1st internal assessment

 

General medicine assignment-2

Moovika Reddy Siddenki

Roll no-84

 I have been given this assignment to solve: http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1

QUESTION 1:  Competency tested for Peer to peer review and assessment 

https://mohammedwahaaj11.blogspot.com/2021/07/bimonthly-assignment-of-medicine-for.html?m=1

1.pulmonology 

https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html

Reasons for patient’s SOB were clearly explained. Etiology was provided properly.he also gave a note on drug induced hyponatremia and how it led to electrolyte imbalance.

Overall good evaluation and required research was done.

2.neurology 

https://mdparvezahmedansari.blogspot.com/2021/06/medicine-blended-assignment.html

This is a case of altered sensorium and the patient was also suffering from diabetes. Etiology was given accurately. Role of alcohol was also stated by giving a appropriate relation between alcohol consumption and iron absorption. Treatment was also explained.

3.cardiology 

https://meesumabbas82.blogspot.com/2021/05/case-opinions-may-2021.html

This is a case of acute pericarditis. Reasons for heart failure were mentioned. Causes for hypotension was discussed. They also mentioned about the risk factors .

It was a good review. More explanation was required.

4. Gastroenterology and pulmonologist.

https://sofiajabeen1912.blogspot.com/2021/05/pulmonogy-1.html

This is a case of pancreatitis and pleural effusion. They mentioned about the symptoms and how the treatment was efficient

More points should have been mentioned regarding the diagnosis.

5.nephrology 

https://abhignyareddy71.blogspot.com/2021/05/online-blended-bimonthly-assignment.html

This is a case of renal infection more probably chronic kidney disease.

Reasons for urosepsis were given. How drugs used that is diuretics caused SOB was explained. All the points were identified and mentioned too.

6. Gastroenterology

https://srinithya27.blogspot.com/2021/05/genral-medicine-e-blogs.html

Clinical symptoms and prevention methods were discussed.good analysis was done.

7. Hepatology

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

Etiopathogenesis was discussed . This is a case of liver abscess. Adverse effects of alcohol consumption and how it led to liver infection was mentioned .

8. Opthalmology, Neurology, Mucormycosis

https://143vibhahegde.blogspot.com/2021/05/medicine-blended-assignment-may.html

Good analysis was done and he added a note on mucormycosis. All positive points were mentioned .

Treatment should have been mentioned.

9. Infectious disease (COVID-19)

Prognosis of COVID was discussed.reference links were provided for more useful information on the topic. Good research was done.

QUESTION 2

I still didn’t get a chance to engage with a patient this month.

QUESTION 3: testing peer review competency of the examines.

1) https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

• Present  and past history of the patient was taken and presented properly.
• Day to day follow up instructions were thoroughly presented.
• Treatment was accurately mentioned.

2) http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

• Systematic arrangement of all the information was done
• Appropriate lab investigations were mentioned along with the reports. This was helpful in easy diagnosis.
• Treatment was very detailed.

3) https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

• Detailed history was taken
• Proper analysis was done and all the required information was provided.

4) https://casereports.bmj.com/content/2009/bcr.03.2009.1726

• Pathological basis of case was mentioned.
• Proper sequence was provided and detailed investigations were given.

5) https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

• History was briefly mentioned and was not properly categorised.
• But the treatment and the lab investigations were precise and were mentioned properly.

6) https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

• All the examinations were detailed and appropriate pictures were provided
• All the all the required updates on treatment were also clearly monitored and were mentioned too.it helps us understand the recovery of patient 

7) https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

• The recommended treatment was accurately described 
• All the investigations and updates regarding the patient were provided 
• All the important information was highlighted. This helps us to easily understand the diagnosis and etiology of the patient .

8) https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

• All the investigations were clearly mentioned.
• All other relevant data was clearly presented.
• Useful links regarding the diseases were attached to provide required information.

9) http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

• History was briefly taken
• Day to day updates about the investigations were given.
• Summary was provided so as to get an idea about the case in short.

10) https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

• Presentation was good .it should have been more detailed.
• History was explained well.

