GENERAL MEDICINE ASSIGNMENT [JULY 2021]

 VIJAYA RATNA DANDE  34 [3^rd SEM]

                                        BIMONTHLY  ASSESSMENT - JULY 2021

I have been given the formative assessment for July 2021 in an attempt to read, comprehend, analyze, reflect upon and discuss captured patient centered data.

This is the blog made in response to the following question

Refer to the link below regarding the assessment

http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1

QUESTION 1

 Peer to peer review

Link: - https://rishitha35.blogspot.com/ 

           All the sub questions of 1st question  on peer review were reviewed  conscientiously and upright.The answers by roll number 82, 2017 batch reviewed by roll number 35, 2019 batch is fairly well.She has come up with a case on recurrent pancreatitis secondary to alcohol.She is in the process of updating it.

The 3rd and 4th questions were given a brief insight concordly along with extra information.

The 5^th question was answered genuinely.

Overall, the assignment was well done.

QUESTION 2

Link of my elog

https://34vijayaratnadande.blogspot.com/2021/07/general-medicine-elog.html

QUESTION 3

Refer to the link below on Acute on CKD

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

Diagnosis: - Acute Renal failure [intrinsic] with Grade 1 L4-L5 and    multifocal  infection spondylodiscits.

                        This case is described precisely. The patient presented with dribbling of urine and lower back pain. All the relevant information has been taken in order. General examination, vitals have also been taken appropriately with necessary details. Systemic examination is thorough. Appropriate investigations were done based on the situation. He had bilateral pedal edema and SOB. Renal function test report shows elevated levels of urea, creatinine and uric acid can be a cause of AKI which results in significant decline in Renal failure. This case has been covered well.

Refer to the link below on CKD

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

                        This is the case of chronic interstitial nephritis secondary to plasma cell dyscariasis probably [multiple myeloma].The patient has been presented with generalized weakness and vomiting ,got operated for  haemorrhoids previously. She is using NSAID’s for muscle aches since 3years.There is normal urine output. She is N/K/C/O- DM-2, HTN, epilepsy, TB, CVA, CAD. On physical examination she was found to have a restricted movement in the right wrist not associated with pain and no involvement of other joints. This blog is impressive, all the details have been taken including menstrual and obstetrics history. On general examination, pallor is present and remaining all appears to be normal. Vitals are normal. Systemic examination has also been presented comprehensively .Data updated day wise.Treatment and diagnosis is satisfactory. 

To know more about kidney disease associated with plasma cell dyscariasis the following article should be referred.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324369/

Biochemical investigations show dimorphic anaemia.

                                                    Increased levels of serum creatinine and blood urea which depicts renal dysfunction.

Refer to the link below on patient with renal failure and coma

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

                            This case is well explained with all the necessary details of the patient. All the relevant examinations have been done thoroughly. she is a known case of diabetes. The patient’s condition has been updated every day along with the treatment plan. Initially, patient is  in a persistent vegetative state and has not shown any prognosis, so she was put on ventilator. She has recovered well later and got discharged. The treatment was appropriate to the condition. Overall, this case has been covered well with timely diagnosis.

Refer to the link below on patient with renal failure and coma

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

                            A 52 year old presented with chief complaints of abdominal distension, constipation, pedal edema and hiccups. Complains of altered sleep patterns .K/C/O Diabetes. He is an alcoholic. Patient has been diagnosed with AKI with alcoholic liver disease and multiple infarcts in the bilateral cerebral and cerebellar regions. Upon general examination pedal edema was eye catching and icterus is present ,other all appears normal. Systemic examination is thorough. All investigations are covered. 2D echo videos are also uploaded. Finally, this case is well explained and treatment plan is also in detail.

Refer to the link below on patient with acute on CKD

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.

                         A 52 years old patient presented with fever and pus in the urine. He has been taking Tab GLIMI M1 for type 2 diabetes, underwent TURP surgery for prostomegaly.After this,patient reported with generalized weakness,drowsiness,decreased appetite and Shortness of breath.  General examination, vitals, systemic examination has been taken with required details. Investigations are also well done. Patient’s condition was updated day wise along with treatment plan.B/L hydroureteronephrosis[swelling of a kidney due to build of urine caused by an obstruction],dilated ureters along with thickened wall of urinary bladder and tiny calcific focus in the pelvis was  found through KUB X-ray. Treatment – antibiotics, diuretics and analgesics along with Vit B12 and insulin are covered.

Refer to the link below on patient with acute on CKD

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

   Diagnosis:-HFrEF secondary to CAD,CRF

           A 48 years old patient presented with shortness of breath grade II which converted into grade III-IV.K/C/O Diabetes mellitus and hypertension since7 years. All the examinations are done. This case is described well in order. Renal function test report shows elevated levels of urea, creatinine which can lead to renal dysfunction. Necessary investigations have been done. This case is presented with detailed report with timely provisional diagnosis.

Refer to the link below on patient with acute on CKD

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

                 A 60 year old patient presented with shortness of breath and anasarca with chief complaints of pedal edema and decreased urine output.All the essential examinations are done and elaborated.

Investigations:-Blood urea and serum creatinine - elevated,

      Serum electrolytes – lowered showing acute kidney problems.

