July assessment

Q1 

Case 1 : https://aitharaveena.blogspot.com

 In my opinion :

Reasoning was good and the diagrams used makes the understanding easy .

Q2-

Case 2 : https://blendedasessmentmadhukumar.blogspot.com

In my opinion : diagnosis inferior wall mi with uncontrolled sugars and dm since 8yrs

chest pain since 3 days  

what is the symptomology in the patient in terms of an event and where is the anatomical localization for the problem and the etiology of patient problem 

giddiness since morning profuse sweating since mrng anatomical location of lesion is inferior wall of the heart

Case 3 :

https://31nehareddy.blogspot.com/

In my opinion :I agree that COVID-19 infection has led to acute exacerbation of underlying intestinal lung disease.COVID can cause exacerbation of ILD symptoms such as dyspnea, decreasing levels of SpO2 further . And also due to ILD the prognosis of the patient is poor. ILD makes the oxygen more difficult to pass into the blood stream

Case 4 :

https://divyasree1999.blogspot.com/?m=1

In my opinion : I agree to the explaination givencerebellar infarct only when there is a blockade in the blood vessels may be due to blood clots .Due to hypertension, there will be increased sheer stress on the blood vessels causing endothelial dysfunction, cerebellar small blood vessels disease leading to stroke.

Case 5 :

https://gsuhithagnaneswar.blogspot.com/?m=1

This is an very intresting case of Mucormycosis (black fungus).The evolution of symptamology was nicely explained but the case would be great if the MRI imaging was also added.

Case 6 :

https://prietyarlagadda.blogspot.com/

In my opinion : The condition of the patient is well-explained. The patient's condition improved and he was discharged after several symptoms were addressed with proper medication. The patient had satisfactory treatment, and his recovery will be contingent on his compliance with the medication prescribed at the time of release.

Case 7 :

https://160vasistamadhavareddy.blogspot.com/

I agree with the opinion ,

The case was explained clearly based on events of the timeline. Each every detail of the case was mentioned specifically with detailed reports and images. 

Case 8 :

https://marisatejaswini.blogspot.com/

I agree with her opinion ,

In this case,the questions were asked very clearly and the mechanism of drugs was better to understand. mentioning the adverse effects of alcohol abuse was interesting

Case 9 : 

https://143vibhahegde.blogspot.com/

In my opinion : Etiology is stated accurately i.e., alcohol withdrawal and symptomatology stand the same [seizures, tremors, restlessness] Thiamine, lorazepam, are standard medication in my view. Alcohol withdrawal symptoms will fit the best. It is the 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 the bleeding ulcer is cause for normocytic anemia.

Case 10 :

https://tejasreekandregula.blogspot.com/

In my opinion : The symptomatology, anatomical localization, etiology of the patients problem were explained, but could have been better to understand, if the diagrams were included. The pathophysiology, mechanism of action of pharmacological and non-pharmacological interventions were listed properly. The reasons for the neurological problems could have been elaborated in a detailed manner. All the other questions were also answered. 

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 of that case. 

https://deekshitha44medicinelogbook.blogspot.com/2021/07/a-58-year-old-patient.html

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

 OVERVIEW 

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 :1week  

Appraisal :

Case history was taken well and examination was very well done 

Negative points :

It would be better if fever chart is added as it was treated with strict temp 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

Overview :

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 

Appraisal :

History was taken well 

Negative points :

There are no pictures of pedal edema .

Proper chronological order of symptoms apperance was not done 

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

Overview :

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 

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: 

With good fever charting with all the necessary information.

History was taken detailed way 

All the tests were properly done 

Negative points : 

I could not find the negative data in the elog  

My 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.

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.hindawi.com/journals/amed/2014/762320/

Q 5) Testing scholarship competency in  

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

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

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