92 Sneha Nadipi
3rd sem(2019)
- I have been given the following formative assessment for bimonthly blended assessment for June 2021 .This is the link regarding assessment
http://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html.
1.QUESTION: Review the three recently made long and short case reports.
Critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.
LONG CASE:
📌The case is very well presented. Regarding completeness and correctness the data is mentioned in the chronological order and the history is taken in a very detailed manner.This really shows the detailed and correct history taking and presentation of the case.The examination is mentioned well.Patient photography’s are shown in detail which gave the case a complete look.The musculoskeletal examination is the beautiful part of the case with picturisation.The investigations and findings or mention up-to-date. The radiographs and the investigation reports are pinned according to the day by day analysis. The patient details are not appearing in the investigation reports which is satisfying. To analyse the diagnostic and therapeutic uncertainties she provided all the useful leads and she gave the reasons to rule out every pathology clearly which helped me a lot to understand the case.Most importantly the drug history is mention accordingly.Diagnosis is mentioned.References mentioned at the last is really helpful.
SHORT CASE 1:
📌The case is well presented.The data is collected according to the condition.Detailed history taking is seen.The capture data is complete and correctly presented.The nervous system examination is very well presented.Investigations are done and the reports are pinned in the e-log.The radiographs are also pinned.The treatment history is mentioned accordingly and the drugs are mentioned. The case is very well presented and the provided leads are helpful to analyse the diagnostic and therapeutic uncertainties.
SHORT CASE2:
📌 The overall case presentation is very nice. About the completeness and correctness the data is mentioned properly and the history is taken in a very detailed manner. Visual representation of Cushing syndrome is really helpful to understand.Investigation reports are placed accordingly to the day by day analysis.The pictures are also given which is the case a complete look. Treatment history is given accordingly.The capture data is nice. To analyse the diagnostic and therapeutic uncertainties of the given case useful leads are provided.Source for resting tremors is mentioned at the last which gave a clear understandable feature in diagnosis.
QUESTION 2:Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):
Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems.
Answer:
👉long case
A 44 year old man
Problem list:
📌3-day history of bilaterally symmetrical rapidly progressive generalized edema.
presented with a 3 day history of anasarca
📌frothy urine,gradually decreasing urine output,
📌on a background of a 10 year history of chronic bilaterally symmetric polyarthritis (evidenced by severe pain, edema and limitation of joint movements).
Diagnostic Approach
With a provisional diagnosis of Acute Glomerulopathy on the background of bilaterally symmetric chronic progressive erosive peripheral polyarthritis, features supporting the diagnosis of glomerulonephritis were -
- Secondary Hypertension
- Oliguria (360 ml urine in the last 24 hours)
- Hypoalbuminemia (Serum Albumin 2.5g/dl) and Anasarca
- Dysmorphic RBCs in Urine
👉Short case1
A 49 year old English and Telugu language lecturer
Problem list:
📌a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
📌Findings - The movements in the right lower limb is slower than the movements in the left lower limb.
📌ECG
Shows Sinus Tachycardia with pseudo infarct pattern in leads I and aVL with dagger q waves in the same leads.
👉 Short case 2
19 year old male resident of Nalgonda
problem list:
📌Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .
📌Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .
📌Abdominal distension and facial puffiness since 6 months.
📌Pedal edema since 3 months.
📌 Low back ache since 3 months .
📌 Feeling low , not feeling to talk to anyone.
Treatment:
Dermatologist opinion for tenia corporis where they advised
📌Ointment AMLORFINE
📌FUSIDIC ACID CREAM.
📌SALINE COMPRESS OVER LEISONS
FINAL DIAGNOSIS :
📌IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
📌TINEA CORPORIS
📌DENOVO HTN .
QUESTION 3:Testing competency in "Evidence based medicine": Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient.
Answer:
👉long case
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis
Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.
This patient has >10 joints involved with multiple small joints involvement - 5 points; Symptom duration 10 years - 1 point; RA Factor - NEGATIVE; CRP elevated & ESR - 120 mm/hr - 1 point; Total Score - 7/10
Thus, a diagnosis of Rheumatoid Arthritis is likely.
👉short case1
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
A middle aged man presenting with a 6 months history of gradually progressive, asymmetric rest tremor with autonomic features is provisionally diagnosed with
1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.
2. Multiple System Atrophy - Parkinsonian Type (MSA-P).
2 D Echo
✓ Grade II diastolic dysfunction.
Treatment
1. Tab. Syndopa Plus 125 mg QID
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD
👉 Short case 2
19 year old male resident of Nalgonda
FINAL DIAGNOSIS :
IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
TINEA CORPORIS
DENOVO HTN .
QUESTION 4: Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :
Share the link to your own case report this month 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.
Click here
Question 5: Testing scholarship competency in logging reflective observations on your concrete experiences of this last month :
🖌I am really glad that our college came up with an idea of a e-log.Due to the Covid pandemic it would be very difficult to attend postings without a e-log idea. The general medicine department did a great work to make us understand the subject in a easy way. I myself got benefited from this idea.
🖌 This is because I am able to prepare log without any fail you even if I am lockdowned at home. This assignment really helps me a lot. I can take history and do examination and investigations.
🖌This is really a very nice opportunity.My experience in lodging a case .My experience in logging a case is very satisfied. I have seen many cases and I learnt how to present a case.
🖌Specially in this assignment I learnt about the history taking very clearly.
🖌I also learnt how to present SOAP NOTES and discharge summary this month and my personal experience with blogging is really satisfied this month.
🖌Now I am able to understand the investigation in the case scenario and can conclude the diagnosis.This type of learning makes our work easier and perfect.
🖌now I know the clinical uses of many drugs and the type of investigations to be done. I also learnt about the history taking and many various things.
🖌 I thank the general medicine department for giving us exposure to this platform. It really made our work easy and understanding properly.
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