General medicine - Assignment

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Bimonthly assignment -


July 2021





Singareddy Manasa
3rd semester
Roll no. - 126


The link to the questions of assignment :

Question - 1

Link to answer paper written by my peer of roll no. 127 about which I am sharing my review 


My review 

     • Answer - 1
             My Friend has written about 10 cases on which our seniors had done an assignment. He gave brief analysis of all the cases but he didn't review the answers written by our seniors like we were asked to

    • Answer - 2 
            An E - log was done by him about a 48yr old male patient diagnosed with altered sensorium secondary to meningoencephalitis. The e - log was prepared very nicely under all the required side headings. Reports of the investigations that were done are attached to the e-log for clear presentation and understanding of the reader. The identify of the patient is not revealed which is a very important and helps maintain patient confidentiality.

     • Answer - 3 and 4
             The case was briefly described. The diagnosis of the case was clearly explained by him based on the investigation reports. How and why was that particular treatment was presecribed is was also mentioned clearly. 

    • Answer - 5 
            He mentioned few points about how he feels about the way we are learning . He also voiced his opinion on online classes and is excited for offline classes to take place soon like the rest of us.




Question - 2

         Sir, this month I have not yet got a chance to prepare an e-log. As soon as I get the chance, I will update it.




Question - 3

      Critical appraisal of the captured data in different aspects about the below cases


1) Case : 

       All the aspects of case presentation are there in it. It is complete with every thing needed from history taking to treatment and everything in between. It has a completeness and correctness. Only the required values of the investigations were mentioned so that the diagnosis could be easy and treatment can be done properly.


2) Case : 

        All details related to case are mentioned like history, general and systemic examinations, required investigations and their reports along with images wherever necessary and treatment. So there is completeness and correctness in the captured data. About leads to analyze the diagnosis, all the required investigation reports are posted in the form of images.


3) Case : 

        About completeness and correctness, history and examinations were clear but the investigations and treatment was not so clearly written. Images of investigation reports were added which helped in better understanding.


4) Case :

        Complete history about the illness and previous treatment was given. The whole e-log has a completeness and correctness. Every thing was explained chearly. Images of investigation reports and images of patient giving severity of the condition were inserted concealing patient identity. Every day follow up of the patient was mentioned.

 
5) Case : 

        The e - log is complete with all the required information presented correctly so as it can be understood easily. It includes pictures of investigation reports and ultrasound videos which definitely make the case more explainable. Provided useful leads to analyze.


6) Case : 

        There is a completeness is the e-log that includes all the aspects of case along with log of previous admission of the patient.  Radiographs, investigation reports and urine color images are added that gives a better understanding of the case.


7) Case :

         About completeness and correctness, history of present and past illness, general amd systemic examinations were covered. Related Images about the investigations done were inserted. About useful leads to analyze, all the required aspects for diagnosis and treatment were highlighted making it easy.


8) Case : 

         The history writing was fine but the examinations were not properly mentioned. Diagnosis of the case was also not mentioned.
The discharge summery could have been better understood if written in points and side headings than pionts. All the required images were inserted in the e - log.


9) Case :  

         About completeness and correctness, history, general a and systemic examinations were clearly covered. Diagnosis and treatment were also mentioned clearly and updated depending upon the progress of the patient.  Useful leads to analyze were also provided.


10) Case : 

         Complete history about the illness and previous treatment was given. The whole e-log has a completeness and correctness. Every thing was explained chearly. Treatment chart was updated regularly. Useful leads to analyze the case were also provided.


11) Case : 

          All the aspects of case presentation are there in it. It is complete with every thing needed from history taking to treatment and everything in between. It has a completeness and correctness. Only the required values of the investigations were mentioned so that the diagnosis could be easy and treatment can be done properly.