QUESTION 4:Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):

1: Acute kidney infection : https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

Complaints:

1. Lower abdominal pain
2. Burning micturation
3. Decrease urine output
4. No H/O chest 
5. The patient has kidney infection associated with bacterial infection.

Solutions:

1. Thiamine injection is given to increase the bit b1.this could reduce kidney infection
2. Lactulose syrup was given to maintain stools
3. Pantop injection is given to treat acid reflux which might be the possible reason for lower abdominal pain.

2. Chronic kidney disease: http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

Complaints:

1. Lower back ache 
2. Dribbling of urine since 10 days
3. Pedal edema since 3 days 
4. Increased involuntary movements
5. The patient has hyperuricemia 

Solution :

1. Lasix injection was given to treat fluid retention and edema
2. Piptaz injection was given
3. Tab neurobion was given. It helps in treating vitamin deficiencies and for improving nervous system health to treat involuntary movements.

3.CKD: https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

Complaints:

1. History of muscle aches 
2. Vomitings since 3 days 
3. No fatigability or pedal oedema 
4. She has generalised weakness.
5. According to investigations she is likely to have multiple myeloma

Solutions:

1. Oral fluids are given 
2. Erythropoietin injection is given.it is the main growth factor of red blood cells .it also produces anti myeloma effect.

4.patient with coma and renal failure: https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

Complaints:

1. Fever and diarrhea 
2. Back pain since 5 days along with abdominal and chest pain
3. The patient is diagnosed with diabetic ketoacidosis with renal failure

Solutions:

1. Dopamine and nor adrenaline was given in order to prevent their deficiencies.
2. Levoflox was given to prevent any bacterial infections 

5. Patient with AKI

Complaints:

1. Loose stools since 20 days 
2. Pedal edema since 20 days 
3. Abdominal distention from 20 days 

Solutions:

1. Thiamine
2. Lasix for water retention
3. Pantop

QUESTION 5 Testing scholarship competency in logging reflective observations on your concrete experiences of this last month : (10 marks)

I’m glad that I’ve been presented with this opportunity. Admidst COVID we’ve been struggling to understand the clinical lectures. The general medicine department have been trying their best to pass on the knowledge to us. I haven’t got a chance to take a case as of now. They are trying to give us enough  clinical exposure through online classes. We were also asked to take patient cases which was very important and it also helps us in our communication with the patients .

general medicine assignment

 

 General medicine monthly online summative assesment

Moovika Reddy Siddenki

roll no:84

General medicine assignment(3rd sem)

 

QUESTION-1

1.PULMONOLOGY

REVIEW:https://31nehareddy.blogspot.com/?m=1

CASE:https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html

This is the case of acute exacerbation of COPD associated with right heart failure and bronchiectasis .she has been presented with pedal edema and facial puffiness. after investigation were done it can be seen that the low oxygen levels  due to COPD caused hypertension in the lungs. this increased the strain on the right heart leading to its failure. using rifampicin might have led to her facial puffiness. required medication for treating the symptoms was given like diuretics and antibiotics. chest physiotherapy was also recommended to prevent the collapse of lungs. monitoring the patient's vitals was also done in order to prevent further complications.

 

2.NEUROLOGY

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://kausalyavarma.blogspot.com/2021/05/a-52-year-old-male-with-cerebellar.html?m=1

This is the case of cerebellar ataxia. symptoms include slurring of speech and deviation of mouth. the probable cause might be due to the presence of cerebellar infarct in the cerebella vessels. patient was asymptomatic at first but after consumption of alcohol he started presented these symptoms so i think that drinking alcohol led to hypertension leading to stroke. suitable medicines like tab vertin and tab ecosprin were recommended in order to prevent the clot formation in his blood vessels.

3. CARDIOLOGY

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://bhavaniv.blogspot.com/2021/05/case-discussion-on-myocardial-infarction.html?m=1

This is a case of acute myocardial infarction. patient presented symptoms like chest pain, and profuse sweating. patient is a known case of type 2 diabetes and hypertension. it can be observed  that deposition of lipids and fats in the blood vessels of the heart led to obstruction of the blood vessels supplying the heart leading to ischemia. risk factors include diabetes and hypertension due to which mobilization of fats and lipids increases . aspirin was given to prevent thrombosis.

