GENERAL MEDICINE ASSIGNMENT [AUGUST 2021]

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 VIJAYA RATNA DANDE 34


                                                BIMONTHLY ASSESSMENT - AUGUST 2021

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

This blog is made in response to following question

Refer to the link below regarding the assessment

QUESTION 1 

Peer to peer Review

https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

LONG CASE 

        Quantitative marking : 10/10

        Qualitative insight 

    The summary of the case is clear and easy to understand.All the relevant information and examinations has been organized so well that it enhances the reader to find out more.All the essential investigations has ben done and elaborated.Upon general exmination,pedal edema was eye catching and noticeable.Clinical examination was thorough and in detail with images.A clear description of rheumatoid arthritis along with pictorial representation was given.The diagnosis has been emphasized properly.The diagnostic approach is comprehensive and the studies has been compared in relation with other countries.It's impressive.Four possible scenarios were mentioned useful to likely make dignosis.The causes of acute glomerulopathy and features to look for was distinct.Overall, the blog is well organized.

Pedagogic Questions

Sub question 1 :- The differences has been related very clearly 

Sub question 2 :- Elucidated in tabular form.Each intervention was in detail.

Sub question 3 :- Could have added theortical analysis instead of only uploading a journal which makes  it difficult to search the answer for given question.

Sub question 4 :- Could have explained it in more detail.

Sub question 5 :- Clear cut.


SHORT CASE 1 

        Quantitative marking : 9/10

        Qualitative insight 

    A 49 years old presented with progressive asymmetric involuntary movements and diagnosed as Idiopathic Parkinson's disease stage 1 with Denovo HTN.The summary of the case is well formatted with all required details.All the necesssary information has been taken in detail.Immunization history is alo mentioned.The general examination and vitals are accurate.Systemic examination has also been presented comprehensively.Nervous system examination is thorough and well presented.Could have shared the images of restricted movements of joints while writing,it would have been much better.Overall, the blog is impressive.


SHORT CASE 2

        Quantitative marking : 10/10

        Qualitative insight

    The summary is well presented with all the necessary details.The history taking was very well done.Allergy history mentioned.The general examination,vitals and systemic examination are thorough.Investigations are updated every day.

Provisional diagnosis - Iatrogenic Cushing's Syndrome

                                                    Tinea corporis

                                                    Denovo HTN

Treatment was appropriate.The striae one year ago and recent image of striae are uploaded ; very well done.The blog is remarkable. 


QUESTION 2 

Problem Solution List

LONG CASE

Patient's problem                                                     

Generalized edema

Facial puffiness

Dilutional Hyponatremia

Decreased urine output

Hyperuricemia

Pain in finger joints and wrist

Sub cutaneous swellings in the proximal joints of fingers

Erosive Rheumatoid arthritis

Burning sensation in eyes with increased tearing


Solution 

Free water restriction for hyponatremia to treat edema

                Hyponatremia in presence of edema

indicates increased total body sodium and water levels resulting in edema

Tab.Febuxostat for Hyperuricemia and pain in finger joints and wrist

Tab Prednisolone for Rheumatoid arthritis and inflammatory conditions


Treatment

Free water restriction for hyponatremia

Tab Predisolone P/O 20mg OD

Tab Febuxostat P/O 80mg OD

Haemodialysis for worsening renal dysfunction


SHORT CASE 1


Patient's problem

Stiffness

Slowness of movements

Involuntary movements rhythmic to and fro oscillations

Hypertension


Solution 

Tab Syndopa Plus for stiffness and involuntary movements

Tab Telma for Hypertension


Treatment

Tab Syndopa Plus 125mg QID

Tab Syndopa 125mg CR OD

Tab Telma 40mg OD


SHORT CASE 2


Patient's problem

Itchy ring lesions

Pedal edema

Facial puffiness

Purple stretch marks

Abdominal distension

Low back ache

Hypertension

Feeling low

Weight gain

Low cortisol levels


Solution

Inj Actom prolongatum for low cortisol levels

Tab Telma for hypertension

Tab Hizone for hypertension,anxiety etc

Saline compress and antifungals for itchy ring lesions


Treatment

Ointment Amorolfine

Fusidic acid cream

Saline compress over lesions

Tab Hizone 10mg/day

Tab Telma 40 mg OD

Tab Shelcal 500 OD

Tab Vit D3 OD

Tab Ultracet/PO/SOS

Inj Actom prolongatum 0.4ml IM



QUESTION 3

Therapeutic  and Diagnostic Interventions


LONG CASE

Therapeutic interventions

Free water restriction for hyponatremia to treat edema

Tab Predisolone helps to reduce inflammation

Tab Febuxostat used to treat hyperuricemia


Diagnostic interventions 

ECG : used to check hearts rhythm and electrical activity .

Urine microscopy : useful diagnostic tool which meets all the   requirements that can be made of an ideal prognostic test. 


SHORT CASE 1

Therapeutic interventions

Tab Syndopa plus 125 mg QID used to treat the symptoms of parkinson's disease like tremors,stiffness and slowness of movements,poor muscle control.

Tab Syndopa 125mg CR OD - antiparkinson agent

Tab Telma used to treat hypertension


Diagnostic interventions 

2D Echo : used to see the actual motion of the heart structure.



SHORT CASE 2

Therapeutic interventions

Ointment Amorolfine - anti fungal

Fusidic acid cream used to treat bacterial infections

Tab Telma used to treat hypertension

Tab Hizone used to treat symptoms of skin allergy like itching,swelling and rashes

Tab Shelcal and Tab Vit D3 for calcium and Vit D deficiency

Tab Ultracet - pain relieving medicine

Inj Actom prolongatum - used to diagnose problems with adrenocortical function


Diagnostic interventions 

CBP : it is done as a routine screening test, when there are signs and symptoms related to the conditions that effect the blood cells. 

USG abdomen : it is used to look at organs in the abdomen , including the liver, gallbladder, spleen, pancreas, and kidneys. 

RBS : A random blood sugar test is the testing of the blood sugar level at any time or random time of the day.

RFT : useful to assess the renal function. 



QUESTION 4

Own Case Report

https://34vijayaratnadande.blogspot.com/2021/08/general-medicine-e-log-2.html



QUESTION 5 

Reflective Writing


    It's been a great experience taking my first patient's history via tele-communication in the lockdown and I have learned how to take history and communicate with the patient.

At first,it was challenging taking the history of the patient as I didn't have clear understanding on taking history in reality,but later my seniors helped me through and it became easy considering my mistakes and not repeating it next time.I learned how to frame the questions and practiced it verbally and became composed facing in person this time.Overall,it's been a good experience and I thank Dr.Rakesh Biswas sir [HOD] and the general medicine department for giving us this oppurtunity.






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