GENERAL MEDICINE FORMATIVE BLENDED ASSESSMENT OCT-2021

Hello and greetings to one and all who are currently reading my blog. 
             This is Rithika, a 3rd semester medical student and this blog is currently an assessment given to me. 

👉 Link to the assessment :assessment link

🍁QUESTION 1 :

My question is, to go through the case reports in the links shared 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 uncertainties around the cases shared.

👉 First case link: gastroenterology case link

Review of the case :

• The case was beautifully presented. 
• Evolution of symptoms are mentioned in a detailed way. 
• Patient's routine lifestyle before disease was also explained. 


👉 Second case link : CNS case

Review of the case :

• HOPI was mentioned in paragraphs and not point wise which made it little difficult. 
• But other than that, everything else was good. 


👉 Third case link : Hematology case link

Review on the case :

• Case isn't presented in a presentable way. 
• It was haphazardly arranged and nade it difficult to understand. 
• The side-headings or the sub topics aren't mentioned at all , which didn't allow us to know which thing came under what. 


👉 Fourth case link : Cardiology case

Review on the case :

• Clinical images and 2D echo was recorded and shown 
• Other than that, the proforma of a basic case sheet is not maintained. 
• All the information was just randomly kept on the paper. 


👉 Fifth case link : Nephrology case link

Review on the case :

• Timeline of events chart was the main attracting feature of this blog
• Clinical images are also shown
• Treatment part was not mentioned which made it incomplete. 


🍁 QUESTION 2 :

My question is, to analyze the below linked  cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. 

👉 First case link : Gastroenterology case

Problems list :

• Yellowish discolortion of eyes  since 1 month.

• History of low grade fever, intermittent, not associated with chills and rigor.

• Patient also complaints of yellowish discoloration of urine since 1 month, passing of clay colored stools since 1 month.

• He also complaints of itching all over the body since 1 month, decreased appetite, loss of weight and generalised weakness since 1 month.

• Patient has pain in both knees since 6 months


Diagnostic and therapeutic uncertainity :

Diagnosis : 

Chronic liver failure and kidney disease.

Investigations :

- RFT , LFT 

- HEMOGRAM , CUE 

- ECG , USG 

- Abdomen , BGT , ABG 

- VIRAL SEROLOGY , CHEST X RAY, 2D echo.


👉 Second case link : CNS case

Problems list :

• Giddiness and blurring of vision since 4 days. 

• H/o generalised weakness since 3 days.

Diagnostic and therapeutic uncertainity :

Diagnosis: 

Hypertension, Demyelinating lesion ,with U/L Optic disc edema with Pyrexia.

•Investigations:

-CUE, Hemogram, ultra sound, ECG,MRI.



👉 Third case link : Hematology case

Problems list :

• Chief complaints of
1. Shortness of breath since 20 days
2. Leg pain on walking since 20 days
3. Pedal edema since morning


Diagnostic and therapeutic uncertainity :

Diagnosis :

Pancytopenia under evaluation

Investigations :

- Haemogram, LFT 

- Blood grouping and Rh typing 

- Serum Electrolytes ,Blood Urea 

- T3,T4,TSH, Bone marrow biopsy, ECG 

👉 Fourth case link : Cardiology case

Problems list :

• multiple episodes of vomitings a day before
• He noticed decreased urine output since January
 • Intermittent shortness of breath on walking for long distance
• spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep
• His creatinine was 15mg/dl
• On February 13th he was referred to NIMS
 i/v/o renal biopsy.
• There his shortness of breath was increased from grade2 to grade 4.


Diagnostic and therapeutic uncertainity :

Diagnosis :

CKD ON MHD WITH HTN WITH B/L TRANSUDATIVE PLUERAL EFFUSION SECONDARY TO HD

Investigations :

- Prothrombin time , LFT

- ABG, CBP, ECG

- Chest X RAY , 2D Echo

- Haemogram, Lipid profile


👉 Fifth case link : Nephrology case

Problems list :

• complaint of pedal edema, pitting type, since 3 years.

