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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