Assessment

 Monthly online summative assessment    

I have been given with the following assignment 

Name: P Charitha 

Roll no : 95 (2019 batch)

Question 1 :competency tested for peer to peer review and assessment 

 Link of the answer I have reviewed : https://02shishirareddy.blogspot.com/

PULMONOLOGY CASE   

     

Case : The patient presented with complaints of episodes of shortness of breath on and off for past 20years. For episodes of shortness of breath the patient used inhalers and nebulizer. The past history of patient included diabetes since 8yrs, undergone treatment for anemia. The ABG results showed respiratory acidosis. The patient is a farmer where she can be subjected to an allergens or toxins. The patient had pedal edema  with pitting type and facial puffiness. 

Diagnosis : chronic obstructive pulmonary disorders with right ventricular dysfunction, arrhythmias. 

Review : The symptomatology was answered with the help of a diagram which was easy to grasp. The mechanism of pharmacological and non pharmacological interventions was clearly  mentioned with specific headings. The electrolyte disturbance especially in sodium and chlorine, which I wasn't able to understand by reading the case was explained clearly by mentioning the mechanism which may caused the disturbance and also the common causes.

 

NEUROLOGY 

Case 1: The patient came to the OPD presenting with slurring of speech, deviation of mouth which has been resolved on the same day. He had bilateral hearing loss and presence of tinnitus. He has postural instability. No dysarthria, dysphagia. He is denovo to hypertension but he didn't continue to take medication. In CNS examination there was bilateral nystagmus, examination of 8th cranial nerve in weber test was no lateralization and ataxic gait was seen. In CT scan of brain there was cerebellar infarct. 

Diagnosis : cerebellar ataxia with infarct in right cerebellar hemisphere. 

Review: The contribution of denovo HTN to cerebellar infarct was explained well with the process which may have contributed. The relation of alcoholism to stroke hasn't been clearly mentioned. 

Case 2 : The patient came to OPD with complaints of palpitation, chest heaviness, chest pain, pain radiating along left upper limb, pedal edema. The patient has past history of blood infection, paresis due to hypokalemia. The chest X ray done due to neck pain shown cervical spondylitis 

Diagnosis : cervical spondylitis with recurrent hypokalemic paralysis 

Review : The changes seen in ECG in case of hypokalemia was described clearly but it would have been more convenient to understand if the ECG graph were present in regarding with the changes.

Case 3 : The patient came to OPD with complaints of un responsiveness, intermittent seizures. The patient had history of multiple falls, minor head injuries, change of gait since 1year.The CT scan of brain showed acute cerebral hemorrhage of parietal, frontal, temporal lobes. 

Provisional diagnosis : Generalized tonic clonic seizures due to acute cerebral hemorrhage.

Review : The reason for development of ataxia due to alcoholism has been explained clearly with the mechanism involved in it. It would have been more clear if the ECG graphs were included.

Case 4 : The patient presented with complaints of weakness of all 4 limbs which was sudden in onset, preceded by alcohol binge. History of HTN since 5yrs. In CNS examination there was absence of reflexes and complete paralysis of limbs. In CT scan osteomalacial changes were seen. 

Provisional diagnosis : Quadriparesis, hypokalemia, C3-C6 osteomalacial changes

Review : The answers were easy to grasp and I have come to know about the myelopathy hand and what causes it which tracts are involved. The Hoffman's reflex answer was not clearly explained about how it was done.

Question 2 : share the link to your own case

I haven't done any elog yet. 

Question 3 : Testing peer review competency 

Case link : https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1

-The patient presented with complaints of weakness of both lower limbs, bowel and bladder incontinence. 

-The patient was on anti tuberculosis treatment using HRZE- rifampin, pyrazinamide, ethambutol since 1 month. 

-The patients lymphocytes count was very less. 

-The Potts spine was in Provisional diagnosis as the tuberculosis bacteria may have effected the spine causing weakness in lower limbs

-In brain MRI there was epidural abscess, enlarged cervical lymph nodes. There was infectious spondylitis of C 4,C5,C6,C7,D1 vertebral bodies and significant erosion at C5 C6 level 

-In treatment optineuron was given which is nutritional supplement. 

-Moncef injected to treat the bacterial infection which was causing the spondylitis. 

-It would have been more better if the MRI photos has been there as I would know how does the scan of epidural abscess would be like. 

-The Case presentation was good I could not understand why the thiamine injection was given as already optineuron were giving which contains Thiamine. 

Question 4 : Testing scholarship competency

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

Problem list :

-Hypertension 

-Chronic kidney disease 

-Anasarca

-High creatinine level

-Metabolic acidosis 

-Altered sensorium 

There was no diagnostic and therapeutic uncertainty 

Sensitivity of diagnostic interventions were the ABG, complete urine examination. 

Efficacy of therapeutic interventions :

-Inj NaHCO3 - for treatment of metabolic acidosis

-T Nodosis - to neutralize the acid in stomach

- Inj Lasix - it is a loop diuretic to treat edema

Case link : https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

Problem list :

-Hypothyroidism 

-Atrial fibrillation 

-Pleural effusion and mild pericardial effusion

The therapeutic uncertainty why was Clexane  injected to the patient

Sensitivity of diagnostic interventions are ECG, echo

Efficacy of therapeutic interventions :

- Inj Amiodarone - for treatment of atrial fibrillation 

- Inj Clexane - anticoagulant

Case link : https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1 

Problem list :

-Decreased urine output

-Pedal edema with pitting type 

-Acute kidney injury secondary to urosepsis

-Diabetes mellitus

Efficacy of therapeutic interventions :

- Inj Magnex forte - for trt of urosepsis which kills bacteria

- Inj Hai - insulin injection for diabetes 

-Neb asthalin respules - for shortness of breath 

-optineuron - nutritional 

-T Ultracet - pain

-T shelcal - vit D and calcium

-T Norflox -bacterial infection

Question 5 : Testing scholarship competency in logging reflective observations on your concrete experience of this last month. 

The experience of seeing patients in video call was disappointing as it would have been more convenient to interact with a patient directly and to know about various aspects. I also got to know various interlinked diseases. I couldn't do the examination of patient due to lock down which could have helped me more. In conclusion to know about the patients complaints and how the treatment was given even the it was in the video call was a bit exciting as it was for the first time. 

 END