General medicine Assessment

JULY 2021 Bimonthly Blended Assessment.

Name:M.YASHWITHA 

Roll.no:73

3rd semester (2019 batch).

Question 1: 

-Competency tested for peer to peer review assessment.

https://madamsneha74.blogspot.com/2021/06/general-medicine-assessment.htm

My review -

    Her review was satisfactory on the cases that she selected and she made clear summary on each case.It was easily understandable, along with the images posted in her blog.

1.She made a clear review on the elogs made by our seniors .

2.The elog made ,was explained well in all ascepts such as history taking,investigations, diagnosis etc..

3.Review on multisystems elogs are made well.

4.She explained the drugs  usage for the treatment of disease.

Question 2: 

-my elog link.

https://73myashwitha.blogspot.com/2021/07/general-medicine-elog-2.html

Question 3:

 Case 1 : 

•AKI

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

•The diagnosis for this case was acute kidney injury secondary to urinary tract infection which was associated with denovo diabetes mellitus 2 ,the diagnosis for this case was clear based on the investigations and laboratory reports .AKI causes a build up of waste products in the blood and it makes it hard for the kidneys to keep the balance of fluids in the body.

If discharge summary was provided it would be well.

The data provided was complete and clear to understand the disease.

Case 2: 

•Acute on CKD

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

•The diagnosis for this case was Acute renal failure ,Hyperuricemia secondary to renal failure ,uremia induced tremors (resolved).

•The case was presented with proper explanation and data provided was sufficient and well diagnosed based on laboratory investigation reports.

•Treatment history,presented well.

•The tremors are resolved .

Case 3:

• CKD

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

•Diagnosis: It is the chronic interstitial nephritis secondary to plasma cell dyscariasis .

•Bone marrow aspiration was done to know if the patient has multiple myeloma.

•The case presentation is complete ,with the laboratory investigation reports and the image of electrophoresis.

•data provided is sufficient to diagnose the disease.

Case 4: 

•Patients with coma and renal failure.

 A). 

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

•Diagnosis:  DKA with AKI.

•The patient was unconscious  ,when she came to hospital. She was known patient of diabetes mellitus type 2 .

•The 2D echo presentation was good .

•The examinations and investigation provided are sufficient to diagnose the diseases. 

•bed sores are seen in this patient.

•The explanation was clear.

B).

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

•Diagnosis: Infective endocarditis with AV Vegetations with moderate as severe AR with AKI..

•The data provided was sufficient and explained with laboratory reports. 

•Discharge summary is presented .

•Advice at discharge is provided.

Case 5: 

•Patients with acute on CKD.

A).

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

•Diagnosis: Renal AKI secondary to urosepsis with b/L hydroureteronephrosis  with DM -2 since 5years with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore.

•The general examination and history of the patient was very concise and easy to understand along with laboratory reports.

•Images of hydronephrosis was appreciated.

B). 

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

•Diagnosis: HFrEF secondary to CAD ;CRF.

•The presentation of the case is very nice ,which helps I easy diagnosis of the disease.

•The investigation reports and treatment is satisfactory. 

• past history and drug history was provided..

C). 

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

•Diagnosis: 

•The case was explained using all the pictures of investigations and reports along with images related to symptoms. 

•The edema in patient is clearly seen through the images provided in the blog.

•The data provided through this blog is sufficient to diagnose the disease.

Case 6 : 

•Patients with AKI.

A). 

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

•Diagnosis: Alcoholic Hepatisis, AKI secondary to acute gastroenteritis. 

•images which are captured during examination like pitting type of edema is appreciated.

•The investigations helps to diagnose the illness of patient easily.

•The treatment provided was well with explanation. 

B).

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

•Diagnosis: Acute kidney injury secondary to urosepsis. 

•The data provided was sufficient and explained with laboratory investigation reports.

•But lack of discharge summary.

•The treatment given was very accurate it helps the patient for early recovery. 

C). 

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

•The diagnosis: Acute pancreatisis with AKI. Case was presented well with proper explanation of diseased condition with appropriate images of investigations .

•Past history of the patient was not collected ,if they collected it would be better.

•The investigations clearly support the diagnosis of the disease and CT scan images are very helpful to diagnose. 

•The presentation of the case was not satisfactory .

