General medicine (bimonthly assignment)25 July 2021
P Sai kiran (old batch)
Roll no 2 (3rd sem)
General medicine:-
BIMONTHLY ASSIGNMENT-JULY:-
I have been given the following assignment in an attempt to read,comprehend,analyze, reflect upon and discuss captured patient centered data.
This is the link of the questions asked regarding the case:
QUESTION 1:
Question 1: Competency tested for Peer to peer review and assessment :
Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :
and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.
My reviews on her e-log is as follows:
*She described her e-log in a very elaborate manner and made it more informative.
*A detailed pinpoint review has been given to each particular case selected, which is helpful in easy analysis.
*Regarding the review she made it very clear by adding pictures wherever necessary.
*She gave picturisation, prime importance and included pictures wherever needed
My reviews on her e-log is as follows:
*She described her e-log in a very elaborate manner and made it more informative.
*A detailed pinpoint review has been given to each particular case selected, which is helpful in easy analysis.
*Regarding the review she made it very clear by adding pictures wherever necessary.
*She gave picturisation, prime importance and included pictures wherever needed
Questions 2:-
Q2) Share the link to your own case report 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.
Question3:-
Q3) your discussion of that case.
Q3) (Testing peer review competency of the examinees) :
Acute on CKD :
Case1:-
Review:-
*This is e log perfect with good explanation
*It is has great patients history and examination
*It has good report collection work
* medication is perfect
CKD :
Case2:-
Review:-
*This is perfect for hemorrhoids case study
*This good in elaborated form of explaining
*With good report collection
*It has good medication history post surgery
Patient with coma and renal failure :
Case3:-
Review :-
*This is perfect for type 2 diabetes case study
*This good in elaborated form of explaining
*With good report collection
*It has good medication history post surgery
* It has very good effected area pictures for keen learners
*Diagnosis and treatment is good in explain
Case 4:-
INFECTIVE ENDOCARDITIS
WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR
WITH AKI
WITH ?UREMIC ENCEPHALOPATHY ? SEPTIC ENCEPHALOPATHY
WITH ULCER OVER SOLE OF RIGHT LEG
WITH HYPOALBUMINEMIA ? ALCOHOLIC LIVER DISEASE
WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES
* It has good case study of very problem
*It has good case report collection
*Perfect General and systamic examination
Patients with acute on CKD :
Case5:-
Good case collection:-
Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore
*IT has great history taking
*It has good examation
*This study has investigative diagnosis
Very good report collection
Case6:-https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
HFrEF secondary to CAD; CRF
* It has good case collection
* It has good collection of reports
* This has best history taking
Well presented
Case7:- shortness of breath and anasarca.
*It has need repots
*It has very picture collection
*It has perfect examination
Overall well done case
Patients with AKI :
Case8:-
Alcoholic Hepatitis and aki sec to gastroenteritis
*These case has perfect history taking
*If has good picture collection
With needed reports
* It has well done medication history post diagnosis
Case9:-Acute Kidney Injury secondary to Urosepsis
*It has good report collection of urine examation, ultrasound with perfect ecg
*It has good history taking
Well done treatment and diagnosis
*It has good post diagnosis medication history
Case10 :-
pancreatitis in a chronic alcoholic with AkI
*it has good case collection with ok past history taking
*It has good reports collection
*This case has medication history
Overall well done case
Question4:-
CASE 1:
Patient with low back ache and Renal Failure
AKI :
*Week back ,after weight lifting
Patient had sudden onset of pain abdomen
*By burning micturation with high fever : grade associated with chills and rigor
*Decrease urine output associated with SOB (grade -4)
*With no H/O chest pain, palpitations, pedal oedema, facial puffiness.
DIAGNOSIS:
☆Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2
TREATMENT:
1)IVF : -RL @ UO+ 30ml/hr
-NS
2)SALT RESTRICTION < 2.4gm/day
3)INJ TAZAR 4.5gm IV/TID
|
2.25gm IV/ TID
4)INJ PANTOP 40mg IV/OD
5)INJ THIAMINE 1AMP IN 100ml NS IV/TID
6)INJ HAI S/C ACC TO SLIDING SCALE
8AM - 2PM - 8PM
7)SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]
8) GRBS - 6th Hourly
9)BP/PR/TEMP - 4th hourly
10) I/O - CHARTING
CASE 2
Acute On CKD
COMPLAINTS:
• Lower backache since 10days
• dribbling of urine since 10days
• Pedal edema since 3days
• SOB at rest since 3days
• Increased involuntary movements of both upper limbs since 10days .
DIAGNOSIS:
Acute renal failure (intrinsic)
Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis
Hyperuricemia 2° to Renal failure
Uraemia induced tremors( resolved)
Delerium 2° to septic /Uremic encephalopathy (resolving)
TREATMENT:
22/7/21
• Inj. Ciprofloxacin 500mg-OD
• Tab.Febuxostat 40mg -OD
• Tab.Neurobion forte -OD
• Tab.pantop 40mg-OD
• Syp.mucaine gel 15ml -TID
• Limb elevation- Crepe bandage
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day
•Tab.Ultracet 1/2 tab.-QID
CASE 3 :
CKD
COMPLAINTS :
- Since 3 yrs she has history of muscle aches, for which she is using NSAIDs.