Dialysis is performed. After 4 sessions of haemodialysis her serum creatinine remained static. Appropriate treatment is given.

Refer to the link below on patient with AKI

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

         Diagnosis:- Alcoholic hepatitis , AKI secondary to acute gastroenteritis

HFreF secondary to CAD

Alcoholic and tobacco Dependence Syndrome

                     A 43 year old patient presented with chief complaints of loose stools, pedal edema and abdominal swelling. He is alcoholic and has a H/O Jaundice since 2 years and TB since 3 years for which he is using ATT for 6 months. All the examinations are done congruously. All the possible investigations have been covered and the treatment is given with timely provisional diagnosis. Acute Kidney injury is rapid deterioration in renal function resulting in accumulation of metabolic waste, sufficient to cause uraemia.

Refer to the link below on patient with  AKI

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

This case is well presented with all the required details of the patient. All the appropriate information has been taken in detail. General examination, vitals and systemic examination are accurate. Necessary investigations are updated every day. Finally, after all the essential examinations and investigations the diagnosis was made as acute kidney injury secondary to urosepsis with hyperkalaemia. This case has been covered well.

Refer to the link below on patient with AKI

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

            This is a case of AKI  with pancreatitis in a chronic alcoholic. He presented with pain in abdomen and vomiting since a week, Shortness of breath since 2 days. N/K/C/O DM, HTN, Epilepsy and TB. All the necessary details are taken in order. Upon general examination High BP was found. Systemic examination is thorough. The provisional diagnosis is made as acute pancreatitis with AKI. The case is well presented with all the investigations.

QUESTION 4

Diagnostic and Therapeutic Interventions

 acute on CKD

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

Therapeutic

·      Lasix has been used to drain out excess fluid to treat edema. It is a potent diuretic used to eliminate water and salt from the body.

·        Febuxostat [xanthine oxidase inhibitors] used to lower hyperuricaemia.

·        IVF NS aids in diuresis    

         Pantop to treat heart burns and GERD.

·       Oral fluids to replace the fluids loss   

       

       CKD

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

 Diagnostic

USG Abdomen – to check the major organs in the abdominal cavity. Her report shows Bilateral Grade 2 RPD.

2D Echo – done to get clear picture of pleural effusion and pericardial effusion.

Bone marrow Aspiration – helps to assess if bone marrow is making normal amounts of blood cells or not.

This test helps to identify particular disease and progression of the disease. Her bone marrow aspiration report showed plasma cell dyscariasis probably multiple myeloma [ plasmacytosis 70%]. Mild to moderate suppression of all cell lineages.

Therapeutic

IVF NS aids in diuresis

Erythropoietin is given as she is severely anaemic.

Generally, erythropoietin produced by the kidneys stimulates the bone marrow to produce red blood cells.

Patient with renal failure and coma

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

Therapeutic

·        Piptaz – used to treat bacterial infections

·        Meropenem – antibiotic used to treat bacterial infections

·        Clexane [anticoagulant]prevents blood clots,treats angina and heart attacks. 

Patient with renal failure and coma

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

Therapeutic

 Ecospirin – combination drug of blood thinning and cholesterol lowering agent[administered to especially who are at high risk of heart diseases]

 Augmentin

 patient with acute on CKD

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

 Diagnostic

·        NCCT KUB X-Ray– assess the abdominal areas and structures of urinary and GI system.

Therapeutic

·        Piptaz  - used to treat bacterial infections

·        Lasix has been used to drain out excess fluid to treat edema. It is a potent diuretic used to eliminate water and salt from the body.

·        Insulin Human actrapid – fast acting effect used to treat diabetes mellitus

 patient with acute on CKD

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

 Therapeutic

  Lasix has been used to drain out excess fluid to treat edema. It is a potent diuretic used to eliminate water and salt from the body.

·        Ecospirin – combination drug of blood thinning agent and cholesterol lowering agent[administered to especially who are at high risk of heart disease]

·        Bisoprolol – used to treat hypertension[high BP]

patient with acute on CKD

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

 Therapeutic

·        Lasix has been used to drain out excess fluid to treat edema. It is a potent diuretic used to eliminate water and salt from the body.

patient with AKI

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

 Therapeutic

·        Plenty of oral fluids and ORS is given to replace the fluids lost due to diarrhoea.

·        Antibiotics are used to treat serious infections.

patient with AKI

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

 Therapeutic

·        Lasix has been used to drain out excess fluid to treat edema. It is a potent diuretic used to eliminate water and salt from the body.

·        Shelcal [calcium supplement]

QUESTION 5

                  Due to this current pandemic, we are unable to appear directly, experience and communicate with patient but still  the general medicine department and Dr.Rakesh Biswas sir, HOD has made it possible by explaining every single case, capturing patient centred data and discussing it through various E-blogs making it informative and beneficial. The online classes especially the postings would have been better offline and gratifying to meet the patient in person rather than virtually, but under these circumstances this have been a better option for getting clinical exposure. This is one of the great opportunities to grab knowledge forthcoming. This assessment helped me learn basics of clinical practice from history taking to writing case sheets.

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