GENERAL MEDICINE AUGUST 2021 BIMONTHLY BLENDED ASSESSMENT

 I, Vanshika Savla, a 3rd sem student of 2k19 batch have been given this assessment on general medicine. 

QUESTION 1: Please provide your peer review assessment on not only the the student's written case report but also the reading of the cases followed by the question answer session linked above in the video and share your thoughts around each answer by the student along with your qualitative insights into what was good or bad about the answer. 

LONG CASE:

• The history taking was thoroughly done from top to bottom 
• It has good discussion points to verify the probable diagnosis
• Examinations are bilaterally done where necessary 
• Diagnosis is done based on current universal classification criteria and was done in a sophisticated fashion
• Possible case scenarios (unifying with the precise history taking) are included leaving no possibility of any type of diagnosis out of the blue 

QUESTION 2: Please analyze the above linked long and short 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.

  

LONG CASE:

Problem list:

• Anasarca and pitting type pedal edema extending up to the middle of the leg
• Frothy urine (indicating proteinuria)
• Severe joint pains (Bilaterally symmetrical progressive inflammatory polyarthritis)
• Morning stiffness 
• Burning sensation in eyes 

Proteinuria causing anasarca strongly supports glomerular pathology. Proteinuria can lead to higher risk of progressive kidney problems. Anasarca if not limited may lead to painful swellings, stiffness and the area becomes more prone to skin infections. Complaints of burning sensation is possibly due to inflammation of eyes which comes as a complication to polyarthritis. 

QUESTION 3: Testing competency in "Evidence based medicine": 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. 

LONG CASE:

Water restriction of about 500 - 1500 ml per day is usually prescribed. The main rule is the excretion of free water should be in excess of the restricted free water taken in. An increase in dietary protein and salt can improve water excretion. Prednisolone eye drops are given to reduce inflammation as it has good intraocular anti inflammatory effect. Febuxostat is given to prevent gout attacks as it tries to decrease the uric acid in the blood. This drug should be taken regularly to prevent further accumulation of uric acid. Reversal of gout can’t be possible with this drug. Although there are a few side effects like chest pain, breathlessness, nausea etc. and in such case, approaching the doctor would be advised. 

DMARDs can be given to stress the immune system to slow down rheumatoid arthritis. Methotrexate is widely prescribed to patients newly diagnosed with RA. It is taken in a lower dose than prescribed for cancer patients. 

QUESTION 4: Share the link to your own case report this month 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.

Link to my e-log: https://vanshikasavla.blogspot.com/2021/08/60-year-old-female-with-chief.html 

QUESTION 5: Testing scholarship competency in logging reflective observations on your concrete experiences of this month

60 year old female with chief complaints of chest pain, SOB and palpitations

Sanjay Bandaru (roll no. 121) and Vanshika Savla (roll no. 122)

3rd sem 

 This is an online e log book to discuss our patient de-identified health data shared after taking his/her/guardians signed informed consent. 

Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evidence based input.

I've been given this case to solve in an attempt 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. 

CASE SCENARIO:

A 60 year old female came to the causality with a cheif complaint of chest pain since 2 hrs SOB since 4 hrs, palpation since 4 hrs K/C/O of HTN 

History of present illness:

The patient was asymptomatic morning. Then she planned on a procedure of intra thecal steroid injection for sclera in the afternoon. She took her morning dose of metxl 50 mg clopitab. But the procedure was delayed due to high bp she stopped taking her normal medication ecosprin since 6 days for the procedure. After the procedure was cancelled she came back home and ate lunch she was feeling discomfort and took ecosprin tablet and sorbibate in the evening. She developed 

• fever, chills and rigor 
• h/o chest pain since 1hr
• dry cough since evening
• no history of orthopnea

She took medication of metxal 50mg, ecosprin 150mg and slorbitrate 5mg

History of past illness:

K/C/O HTN

H/O PTCA 

Treatment history:

N/K/C/O Diabetes 

K/C/O HTN 

N/K/C/O CAD

Physical examination :

General:

Temp: 103 F

HR: 60 bpm 

RR: 24/min 

SPO2 93%

BP: 200/100

GRBS: 194

Mild oedema of feet 

Systemic Examination :

RS BAE+

CVS: S1 S2 +

PA: soft and non tender 

CNS: NAD 

Complaints and duration 

C/O SOB grade 3-4 

Palpations: 2 hrs 

Fever and chills: 2 hrs 

Chest pain: 2hrs

INVESTIGATIONS :

                                                        ABG analysis:

                                                         Troponin I :

Serum Electrolyte:

Blood Sugar:

Blood Urea:

Rapid Test

                                                                   ECG

RT-PCR

2D Echo screening

TPR Graphic Sheet (day 1 and day 2)

TREATMENT :

Day 1:

Tab SLORBITRATE 5mg 

Inj CEFTRIAXONE 1gm

Inj PANTOP 40gm

Syrup ASCRIL 15ml 

Tab PARACETAMOL 650 gm 

Inj NEOMAL 100gm

Inj NEUMA 1gm

Tab TELMA 40mg 

Tab CLOPITAB 75mg

 Tab ECOSPIRIN 75mg 

Tab ALORIVAS 20mg 

Tab METXL 50mg

Inj LASIX 40mg

Day 2:

Inj CEFTRIAXONE 1gm (2)

Inj PANTOP 40gm

Tab MET-XL 50gm

Tab TELMA 40gm

Tab CLOPIDOGREL 75gm

Tab ECOSPIRIN 75gm

Tab ATORVAS 20mg

Tab PCM 500gm (3)

Inj NEOMOL 1gm

Tab THYRONEUM 25gm

Neb BUDECORT, MUCOMIST

Syrup ASCORIL (2)