GENERAL MEDICINE
HARIKRISHNA,01
SUMMATIVE ASSESSMENT 2 :(july2021)
Link of questions regarding the cases:
http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
QUESTION:1(peer to peer review)
--Below is the link of the student E-Log for which I am sharing my review.
{{My review is given question wise according to the peer's assignment}}
!!Review to QuestioN 1 from peer's assignment!!
1.The quantitative and qualitative insights(reviews) were given genuienly according to the deservance of E-Log case studies made by our seniors.(2017 batch)
FOR EXAMPLE:
2.The clear cut appraisal is given by mentioning both pros and cons.
!!Review to 2nd QuestioN from peer's assignment!!
>>This is the case of HFref 2° to ?CAD b/l pleural effusion.
>>History taking,Examination,Investigations(pathological &biochemical)were well presented,with timely treatment history.
>>Links for Reference and Journals were given for further analysing the case..
!!Review to the 3rd QuestioN from peer's assignment!!
4.The question is based on the analysis and description of the case.
A good and well described appraisal has been provided regarding the important aspects of the case.
(https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1)
*the case is based on the acute kidney injury,the review given by the peer on the pharmacological aspects,investigations etc comes under the pros and the review on date of discharge,advise during discharge and images comes under the cons..
5. THis clearly reflects the well understanding capability of the peer on the given case studies.
!!Review to the 4th QuestioN from peer's assignment!!
6.The next question is based on the discussion of the diagnostic and therapeutic uncertainty around solving those problems.And also 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.
CASE:
(https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1)
FOR EXAMPLE:
7.Also clearly mentioned about the Journals and sources followed..
8.Key review -Therapeutics : defibrillation is done to correct it .
Specificity on therapeutics could have made it complete.
Her thyroid profile should have been included in the Diagnostic interventions.
!!Review to the 5th QuestioN from peer's assignment!!
9.THe review written by peer to 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 locke down at home,,is very genuiene.
10.Since there are many flaws at staying home while studying especially practical sessions is miserable.The clear cut mentioning of missing clinical knowledge is well explained by the peer.
QUESTION 2:
>>BELOW IS THE LINK OF THE E-LOG MADE BY ME RECENTLY..
https://01harikrishnamunna.blogspot.com/2021/07/01-harikrishna.html
QUESTION 3:
"Review on Patient centered data around the theme of renal failure patients with AKI,CKD and acute on CKD".
CASE1:
>>This is the case of AKI secondary to UTI associated with DM2,,history of the patient is well elucited.
>>Biochemical and other investigations were presented upto time,which provides more knowledge about the progression of the disease.
>>Timely treatment is well depicted.
CASE2:
>>This is the case of acute Renal Failure(intrinsic).
>>Examination of the patient is well done systematically.Investigations and Identifications are well directed towards the case.
>>Since the peer had mentioned that the case is presented later to the orthopaedic department due to "Multifocal Spondylitis" further investigations regarding this were well presented.
CASE3:
>>this is the case of CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
>>Since the patient is previously diagnosed with the hemorrhoids and got operated, the past and the personal history like obstetric, menstrual and birth etc..were clearly mentioned.
>>And various investigations like Colour Doppler 2D Echo,,Bone Marrow Aspiration,,Serum Electrophoresis and USG abdomen were presented well and good..
CASE4: Patient with coma and renal failure :
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
>>Since the patient has a known history of type 2 diabetes, the past history is well explained..
>>COURSE In hospital with intubation and CPR notes were briefly mentioned.
>>Radiological(MRI,X-RAYS) laboratory investigations(FUNCTIONAL TESTS,CULTURE TESTS) and examination were highly appreciated(there are lot of images regarding patient physical examination and investigations which is highly useful for case understanding)
CASE5: Patient with coma and renal failure :
https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
>>It is the lenghty case since it has more complications as patient is diagnosed with many conditions like Alcoholic Liver Disease,AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,Hepatic encephalopathy grade 2..
>> I Think in complicated cases like this the cause for diierent complications must be explained for better understanding.
>>Discharge advice and summary is well appreciated.
CASE6: Patient with acute on CKD :
https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
>>Overall the case is well presented & the links and resources were given for further understanding of the case.{Like--}
1. MEDICAL MANAGEMENT OF HEART FAILURE WITH REDUCED EJECTION FRACTION IN PATIENTS WITH ADVANCED RENAL DISEASE
2. Heart failure in patients with chronic kidney disease: a systematic integrative review
>It is highly helpful..
