GENERAL MEDICINE SEPTEMBER 2021 BIMONTHLY BLENDED ASSIGNMENT

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

QUESTION 1 :

(Testing peer review competency in the active reader of this assignment) 

Please go through the case reports 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.

QUESTION 2 :

Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):

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. 

QUESTION 3 :

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. 

QUESTION 4 :

Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :

QUESTION 5 :

Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month :

Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 

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)

GENERAL MEDICINE JULY 2021 BIMONTHLY BLENDED ASSESSMENT

 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. 

This is an online E-Log book recorded to discuss our patient's de-identified health data shared, after taking his/her/guardian's signed informed consent. 

CASE SHEET

58 year old male came to casualty with chief complaints of abdominal pain and shortness of breath with history of alcohol consumption. 

Patient was admitted to the hospital (day 1) with chief complaints of 

• abdominal pain since 15 days. 
• shortness of breath since a week
• full back pain 

History of presenting illness:

Patient was asymptomatic 15 days ago after which he developed progressive left sided abdominal pain  along with back pain. 

He experienced shortness of breath a week ago, which was grade 2 initially and progressed to grade 4.

He consulted an RMP and got medication which may have led to aggravation of symptoms. He was immediately admitted to a hospital in the city where he was diagnosed with RPD grade 4. He underwent dialysis twice (7 days ago and 1 day ago). One day ago, the patient received 2 unit blood transfusion during dialysis. 

History of past illness:

Patient had food poisoning a year ago.

No known history of diabetes mellitus or hypertension.

Personal history:

• married 
• mixed diet
• adequate sleep 
• regular bowel movements
• no allergies
• Patient has a h/o taking alcohol intake since 10 years.

Family history:

not significant 

General Examination:

Patient was moderately built and moderately nourished.

Pallor: -

Icterus: -

Cyanosis: -

Clubbing: -

Edema: -

Lymphadenopathy: -

Vital:

BP: 140/80

Pulse rate: 83

Respiratory rate: 15

Temperature: afebrile / 98

Systemic Examination:

Cardiovascular system examination:

inspection: 

• chest wall is bilaterally symmetrical
• no visible engorged veins, pulsations, scars or sinuses

palpation:

• JVP is normal
• apex beat felt in 5th intercoastal space in mid clavicular line.

auscultation:

• s1, s2 heard
• no murmurs

Respiratory system examination:

• central position of trachea
• normal vesicular breath sounds are heard
• no additional sound was heard

Central nervous system examination:

• conscious, coherent and cooperative 
• normal speech 
• normal gait

Abdominal examination:

• abdomen is soft and tender towards the left
• no guarding 
• no palpable mass

Provisional diagnosis:

Pancreatitis?

AKI on CKD?

Investigations:

Urinalysis 

Complete Blood Picture

Ultrasound

Serum electrolyte, ALT, AST, ALP profile

Diagnosis:  Bilateral grade 2 or 3 RPD (renal parenchymal disease)

The patient was referred  to Nephrology department.

(This blog was made under the guidance of Dr. Pavan Sir and Dr. Kusuma ma'am. I'm glad to have had this opportunity to learn about this educative case)

GENERAL MEDICINE JUNE 2021 BIMONTHLY BLENDED ASSESSMENT

I, Vanshika Savla, 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 quantitative marking input as well as qualitative insights into what was good or bad about the answer. 

PULMONOLOGY CASE: A 55F with chief complaints of shortness of breath, pedal edema and facial puffiness.

> Roll no. 21 

https://divyaraju266.blogspot.com/

Quantitative assessment: 9/10

Qualitative assessment: The aetiology was explained very explicitly in a full circle along with a relatable image. The pharmacological interventions were sophisticatedly arranged explaining the site of action and the outcome accumulated. Evolution of symptomatology was not mentioned. It was good overall.

> Roll no. 42

https://gumudalavishal.blogspot.com/

Quantitative assessment: 8/10

Qualitative assessment: Symptomatology was mentioned clearly. Primary aetiology could have been more precise and elaborate. It should have been inclusive of more details and other possible diagnostic findings. The work was appreciative.

CARDIOLOGY CASE:

1)patient details: https://muskaangoyal.blogspot.com/2021/05/a-78year-old-male-with-shortness-of.html

> Roll no. 46

https://jatinsharma46.blogspot.com/

Quantitative assessment: 7/10

Qualitative assessment: Informative and elaborate. Hypotension caused in case of anemia was not accurately described. A flow chart to discuss the complication would be more detailed.

2) patient details: https://muskaangoyal.blogspot.com/2021/05/a-73-year-old-male-patient-with-pedal.html

> Roll no. 19

https://preethicheera.blogspot.com/?m=1

Quantitative assessment: 9/10

Qualitative assessment: The information was precise and explicit. Very clearly explained the reasoning.

NEUROLOGY CASE:

> Roll no 24

https://daddalavineeshachowdary.blogspot.com/

Quantitative assessment: 7/10

Qualitative assessment: Symptomatology was brief. If it were written in chronology with bullet points, it would have been more comprehensive. Statement for cause for neurological symptoms appearing for the first time is not bought up. Further complications are explained satisfactorily.

NEPHROLOGY CASE:

> Roll no. 138

https://vaishnavimaguluri138.blogspot.com/ 

Quantitative assessment: 10/10

Qualitative assessment: On the whole, the case study was very enlightening. It covered all necessary information from the progression of ADHD to the array of therapeutic methods with efficacy. It was brilliantly done.

> Roll no. 29 

https://laharika29.blogspot.com/2021/05/medicine-assignment_31.html

Quantitative assessment: 7/10

Qualitative assessment: A very vague and basic information is given regarding the topic. Everything is briefly explained. It could have been more descriptive.

> Roll no. 151

https://151arushikimari.blogspot.com/2021/05/online-blended-bimonthly-assignment.html

Quantitative assessment: 8/10

Qualitative assessment: Vague descriptive regarding is given. Although pharmacological interventions are properly put. Psychiatric conditions could be more elaborated. 

GASTROENTEROLOGY CASE:

> Roll no. 18

https://jahnavichatla.blogspot.com/2021/05/Jahnavi%20Online%20blended%20Bimonthly%20Assessment-%20May.html

Quantitative assessment: 9/10

Qualitative assessment: It has descriptive flowcharts with a detailed and elaborate content. The answer formatting is on point. It is very helpful for concise learning. 

INFECTIOUS DISEASES (MUCORMYCOSIS):

> Roll no. 92 

https://muskaangoyal.blogspot.com/2021/05/bimonthly-clinical-case-assignment-1.html

Quantitative assessment: 9/10

Qualitative assessment: The prevalent topic of mucormycosis was greatly put along with the statistics and crucial information. The drug action for treatment was explained with authentic diagrams.