I, Vanshika Savla, (roll no. 122) a 3rd sem student of 2k19 batch have been given an assignment on general medicine.
QUESTION 1: Share your peer review of each answer with your qualitative insights into what was good or bad about the answer.
Roll no. 123
https://seemalaanjali123.blogspot.com/2021/07/general-medicine-assignment.html?m=1
POSITIVES: Vital information of each case is given in brief. Proper reasoning for complications is also given.
NEGATIVES: The evaluation of each case is not listed. The reviews could have been more elaborate and the negatives and positives of the each case should have been mentioned. There were few unattempted bits.
RELEVANCY: Relevant material was provided.
QUESTION 2:
https://vanshikasavla.blogspot.com/2021/07/58-year-old-male-came-to-casuality-with.html
QUESTION 3: 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 :
Well presented case with accurately mentioned history of past and present illness and day to day updated investigations. Diagnosis should have been provided.
Acute on CKD :
Good elements of data is provided. The data was inclusive of all investigational reports and diverse treatment information.
CKD :
Complaints and examination of each day were noted. The reports of investigations undergone by the patient were preserved and included in the blog. It was an impressively detailed case.
Patients with coma and renal failure :
The investigation findings of the case was well elaborated . The discharge summary wasn’t updated yet. The case is inclusive of all important information required for diagnosing it.
Treatment history wasn’t included.
The final diagnosis was still uncertain.
The hospital name wasn’t censored in the blog.
Patients with acute on CKD :
Treatment history of present or past illness is not provided. Well organised work.
Important pieces of information for easy diagnosis were highlighted. Reference links were provided below related to the case explaining about the complications and outcome of the disease.
History of the patient was very brief. Course of the disease is provided in the end giving a brief idea of the outcome and treatment relating to the case.
Patients with AKI :
Complaints were updated day to day and were recorded on track. Discharge information with diet plan prescribed for the patient should have been of help.
Thorough history taking was done. Appreciable work.
Clear pictures of investigation reports and precise summary is given.
QUESTION 4:
AKI :
Chief complaints:
- Abdominal pain
- Burning micturition
- High fever associated with chills and rigor
- Shortness of breath
- Decreased urine output
Diagnosis: Acute kidney injury secondary to UTI
Treatment:
- Anti bacterial drugs regularly
- Salt restriction
- IV fluid
Acute on CKD :
Chief complaints:
- Shortness of breath
- Lower backache
- Pedal edema
- Dribbling of urine
Diagnosis: Acute kidney injury grade 1 L4-L5 Spondylodiscitis (infectious)
Delirium secondary to uremic encephalopathy
Treatment:
- Oral therapy
(Back pain will persist irrespective of the variety of treatment taken)
CKD :
Chief complaints:
- Fever
- Muscle ache and weakness
- Non projectile, non bilious vomitings
Diagnosis: Chronic interstitial nephritis secondary to plasma cell dyscrasia
Treatment:
- Serotherapy
- Immunomodulatory drugs
Patient with coma and renal failure :
Chief complaints:
- Back pain, abdominal pain, chest pain
- Fever
- Diarrhoea
Diagnosis: Pyelonephritis
Treatment:
- Relevant oral antibiotic therapy
- Surgery becomes necessary if the patient doesn’t respond to antibiotic therapy or in case of renal abscess
Chief complaints:
- Abdominal distension
- Constipation
- Disturbed sleep patterns
- Pedal edema
Diagnosis: Infectious endocarditis with uremic encephalopathy
Treatment:
- Oral antibiotics with good bioavailability
- If infection is fungal, anti fungal medication should be prescribed
Patients with acute on CKD :
Chief complaints:
- High grade fever associated with chills and rigor
- Burning micturition
- Shortness of breath
- Pus in urine
Diagnosis: Renal AKI secondary to urosepsis with bilateral hydroureteronephrosis
Treatment:
- IV fluid administration
- Temporary hemodialysis
- Medicines to control the amount of vitamins and minerals in the blood
Chief complaints:
- Shortness of breath
- Pedal edema
- Irregular bowel movement
Diagnosis: HFrEF secondary to CAD
Treatment:
- ACE inhibitor, beta blockers, calcium channel blockers
- Diuretics
Patients with AKI :
Chief complaints:
- Pedal edema
- Abdominal distension
- Loose stools
Diagnosis: Alcoholic hepatitis and AKI secondary to gastroenteritis
Treatment:
- Steroid drugs to reduce liver inflammation
- Rehydration drinks
- Antibiotics if bacteria is the cause, anti parasitic drugs if parasite is the cause
Chief complaints:
- Pedal edema
- Fever
- Decreased urine output
- Shortness of breath
Diagnosis: Acute kidney injury to urosepsis with hyperkalemia
Treatment:
- Lasix acts as a strong diuretic used to treat excessive fluid accumulation caused by nephritis syndrome. Reduces pedal edema
- Antibiotics
- Intravenous fluids
Chief complaints:
- Abdominal pain
- Non projectile,bilious vomiting
- Shortness of breath
- Pedal edema
Diagnosis: Acute pancreatitis with AKI
Treatment:
- Fluid replacement
- Diuretics
- Temporary hemodialysis
QUESTION 5:
Experience of the logs done in this month.
I received a case of AKI in the beginning of this month. It was the first log I was working on so I collected info on how to proceed with it and I also learnt how to advance with history taking. It was difficult to communicate with the attender of the patient as I wasn’t fluent in the patients regional language but with the help of the intern assigned to me, the task became easier. The intern guided me well all through the process of making the e-log and I’m looking forward to doing more of it in future.
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