Question - 4

Preparing a problem list for each of the patients in the below cases and discussing the diagnostic and therapeutic reasons around these problems


1) ACUTE KIDNEY INJURY 

Case link :  

 Case overview : It is a case of a 58yr old male patient with Chief complaints of lower abdominal pain, burning micturation, low back ache after lifting weight, dribbling and decrease in urine output, fever and shortness of breath, all since one week.
  • K/c/o hypertension
  • Loss of appetite
  • Irregular bowels
  • Alcoholic
  • On examination tenderness is seen in right iliac fossa
  • Investigations showed uremia and increase in serum creatinine 
  • Decrease in total Leukocyte count
  • Presence of pus cells and epithelial cells in urine
Diagnosis : Acute kidney failure secondary to urinary tract infection associated with denovo diabetes mellitus 2
  1. IVF : RL and NS - AKI causes build of waste products in body and makes it harder for kidenys to keep the right balance of fluid in body. This solution helps in replacing fluilds and electrolytes.
  2. Injection TAZAR contains two antibiotics namely, piperacillin and tozabactam. Piperacillin inhibits bacterial cell wall formation which is essential for the survival of bacteria. Tozabactom prevents bacteria from gaining resistance against piperacillin.
  3. THIAMINE injection - the provision of thiamine in patients with sepsis may reduce the incidence and severity of sepsis related AKI and further preventing the renal failure
  4. Injection human actrapid(HAI) solution is a short acting insulin used for type 1 and 2 diabetes mellitus.
  5. Syrup LACTULOSE is used mainly to treat constipation.


2) ACUTE ON CKD (CHRONIC KIDNEY DISEASE)
   
Case link : 

Case overview : It is a case of a 75yr old male patient with chief complaints of low backache, dribbling of urine and increased  involuntary movements of both upper limbs - since 10 days, pedal edema and shortness of breath since 3 days     
  • Dyspnoea  - grade 4
  • Slurred speech
  • Power is 4 on left upper and lower limbs
  • Tone is increased in left lower limb
  • Investigations showed uremia, hyperuricemia and increase in serum creatinine.
  • Increase in total leukocyte count
  • Decrease in hemoglobin percentage
  • Urine examination showed presence of pus cells
  • Bacterial culture of blood cells showed staphylococcus growth
 
Diagnosis : Acute kidney failure (intrinsic), hyperuricemia 2° to kidney failure, uremia induced tremors, Delerium 2° to septic / uremic encephalopathy
        Grade 1 L4/L5 multifocal infectious spondylodisctis

  1. Injection TAZAR contains two antibiotics namely, piperacillin and tozabactam. Piperacillin inhibits bacterial cell wall formation which is essential for the survival of bacteria. Tozabactom prevents bacteria from gaining resistance against piperacillin.
  2. LASIX injection is a diuretic used to treat fluid retention (edema) in high blood pressure, congestive heart failure or kidney disorders.
  3. SALBUTAMOL nebulizer is a solution used to treat chronic bronchiospasm and severe acute asthma. In this case to treat SOB.
  4. PCM 650mg tablet is an antipyretic and is used to treat moderate pain of different kinds. Is considered as safest pain killers for kidney  disease patients.
  5. FOLEY CATHETER is used to treat urine problems. It is a flexible tube that can be passed through the urethra and into the bladder to drain urine. Insertion of catheter into the the bladder is called catheterization.
  6. Tablet FEBUXOSTAT decreasees the amount of uric acid made in the body. So it is used to prevent gout attacks but it is not to treat gout once it occurs.


3) CHRONIC KIDNEY DISEASE

Case Link : 

Case overview : It is a case of a 49yr old female with chief complaints of generalized weakness since 20 days and vomitings since 3 days.
  • Loss of appetite
  • Restricted movement in the right wrist joint
  • Pallor is present
  • Haemogram showed dimorphic anemia
  • Investigations showed uremia and increase in serum creatinine
  • Serum electrophoresis showed M - band in gamma region
  • Bone marrow aspiration showed plasma cell dyscaria
Diagnosis : Chronic kidney disease - Chronic interstitial nephritis secondary to plasma cell dyscariasis (Multiple myeloma - 70% plasmacytosis)

  1. T PAN 40mg is a medicine that reduces the amount of acid produced in the stomach. It is commonly used for the treatment of gastro-oesophageal reflex disease, heat burn and stomach ulcers.
  2. T ZOFER 4mg is usually used to treat nausea and vomiting
  3. Oral fluids and protein are given to build up strength and reduce weakness
  4. Iron supplementation to treat anemia once gastritis is solved
  5. TAB NODOSIS is an antacid tablet. It used to treat acid indigestion, heart burn and gas.
  6. OROFER - XT increases the red blood cell and hemoglobin production in the body, thy helps in treatment and prevention of different types of anemia


