Internal Assessment (General Medicine)

 

Answer sheet is uploaded in reverse fashion.

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.

A 44 year old male patient came to the hospital with chief complaints of fever with chills and rigor, shortness of breath, epigastric pain since 20 days and back pain on the left side since 10 days

HISTORY OF PRESENTING ILLNESS: 

The patient was asymptomatic 15 years back and had history of intake of alcohol initially 90 ml which gradually progressed to daily intake of 300 ml of alcohol with no or minimal food intake. The patient developed high grade fever with chills and rigor. He was admitted to a hospital outside for a month and was treated as alcoholic liver disease with Total Bilirubin 23.7 gradually reduced to 2.5. The patient developed epigastric pain since past 20 days and back pain on the right side since 10 days.

Patient has decreased appetite and an episode of vomiting.

High grade fever with chills and rigor on and off

SOB on exertion 

Pain in abdomen in left lumbar region, dragging type of pain 

HISTORY OF PAST ILLNESS:

The patient was admitted to a hospital 4 years back with complaints of fever and was treated within 3 days.

N/K/H/O Diabetes, HTN, Asthma, TB, Epilepsy; 

PERSONAL HISTORY:

Divorcee 

Loss of appetite 

Normal bowel movement (1 to 2 times per day)

Normal micturition (4 to 5 times per day)

Disturbed sleep due to pain since 20 days 

Alcohol intake since 15 years 

Tobacco chewing since 15 years (1 pack every 2 days)

PSYCHIATRIC HISTORY:

The patient tried to commit suicide 7 years back by intake of pesticide. 

FAMILY HISTORY:

N/K/C/O DM, HTN, Epilepsy, TB, asthma; 

GENERAL EXAMINATION:

No pallor

icterus present - yellowish discolouration of sclera

No cyanosis 

No clubbing of fingers 

No lymphadenopathy

VITALS:

Temperature- febrile

Pulse rate- 135 bpm

BP- 90/60 mm Hg 

SpO2- 98%

GRBS- 85 mg/dl 

SYSTEMIC EXAMINATION:

CVS:

S1, S2 heard, no murmurs

RESPIRATORY SYSTEM:

BAE +

P/A: obese, splenomegaly, no tenderness 

CNS:

No abnormalities detected;

Glasgow scale- 15/15 

PROVISIONAL DIAGNOSIS:

Alcoholic Liver Disease with alcohol dependence 

INVESTIGATIONS:

CBC:

USG 

5.2 mm calculus noted at lower pole of right kidney 

USG findings: Gross hepatomegaly,

Emphysematous pyelonephritis

TREATMENT:

1) IVF NS @ 5 ML /HR  ,RL,5 %D 

2) INJ PANTOP 40.MG IV/OD 

3)INJ ZOFER 4 MG IV/SOS 

4) INJ NEOMOL 100 ML NS IV / SOS (IF TEMP GREATER 101 F ) 

5) TAB PCM 500 MG.PO/TID 

6) I/O CHARTING 

7) TEMP CHARTING 

8) GRBS 6 TH HOURLY 

9) SYP LACTULOSE 15 ML PO/HS

10) INJ TRAMADOL 1 AMP IN 100 ML NS IV/BD 

11) VITALS 2ND HOURLY

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 53 year old male patient came to the hospital for Dialysis 

History of Presenting Illness:

The patient was asymptomatic 4 years ago. 3 years back the patient went to a medical practitioner with complaints of shortness of breath and fatigue, malaise, loss of appetite and fatigue. Patient was diagnosed with kidney failure on one side. The patient was given medication to sustain kidney failure. The patient continued his medication for kidney failure which he eventually stopped after a year. 

One month back, the patient went to a hospital with chief complaints of headache, fever and pedal oedema. He was admitted there and was diagnosed with CKD. He underwent 4 dialysis procedures there. The patient came to the hospital and underwent further 9 dialysis till date. 

History of Past Illness:

3 years back, the patient was diagnosed with Tuberculosis and was given drug therapy (ATT) for 6 months. He was cured. One month back the patient was again diagnosed with recurrent Tuberculosis and drug therapy is being given. 

1 year ago, the patient met with a bike accident. Since then, the patient claims to have neck stiffness. 

Patient has a history of HTN since one month. 

Personal History:

• married
• mixed diet 
• loss of appetite since the past month 
• discomfort in sleeping since 2 days 
• Patient had a history of alcohol intake. He used to drink half a bottle everyday and then stopped taking alcohol 3 years ago. He drinks it occasionally now. 
• Patient had a history of smoking 2 to 3 cigarettes per day which he stopped 3 years ago. 

Family History: Not significant 

Treatment history:

For reactive TB, a combination therapy with isoniazid, rifampin, pyrazinamide and ethambutol is being given. 

General Examination:

Pallor -

Icterus -

Clubbing -

Cyanosis - 

Lymphadenopathy -

Edema - pedal edema seen until the ankle 

Vitals:

PR: 96 bpm

BP: 130/90 

SpO2: 97%

RR: 40 

Systemic Examination:

 

CVS:

The chest wall is bilaterally symmetrical 

S1, S2 heard ; no murmurs 

CNS:

Patient is conscious, coherent and cooperative

R/S: 

Central position of trachea 

Bilateral crests are heard in all areas 

https://youtu.be/584IkrZ1XR4

 PROVISIONAL DIAGNOSIS: CKD on Hemodialysis 

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.