59 K. Rithika Vasantha

June 2021-BIMONTHLY BLENDED ASSESSMENT

       

         Greetings to one and all who are currently reading my blog. 

          This is Rithika, roll no 59 , a third semester medical student. And this blog us currently an assignment given to me. 

     

Question link:assignment link

   👉My first question was to go through answers in the following link and share my peer review on what's good and bad about it.

 Link:question link

 

 ❄Answer: I have decided to take, refer and study pulmonology case from 10 different links and this is my peer review about it🙂

        Out of the 10 different case sheets I have referred, the details of the patient are:

Patient details:details

Evolution of symptomology :

20 yrs back-First episode of shortness of breath(lasted for 1 week during January)and continued in the same pattern for 7 years

↓

12 years back-Episode lasted for 20 days and continued in the same pattern till 30 days back

↓

Latest episode- lasted for 30 days and not getting relieved on medication

↓

Other symptoms

5 yrs ago-Anaemia

1 month back-Generalised weakness

20 days ago- Hypertension 

15 days ago- pitting type of pedal edema and facial puffiness. 

                 After reviewing 10 histories of the same case, I found that all of them conclude to a same diagnosis i.e Respiratory infection due to bacterial pathogens like haemophilus influenzae, streptococcus pneumoniae and moraxella catarrhalis, etc. 

         But few links also have it mentioned that it was due to occupational pathology, as the patient is a farmer working in paddy fields., and the paddy dust could act as a triggering factor affecting the lung parenchyma. 

occupational pathology - working in paddy fields ) ,,

                working in paddy field

                              ⬇️

           Allergen leading to increased 

                Mucus secretion 

                              ⬇️

            Secondary bacterial infection

                              ⬇️

                    BRONCHIECTASIS

                              ⬇️

                   SOB ,INCREASED work load 

                       on heart ,

                              ⬇️

                  Right heart Heart failure 

                             ⬇️

                      Fluid over load 

                       ↙️ ↘️

   Kidney stress. Edema 

       The etiology was pretty well explained and it also supports all of her given symptoms. 

       The pharmacological and non-pharmacological interventions were also pretty same in all my reviewed links like head end elevation, inj. Augmentin, tab azithromycin, inj. Lasix, tab pantop etc. Even all these fit perfectly to the referred symptoms of the patient. 

         On the whole, my review would be that, the diagnosis, investigations,and the treatment all add up to a well solved case in all my reviewed links☺. 

👉My second question was Link to my blog. 

 ❄I'm really sorry for not answering this question sir. I have not taken up any case as of now yet. I'm actually very new to all of this technical stuff and it took me a while to understand about it and learn. I promise, the next assessment would definitely include my case blog sir. Thank you 🙂. 

A small edit : My case e-log

👉My third question was to choose a case and to give a critical appraisal. 

 First case chosen by me:case link

        ❄  This case was about a 45 yr old male, with acute kidney injury on chronic kidney disease (hypertensive nephropathy) with uraemic encephalopathy. 

          With a detailed study of the past history, we come to know about the history of hypertension from the past 5 yrs and chronic kidney disease for 5 yrs. 

My take on this case:

         The case history shows the patient was hypertensive for the past 5 yrs. Over time, uncontrolled high blood pressure can cause arteries around kidney to narrow or weaken or harden. These damaged arteries are not able to deliver enough blood to kidney. Damaged kidney arteries do not filter blood as well. Damaged kidney arteries fail to regulate BP. As more arteries become blocked, and stop functioning, kidneys eventually fail. 

Second case chosen by me:case link

         

             ❄This case was about a 60 yr old female with chief complaints of pedal edema, decreased urine output and fever since 10 days. She also had burning micturition. 

              With a detailed study of the past history we come to know that she is a patient of DM-type 2 , along with shortness of breath. 

              My take on this case:

      She has been diagnosed as acute kidney disease secondary to urosepsis. Urosepsis is an untreated urinary tract infection (UTI) , which has now spread to her kidney. This urosepsis is associated with systemic hypotension, cytokinemia, and activation of neutrophila by endoroxins and other peptides, which indirectly and directly contribute to renal tubular failure. 

👉My fourth question was to review sensitivity and specificity of all the diagnostic interventions. 

   

❄Answer :  first case referred

            The diagnosis was Acute kidney injury with chronic kidney disease(hypertensive nephropathy). 

            

        The investigations taken were :

• Complete blood picture

•Complete urine examination

•ECG

•Ultrasound

•HbsAg-rapid

•Anti HCVAb -rapid

•HIV-rapid

         The steps taken were:

• Inj. Lasix - helps to treat fluid retention (edema) and swelling that is caused by kidney disease. 

• Inj. NaHCO3 - used to correct metabolic acidosis in chronic kidney disease. 

• tab. Nidosis - works by increasing ph of blood and urine, thereby correcting metabolic acidosis. 

      The final treatment would be hemodialysis. 

         A small inclusion from my side would be including kidney function tests too in the investigations. 🙂

❄second case:case referred 

            The diagnosis was acute kidney disease secondary to urosepsis. 

            The investigations taken were:

•complete blood picture

•complete urine examination

•serum electrolytes

•RBS and FBS

• urinary electrolytes

•CBP

•ABG

•bacterial culture and sensitivity report

           The treatment was:

• inj. Lasix - to treat fluid retention and pedal edema caused due to kidney disease. 

•tab. Nodosis - increases ph of blood and urine and treats metabolic acidosis. 

• inj. Magnexforte - to treat serious and severe bacterial infections. 

•tab orofer - for treatment and prevention of different types of anaemias  , and also for preventing iron, folic acid, vit. B12, zinc deficiencies. 

• tab. Ultracet - acts as a pain killer

• tab. Norflox - an antiniotic

•tab shelcal - to treat vit. D and calcium deficiency

👉My fifth question was to Login reflective observations on my concrete experiences for the past one month. 

❄ Answer:

           Me being a third semester student in this COVID-19🦠😷 pandemic, made me an online 👩‍🎓student. 

           Although it was tough coping up with the clinicals, 🏥 , Dr. Rakesh Biswas sir had made it easier through the whatsApp group discussions which made our communication gap narrower. 

            The different cases being presented in this group gave us a virtual exposure to a significant number of cases and to learn about them in detail. 

            We learned about how we come to a diagnosis and how a particular medication is suggested. The ocean of information which goes before confirmation of each treatment is highly appreciable. 

             It also taught us the connection between various different symptoms. We also had exposure to a rare condition of a live patient with Multi-system inflammatory syndrome in children👶👧👦 (MIS-C) as a very rare and severe complication of SARS CoV-2 infection in children and adolescents. 

            All in all, even though the virtual clinical classes were a little non - convenient, we all are managing and striving hard together 👫 to make this time productive too and enjoy the new normal i.e the virtual exposure of a wide variety of cases. 🙃

          I thank the department of general medicine 💊 for giving me this opportunity. ☺