4) DIABETIC KETOACIDOSIS WITH AKI 

Case link : 

Case overview : It is a case of a 35yr old female with chief complaints of back ache with abdominal pain and chest pain 5 days ago, fever and diarrhea (4-5 times a day with blood in discharge) since 5 days.
  • K/c/o DM since 3years 
  • Unconscious but before loosing consciousness complained of severe breathlessness and chest pain
  • General random blood sugar - 580mg/dl
  • In the state of altered sensorium 
  • Pallor is present
Provisional diagnosis : Diabetes ketoacidosis with acute kidney failure and pyelonephritis

  1. NORAD 2amp injection is used to treat hypotension that may occur due to sepsis.
  2. PIPTAZ 2.25gm injection is used in the treatment of urinary tract infections, intra abdominal infections, skin and soft tissue infections and some other infections.
  3. DOPAMINE 2amp injection - used to treat conditions that occur in shock like heart attack, trauma, kidney failure etc. It usually helps to improve the pumping strength of the heart and therefore improves blood flow to kidneys.
  4. Injection human actrapid(HAI) solution is a short acting insulin used for type 1 and 2 diabetes mellitus.
  5. VANCOMYCIN injection is used to treat serious infections.


5) INFECTIVE ENDOCARDITIS WITH AKI

Case Link : 

Case overview : It is a case of a 52yr old male patient with chief complaint of abdominal distention for the past 7 days
  • K/c/o DM 
  • Constipation and not passed stools since 5days
  • Pedal edema grade 2 
  • Alcoholic
  • Icterus is present
Diagnosis : Infective endocarditis with acute renal injury and uremic / septic encephalopathy and alcoholic liver disease

  1. MONOCEF 1mg is an antibiotic that is used to treat various bacterial infections brain, abdomen, urinary tract etc.
  2. VANCOMYCIN 500mg is also used to treat various bacterial infections that cause watery or bloody diarrhea.
  3. Procto clysis enema - sodium phosphate -- a saline laxative is used to relieve occasional constipation.
  4. AGUMENTIN 1.2gm injection is penicillin type of antibiotic of infections.
  5. ECOSPRIN 150mg is an antiinflammatory and analgesic. It is a blood thinner and reduces the risk of blood clotting in blood vessels thus preventing heart attacks.


6) AKI 2° TO UROSEPSIS

Case Link : 

Case overview : It is a case of a 52 yr old male with chief complaints of fever since 4 days and pus in urine
  • TURP
  • K/c/o DM since 5years
  • Decreased appetite and increased frequency of bladder
Diagnosis : Renal AKI 2° to urosepsis with b/l
hydroureteronephrosis, diabetic nephropathy with anemia 2° to CKD with grade 1 bed sore.

  1. PIPTAZ injection is used in the treatment of urinary tract infections, intra abdominal infections, skin and soft tissue infections and some other infections.
  2. LASIX injection is a diuretic used to treat fluid retention (edema) in high blood pressure, congestive heart failure or kidney disorders.
  3. OPTINEURON injection is a combination of nutritional supplememts to treat nutritional deficiencies as well as B12 deficiencies.
  4. NEOMOL injection 2ml is an antipyretic and also belongs to group of mild analgesics.
  5. PCM 650mg tablet is an antipyretic and is used to treat moderate pain of different kinds. Is considered as safest pain killers for kidney  disease patients.


7) CHRONIC RENAL FAILURE ( CRF )

Case Link : 

Case overview : It is a case of a 48 yr old male with chief complaint of  shortness of breath since 1 week.
  • K/c/o DM and hypertension since 7 years
  • Irregular bowel movements
  • Edema of feet present
  • Dyspnoea
Diagnosis : Chronic renal failure, HFrEF 2° to coronary artery disease

  1. BISOPROLOL 5mg tablet belongs to group of beta blockers. It I used to treat high blood pressure.
  2. NITROHART tablet is a vasodilator. It is composed of two medicines namely isosorbide dinitrate and hydralazine. It is used to treat heart failure.
  3. NICARDIA XT 30mg tablet is a calcium channel blocker. It lowers the blood pressure and reduces the work load of the heart, thus it used in the treatment of high blood pressure and to prevent angina.
  4. GLICLAZIDE 80 mg tablet increases the amount of insulin released by the pancreas and helps the body to use insulin more efficiently, thus used in the people with type 2 DM.
  5. NODOSIS 500mg tablet is used to treat acid indigestion, heart burn and gas.


