This is Varshini reddy of roll no.25 from third semester.
The following blog is an assignment that was given to us.
Questionlink: http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
Question 1: Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1 and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.
Answer:
Link to the answer paper that I have chosen to give my peer review:https://23bonthadivya.blogspot.com/2021/07/23divyab.html
Qualitative insight: The answer that was given to the first question was complete and it was about giving a peer review on one particular answer of ten students from the link that was given. In the answer, different cases were chosen for different students, to give the review, which was good, because all the different case studies were reviewed, from which a lot of information can be known on each of the case study that was chosen.
The answer to the second question was incomplete, the E-LOG of their own case report was not shared.
The third question was about to give their critical appraisal of the captured data in terms of completeness, correctness and ability to provide the useful leads to analyze the diagnostic and therapeutic uncertainities around the case, the answer that was given to the question by the student was incomplete, it was not answered in terms of completeness and correctness and the therapeutic uncertainities were not mentioned. The answer that was given was only about the overview of the case study and about the treatment that was given for the case.
The fourth question was about to prepare a problem list to the patient and then discuss about the diagnostic and therapeutic uncertainities. The answer that was given to the question was not totally a complete answer, all the problems were not listed in the answer, the answer given was about the overview of the case, about the investigations that are done and about the treatment that was given.
The fifth question was to share their telemedical learning experience.
Question 2: Share the link to your own case report of a patient, along with your discussion of that case.
Answer:
Link:https://varshinireddychada.blogspot.com/2021/07/a-30yr-old-male-with-alcoholic-liver.html
This is a case of 31 year old male with Chronic Liver Disease with Grade 1 varices with Acute Kidney Injury. He came with the chief complaints of Abdominal pain and distension, pedal edema extending upto knees, and fever.
Diagnostic ascitic tap of 1 litre was done and the ascitic fluid was sent for investigation which showed high SAAG and low protein. UGIE showed Grade 1 varices with low grade portal HTN and mild PHG.
Other investigations that were done are LFT, Blood sugar random, Serum creatinine, Blood urea, Serum electrolytes, HBsAg-RAPID, HIV 1/2 Rapid test, Anti HIV antibodies-RAPID, APTT, Prothrombin time(PT), Hemogram and Ultrasound.
Patient was treated with Inj. Vit k 10mg, Tab Udiliv 300mg, Tab Rifaximine 550mg, Syp. Hepamerz 10ml, Syp Lactulose, Tab Lasix 20mg, Tab Aldactone 25mg everyday and was advised discharge.
Question 3 and Question 4: Please go through the case in the link and provide your critical appraisal of the captured data in terms of completeness, correctness, analyze the patient data by preparing a problem list for the patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems.
Answer:
Patients with AKI:
Link: https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
It is a case of 58 year old male with Acute Kidney Injury secondary to UTI, associated with Denovo-DM-2.
In terms of completeness, the history that was taken, the investigations that are done, the examination data that was written, all these elements were complete along with diagnosis but the treatment part was not complete, the medication that was given to patient was not updated on daily bases. And there was no information about the discharge of the patient.
In terms of correctness, the data was given correctly.
The problem list in this patient includes- the patient was having chief complaints of lower abdominal pain, burning micturition, low back ache after lifting weights, dribbling/decrease of urine output, fever, SOB at rest since 1 week.
He was also a known case of Hypertension for past 1 year, for which he was not on medication. The investigations that were done in this patient are Hemogram , CUE , RFT , LFT , ECG , 2D Echo , Chest X-ray , FBS , PLBS ,HbA1C
From the investigations that were done, it was known that there was mild hepatomegaly with grade-1 fatty liver, from the bacterial culture and sensitivity report, plenty of pus cells were seen in the urine specimen and polymicrobial flora from culture report. There was increase in the level of blood urea, serum creatinine, and decrease in the level of serum albumin.
The diagnosis of this patient was Acute Kidney Injury secondary to UTI, associated with Denovo-DM-2, with right heart failure, and K/C/O HTN. The treatment that was given includes IVF, salt restriction, Inj. Tazar, Inj. Pantop, Inj. Thiamine, Syp Lactulose to maintain stools less than or equal to 2.
It is a case of 43 year old male with Acute Kidney Injury secondary to gastroenteritis and Alcoholic Hepatitis.
In terms of completeness, the history that was taken, all the examinations that were done, investigations, diagnosis, and treatment, everything was included and it was complete. And the investigations and treatment part were updated on daily basis.
In terms of correctness, the data was given correctly.
The problem list in this patient includes- the patient was having chief complaints of loose stools which were watery in consistency, b/l pedal edema extending upto knee( pitting type, non tender), Abdominal distension since 20 days. Pallor was also present.
He was also a known case of TB for the past 3 years for which he took ATT for 6 months. Investigations that were done in this patient
are: Hemogram, CUE, CBP, RFT, LFT, ECG,CXR PA VIEW, USG ABDOMEN, PT/ INR
APTT, BT/CT
From the investigations that were done, it was known that there was mild hepatomegaly with grade 2 fatty liver from USG, increase in the level of serum creatinine, decrease in the level of serum albumin.
The diagnosis of the patient was Alcoholic Hepatitis, AKI secondary to acute gastroenteritis, HFrEF secondary to CAD, Alcoholic and Tobacco dependence syndrome.
Treatment was given on daily basis by which there was decrease in pedal edema, stools (2-3 episodes/day) which were soft in consistency, and Alcohol withdrawal tremors were seen. Treatment included plenty of oral fluids, Inj. metrogyl, Inj. ciproflox, Inj. Pantop, Inj. Thiamine, Inj. Optineuron, Tab. lorazepam, ORS sachet and Tab. ecosporin.
