Medicine paper for July 2021 bimonthly blended assessment
Medicine paper for July 2021 bimonthly blended assessment
Question 1: Competency tested for Peer to peer review and assessment :
Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :
ANSWER:
The referred blog :
https://uakanksha.blogspot.com/2021/07/135-uakanksha.html?m=1
The explanation was good, but the certain points could have been highlighted. If a summary of patients details were given it would have been much easier to understand.
- The relevant medical history of the patient has been shared in a comprehensive and systematic manner. The problem list was well mentioned.
- The case sheet has captured all the relevant data in the right order.
- Correct terminology was used.
- The reports of all the lab investigations conducted were deidentified and shared.
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.
ANSWER
The link to my blog link:
The above link : A 35yr Old female with shrunken kidney ,renal calculi .
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.
ANSWER:
👉Patient with coma and renal failure :https://pallavi191.blogspot.
The case has been presented very clearly . The history taking and examination has been done precisely , providing all required information for the reader to understand the case . All the associated clinical pictures have also been provided. The data provided is correct and complete.
The data provided is correct . But lack the discharge summary.
The case has been presented very clearly and to the point . All the data pertaining to the case has been provided . History taking and all the other investigations carried out have been done and presented meticulously .
👉AKI :
The case has been presented very clearly . The history taking and examination has been done precisely , providing all required information for the reader to understand the case . All the associated clinical pictures have also been provided. The data provided is correct and complete.
👉CKD :
The document is very well listed but should have been more enhanced. Indication for drug use and dosage have been included.
👉Patient with coma and renal failure :
The symptomatology in the given patient is very well listed . The answers are written in very understandable format.
👉Patients with acute on CKD :
The case was very well presented and explained however a flowchart would be more helpful. The important points were highlighted. Over all the presentation was very neat and understandable.
👉Patients with acute on CKD :
Information about the drug and numerous interventions have been provided.
The presentation is neat .
👉Patients with acute on CKD :
The evolution of symptomatology is described beautifully and it is very easy to comprehend .
Each intervention described for the particular patient has been given in a simple and legible manner.
👉Patients with AKI :
The entire document is very well-formatted, the organization of the data makes it very easy to look through.
Symptomatology has been given in chronological order.
👉Patients with AKI :
The symptomatology is in chronological order and well listed, the anatomical representation is done with the help of diagrams that make it easier to understand.
the document is well listed but could have been enhanced with the help of diagrams. the content of the document is explained well in a language that is easy to understand. the readability of the document could have been increased
Q4: Testing scholarship competency of the examinees
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.
ANSWER
👉Patient with coma and renal failure :https://pallavi191.blogspot.
Problem list
- patient presented to the casualty with Abdominal Distension NOT associated with pain
- No nausea No Vomiting, No loose stools and was diagnosed with
- Alcoholic Liver Disease,
- AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,
- Hepatic encephalopathy grade 2
28-06-2021:
Treatment:
Day 1:
1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
Day 2&3:
Same treatment followed
Day 4:
- Same treatment followed except Inj. Monocef.
- Inj. Augmentin 1.2 gm IV/TID
- Tab. Ecospirn 150mg PO/HS/SOS
- Tab. Clopidogrel 75mg PO/HS/SOS
- Tab. Atorvas 20mg PO/HS/OD added
FINAL DIAGNOSIS:
- INFECTIVE ENDOCARDITIS
- WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR
- WITH AKI
- WITH ?UREMIC ENCEPHALOPATHY ? SEPTIC ENCEPHALOPATHY
- WITH ULCER OVER SOLE OF RIGHT LEG
- WITH HYPOALBUMINEMIA ? ALCOHOLIC LIVER DISEASE
- WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES
problem list:
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 .
Probable Diagnosis
- 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)
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 , rest :1week
COMPLAINTS AND DURATION:
-week back , after weight lifting
Patient had sudden onset of pain in abdomen
By burning micturation with high fever : grade associated with chills and rigor
Decrease urine output associated with SOB (grade -4)
With no H/O chest pain, palpitations, pedal oedema, facial puffiness.