8) ACUTE ON CKD

Case link  : 

Case overview : It is a case of a 60yr old female with chief complaints of pedal edema and decreased urine output since 3 days.
  • Putting edema progressed to anasarca
  • Vomiting since 5 days 
  • Loose motions - 5 days ago
  • History of pneumonitis and episodes of SOB
Diagnosis : pneumonitis and acute on Chronic kidney disease

  1. PAN 40mg tablet
  2. LASIX 80mg injection
  3. THIAMINE 200mg
  4. LEVOCET 5mg tablet is an antihistamine. It is used to relieve allergy symptoms.


9) AKI 2° TO GASTROENTERITIS

Case link :

Case overview : It is a case of a 43yr old male with chief complaints of loose stools, pedal edema and abdominal distention , all since 20 days
  • H/o TB 3years back and jaundice 2yrs back
  • Alcoholic
  • Pallor is present
  • Dilated veins seen on abdominal inspection
Diagnosis : AKI 2° to acute gastroenteritis, alcoholic hepatitis, alcohol and tobacco dependence syndrome

  1. THIAMINE 100 mg injection
  2. LASIX injection 40mg
  3. ALDACTONE 50 mg tablet prevents the body from absorbing too much salts and helps to keep pottasium levels from getting too low
  4. METROGYL 400mg injection - antibiotic used to treat various infections caused by bacteria and parasites. Used in the treatment of diarrhea caused by microorganisms
  5. CIPROFLOX 500mg injection - antibiotic used to treat bacterial infections of urinary tract, nose throat and lungs ( pneumonia)


10) AKI 2° TO UROSEPSIS

Case link :

Case overview : It is a case of 60 yr old female with chief complaints of pedal edema, decreased urine output and fever, all since 10 days 
  • K/c/o DM
  • Burning micturition 
  • Pallor present
  • Edema - pitting type 
Diagnosis : AKI 2° to urosepsis with anemia of chronic disease

  1. LASIX 40mg injection
  2. MAGNEX FORTE 1.5 gm injection - used to treat bacterial infection of ear, throat, lung and urinary tract
  3. NODOSIS tablet is used to treat acid indigestion, heart burn and gas.
  4. OROFER XT tablet is used for treatment of anemia, folate deficiency and iron deficiencies.
  5. HAI injection


11) ACUTE PANCREATITIS WITH AKI

Case link : 

Case overview : It is a case of a 31 yr old male with chief complaints of pain in abdomen and vomiting since 2 weeks and SOB since 2 days.
  • Alcoholic
  • Pitting type pedal edema
  • Tremors present
  • Tenderness in epigastric and hypogastric regions of abdomen
Diagnosis : Acute Pancreatitis with AKI , b/l pleural effusion and moderate ascitis

  1. LASIX 40mg injection
  2. NODOSIS tablet
  3. PIPTAZ injection is used in the treatment of urinary tract infections, intra abdominal infections, skin and soft tissue infections and some other infections
  4. NICARDIA tablet - has nifedipine as an active part in this medicine. It is used to decrease the blood pressure.
  5. 25% DEXTROSE 100ml





QUESTION - 5


       In competency based medical education reflection reflective logging of ones own experience is very important.

       Online learning is going good so far but offline experience of clinical postings would be much better. In the online classes, we are trying to interact with the patient under the guidance of our HOD sir. 
    
       We learnt to understand e-log and prepare them based on information of patient and everything related to that case as in history, examinations and investigations, related reports etc.
  
        We are also doing monthly assignments that are helping us understand different aspect of disease, like this month assignment I'd completely focused on chronic and acute kidney diseases. This gives us chance to explore the disease more.

        In these assignments along with above mentioned aspects we also get to see our peers assignment and review them. In that way we can know each others mistakes and learn from them.
 
        I want to thank sir for this assignment which gave us an opportunity to learn more.












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