• Developed shortness of breath 10 days back and cough and cold since 5 days back.


Diagnostic and therapeutic uncertainity :

Investigations :

- Hemogram

- RFT, CUE 

🍁 QUESTION 3 :

My question is, to 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. 

👉 First case link :Gastroenterology case

Treatment :  

- Fluid restriction : < 1t / day

- Salt restriction : < 2gm / day

- Tab . Lasix - 40 mg , BD

- Tab . Metalazone 5mg , BD 

- Tab . Thiamine 100 mg , OD

- Syrup . Lactulose 15 ml , BD

- Tab . Rifagut 550 mg , BD

- Protein powder with 100 ml milk , 2 times daily 

- Abdominal girth & weight measurement daily

- Tab . Udiliv 300 mg , BD

- 2-3 egg whites / day


👉 Second case link : CNS case

Therapeutics:

- INJ. MANNITOL 100ml IV/ TID .
-INJ. ZOFER 4MG IV/ BD .
-INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD.
 -INJ. CIGXANE 60MG SC/OD .
-INJ. NEOMOL 100ML IV/ SOS.
 -TAB. VERTIN 16 MG PO/ BD .
-TAB. PCM 650 MG PO/ TID .
-Strict temperature monitoring 4th hourly .
-Strict BP monitoring 2nd hourly .


👉 Third case link : Hematology case

Treatment :

- Inj METHYLCOBALAMINE 1000mg IV OD

- Inj IRON SUCROSE 1 amp in 100ml NS IV

- Vitals monitoring


👉 Fourth case link : Cardiology case

Treatment :

- Salt and water restriction

- Inj.augmentin 625mg od

- Tab nicardia10mg tid

- Tab.pantop 40mg od

- Tab.lasix 40mg bd

- Tab.orofer xt od

- Tab shelcal.hs od

- Tab nodosis 550mg od

- Tab zofer 4mg tid

- Nebulisation with budecort and salbutomol 8th hrly

- Bp/pr/temp/spo2 and I/O charting monitoring


🍁 QUESTION 4 :

My question is, to share the link of my own case report this month of a patient that I've connected with and engaged while capturing his/her sequential life events before and after the illness and clinical and investigational images along with my discussion of the case. 


🍁 QUESTION 5 :

Testing scholarship competency in  
logging reflective observations on your concrete experiences of this last month 

           After a very long break to the academics due to the pandemic, we finally started having offline classes since August. Even then, our clinical postings were still a dream as we didn't hit them right in the start. 

           So, October 18th is the day when my batch started having general 💊medicine postings and all of us were very excited for it ( especially me!!!!). 

           And on the first day, I've been to ICCU, AMC, CKD Ward, general ward and I also saw a variety of patients with diverse sufferings. I also saw the pain in the attenders of the patients too. Before even knowing the problem or approaching and talking to them, looking at the patient from a distance made me 😞upset on how much pain he was going through. Few of them were tossing on the bed with pain and many more with many other problems. Watching all of them was heart wrenching...... It also made me feel more responsible towards what I was reading, and how effective 💪 physician I should become on order to relieve all of them. 

           Our GM sir, Dr. Rakesh Biswas sir, took all of us through every single patient in every single ward and explained every single case in detail. Even though I'm a 3rd semester student, the explanation given by sir and the way he broke down every single case into basic sciences of anatomy and physiology is very very fascinating!!!!! 

           We also had many case discussions in our clinical lecture halls, where all different types of cases, their etiology, their pathogenesis, their progression, how to come to a provisional diagnosis from differential diagnosis and treatment part too, which is very cool right!!!! 

           Every single day is a new experience and every single case is a ✨💭fantasy to look into and I'm having an amazing👍 time in GM postings and looking forward to many more!!!!! 

          Apart from our Rakesh Biswas sir, each and every intern and PG were very very understanding and cooperative, which made us much more comfortable😌 in approaching them and learning more about the case studies in detail. I thank the GM department for giving me this opportunity. Thank you 🙂

          

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