MEDICINE DEPARTMENT PAPER FOR JULY 2021 BIMONTHLY BLENDED ASSESSMENT

Question 1

    πΆπ‘Žπ‘ π‘’ π‘™π‘–π‘›π‘˜- https://tejaswienduri.blogspot.com/

𝑰 π’˜π’†π’π’• π’•π’‰π’“π’π’–π’ˆπ’‰  π‘¬π’π’…π’–π’“π’Š π‘»π’†π’‹π’‚π’”π’˜π’Š'𝒔 π’‚π’”π’”π’Šπ’ˆπ’π’Žπ’†π’π’•,𝒂𝒏𝒅 π’ƒπ’“π’Šπ’†π’‡π’π’š π’“π’†π’—π’Šπ’†π’˜π’†π’… 𝒂𝒍𝒍 𝒉𝒆𝒓 π’‚π’π’”π’˜π’†π’“π’”. 


•  𝑸1. 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒄𝒉𝒐𝒔𝒆𝒏 10 𝒄𝒂𝒔𝒆𝒔 𝒐𝒇 π’…π’Šπ’‡π’‡π’†π’“π’†π’π’• 𝒃𝒓𝒂𝒏𝒄𝒉𝒆𝒔 𝒂𝒏𝒅 𝒆𝒗𝒆𝒏 π’Š 𝒉𝒂𝒗𝒆 π’ˆπ’π’π’† π’•π’‰π’“π’π’–π’ˆπ’‰ 𝒂𝒍𝒍 𝒕𝒉𝒆 𝒄𝒂𝒔𝒆𝒔 𝒕𝒉𝒂𝒕 𝒔𝒉𝒆 𝒉𝒂𝒔 π’‘π’Šπ’„π’Œπ’†π’… 𝒂𝒏𝒅 π’Š 𝒇𝒆𝒍𝒕 𝒉𝒆𝒓 π’Šπ’π’”π’Šπ’ˆπ’‰π’•π’”   π’‡π’π’“ 𝒆𝒂𝒄𝒉 𝒄𝒂𝒔𝒆 π’˜π’‚π’” π’—π’†π’“π’š π’‘π’“π’†π’„π’Šπ’”π’†π’π’š  𝒂𝒏𝒅 π’‚π’„π’„π’–π’“π’‚π’•π’†π’π’š  π’˜π’“π’Šπ’•π’•π’†π’ 𝒂𝒏𝒅 π’˜π’‚π’” 𝒑𝒓𝒆𝒔𝒆𝒏𝒕𝒆𝒅 π’Šπ’ 𝒂 π’—π’†π’“π’š 𝒓𝒆𝒍𝒆𝒗𝒂𝒏𝒕 π’Žπ’‚π’π’π’†π’“.

• 𝑸2. 𝑺𝒉𝒆  𝒉𝒂𝒔 π’Žπ’‚π’…π’† 𝒂 𝒆-π’π’π’ˆ 𝒐𝒇 40π’šπ’“ 𝒐𝒍𝒅 π’‡π’†π’Žπ’‚π’π’† ,π’˜π’‰π’ 𝒉𝒂𝒔 𝒃𝒆𝒆𝒏 π’…π’Šπ’‚π’ˆπ’π’π’”π’†π’… π’˜π’Šπ’•π’‰ 𝒕𝒓𝒂𝒏𝒔𝒗𝒆𝒓𝒔𝒆 π’Žπ’šπ’†π’π’Šπ’•π’Šπ’”.

• 𝑺𝒉𝒆 𝒉𝒂𝒔 π’˜π’“π’Šπ’•π’•π’†π’ 𝒕𝒉𝒆 𝒄𝒂𝒔𝒆 π’Šπ’ 𝒂 π’„π’‰π’“π’π’π’π’π’π’ˆπ’Šπ’„π’‚π’ π’Žπ’‚π’π’π’†π’“ π’ƒπ’š π’‡π’π’π’π’π’˜π’Šπ’π’ˆ 𝒂𝒍𝒍 𝒕𝒉𝒆 π’π’π’“π’Žπ’” 𝒐𝒇 π’‘π’“π’†π’”π’†π’π’•π’Šπ’π’ˆ 𝒂 𝒄𝒂𝒔𝒆 𝒔𝒉𝒆𝒆𝒕.(π’…π’†π’Šπ’π’…π’†π’π’•π’Šπ’‡π’šπ’Šπ’π’ˆ 𝒕𝒉𝒆 π’‘π’‚π’•π’Šπ’†π’π’• ,π’•π’‚π’Œπ’Šπ’π’ˆ π’ˆπ’–π’‚π’“π’…π’Šπ’‚π’π’” 𝒄𝒐𝒏𝒔𝒆𝒏𝒕 )