CASE7:Patient with acute on CKD:
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
>>It is a case with Post TURP with non oliguria ATN.Hospital history like number of admissions is clearly mentioned.
>>Radiological investigations like NCCT KUB impressions were given and Hydronephrosis is explained with MRI scans.
CASE8: Patient with acute on CKD:
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
>>History taking may be improved & the case study is full of investigation reports and all.I'm bit dissatisfied with the case presentation since it lacking saquences and information.
CASE9: Patient with AKI:
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
>>This is a case of ALCOHOLIC HEPATITIS ,AKI SECONDARY TO ACUTE GASTROENTERITIS .
>>Case is well presented with brief history,investigations and treatment history.
>> The Diagnosis and the causes may be elaborated.
CASE10: Patient with AKI :
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
>> THe case is about AKI secondary to urosepsis.
>>it is presented well and good with all requirements.
CASE 11:Patient with AKI :
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
>> The case is about pancreatitis in a chronic alcoholic with AKI.
>>Many investigations are done including ultrasound to get a detailed view of the liver and if condition due to alcholism.
QUESTION 4: Problem Solving Comprehension:
CASE1: {AKI}
PROBLEMS:
> lower abdominal pain
> burning micturation
- > low back ache after lifting weights
- >dribbling / decrease of urine out put..
DIAGNOSIS:Acute kidney injury( AKI) 2° to UTI, associated with - DM -2
-With ? Right HEART FAILURE.
SOLUTIONS:
{Generalized Management and treatment}
TREATMENT:
)IVF : -RL @ UO+ 30ml/hr
-NS
2)SALT RESTRICTION < 2.4gm/day
3)INJ TAZAR 4.5gm IV/TID 2.25gm IV/ TID
4)INJ PANTOP 40mg IV/OD
5)INJ THIAMINE 1AMP IN 100ml NS IV/TID
6)INJ HAI S/C ACC TO SLIDING SCALE
8AM - 2PM - 8PM
7)SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]
8) GRBS - 6th Hourly
9) BP/PR/TEMP - 4th Hourly
10) I/O - CHARTING
Consequently , Foley's is removed and ultracet tablet , input of 2 liters only and output monitoring is done .
CASE2:(Renal failure)
PROBLEMS:
• Lower backache
• dribbling of urine
• Pedal edema
• SOB at rest
• Increased involuntary movements of both upper limbs.
>Multifocal spondylitis
>Hyperurecemia 2 to renal failure.
SOLUTIONS:
1.Management
Renal failure::
SPOndylitis::
Hyperurecemia:
2.Treatment :
IVF - NS-0.9% @100ml/hr
• Inj. Tazar 2.25gm I.V -TID
• Inj. Lasik 40mg I.V -BD
•Nebulization Salbutamol -4th hourly
• Inj. Pantop 40mg I.V -OD
• Tab. PCM 650mg -TID
• Foleys catheterization
• Strict IO Charting
•GRBS -12th hourly
• Inj.25% D with 10units of insulin IV -slow for 1hr
Nebulization is reduced consequently and daily monitoring of vitals is being done . And oral fluids restricted to 2 to 3 liters per day .
CASE 3:
PROBLEMS:
>> Mass peranum with bleeding , diagnosed as haemorrhoids , got Operated. History of muscle aches.
>> Has h/o vomitings.
Diagnosis :
CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis..
SOLUTIONS:
(1.Management)
chronic intestitial nephritis:
(2.Treatment)
- T. PAN 40mg /PO / OD
- oral fluids upto 1.5 - 2 lit / day
- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk
- Donot give IV fluids unless instructed
- T. ZOFER 4mg / PO / SOS
- Evaluate Anaemia start Iron Supplementation (oral )
- TAB NODOSIS 550 BD
CASE4:
PROBLEMS:
>>Fever and Diarrhea since 5 days.
>>Back pain( 5 days ago) with abdominal pain and chest pain.
>> severe breathlessness and pain in the chest region.
Diagnosis :
- DKA with AKI.
- Pyelonephritis.
SOLUTIONS:
(Management)
Treatment :
Inj. NORAD 2amp in 50ml NS
Inj. PIPTAZ 2.25gm.
Inj. DOPAMINE 2amp in 50ml
Inj. HAI 1ml in 39ml NS
Inj. CLEXANE 40gm.
Iv infusion NS RL @100ml/hr.
Inj. NORADRENALINE(2 amp+46ml NS)
Inj. LEVOFLOX
Inj. VANCOMYCIN
Inj. MEROPENEM
Inj. FOSFOMYCIN
Inj. LASIX was given.
