59 K.Rithika Vasantha

                                           GENERAL MEDICINE

             BIMONTHLY BLENDED ASSESSMENT FOR AUGUST 2021


      Hello and greetings to one and all who are currently reading my blog.

               This is Rithika , a third semester medical student and this blog is an assessment currently given to me.


👉 LINK TO THE ASSESSMENT : https://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html?m=1


💨QUESTION 1 :  Competency based peer to peer review and assessment:


  My question is , to review all the cases provided as links below and provide my critical appraisal of the captured data in terms of completeness , correctness , and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainities around the cases shared.

👉 First case : A case of acute glomerulonephritis  , due to sec. amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis .

Completeness :   The E-log was complete in all factors . It included chief complaints , present history , past history , medical/surgical history , personal history , family history , social & educational history , immunization history .
           This elog had everything one could have asked for ; for a better understanding of the case and to treat in a better way .


Review on the case :
  • The case was beautifully presented in detail , which is almost closely knit with his details , which seemed like a story to me , like a step-to-step detailed explanation .
  • Evolution of symptomatology was described in a detail manner .
  • There was also a detailed explanation of the patient's acute and chronic problem .
  • General examination was done in a much detailed way ; in different positions with clear documentation .
  • Clinical images of the patient and investigations were added with deidentification .
  •  Systemic examination with detailed inspection , palpation , range of movements was explained .
  • Diagnostic approach and treatment was also well explained .

 Correctness : All the data provided in the E-log is correct .


👉 Second case : Idiopathic Parkinson's disease stage 1 with denovo HTN & multiple system atrophy - parkinsonian type ( MSA-P )

Completeness : The elog was complete . it included chief complaints , history of presenting illness , history of past illness , medical / surgical history , personal history , family history , social & education history , immunization history.

Review on the case:
  • The case was beautifully presented in detail , which is almost closely knit with his details , which seemed like a story to me , like a step-to-step detailed explanation .
  • Evolution of symptomatology was described in a detail manner 
  • CNS examination was described extremely well with all detailed documentation of reflexes etc.
  • Clinical images of the patient and investigations were added with deidentification .

 Correctness : All the data pirovided in the E-log is correct .


👉 Third case : Iatrogenic cushings syndrome secondary to topical clobetasol application all over the body for approx. 1 yr.

Completeness :  this elog was little incomplete acc. to me as it didn't include his past history , family history , treatment history , personal history .

Review on the case:
  • Evolution of current symptomatology was described beautifully .
  • De-identified clinical images in the presentation , showed us the condition of the pt. clearly .
  • His follow up details were also neatly documented .
 Correctness : All the data provided in the E-log is correct .


💨QUESTION 2: Testing the scholarship competency of the examinees

                   My question is , to analyze the cases and provide a problems list for each case and then discuss the diagnostic and therapeutic uncertainities around solving those problems


CASE 1 :👉 First case : A case of acute glomerulonephritis  , due to sec. amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis .


CASE 2:👉 Second case : Idiopathic Parkinson's disease stage 1 with denovo HTN & multiple system atrophy - parkinsonian type ( MSA-P )


CASE 3: 👉 Third case : Iatrogenic cushings syndrome secondary to topical clobetasol application all over the body for approx. 1 yr.


💨QUESTION 3: Testing competency in evidence based medicine 

                 My question is to review the literature around sensitivity and specificity of diagnostic interventions mentioned and same around efficacy of this therapeutic interventions mentioned for each patient .



CASE 1: 👉 First case : A case of acute glomerulonephritis  , due to sec. amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis .

Investigations ordered in this case :
  • X-Ray of hands and wrists
  • Chest X-Ray - Rt. heart border showed mildly dilated rt. atrium . The lt. heart border shows a prominent aortic knuckle .
  • ECG
  • Blood tests
  • 24 hr Urinary protein : 1500mg
  • 24 hr Creatinine: 0.8
Urine microscopy: Showed dysmorphic RBCs and occasional pus cells .

Diagnostic Approach :
  • Features supporting diagnosis of glomerulonephritis
                       Oliguria , Hypoalbuminemia , dysmorphic RBCs in urine


CASE 2:👉 Second case : Idiopathic Parkinson's disease stage 1 with denovo HTN & multiple system atrophy - parkinsonian type ( MSA-P )

Investigations ordered in this case :
  • ECG- Showed sinus tachycardia , with pseudo infarct pattern in lead I and aVL with dagger q waves in same leads ; also showed LVH .
  • 2 D ECHO: Grade II diastolic dysfunction


CASE 3:👉 Third case : Iatrogenic cushings syndrome secondary to topical clobetasol application all over the body for approx. 1 yr.