• 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒂𝒍𝒔𝒐 π’Žπ’†π’π’•π’Šπ’π’π’†π’… 𝒕𝒉𝒆 π’•π’Šπ’Žπ’† 𝒕𝒐 π’•π’Šπ’Žπ’† π’…π’†π’•π’‚π’Šπ’π’” 𝒐𝒇 𝒕𝒉𝒆 π’‘π’‚π’•π’Šπ’†π’π’• 𝒂𝒏𝒅 𝒂𝒍𝒔𝒐 𝒕𝒉𝒆 𝒑𝒂𝒔𝒕,π’‡π’‚π’Žπ’Šπ’π’š 𝒂𝒏𝒅 𝒑𝒆𝒓𝒔𝒐𝒏𝒂𝒍 π’‰π’Šπ’”π’•π’π’“π’š π’Šπ’ π’…π’†π’•π’‚π’Šπ’.

• 𝑨𝒍𝒍 𝒕𝒉𝒆 π’…π’‚π’š 𝒕𝒐 π’…π’‚π’š π’Šπ’π’—π’†π’”π’•π’Šπ’ˆπ’‚π’•π’Šπ’π’ 𝒓𝒆𝒑𝒐𝒓𝒕𝒔 π’˜π’†π’“π’† 𝒖𝒑𝒅𝒂𝒕𝒆𝒅 𝒂𝒏𝒅 𝒂𝒍𝒔𝒐 𝒕𝒉𝒆 π’•π’“π’†π’‚π’•π’Žπ’†π’π’• π’˜π’‚π’” 𝒖𝒑𝒅𝒂𝒕𝒆𝒅 𝒐𝒏 𝒂 π’“π’†π’ˆπ’–π’π’‚π’“ π’ƒπ’‚π’”π’Šπ’” . 

𝑸3 & 𝑸4-
•    𝑺𝒉𝒆 𝒉𝒂𝒔 π’•π’‚π’Œπ’†π’ 𝒂𝒏 π’‰π’†π’‘π’‚π’•π’π’π’π’ˆπ’š 𝒄𝒂𝒔𝒆 𝒐𝒇  46π’šπ’“ 𝒐𝒍𝒅 π’Žπ’‚π’π’† π’˜π’‰π’ π’˜π’‚π’” 𝒂 π’Œπ’π’π’˜π’ 𝒄𝒂𝒔𝒆 𝒐𝒇 π’π’Šπ’—π’†π’“ π’„π’Šπ’“π’“π’‰π’π’”π’Šπ’” 𝒂𝒏𝒅 π’Žπ’‚π’…π’† 𝒂 π’ƒπ’“π’Šπ’†π’‡ π’‚π’‘π’‘π’“π’‚π’Šπ’”π’‚π’.
• 𝑺𝒉𝒆 𝒉𝒂𝒔 π’†π’™π’‘π’π’‚π’Šπ’π’†π’… 𝒂𝒃𝒐𝒖𝒕 π’‰π’Šπ’” 𝒑𝒓𝒆𝒔𝒆𝒏𝒕 𝒂𝒏𝒅  𝒑𝒂𝒔𝒕 𝒂𝒏𝒅 π’…π’“π’–π’ˆ π’‰π’Šπ’”π’•π’π’“π’š π’Šπ’ 𝒂 π’—π’†π’“π’š π’…π’†π’•π’‚π’Šπ’π’†π’… 𝒂𝒏𝒅 π’‘π’“π’†π’„π’Šπ’”π’†π’… π’Žπ’‚π’π’π’†π’“.
• 𝑺𝒉𝒆 𝒉𝒂𝒔 𝒂𝒍𝒔𝒐 𝒂𝒕𝒕𝒂𝒄𝒉𝒆𝒅 𝒕𝒉𝒆 π’Šπ’π’—π’†π’”π’•π’Šπ’ˆπ’‚π’•π’Šπ’π’ 𝒓𝒆𝒑𝒐𝒓𝒕𝒔 𝒂𝒏𝒅 𝒕𝒉𝒆 π’•π’“π’†π’‚π’•π’Žπ’†π’π’• 𝒑𝒓𝒐𝒕𝒐𝒄𝒐𝒍 π’‡π’π’π’π’π’˜π’†π’… .

