QUESTION 1 Competency tested for Peer to peer review and assessment
https://vaishnavimanga.blogspot.com/2021/07/77-vaishnavi-manga.html.
1) Peer review is done on 10 neurology cases. Cases selected are well interesting . All the investigation pattern and line of treatment is explained precisely keeping around minimizing the presented symptoms with the underlying cause.
2) E-log in that assignment is not available.
3) Two cases are mentioned there. Both are properly reviewed and concluded.
Patient data has be deidentified and privacy is marked. Clearly explained about diagnosis, investigations with line of treatment.
4) Problems are clearly mentioned with its solutions and line of treatment.
all the drugs are mentioned appropriately in accordance to the presenting syptoms.
mechanism of action of drug is not mentioned
5) Crystal clear and non fabricated experience is presented highlighting the hardships of pandemic and asynchronized communication.
QUALITATIVE ASPECT
1) 3/5
2) N/A
3) 3.5/5
4)3/5
5)5/5
QUESTION 2
A CASE OF HEPATIC ABSCESS PRESENTED IN SUMMER 2021 (asjad24.blogspot.com)
QUESTION 3
CASE 1
Review is done to the best of my understandings.
https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
Patient came to casualty with chief complaints of:
Lower abdominal pain: 1 week
Burning micturation:1week
Decrease of urine out put:1week
Fever :1 week
SOB , rest :1week
With no H/O chest pain, palpitations, pedal oedema, facial puffiness.
K/C/O - HTN: 1 year (not on medication)
N/K/C/O- DM-2
Burning micturation and -fever signifies UTI
TLC-13,100
Serum creatinine: 5.9 mg/ dl
Blood urea: 128 mg/ dl
- plenty of pus cells (>10/HPF) seen
-culture report: Polymicrobial flora
- AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.
-mild hepatomegaly with Grade-1 fatty liver
-With K/C/O - HTN exaggerated the condition
PROVISIONAL DIAGNOSIS :
acute kidney injury secondary due to UTI(positive urine culture with increased total count)
as creatinine and urea level lowers just by using antibiotics(without dialysis)
AKI can also be attributed to no medication for HTN
hepatomegaly can be attributed due to regular alcohol intake
RT heart failure cant be put into diagnosis with proper investigations like ECG as physical CVS examination is normal
Answers are well presented outlining the physiology behind the symptoms.
Although this E-log is not updated.
CASE 2
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
dribbling of urine since 10days
• Pedal edema since 3days
• SOB at rest since 3days
• Bilateral pedal edema ( R >L)
• Left upper limb edema
personel history and drug history is mentioned
probable diagnosis
ARF
infective spondylitis(increased total count and X ray) hyperuricemia causing pain
tremors due to uremia
use of antibiotics can resolve the condition
use of ultracet should be avoided as it can exaggerate the ARF.
The physiological reasons and drug interventions are neatly outlined.
CASE 3
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
She is using NSAID for long term . This can also be probable cause of CKD.
Urine output - Normal
No fatigability , pedal edema
No SOB , facial fluffiness , yellowish discoloration of stools
- pallor ++
SERUM CREATININE : 6.6 mg/dl
BLOOD UREA : 120mg /dl
M band detected due multiple myeloma
CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma
The case is well presented and precisely structured but it needs to be updated
Chief complaint is not mentioned separately
CASE 4
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
Type 2 Diabetes 3 years
severe breathlessness and pain in the chest region.
GRBS(general random blood sugar) was 580mg/dl
- Unconscious / altered
- Speech no response
- No signs of meningeal irritation
- GCS (coma scale) :E 3 V 4 M 5 ( before arrest )
- After arrest E 1 V T M1
- Provisional diagnosis: DKA with AKI ( ? Pre renal)
The ELOG is more specific and accurate.
Case is explained best of the understanding.
CASE 5
A 52-year-old man presented to the OPD with Chief Complaints of abdominal distension from the past 7 days.
Tingling in the upper limbs up to the palms, in the lower limbs up to the knee.
Abdominal Distension NOT associated with pain, No nausea, No Vomiting, No loose stools and was diagnosed with
pedal edema grade 2
FINAL DIAGNOSIS:WITH ?UREMIC ENCEPHALOPATHY
WITH AKI
WITH HYPOALBUMINEMIA ?
Evaluation is proper but needs better presentation of case.
Treatment mentioned is well established
CASE 6
COMPLAINTS
Fever
Pus in urine
k/c/o DM 2
Treatment mentioned is well established and elaborated but adverse effects should be there for wide array of comprehension.
CASE 7
Shortness of breath grade - II
- Diabetes Mellitus from the past 7 years
- Hypertension from the past 7 years
- Edema of feet present
PROVISIONAL DIAGNOSIS - HFrEF secondary to CAD; CRF
ELOG is briefly structured and providing the evolutionary timelines.
CASE 8
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
COMPLAINTS
Pedal edema
Decreased urine
Elog is precisely outlined describing the proper prognosis and and diagnosis.
