BIMONTHLY BLENDED ASSIGNMENT FOR JUNE 2021
Jella Mounika
Roll No: 51
Batch: 2019( 3rd Semester)
I have been given the following assessment to analyze and review, in an attempt to understand the topic of patient 'clinical data analysis' to develop my competency in reading. This is the link regarding assessment:
https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1
QUESTION 01: competency tested for review and assessment
Reviewing 10 answers in the link given above.
CASE 01: NEUROLOGY
The case was diagnosed as cerebellar ataxia secondary to the cerebrovascular accident which was supported by the patient's chief complaints of slurring of speech, deviation of mouth.
Cerebellar ataxia is due to blockage in the brain which causes decreased blood supply because of that, Oxygen and nutrients to the cerebellum are reduced which ultimately leads to ataxia in the cerebellum.
Patient hypertension and alcoholism have also added to worsen the conditions.Flowcharts are used for the mechanism of action of each drug. Overall it was good and easy to comprehend
CASE 02: PULMONOLOGY
The case was diagnosed as Acute exacerbation of COPD associated with right heart failure and bronchiectasis.
Review on answered questions:
The evolution of symptomology was very clean and neat as everything like event timeline, location of the problem, and primary etiology was mentioned under seperate headings that make it easier for understanding. Answers were to the point.
CASE 03: NEUROLOGY
The case was diagnosed as Wernicke's Encephalopathy caused due to thiamine deficiency
Review on answered questions:
As the most common cause of this disease is alcoholism, so explained well how GABA and glutamate systems were affected in brain communications in chronic alcoholics. The mechanism of action and efficacy of each drug was described well. Alcohol Withdrawal Timeline could have included for knowing of altered neurological symptoms. The flowcharts and diagrams would have been added to the answer for better understanding.
CASE 04: GASTROENTEROLOGY
The case was diagnosed as chronic pancreatitis along with other complications like left pleural effusion with basal atelectasis which can be known by chest X-ray. Upon (ICD)intercostal drain cough bubble sign is seen which suggests broncho-pleural fistula that led to Pneumothorax. Plural effusion is caused by escape of fluid abdominal cavity to thoracic cavity through diaphragm by pancreatic-plural fistula. Evolution of symptomology was very well explained. Different topics were separated and clearly marked.
CASE 05: CARDIOLOGY
Link: https://gsuhithagnaneswar.blogspot.com/?m=1
Diagnosis of the case: Acute pericarditis with moderate pericardial effusion
Review on answered questions:
Good explanation was given for the cause of hypotension in these patients and why pericardiocentesis is not needed was also mentioned as effusion was self-healing.Risk factors for development of heart failure are coronary artery disease, heart attack and high blood pressure.
CASE 06: NEPHROLOGY AND UROLOGY
Link: https://gnanaprasunareddy.blogspot.com/
This is a case of acute renal failure secondary to urosepsis who is also a known case of diabetes mellitus after lab investigations are done,it was shown of bilateral hydronephrosis and dilated ureter with thickened wall of urinary bladder as it was chronic disease recovery process is slow. Flow charts and diagrams should have been added for easy understanding .
CASE 07:CARDIOLOGY
As the Chief complaints of the patient were chest pain for 3 days and giddiness and profuse sweating, the case was diagnosed as myocardial infarction. The patient has blockage of blood flow to the muscle mainly coronary arteries were blocked so in order to relieve that angioplasty has done which improved his health. The etiopathogenesis of this disease was very well explained using a flowchart .
CASE 08: GASRTOENTEROLOGY
The case was about patient with the epigastric pain and was diagnosed as acute pancreatitis with diabetes mellitus 2
Answers for easy to understand and simple. case presentation was very neat and good.
CASE 09: INFECTIOUS DISEASE
The case was diagnosed as Rhino Orbital Mucormycosis with diabetic ketoacidosis. The patient came with altered sensorium. Presentation was brief and easy to understand. Necessary links are also provided for detailed information.
CASE 10:INFECTIOUS DISEASE AND HEPATOLOGY
The case was about liver abscess patient who has a chief complaints of pain in the abdomen and decreased appetite for a week and have fever. Predisposing factor for liver abscess is due to the consumption of contaminated toddy on daily basis.
Overall presentation was neat and clean. Answers were to the point.
Question 02
Share the link to your own case report 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.
I haven't got a chance to make a case report.
Question 3- Testing peer review competency of the examinees.
Answer:
Link - https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1
The case was of a 28 year old male with chief complaints of sudden fall followed by weakness of both the lower limbs (paraplegia) and loss of hand grip 10 days back, associated with bowel and bladder incontinence. The final diagnosis of the patient is Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level.
My critical appraisal of the case.
- The data of the patient is captured very well.
- The pictures of the patient were captured properly without revealing the patient's identity.
- The history of the patient is covered clearly including the history of present illness, past history, family history, and personal history.
- The general examination and systematic examination of the patient were performed well and presented clearly with appropriate grading of the reflexes.
- All the investigations done are attached to the blog.
- The diagnostic and therapeutic uncertainties around the case were analyzed correctly. Initially, the provisional diagnosis was cervical myelopathy and pott's spine but later finally it was diagnosed as quadriceps secondary to infectious spondylitis.
Overall the data in the case is well covered and completed including the diagnostic and therapeutic uncertainties involved with the case.
Question 04: Testing Scholarship competency for examinees
CVS:
This is the case of the patient with abdominal distension and short ness of breath.
The case was diagnosed as
HFrEF with Atrial fibrillation secondary to IHD :
Heart failure is a complex clinical syndrome that results from either functional or structural impairment of ventricles resulting in symptomatic left ventricle dysfunction. The symptoms come from an inadequate cardiac output, failing to keep up with the metabolic demands of the body
Etiology:
Coronary artery disease (CAD): chronic and acute ischemia causes direct damage to the myocardium and leads to remodeling and scar formation, resulting in inadequate relaxation in diastole and impaired contraction in systole, which decreases contractility and cardiac output (CO).
HBP is an independent risk factor for CAD. The high prevalence of HBP makes it a possible cause of HF in around one-fourth to one-third of cases. HBP increases vascular resistance and activates the renin-angiotensin-aldosterone system . The heart must pump up blood against a higher afterload caused by high blood pressure , which increases the myocardial mass as a compensatory mechanism to maintain a normal CO and that causes left ventricular hypertrophy
Treatment and management of the disease:-
Pharmacologic therapy for HFrEF
- 1- ACEi or ARBs (class IA) are the first-line therapies
2- Beta Blockers (Class IB)
5- Digoxin
QUESTION 05:Testing scholarship competency in logging reflective observations
Answer:
In this pandemic, every aspect of life was damaged. Coming to medical education, it was very difficult to understand clinical aspects unless and until we go and meet the patient in person. But somehow making these blogs helped to catch things how they would be in the clinical postings. Through this assignment, I have learned some of the things like history taking, the evolution of symptomatology, and how we need to approach diagnosis by doing necessary investigations. And also learned some of the clinical terms like malecot catheter for drainage of different body fluids, some of the clinical signs like finger escape sign, Hoffman signs. and also few diseases too. If the classes were offline, we might have seen emergency cases in the ward and would have known how fast we need to take steps to better the patient.
Despite the uneasiness and discomfort facing during online classes, we are very thankful to HOD sir for making these classes compulsory so that we can know how clinical postings would be to some extent.
Thanks to the interns for helping me to complete this.
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