𝑸5.
      𝑺𝒉𝒆 𝒉𝒂𝒔 𝒔𝒉𝒂𝒓𝒆𝒅 𝒉𝒆𝒓 π’‘π’π’”π’Šπ’•π’Šπ’—π’† π’—π’Šπ’†π’˜π’”  𝒐𝒏    π’„π’π’Šπ’π’„π’‚π’ π’π’π’π’Šπ’π’†  𝒄𝒍𝒂𝒔𝒔𝒆𝒔 ,𝒉𝒆𝒓 π’†π’π’•π’‰π’–π’”π’Šπ’‚π’Ž ,𝒉𝒆𝒓 π’†π’™π’‘π’†π’“π’Šπ’†π’π’„π’† 𝒐𝒇 π’•π’‚π’Œπ’Šπ’π’ˆ π’‰π’Šπ’”π’•π’π’“π’š π’‡π’“π’π’Ž 𝒕𝒉𝒆 π’‘π’‚π’•π’Šπ’†π’π’• 𝒇𝒐𝒓 𝒕𝒉𝒆 π’‡π’Šπ’“π’”π’• π’•π’Šπ’Žπ’†  𝒂𝒏𝒅 𝒉𝒆𝒓 π’ˆπ’“π’π’˜π’Šπ’π’ˆ π’„π’–π’“π’Šπ’π’”π’Šπ’•π’š 𝒕𝒐 π’Œπ’π’π’˜ π’Žπ’π’“π’† 𝒂𝒃𝒐𝒖𝒕  𝒕𝒉𝒆 𝒔𝒖𝒃𝒋𝒆𝒄𝒕 π’Šπ’ 𝒂 π’ƒπ’†π’‚π’–π’•π’Šπ’‡π’–π’ π’Žπ’‚π’π’π’†π’“.

Question 2:
https://pavankalyanc.blogspot.com/2021/06/a-35-year-old-male-resident-of.html?m=1
https://pavankalyanc.blogspot.com/2021/04/short-case.html?m=1
https://pavankalyanc.blogspot.com/2020/05/case-1.html?m=1
https://anahitabehara.blogspot.com/2021/07/general-medicine-elog.html
https://96sanjanapalakodeti.blogspot.com/2021/07/a-23-year-old-female-with-sore-throat.html
https://96sanjanapalakodeti.blogspot.com/2021/07/a-48-yo-male-with-bl-pedal-edema-facial.html
https://nadipisneha.blogspot.com/2021/07/a-case-of-bl-pedal-edema-altered.html
http://munukutlasaimythili.blogspot.com/2021/07/a-63-yo-male-with-pedal-edema-shortness.html
http://munukutlasaimythili.blogspot.com/2021/08/a-45-yo-male-with-fever-dyspnea-burning.html

https://nadipisneha.blogspot.com/2021/07/a-45-year-male-with-feverdyspneaburning.html


Question 3


The case has been presented very clearly and to the point .
The data provided is correct . But lack the discharge summary
All the investigations done are appropriate and explained with all the laboratory reports. 



The presentation was great with some points highlighted. 
Prognosis of the symptoms were explained with good photographs
Treatment given was also told but the reason for giving the particular treatment was not explained properly. 

*Patient with coma and renal failure  :https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

The case has been presented very clearly . The history taking and examination has been done precisely , providing all required information for the reader to understand the case . All the associated clinical pictures have also been provided. The data provided is correct and complete.

*AKI :


Well explained case scenario with fine history taking. 
Treatment given was virtuous with proper dosage and was very clear.
The data provided is correct and complete.

*Patients with acute on CKD :

Information about the drug and numerous interventions have been provided. 


The document listed was with little insufficient explanation I hope.
Investigations are precisely done and edema in Patient
is shown clearly. 

*Patients with AKI :


The entire document is very well-formatted, the organization of the data makes it very easy to look through. 
Symptomatology has been presented in chronological order. 