CASE 9
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1A 43 yr old male came to casuality with chief complaints of
- loose stools since 20 days
- Pedal edema since 20 days
- Abdominal distension since 20 days
- AKI SECONDARY TO ACUTE GASTROENTERITIS
Any identifiers such as address of the patient should not be mentioned.
Allergic history should also be mentioned.
CASE 10
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
Pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.
Elog is perfectly structured showing day wise parameters needful in improving the patient care and in closely monitoring the prognosis of patient
CASE 11
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
31 yr male farmer by occupation came with c/o
pain in abdomen since a week
Vomiting since a week
Sob since 2 days.
SOB since 2 days
Any identifiers such as address of the patient should not be mentioned.
Over all elog is perfectly structured making the patient more efficient.
QUESTION 4
Case 1
https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
COMPLAINTS
Lower abdominal pain.
Burning micturation.
Lower back ache after lifting weights.
Dribbling / decrease of urine output.
Fever.
SOB at rest
INVESTIGATIONS
X-ray of pelvic region to rule out any fractures or age related bone erosion.
RFT to check for the functional viability of kidney
Hemogram to rule out any blood infection and anemia .
CUE and bacterial sensitivity test to rule out UTI .
USG abdomen for ruling out any organ abnormality and fluid accumulation.
TREATMENT
INJ.TAZAR 2.25gm IV/ TID- Azithromycin is an antibiotic used to treat UTI.
SYP LACTULOSE 15ml PO/TID-Lactulose is a type of sugar used to treat constipation. It’s known as a laxative and makes your stool easier to pass by drawing water into your bowel.
Case 2
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
COMPLAINTS
Lower back ache
Dribbling of urine
Pedal edema
SOB at rest
Increased involuntary movements of both upper limbs
INVESTIGATIONS
ECG to rule out any cardiac dysfunction .
RFT to check for the functional viability of kidney.
CUE to rule out hematuria or albuminuria and urosepsis.
Hemogram to rule out any blood infection or anemia.
Serum electrolytes to rule out electrolyte imbalance secondary to AKI
USG Abdomen for ruling out any organ abnormality and fluid accumulation
MRI brain to rule out any neural damage causing involuntary movements
TREATMENT
Inj. PIPTAZ 2.25gm -I.V -TID Piperacillin+Tazobactum is a combination of two antibiotics. It is used to treat various types of bacterial infections. It fights against the infection by killing the microorganisms.
Inj.Lasix 40mg I.V -BD diuretics to reduce the swelling (edema) caused by too much water
Case 3
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
COMPLAINTS
Generalized weakness
Vomiting
Pallor present
INVESTIGATIONS
RFT to check for the functional viability of kidney
CBC to rule out any blood infection , anemia and cause of anemia.
Since iron and vitamin B-12 are normal still there is persisting anemia then bone marrow aspiration is done to rule out bone marrow suppression.
TREATMENT
T. PAN 40mg /PO / OD Pantoprazole is a medicine that reduces the amount of acid produced in your stomach.
T. ZOFER 4mg / PO /SOS Anti emetics .Ondansetron is a medicine used to prevent you from feeling or being sick (nausea and vomiting)
Case 4
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
COMPLAINTS
Fever and Diarrhea
Back pain
Abdominal pain
Chest pain.
Unconscious
Altered Sensorium
INVESTIGATIONS
2D echo to check for cardiac abnormalities which can be a cause of chest pain.
ABG to check for metabolic abnormalities like acidosis and alkalosis.
Complete blood picture to rule out any blood infection, anemia and cause of anemia.
Liver function tests: to rule out liver dysfunction
RFT to check for the functional viability of kidney
TREATMENT
Inj. NORAD 2amp in 50ml NS Norepinephrine is used to treat hypotension (low blood pressure) that may occur due to causes such as sepsis (infection). It helps to increase blood pressure by narrowing the blood vessels of the heart.
Inj. PIPTAZ 2.25gm.Piperacillin+Tazobactum is a combination of two antibiotics. It is used to treat various types of bacterial infections. It fights against the infection by killing the microorganisms.
Inj. DOPAMINE 2amp in 50ml for inotropic effects
Case 5
COMPLAINTS
Abdominal distension
Constipation
Pedal edema grade 2
INVESTIGATIONS
Complete blood picture to rule out any blood infection, anemia and cause of anemia.
Liver function tests: to rule out liver dysfunction
RFT to check for the functional viability of kidney .
2D echo to check for cardiac abnormalities which can also cause edema
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
USG Abdomen for ruling out any organ abnormality and fluid accumulation.
Bacterial sensitivity test to rule out UTI
TREATMENT
Inj. Monocef 1gm IV/BD Ceftriaxone is an antibiotic medicine used to treat bacterial infections in your body. It is effective in infections of the brain, lungs, ear, urinary tract.
Inj. Vancomycin 500mg IV/BD in 100ml NS Vancomycin is an antibiotic used in the treatment of severe bacterial infections in hospitalized patients. It is effective against infections of the respiratory tract (eg. pneumonia), urinary tract, over 1hr both are antibiotics for treating urosepsis
Procto clysis enema for constipation
Maintenance Hemodialysis. for removal of excess fluid and metabolic wastes
Case 6
COMPLAINTS
Fever
Pus in urine
k/c/o DM 2
INVESTIGATIONS
Complete blood picture to rule out any blood infection, anemia and cause of anemia.
