Practical class have been difficult
to hold and these online postings have helped us
Attending online classes is a very challenging job for the
teacher as well the students.
While the teacher’s puts
in their best effords to grasp the attention of the students,
the students also need to
pay undivided attention to follow the subject being taught.
Online postings have come in as a blessing in disguise to bind
the students & teachers, virtually
Giving a 360 degree feel of attending to patients,
Enhances learning experience
Better understanding of subject by correlating theory &
practicals
The case sheets being given to us actually make us more
inquisitive and helps us in furthering our knowledge . It has also had a
profound impact on patient-student relationship , history taking has been a bit
difficult but has been thought provoking . Although I personally prefer offline to online these
classes provide a great alternative . I would like to commend the faculty for
taking the initiative and personally mentoring us.
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