Case was presented well with proper explanation .
Data provided was sufficient and explained with all lab reports.


The symptomatology is in chronological order and well listed, the anatomical representation is done with the help of diagrams that make it easier to understand.

Question 4


Problem list

:abdominal distension 
:alcoholic liver disease
:AKI secondary to UTI on CKD ,secondary to diabetic nephropathy.
:hepatic encephalopathy grade 2

Treatment:
Day 1:
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

Day 2&3:
Same treatment followed

Day 4:
  1. Same treatment followed except Inj. Monocef.
  2. Inj. Augmentin 1.2 gm IV/TID
  3. Tab. Ecospirn 150mg PO/HS/SOS
  4. Tab. Clopidogrel 75mg PO/HS/SOS
  5. Tab. Atorvas 20mg PO/HS/OD added

FINAL DIAGNOSIS:
  • 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

Problem list

-lower back ache since 10 days 
-dribbling urine since 10 days
-pitting type of  edema since 3 days
-SOB at rest since 3days 

• Increased involuntary movements of both upper limbs since 10days . 

 Final diagnosis

Acute renal failure (intrinsic)
 Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis
Hyperuricemia 2° to Renal failure 
Uraemia induced tremors( resolved)
Delerium 2° to septic /Uremic encephalopathy (resolving)

chief complaints of:

  1. - lower abdominal pain: 1 week
  2.  -burning micturation:1week
  3. - low back ache after lifting weights
  4. -dribbling / decrease of urine out put:1week
  5. -fever :1 week
  6. - SOB , rest :1week

COMPLAINTS AND DURATION:

-week back , after weight lifting 

Patient had sudden onset of pain in abdomen 

By burning micturation with high fever : grade associated with chills and rigor 

Decrease urine output associated with SOB (grade -4)

With no H/O chest pain, palpitations, pedal oedema, facial puffiness.


"Chief complaints"
  • Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).
Back pain( 5 days ago) with abdominal pain and chest pain

Investigations:
  • Left Kidney 13.2x7.5cm increased size, abnormal echogenicity of Ρ€Π°renchyma noted with Π‹ΡƒΡ€ΠΎ and hyper echoic regions.
  • However no E/O  air focii was  noted. However no e/o any abscess, Perinephric collections, mild hydronephrosis in left PCS
  • Aorta I.V.C. - (N)
  • No Ascitis 
  • No lymph-adenopathy
  • U.bladder -  normal Empty
  • V-U Junctions - Foley'sbulb insitu.
  • Uterus-Size - Pelvis couldn't be assessed 
  • Parenchyma with (Lt)Abnormal echogenicity, mild hydronephris ,no perinephric collections suggested 
  • clinical corelation to
  • Acute pyelonephritis.

Provisional diagnosis:  DKA with AKI ( ? Pre renal
Patients with acute on CKD :


CHIEF COMPLAINT - 48-Year-old male presented to the OPD with chief complaints of Shortness of Breath grade -II from the past 1 week, which converted into grade -III-IV from the past 4 days 
Findings- 
Pre Medication findings 
1. Early small airway obstructions as FEF25-75 % Pred or  PEFR % Pred <70
2.Spirometry within normal limits as (FEV1/FVC) % Pred> 95 and FVC% Pred >80 
Post Medication Findings 
3. Mild restriction as (FEV1/FVC) % Pred >95 and FVC % <80 

PROVISIONAL DIAGNOSIS  - HFrEF secondary to CAD;h coma and renal failure  :

*PATIENT WITH COMA AND RENAL FAILURE 



I see a there was a different types of renal related cases here although some of the symptoms for renal disease may be same but..there is a clear diagnosis of each case..by this I learned that each symptom and eachceach of the patient should be taken into consideration..then only we are able to diagonse patient...there were many efforts kept by our doctors to diagnose the disease..there is more to learn from this elogs.

QUESTION 5:
Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. 

 By doing this assignment I could view many cases and many case scenarios through which I learned many  things . i feel sad  that the medicine postings are endings i learned many skills in these two months and i would like to specially thank medicine department for properly guiding us .I also learned how to interact with patients.. I had been taken part in discussions occured in wards icu and and also 2-4sessions i learned the importance of making elogs and i also made my jrns do. There were little ups and downs as this is the beginning of the internship.I would like to thank GM dept for this opportunity to explain our thoughts. 



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