159 Ravali Irugurala GM

 

BIMONTHLY BLENDED ASSIGNMENT                                                                                                 

  - October 2021 

Ravali Irugurala

 Roll no: 159 

3rd sem (2019)

I have been given the following cases 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 taking,clinical findings,investigations and diagnosis and come up with a treatment plan.

This is the link to the questions asked in the assignment:

https://medicinedepartment.blogspot.com/2021/10/oct-2021-formative-bimonthly-blended.html?m=1

QUESTION : 1) 

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.

ANSWER :

Critical Appraisal -

GASTROENTEROLOGY -

https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

- The case discussed is of Chronic liver failure and kidney disease.

- The case is very well explained.

- The main abnormalities of patient are highlighted which are easy to grasp. 

- There is a video link kept which is very clear about ascitic tap.

CNS -

 http://keelasreevalli.blogspot.com/2021/09/a-52-yr-old-female-homemaker-by.html

- This case is well presented.

- The day to day investigations and treatment are mentioned clearly.

- The clinical presentation of patient is clear in the pictures.

HAEMATOLOGY -

https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1

- The above case presentation is nice. 

- The case is of Pancytopenia. 

- The vitals of the patients are well updated day to day.

CARDIOLOGY , PULMONOLOGY -

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

- The case is explained good.

- It would be more effective if the main events are highlighted.

NEPHROLOGY -

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

- The case presentation is nice.

- As the case is currently ongoing the investigations and treatment are to be updated.

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. 

ANSWER :

-Long case:

Problems list:

•patient presented with a 3 day history of Anasarca.

•frothy urine.

•gradually decreased urine output.

•10 year history of chronic bilaterally symmetric polyarthritis ,evidenced by severe pain ,edema and limitation of joint movements. 

Diagnosis:

Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

-Short case:1

Problems list :

 •Patient with a 6 months history of gradually progressive, asymmetric rest tremor with autonomic features.

Diagnosis :

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

Short case:2

Problems list :

Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .

-Abdominal distension and facial puffiness since 6 months.

- Pedal edema since 3 months.

- Low back ache since 3 months .

- Feeling low , not feeling to talk to anyone.

- Weight gain and decreased libido since 3months.

- Loss of libido and erectile dysfunction since 2 months .

Diagnosis :

IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

TINEA CORPORIS

DENOVO HTN .

Q3)

 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:

Investigations:

X-RAY, ECG ,CUE ,ESR .

Serum urea ,creatinine. 

Electrolytes:Na,K,Cl.

2D echo .

USG 

Urinary microscopy.

TREATMENT:

•Free water restriction for Hyponatremia.

•Tab. PREDNISOLONE P/O 20 mg OD.

•Tab FEBUXOSTAT P/O 80 mg OD.

•Haemodialysis for worsening renal dysfunction.

Short case:1

Investigations:

ECG 

2D ECHO. 

Treatment:

1 .Tab. Syndopa Plus 125 mg QID.

2. Tab. Syndopa 125 mg CR OD.

3. Tab. Telma 40 mg OD.

Short case:2 

Investigations:

CBP ,TLC ,PLT ,ALBUMIN.

RFT ,LFT.

Serum creatinine, electrolytes (Na,K ,Cl).

USG abdomen 

ECG and 2D Echo. 

Treatment:

 -Ointment AMLORFINE .

-FUSIDIC ACID CREAM.

-TAB HIZONE 15 mg per day.

Q4) 

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. 

https://iruguralaravali.blogspot.com/2021/10/159-ravali-irugurala-gm.html

Q 5)

Please reflect on and share  your telemedical learning experiences from the  hospital as well as community  patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.

Changing to Competency based medical education and offline classes is very helpful  to know about the clinical scenarios . 

In this month we got a chance of history taking and went to the wards.

This is very useful for improving our skills in history taking and examination.