SEROLOGICAL INVESTIGATIONS:
- pH : 7.46
- PCo2 : 36.6
- PO2 : 81.8
- HCO3 : 26.0
- St.HCO3 : 26.8
- SPO2 : 94.3
- USG Abd : B/L Grade -1 RPD
- Rigth:10×6cm
- left:9.6×5cm
- -mild hepatomegaly with Grade-1 fatty liver
- Hb-13.6
- TLC-13,100
- N-91
- L-04
- E-02
- M-03
- B-00
- PLT(plateletcount)-1.26
- Clinical Urine Examination:
- Pus cells-4 to 6
- Epithelial cells-3 to 4
- Alb: Trace
- Urine: plenty of pus cells
- HbA1C : 6.8
- RBS : 120mg/dl
- Serum creatinine: 5.9 mg/ dl
- Blood urea: 128 mg/ dl
- Sodium : 133 mEq/L
- potassium : 3.6 mEq/L
- chloride : 53 mEq/L
- Liver Function Test:
- TB -1.63
- DB -0.48
- AST -26
- ALT -30
- PROVISIONAL DIAGNOSIS :
- - AKI 2° to UTI, associated with Denovo - DM -2
- -With ? Right HEART FAILURE,
- -With K/C/O - HTN ( Not on Rx)CKD :
👉CKD : https://krupalatha54.blogspot.
,*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.
Investigations:
* Serum electrophoresis:-
- showed M- band in gamma region.
- * Bone marrow aspiration:-
- showed plasma cell dyscaria, probably multiple myeloma ( plasmacytosis 70%).
- Mild to moderate supression of all cell lineages.
- *2D echo
- No significant abnormality.
- *ECG
- No significant changes.
- *USG abdomen
- Bilateral grade 2 RPD
- * Haemogram
- * Hb:6.5
- TLC: 5200
- Platelet count: 2.15
- Smear : dimorphic Anaemia.
- Reticulocyte count: 1%
- *serum B12 and Iron profile
- are with in normal limits.
DIAGNOSIS :
- CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
👉Patient with coma and renal failure :
"Chief complaints"
- Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).
Investigations:
- Left Kidney 13.2x7.5cm increased size, abnormal echogenicity of раrenchyma noted with Ћуро and hyper echoic regions.
- However no E/O air focii was noted. However no e/o any abscess, Perinephric collections, mild hydronephrosis in left PCS
- Aorta I.V.C. - (N)
- No Ascitis
- No lymph-adenopathy
- U.bladder - normal Empty
- V-U Junctions - Foley'sbulb insitu.
- Uterus-Size - Pelvis couldn't be assessed
- Parenchyma with (Lt)Abnormal echogenicity, mild hydronephris ,no perinephric collections suggested
- clinical corelation to
- Acute pyelonephritis.
Provisional diagnosis: DKA with AKI ( ? Pre renal)
👉Patients with acute on CKD :
problem:
He presented to the hospital on june 14th 2021 with complaints of High grade fever and pus in the Urine ( 4th Admission )
Treatment:
- Injection PANTOP 40mg IV/OD
- Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
- Injection LASIX 40mg IV/BD
- Injection optineuron 1AMP in 100ml NS slow IV/OD
- Injection NEDMOL 100ml IV/SOS
- Tab PCM 650mg TID
- Insulin Human actrapid - 16 IU/TID
Diagnosis
Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore
👉Patients with acute on CKD :
CHIEF COMPLAINT - 48-Year-old male presented to the OPD with chief complaints of Shortness of Breath grade -II from the past 1 week, which converted into grade -III-IV from the past 4 days
Findings-
Pre Medication findings
1. Early small airway obstructions as FEF25-75 % Pred or PEFR % Pred <70
2.Spirometry within normal limits as (FEV1/FVC) % Pred> 95 and FVC% Pred >80
Post Medication Findings
3. Mild restriction as (FEV1/FVC) % Pred >95 and FVC % <80
TREATMENT - 14/7/2021
1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml
PROVISIONAL DIAGNOSIS - HFrEF secondary to CAD; CRF
👉Patients with acute on CKD :
Chief complaints:-
A 60 yr old patient came to the opd with chief complaints of..