 

4.GASTROLOGY

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://vyshnavikonakalla.blogspot.com/2021/05/a-40-year-old-lady-with-dysphagia-fever.html

This is a case of dysphagia or could be tracheoesophageal fistula. it can be observed that patient has already suffered for bring RVD positive. she is in an immuno compromised state and might be susceptible to immune reconstruction inflammatory syndrome in which they present hyper inflammatory responses.

 

5.HEPATOLOGY

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html

This is a case of liver abscess. consumption of local alcohol might have lead to liver abscess. decreased movements in the right upper quadrant are observed this might tell us that the right lobe of liver was affected. this is due to fact that right lobe has more blood supply which includes portal vessels. local alcohol contains many microorganisms which might have infected the blood leading to liver abscess.

 

6.GASTROLOGY

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://nehae-logs.blogspot.com/2021/05/case-discussion-on-25-year-old-male.html

This a a case of epigastric pain. symptoms include severe abdominal pain ,vomiting and shortness of breath. tenderness was observed around umbilical regions and decreased breathing sounds were heard probably due to pleural effusion. 24 hour urine protein sample test was recommended.

 

7.GASTROLOGY

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html

This is a case of pancreatitis. this might be due to the obstruction of the duct system of the pancreas. patient had history of alcohol consumption which might have led to the injury of acinar cells of the pancreas leading to pancreatitis. medicines like pantop were recommended to decrease acid secretion and prevent further complications .

 

8.CARDIOLOGY

REVIEW:https://santhoshdarimedi.blogspot.com/

CASE:https://daddalavineeshachowdary.blogspot.com/2021/05/67-year-old-patient-with-acute-coronary.html?m=1

This is a case of acute coronary syndrome. patient had episodes of heart burn. i think there must have been a rupture of plaque or coronary vessels might have been occluded leading to acute coronary syndrome. percutaneous coronary intervention was  suggested in which a small stent like structure will be placed in the damaged blood vessels in order to open them and ensure that the blood supply to heart is not interrupted.

 

9.CARDIOLOGY

REVIEW:https://dthanmai27.blogspot.com/

CASE:https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html

This is a case of atrial fibrillation and biatrial thrombosis. patent is a known patient of hypertension which might have let to the formation of thrombus. due to the formation of thrombus cardiac output was low leading to decreased GFR leading to the increased action of renin and aldosterone . increased aldosterone leads to sodium retention . this explains the puffiness of her face .dytor was recommended as it has antagonistic actions against aldosterone.

 

10.NEUROLOGY 

REVIEW:https://divyaraju266.blogspot.com/

CASE:https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html

This is a case of altered sensorium .patient presented with the symptoms of short term memory loss and seizures and patient has a known history of type 2 diabetes. he also has a history of alcohol consumption and cigarette smoking. alcohol contains ethanol which is a depressant of central nervous system. this explains why he has altered sensorium because sudden with drawl form alcohol leads to sensitization of GABA  receptors.

 

QUESTION 2

I have not gotten a chance to make a case report yet.

 

QUESTION 3 and 4

https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

This is a case of hypertensive nephropathy.

symptoms include altered sensorium ,shortness of breath, lethargy .patient has a known history of hypertension and chronic kidney disease. his creatinine levels were high(11-14.8). patient was also complaining of back and neck pain.

general examination of the patient tells us that pallor is present.

in systemic examination of the patient it can be inferred that dyspnoea is present which means patient is suffering from breathing difficulties and he is hypoactive.

treatment-lasix is given to the patient. it helps in decreasing the hypertension and also acts as a diuretic and increases production of urine which further decreases hypertension.

sodium bicarbonate is also given to adjust the blood pressure and it also inhibits the angiotensin converting enzyme therefore prevents the increase in blood pressure by decreasing the absorption the water.

 

 

QUESTION 5

 

online clinical postings have been little challenging for all of us but our general medicine department was very helpful. these interactive lectures were very encouraging. i have learnt many new things about the subject. all the professors and interns have been doing their best to pass on their knowledge to us and were helping us to apply our knowledge in these clinical cases .i would also like to thank our HOD of general medicine ,Dr.Rakesh Biswas for giving me this opportunity.