Question 4 :

Case 1: 

•AKI 

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

The diagnosis , Acute Kidney injury secondary to urinary tract infection.

CHIEF COMPLAINTS:

-lower abdominal pain:1 week.

-burning micturition:1 week.

-low back ache after lifting weight.

-dribbling or decrease of urine output

    :1week.

-fever:1 week.

INVESTIGATIONS:  

-Hemogram,complete urine examination, complete blood picture ,2D echo, Chest X ray,renal and liver  function tests ,HbA1c,ABG report,Bacterial culture and sensitivity report ..

TREATMENT:

-IVF:RL@UO+30ml/hr.

-Salt restriction <2mg/day.

-Inj.TAZAR 4.5 gmIV/TID-2.25gm.

-Inj PANTOP 40 mg IV/OD.

-Lactulose 15 ml PO/TID.

Case 2:

•Acute on CKD 

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

•The diagnosis ,Acute renal failure, Hyperuricemia secondary to renal failure. 

CHIEF COMPLAINTS:

-Lower back ache :10 days.

-dribbling of urine:10 days.

-pedal edema:3 days.

-SOB at rest since 3 days.

-increased involuntary movements of both upper limbs :10 days.

INVESTIGATIONS:

-ECG,RFT,CUE,Hemogram,ABG,serum electrolytes (creatinine,uric acid,etc..),Blood urea,LFT,USG of abdomen and pelvis ,urine culture ,blood culture..

TREATMENT:

-IVF_NS-0.9%@100ml/hr.

-Inj.Tazar 2.25mg I.V-TID.

-inj.lasik 40 MG I.V-BD.

-Nebulization salbutamol-4th hourly.

-foley's catheterization. 

-inj.piptaz 2.25 gm I.V-TID.

-inj.Ciprofloxacin etc...

Case 3: 

•CKD .

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

•Diagnosis,Chronic interstitial nephritis secondary to plasma cell dyscariasis. 

CHIEF COMPLAINTS:

-Generalized weakness.

-vomitings since 3 days.

INVESTIGATIONS:

-ABG ,CUE ,LFT ,ECG , Blood urea, serum electrolytes, serum creatinine,serum calcium,Thyroid function tests, Hemogram,x rays ,2D echo,BONE MARROW ASPIRATION, SERUM ELECTROPHORESIS..

TREATMENT:

-T.PAN 40mg,Oral fluids upto 1.5 to 2 lit/day,T.Zofer 4mg/PO/SOS, Tab NODOSIS 550BD etc..

Case 4: 

•Patients with Coma.

A).

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

•Diagnosis: DKA with AKI.

CHIEF COMPLAINTS:

-Fever and diarrhea since 5 days( 4 to 5 times a day with blood discharge).

-Back pain with abdominal pain and chest pain .

NOTE: this history was told by Patient's daughter because patient was unconscious at the time.

INVESTIGATIONS:

-ABG analysis ,complete blood picture, LFT, KFT, Bacterial culture and sensitivity report, hemogram ,X rays ,MRI scan ,2D echo, CBP..

TREATMENT:

-Inj.NORAD 2 amp in 50 ml NS.

-inj.PIPTAZ 2.25 gm.

-inj dopamine 2 amp in 50 ml.

-IV infusion. 

-inj Nor Adrenaline.

-inj.vancomycin.

-inj Lasix etc are given.

B).

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

•Diagnosis ,Infective endocarditis with AV Vegetations with moderate as severe AR with AKI ..

CHIEF COMPLAINTS:

-Abdominal distension from past 7 days.

-Constipation from past 5 days.

INVESTIGATIONS:

-CUE,Hemogram, RFT, LFT, ECG, 2D echo, ABG, serum electrolytes, urinary sodium,chloride,potassium, Bacterial culture and sensitivity report, CBP, MRI Brain etc...

TREATMENT:

-inj.Monocef 1gm IV/BD.

-inj.vancomycin .

-inj.Thiamine 200 mg in 100 ml NS /BD.

-tab.Ecospirn 150 mg .

-inj .Augmentin 1.2 gm IV/TID etc...

Case 5:

• Patients with Acute on CKD.

A).

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

•Diagnosis, Renal AKI secondary to urosepsis ..

CHIEF COMPLAINTS:

-Fever since 4 days.

-pus in the urine.