Pedal edema since 3 days.
Decreased urine output since 3 days.
H/o vomitings and loose stools 5 days ago lasted 3 days and subsided.
Treatment:-
1. IV fluids
2. Tab. Pan 40 mg po OD
3. Inj. Lasix 80 mg IV BD
4. Thiamin 200 mg in 100 ml NS IV BD
5.Tab. Levocet 5 mg Po BD
6.Liquid paraffin for LIA
7.Grbs 6 th hrly
8.I/o charting, temp. Charting
👉Patients with AKI :
A 43 yr old male ,resident of nalgonda came to casuality with chief complaints of
- loose stools since 20 days
- Pedal edema since 20 days
- Abdominal distension since 20 days
TREATMENT
- INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
- INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
- INJ LASIX 40 mg
- TAB. ALDACTONE 50 mg PO / BD
- INJ PANTOP 40 mg IV/ OD
- ABDOMINAL GIRTH MEASUREMENT DAILY
- BP /PR/TEMP/ RR -4 hourly
- I/O CHARTHING
PROVISIONAL DIAGNOSIS: ALCOHOLIC HEPATITIS ,
AKI SECONDARY TO ACUTE GASTROENTERITIS
HFrEF SECONDARY TO CAD
ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME
👉Patients with AKI :
Problem list:
- A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days
- decreased urine output since 10 days
- fever since 10 days.
INVESTIGATIONS
Blood urea:
15/6/21 - 65 mg/dl
16/6/21 - 62 mg/dl
18/6/21 - 76 mg/dl
21/6/21 - 81mg/dl
Serum creatinine:
15/6/21 - 3.4 mg/dl
16/6/21 - 3.4 mg/dl
18/6/21 - 3.2 mg/dl
21/6/21 - 3.1 mg/dl
Total leukocytes count:
16/6/21 - 24700
18/6/21 - 26500
21/6/21 - 31700
Serum Electrolytes:
15/6/21 - Na: 139 ; K: 5.2 ; Cl: 106
16/6/21 - Na: 138 ; K: 5.1 ; Cl: 105
18/6/21 - Na: 136 ; K: 4.9 ; Cl: 102
21/6/21 - Na: 134 ; K: 5.5 ; Cl: 98
Diagnosis:
Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease
👉Patients with AKI :
Problem list:
- pain abdomen since a week, epigastric region, non radiating ,intermittent type ,relieved by asuming sitting position.
- Co vomiting non projectile, billious contents of previous meal since a week ;
- 4-5 eps /day ,lasted for 3 days
T R E A T M E N T :
- Iv fluids : NS 40 ml /hr.
- IV lasix 40 mg BD .
- Tab Nodosis .
- IV PIPTAZ 4.5 Gms. BD
- Iv 25%Dextrose. 100 ml BD
- Tab . Nicardia 10 mg TID.
- D A Y W I S E U P D A T E S:
- Day 1and 2 =Urine output 1500ml,
- Fluid intake 3000ml
- DAY 3 :
- Scrotal and penile swelling was obsereved since yesterday, due to which his gait was effected , , for which the fluid input has been reduced .
PROVISIONAL D I A G N O S I S-
- Acute pancreatitis with AKI
- with ?B/L pleural effusion and moderate ascitis .
- Currently in ?Alcohol withdrawal.
Q 5) Testing scholarship competency in Reflective logging
ANSWER:
Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. Reflective logging enable the student to stay up to date and keep a track of their progress . They enable one to apply their theoretical knowledge into practical application. In the times of COVID when we are unable to physically attend clinical posting and acquiring practical knowledge , logs enable us to keeping a track of the patient assigned and practice important skills like history taking .
This helped me to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.
Reflective logging give us an opportunity to know the patient and study the case, inspite of us not being in the hospital.
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