- She has h/o fever 20 days back, got treated in the local hospital, and
- Since 20 days she has generalized weakness.
- She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.
DIAGNOSIS:
Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
TREATMENT:
- T. PAN 40mg /PO / OD
- oral fluids upto 1.5 - 2 lit / day
- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk
CASE 4:
Patient with Coma and Renal Failure
COMPLAINTS:
➡Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).
➡Back pain( 5 days ago) with abdominal pain and chest pain.
DIAGNOSIS:
DKA with AKI
TREATMENT :
Day 12
Inj. MEROPENEM
Inj. FOSFOMYCIN
Inj. CLEXANE
CASE 5:
Patient with Coma and Renal Failure
COMPLAINTS:
➡From the past 7 Days, He Complains of Abdominal Distension.
➡From the past 5 days, he complains of Constipation and has not passed stools since 5 days.
➡He also complains of altered Sleep patterns from the past 5 Days
➡From the past 7 Days, He Complains of Abdominal Distension.
➡From the past 5 days, he complains of Constipation and has not passed stools since 5 days.
*He also complains of altered Sleep patterns from the past 5 Days
*He has hiccups since today morning
He also Complains of pedal edema grade 2
He has hiccups since today morning
He also Complains of pedal edema grade 2.
DIAGNOSIS:
INFECTIVE ENDOCARDITIS
TREATMENT:
Day 1:
1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
Day 2&3:
Same treatment followed
Day 4:
Same treatment followed except Inj. Monocef.
Inj. Augmentin 1.2 gm IV/TID
Tab. Ecospirn 150mg PO/HS/SOS
Tab. Clopidogrel 75mg PO/HS/SOS
Tab. Atorvas 20mg PO/HS/OD added
CASE 6 :
Patients with Acute On CKD
COMPLIAINTS :
Fever since 4 days
Pus in the Urine.
DIAGNOSIS:
➡Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore.
TREATMENT:
Injection PANTOP 40mg IV/OD
Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
Injection LASIX 40mg IV/BD
Injection optineuron 1AMP in 100ml NS slow IV/OD
Injection NEDMOL 100ml IV/SOS
Tab PCM 650mg TID
Insulin Human actrapid - 16 IU/TID
CASE 7
Patient With Acute on CKD
COMPLAINTS:
48-Year-old male presented to the OPD with chief complaints of Shortness of Breath grade -II from the past 1 week, which converted into grade -III-IV from the past 4 days
DIAGNOSIS:
HFrEF secondary to CAD; CRF
TREATMENT:
1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml
CASE 8
Patient with Acute on CKD:
COMPLAINTS:
*Pedal edema since 3 days.
*Decreased urine output since 3 days.
*H/o vomitings and loose stools 5 days ago lasted 3 days and subsided.
Diagnosis:-
Acute On CKD
Treatment:-
1. IV fluids
2. Tab. Pan 40 mg po OD
3. Inj. Lasix 80 mg IV BD
4. Thiamin 200 mg in 100 ml NS IV BD
5.Tab. Levocet 5 mg Po BD
6.Liquid paraffin for LIA
7.Grbs 6 th hrly
8.I/o charting, temp. Charting
CASE 9 :
Patients with AKI
COMPLAINTS:
⛤loose stools since 20 days
⛤ Pedal edema since 20 days
⛤ Abdominal distension since 20 days.
DIAGNOSIS:
⛤ALCOHOLIC HEPATITIS ,
⛤AKI SECONDARY TO ACUTE
⛤GASTROENTERITIS
⛤HFrEF SECONDARY TO CAD
⛤ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME.
TREATMENT:
⛤INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
⛤INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
⛤INJ LASIX 40 mg
⛤TAB. ALDACTONE 50 mg PO / BD
⛤INJ PANTOP 40 mg IV/ OD
⛤ABDOMINAL GIRTH MEASUREMENT DAILY
⛤BP /PR/TEMP/ RR -4 hourly
⛤I/O CHARTHING.
CASE 10 :
Patient with AKI
COMPLIANTS:
pedal edema bilateral and pitting type, with decreased urine output and burning micturition.
DIAGNOSIS:
Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease
TREATMENT:
.Inj-LASIX 40mg (8am- 2pm -8pm)
.IVF-NS @ UO + 50 ml/hr
CASE 11
Patient with AKI
COMPLAINTS:
pain in abdomen since a week
Vomiting since a week
Sob since 2 days.
DIAGNOSIS:
pancreatitis in a chronic Alcoholic.
TREATMENT:
Iv fluids : NS 40 ml /hr.
IV lasix 40 mg BD .
Tab Nodosis .
IV PIPTAZ 4.5 Gms. BD
Iv 25%Dextrose. 100 ml BD
Tab . Nicardia 10 mg TID.
Questions 5:-
Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month
🌟E log making helps was in improving knowledge of practice
🌟It is good for history taking learning
🌟with pandemic it is difficult to learn case without direct meeting with patients
🌟It is good for accessing for various case study
🌟 Hopefully in future it helps me to improve E log making
🌟We know patients have several options when choosing a health care provider. We would like to express our sincere appreciation for having had the chance to be yours. Which helps us in learning case with their co operation
Thank you