CASE5:
PROBLEMS:
>> Abdominal distension, 2 yrs back he complained of tingling in upperlimbs upto palms lowerlimbs upto knees
>>Alcoholic Liver Disease,,AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,
>> Constipation and has not passed stools since 5 days.>>altered Sleep patterns from the past 5 Days
>>He had hiccups.
>>He also Complains of pedal edema grade 2.
SOLUTIONS:
1.Management:
a.Diabetic nephropathy--
b.Alcohol Liver disease--
TREATMENT:
1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
Same treatment followed except Inj. Monocef.
Inj. Augmentin 1.2 gm IV/TID
Tab. Ecospirn 150mg PO/HS/SOS
Tab. Clopidogrel 75mg PO/HS/SOS
Tab. Atorvas 20mg PO/HS/OD added
CASE 6::
PROBLEMS:
>>fever and pus in urine, he had prostatomegaly and underwent TURP before.
>>Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore.
SOLUTIONS:
1.Management--
TURP:
TREATMENT:
Injection PANTOP 40mg IV/OD
Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
Injection LASIX 40mg IV/BD
Injection optineuron 1AMP in 100ml NS slow IV/OD
Injection NEDMOL 100ml IV/SOS
Tab PCM 650mg TID
Insulin Human actrapid - 16 IU/TID
CASE7:
PROBLEMS:
>>Shortness of Breath grade -II from the past 1 week, which converted into grade -III-IV from the past 4 days .
>>HFrEF secondary to CAD; CRF
SOLUTION:
>TREATMENT::
1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml
CASE 8:
PROBLEMS:
>>
Pedal edema since 3 days. Decreased urine output since 3 days.
H/o vomitings and loose stools 5 days ago lasted 3 days and subsided.
>>
Shortness of breath. >> pneumonitis with Type 1,Respiratory Failure. ? Interstial lung disease,
? Right heart failure .
SOLUTIONS:
1, Management:
pneumonitis:
TREATMENT:
1. Tab. Augmentin 625 mg ×7 days
2. Tab. Wysolone 40 mg ×10 days.
30 mg × 10 days
20 mg ×10 days
10 mg ×10 days.
3. Tab . Lasix 20 mg × 1 month.
4. Pantop
5. Montek FX -- 1 month.
6.Oxygen inhalation.
CASE9:
PROBLEMS:
>>loose stools since 20 days
>> Pedal edema since 20 days
>> Abdominal distension since 20 days
ALCOHOLIC HEPATITIS ,
AKI SECONDARY TO ACUTE GASTROENTERITIS
HFrEF SECONDARY TO CAD
ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME
Management:
loose stools-
tobacco dependence syndrome:
TREATMENT;
INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
INJ LASIX 40 mg
TAB. ALDACTONE 50 mg PO / BD
INJ PANTOP 40 mg IV/ OD
ABDOMINAL GIRTH MEASUREMENT DAILY
BP /PR/TEMP/ RR -4 hourly
I/O CHARTHING
CASE 10:
PROBLEMS:
pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.
Diagnosis:
Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease
SOLUTIONS:
Management:
1.hyperkalemia;
3.Anemia of chronic disease: PROBLEMS:
pain in abdomen.
Vomiting.
Sob since 2 days.
Diagnosis :
Acute pancreatitis with AKI
with ?B/L pleural effusion and moderate ascitis .
Currently in ?Alcohol withdrawal.
SOLUTIONS:
Management:
1.AKI in Acute pancreatitis:
2, pleural effusion:
3.
Ascitis:
TREATMENT
Iv fluids : NS 40 ml /hr.
IV lasix 40 mg BD .
Tab Nodosis .
IV PIPTAZ 4.5 Gms. BD
Iv 25%Dextrose. 100 ml BD
Tab . Nicardia 10 mg TID.
D A Y W I S E U P D A T E S:
Day 1and 2 =Urine output 1500ml, Fluid intake 3000ml
QUESTION:5:Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month :
I am really glad to have an oppurtunity to attent these online postings where we get to come across so many cases, take up a case , talk to the patient/attendant and take history and make a blog on that case. in this whole process we are getting clinical exposure which we were supposed to get by attending the hospital but due to this pandemic we have been missing it, but his whole process has really helped us not to miss out on the clinical aspects of learning which is of utmost importance in becoming a good clinician . i have personally taken history of the patient, which helped me learn better about what and how the questions should be asked to the patient/ attendant.
Though it's tough time , our general medicine department is putting efforts in making us understand every case possible. And my experience towards this type of learning online was somehow mixed but interesting.
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