INVESTIGATIONS:

-Hemogram ,X rays ,ECG ,Fever Chart ,Bacterial culture and sensitivity report,  CBP, Serum creatinine, serum sodium,potassium,chloride .Blood urea ,ABG,2D echo etc...

TREATMENT:

-Inj.pantop 40 mg ,inj Piptaz...

-inj Lasix 40mg .

-tab.PCM 650 mg TID.

-Insulin Human actrapid -16 IU/TID.

-inj. Optineuron etc...

B).

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

•Diagnosis:HFrEF secondary to CAD;CRF.

CHIEF COMPLAINTS:

-shortness of breath..

INVESTIGATIONS:

-Fasting blood sugar.

-post lunch blood sugar.

-glycated Haemoglobin. 

-ESR ,CBP ABG ,LFT, Lipid profile ,USG report ,RFT ,2D Echo ,ECG .

-AFB culture and sensitivity report. 

-PULMONARY FUNCTION TESTS. 

TREATMENT:

-Tab.Bisoprolol 5mg OD.

-Tab.Nitrohart 20/37.5mg 1/2 T/D.

-Tab.Nicardia XL 30 mg OD.

-Tab.Gliciazide 80 mg BD.

-Tab Nodosis 500 mg TD.

-Syp.Lactulose 15 ml.

C).

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

•Diagnosis, 

CHIEF COMPLAINTS:

-Shortness of breath.

-pedal edema.

-decreased urine output.

-anasarca.

INVESTIGATIONS:

-Ultrasound abdomen ,2D echo ,ECG ,Hemogram, CUE. 

-Urinary chloride ,sodium ,potassium. 

-serum creatinine, electrolytes. 

-Blood urea,  X ray ..

TREATMENT:

-IV fluids. 

-Tab.Pan 40 mg .

-Inj.Lasix 80 mg.

-liquid paraffin for LIA.

-tab.Levocet..

Case 6: 

•Patients with AKI.

A).

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

•Diagnosis, Alcoholic Hepatisis,AKI secondary to acute gastroenteritis. 

CHIEF COMPLAINTS:

-Loose stools,

-pedal edema .

-Abdominal distension. 

INVESTIGATIONS:

-Hemogram,CUE ,CBP ,RFT ,LFT ,ECG .

-CXR PA view,X ray .inj.Thiamine 100 mg 

-USG Abdomen ,APTT ,BT /CT.

TREATMENT:

-inj.Thiamine 100 mg .

-inj.Lasix 40 mg.

-inj.Optineuron .

-Tab.Aldactone 50 mg .

-inj.pantop 40 mg .

B).

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

•Diagnosis, Acute Kidney injury secondary to urosepsis. 

CHIEF COMPLAINTS:

-Pedal edema.

-decreased urinary output. 

-fever.

INVESTIGATIONS:

-CUP ,ECG , ABG ,Ultrasound ,serum electrolytes. 

-blood urea ,serum creatinine and potassium.

-blood sugar Random and fasting .

-Hemogram ,CBP etc...

TREATMENT:

-inj Lasix 40 mg.

-IVF -NS @UO+50 ml/hr.

-tab. NODOSIS .

-Inj.Magnefortev1.5 gm .

-Tab.Orofea.

C).

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

•Diagnosis, Acute pancreatisis with AKI.

CHIEF COMPLAINTS:

-pain in abdomen .

- vomitings .

-SOB.

INVESTIGATIONS:

- LFT, ECG, X ray ,Bacterial culture and sensitivity report, ABG, serum creatinine, CT scan ,CBP etc..

TREATMENT:

-IV fluids:NS 40 ml /hr.

-IV Lasix 40mg. 

-IV piptaz  .

-tab.Nodosis.

Question 5:

 Online postings are not as effective as offline .We are not able to diagnose the case properly due to lack of Patient's direct interaction while taking history .

Because of the online teaching, these assignments are helping us a lot to understand the clinical practice of taking Patient's history and how to diagnose a case and treatment suggested to the particular disease.

The case discussions helping us to differentiate the diagnosis of  a disease with common symptoms, like edema,vomitings, anemia etc...which are  seen in many diseases.

-during our online postings, we are able to appreciate the diagnosis based on Patient's symptoms .laboratory investigation are very useful to understand the illness or disease .

-case discussion during online postings on involuntary movements is quite interesting.

Thank you !.