RFT to check for the functional viability of kidney ,
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
ABG to check for metabolic abnormalities
TREATMENT
tab pcm-antipyretics for reducing body temp.
pantop 40-preventing s/e of pcm
optineuron - preventing vit b12 deficiency and curing anemia
Case 7
COMPLAINTS
Shortness of breath grade - II
Edema of feet present
INVESTIGATIONS
Hb1ac - for monitoring the control of diabetes
ESR-for figuring out any inflammation
Complete blood picture to rule out any blood infection, anemia and cause of anemia
RFT to check for the functional viability of kidney ,
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
Liver function tests: to rule out liver dysfunction
USG for ruling out any organ abnormality and fluid accumulation, in either peritoneal cavity or
pleural cavity
2D echo to check for cardiac abnormalities which can also cause edema
ECG to rule out any cardiac dysfunction
ABG to check for metabolic abnormalities like acidosis or alkalosis
TREATMENT
TAB. BISOPROLOL 5mg OD Bisoprolol belongs to a group of medicines called beta-blockers. It is used to treat high blood pressure
TAB NICARDIA XL 30mg OD Nifedipine is a medicine used to treat high blood pressure (hypertension) and to prevent angina
TAB. GLICIAZIDE 80mg BD Gliclazide is a medicine used to treat type 2 diabetes mellitus in adults.
TAB. NODOSIS 500 mg TD treatment of metabolic acidosis
Cap. GEMSOLINE OD supplement for calcium, vitamin D and zinc deficiency.
TAB.LASIX 40mg BD diuretics to reduce the swelling (edema) caused by too much water
Case 8
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
COMPLAINTS
Pedal edema
Decreased urine output
Complete blood picture to rule out any blood infection, anemia and cause of anemia.
Liver function tests: to rule out liver dysfunction
RFT to check for the functional viability of kidney .
2D echo to check for cardiac abnormalities which can also cause edema
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
USG Abdomen for ruling out any organ abnormality and fluid accumulation.
Bacterial sensitivity test to rule out UTI
TREATMENT
- Inj LASIX 40 mg IV/TID 1 -1 - 1 diuretics to reduce the swelling (edema) caused by too much water
- T. PAN 40mg /PO / OD Pantoprazole is a medicine that reduces the amount of acid produced in your stomach.
Case 9
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
COMPLAINTS
Loose stools
Pedal edema
Abdominal distension
INVESTIGATIONS
Complete blood picture to rule out any blood infection, anemia and cause of anemia
RFT to check for the functional viability of kidney
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
ABG to check for metabolic abnormalities
CUE to rule out urosepsis, glycosuria, hematuria
X RAY chest pa-to rule out any chest congestion and pulmonary hypertension
Liver function tests: to rule out liver dysfunction
USG Abdomen for ruling out any organ abnormality and fluid accumulation,
TREATMENT
PLENTY OF ORAL FLUIDS and ORS- for fluid replacement compensating fluid loss in diarrhea
INJ.METROGYL 400mg /IV/TID antibiotic and anti-parasitic for controlling loose stools
INJ .CIPROFLOX 500mg /IV//OD antibiotics
INJ.OPTINEURON 1ampin 100ml NS IV/OD combination of nutritional supplements that is prescribed to treat nutritional deficiency
TAB .SPORLAC DS PO/TID composed of lactic acid bacilli that bear spore probiotic used to treat diarrhea caused due to infections, antibiotics, etc.
Case 10
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
COMPLAINTS
Chief complaints of pedal edema
Decreased urine output
Fever
INVESTIGATIONS
RFT to check for the functional viability of kidney
CUE to rule out hematuria or albuminuria
Hemogram to rule out any blood infection and anemia
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
ABG to check for metabolic abnormalities like acidosis or alkalosis
TREATMENT
Case 11
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
COMPLAINTS
Pain in abdomen
Vomiting
SOB .
INVESTIGATIONS
CUE to rule out hematuria or albuminuria
Hemogram to rule out any blood infection and anemia
Serum electrolytes, to rule out electrolyte imbalance secondary to AKI
USG for ruling out any organ abnormality and fluid accumulation in either peritoneal cavity or pleural cavity
RFT to check for the functional viability of kidney
TREATMENT
Lasix 40 mg BD . diuretics to reduce the swelling (edema) caused by too much water
Zofer antiemetic medicine commonly used to control vomiting
QUESTION 5
The current situation of COVID-19 pandemic has posed challenges in all quadrants of our lives, majorly the healthcare and education sector.
However, today's digital era has emerged has a powerful medium to support both education and provide healthcare services in our country.
The online connects with Faculty, Patients and the Hospital Wards and ICU have indeed provided with lot of exposure and learning in a very short
span of 2 hours bi-weekly.
The assignment has really helped me to enhance my knowledge on the Clinical aspects of MBBS curriculum. I got an opportunity to personally
go through on Patient's medical condition, associated drugs and intervention required.
I am grateful to HOD sir for providing mw with this valuable opportunity for patient-centered active learning.
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