Investigations ordered in this case :
  • CBP
  • TLC
  • PLT
  • RBS - 139mg/dl
  • CUE Albumin - +1
  • LFT - TB - 1.03
  • Albumin - 3.9
  • RFT- urea - 22 
  • Serum creatinine - 0.6
  • Electrolytes -NA - 136 , K+ - 4 , Cl- - 98
  • ECG - Sinus tachycardia . LVH present
  • USG- Abdomen

💨QUESTION 4: Share the link to your own case report of a patient that you connected with and engaged while capturing his/her life events before and after illness and clinical and investigational images along with your discussion of that case.


👉Links to my E-logs : 





💨QUESTION 5:  Testing scholarship competency in logging reflective observations on our concrete experiences of this last month.

                   My question is to reflect and share my telemedical learning experiences from the hospital as well as community patients over the last month , particularly while E- logging case reports.

       
            Overall this month has been great . From the past 3 months , we've been doing elogs for the patients cases from home . I never came in direct contact nor did I see any patient in person during the logging experience of last 3 months .

             But , this month gave me that chance even though we didn't start with our clinical postings yet . I got to see the patient ,  about whom I was logging . I  also saw the environment present inside the hospital , all the hustle-bustle  going around with different cases and also the care which is being taken for each and every patient . I also learned about how medicines were prescribed and handling the attenders of the patients .

           All in all ,  With E-logging , and integrating learnings with my current subjects , pharmacology , pathology , microbiology , I have understood the why's of the disease and its clinical presentation. I understood why a particular drug is prescribed and how it helps the patient. Telemedicine has made me step into their shoes and understand what life is with the disease.

              I'd like to commend the faculty, interns , PGs  and HOD , Dr.Rakesh Biswas sir  for taking the initiatives and personally mentoring us.

              I thank the department of GENERAL MEDICINE for giving me this opportunity and I'm grateful🙌 for it !!!!!

              







Comments

Post a Comment

Popular posts from this blog

K. Rithika 59

Image
Greetings to one and all who are currently reading my blog. This is Rithika, 8th semester medical student.                                               This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  Note : This is an on-going case and will be updated as and when I receive any information.  CHIEF COMPLAINTS Patient came with chief complaint of cough since  7 Days, Fever since 7 days, with difficulty in breathing since 7 days HOPI Fever since 15-days high grade-not associated with chills and rigor, evening rise + Associated with sweating Cough since 7- days associated with less amount of sputum, mucoid. blood tinged aggravated on changing position from l
Read more

PREFINAL EXAMINATION OSCE LEARNING POINTS

My case for today was a case of acute cervical dystonia. Was a quite interesting case which I saw in the recent times.               Different diagnosis were considered for it like   Tetanus   Focal seizures   Drug induced dystonia     Now my learning points were:     - With so many differentials in mind, how to land up in a particular diagnosis    - Why drugs cause dystonia in a few and doesn't in the other?        Let's dig deep to know how🙂 Focal dystonia Focal dystonia is limited to one area of the body and can affect the neck (cervical dystonia or spasmodic torticollis), eyes (blepharospasm), jaw/mouth/lower face (oromandibular dystonia), vocal cords (laryngeal dystonia) or arms/legs (limb dystonia). Other less common types of focal dystonias can cause unusual stretching, bending or twisting of the trunk (truncal dystonia) or sustained contractions and involuntary, writhing movements of the abdominal wall (abdominal wall dystonia). Symptoms Dystonia affects different peop
Read more

59 K. Rithika Vasantha

Image
Greetings!! I'm Rithika, a third semeter medical student. This blog aims at providing a wide array of information of cases evaluated to the best of my understanding. This blog paces up with spectrum of patient centered active learning under the guidance of my experienced seniors.  A 65 YEAR OLD FEMALE WITH HYPOGLYCEMIA  SECONDARY TO THE PRESENCE OF CANCER Date of admission: On 5.7.21 Note : The following blog aims at discussing our patient's deidentified health data shared after taking the guardian's signed consent.  This blog is prepared under the guidance of Dr. Siddharth.  A 65 year old female came to the casuality in altered state at 3 am.  CHIEF COMPLAINTS : • Slurring of speech and profuse sweating since a day before (4. 7.21) , (from evening).  • And at around 3 am, was brought to casuality in unconscious state, responding to deep stimulation and LOC + HISTORY OF PRESENT ILLNESS : • Pt was apparently asymptomatic since yesterday evening 4 pm.  • Pt had episodes of sl
Read more