Patient with acute on CKD:
It is a case of 48 year old male with CRF, HFrEF secondary to CAD.
In terms of completeness, all were included like history taking, examinations, investigations, diagnosis, treatment and everything was complete. Investigations were included on daily basis whenever they were done. There was no information regarding the discharge process of the patient.
In terms of correctness, the data was given correctly.
The problem list in this patient includes- The patient was having chief complaints of Shortness of breadth grade-II for 1 week which progressed to grade III-IV later. He was also having Orthopnoea and Bendopnoea. Edema of the feet was present. He was also having irregular bowel movements.
He was also a known case of Diabetes mellitus and Hypertension for the past 7 years. He also had an angiogram done for the heart failure. In the past he was diagnosed for Chronic renal failure and was treated symptomatically.
Investigations that were done in this patient are Fasting blood sugar, post lunch blood sugar, Glycated haemoglobin, ESR, Complete blood picture, ABG, LFT, Lipid profile, USG, RFT, 2D Echo, ECG.
From the investigations that were done, it was known that there is elevated fasting blood sugar and post lunch blood sugar. ESR was also elevated. From the complete blood picture it was known that Hb level was lower than the normal. From the pulmonary function test- the premedication findings were Early small airway obstructions as FEF25-75 % Pred or PEFR % Pred <70 and Spirometry within normal limits as (FEV1/FVC) % Pred> 95 and FVC% Pred >80. The post medication findings was Mild restriction as (FEV1/FVC) % Pred >95 and FVC % <80
The diagnosis of this patient was CRF, HFrEF secondary to CAD. The treatment that was given to this patient includes Tab. Bisoprolol, Tab. Nitrohart, Tab. Nicardia, Tab. Gliciazide, Tab. Nodosis, Tab. Ecosprin, Tab. Lasix, Cap. Gemsoline, Syp. Lactulose.
Patient with CKD:
It is a case of 49 year old female with CKD.
In terms of completeness, everything was included and it was complete. Treatment and investigations were updated on daily basis.
In terms of correctness, the data was given correctly.
The problem list in this patient includes- The patient was having chief complaints of generalized weakness since 20 days, Vomitings with food as content, non-projectile, non bilious. She has a h/o muscle aches for the past 3 years, for which she was using NSAIDs. In the past she was also diagnosed with haemorrhoids and got treated. From the physical examination there was restricted movement in the right wrist joint which was not associated with pain. Pallor was also present.
The Investigations that were done in this patient are ABG, Hemogram, LFT, Serum Electrolytes, Serum Creatinine, Blood urea, CUE, Thyroid function tests, ECG, 2D echo, Serum electrophoresis, Bone marrow aspiration was also done. From the investigations, it was known that there was a M-band seen in Gamma region from electrophoresis, From Bone marrow aspiration there was plasma cell dyscaria, probably multiple myeloma(plasmacytosis 70%), Mild to moderate supression of all cell lineages. From the USG abdomen there was Bilateral grade 2 RPD. There was dimorphic anemia seen from the smear. Serum B12 and Iron profile were in normal limits.
The diagnosis of this patient was CKD, Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis). The treatment was given on daily basis based on the symptoms and everything else was monitored regularly.
Patient with coma and renal failure:
It is a case of 52 year old male with AKI with acute multiple infarcts in bilateral cerebral and cerebellar hemispheres.
In terms of completeness, the history that was taken, the investigations that are done, the examination data that was written, all these elements were complete along with diagnosis and the treatment. The update on the discharge was also mentioned.
In terms of correctness, the data was given correctly.
The problem list in this patient includes- the patient was having chief complaints of abdominal distension and shortness of breadth after having the food. He had complaints of constipation and altered sleep patterns. Pedal edema was also present. From the systemic examination, on auscultation, Ejection systolic murmers were heard in all the areas radiating to carotids. On palpation, Apex beat was felt in the left 5th intercoastal space in the midclavicular line.
The Investigations that were done in this patient are CUE, LFT, Hemogram, RFT, ECG, ABG, Serum Electrolytes, Urine sodium, Urinary potassium, Urinary chloride, Urine protein/Creatinine ratio, 2D echo, Complete blood picture, Bacterial culture and sensitivity report.
From all the investigations, the Diagnosis of the patient was Infective Endocarditis, with AV vegetations with moderate as severe AR, with AKI, with Uremic encephalopathy, septic encephalopathy, with ulcer over sole of right leg, with Hypoalbuminemia, Alcoholic liver disease, with Acute multiple infarcts in bilateral cerebral and cerebellar hemispheres.
The treatment was given on daily basis. The advice that was given at the discharge was Inj. Vancomycin, Inj. Pan, Inj. Thiamine, Inj. HAI, Inj. Augmentin, Tab. Ecosprin, Tab. clopidogrel, Tab. Atorvas.
After the discharge, the patient came back to the hospital again after a few days for maintenance Hemodialysis. The next day evening, he had sudden cardiac arrest, CPR was initiated, intubation was done, but the patient couldn't be revived.
Question 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.
Answer:
The clinical postings for our semester began last month after our results were announced. But, the unfortunate thing is that because of the the lockdown due to the pandemic, we didn't get a chance to attend our clinical posting in the hospital. So we have been working on the virtual clinical cases, with discussions made through the whatsapp groups, and making an E-LOG for our case studies. This month we have been assigned to interns, which had been of great help, in making our E-LOGs. They have been guiding us, providing us with all the information that we need and updating us about the case. The E-LOGs had been a great help in keeping up with update of the patient every day. The telemedical experience was good, but the most important thing that was missing was direct communication with the patient. Even though attending classes, clinicals through the online classes, was a little difficult, but we are trying to cope up with our studies in this pandemic situation. I hope the situation of this pandemic gets better and we get attend our offline classes.
THANK YOU
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