GENERAL MEDICINE BLENDED ASSIGNMENT FOR AUGUST BY ASJAD ALAM ROLL NO. 78
ASSIGNMENT LINK
QUESTION 1:- Testing peer review competency in the active reader of this assignment
https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
LONG CASE :-
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
Case is well presented. and patient data has be deidentified and privacy is marked.
case history is taken beautifully precisely taken including social ,educational and sugical history which is way too essential to understand the socio economic back ground of the patient and helpful in accurate diagnosis.
Final Diagnosis : -
Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis
Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.
All investigations were directly related to the presented symptoms
like ESR was 120mm/hour which clearly provides the lead for inflammatory process occurring due to osteoarthritis .
Serum creatinine and urea levels were elevated signifying the AKD .
Treatment
- Free water restriction for Hyponatremia
- Tab. PREDNISOLONE P/O 20 mg OD -Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders
- Tab FEBUXOSTAT P/O 80 mg OD Febuxostat, sold under the brand names Uloric and Adenuric among others, is a medication used long-term to treat gout due to high uric acid levels.
- Haemodialysis for worsening renal dysfunction
All the drugs are mentioned appropriately in accordance to the presenting symptoms.
mechanism of action of drug is not mentioned
SHORT CASE-1 :-
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
They were not troublesome initially but for the past 2 months he has been unable to correct answer sheets. He has symptoms which include stiffness, involuntary movements, with no morning erections from last two months, also denies cotton wool sensation of floor, denies burning pain or inability to feel hot or cold stimuli
The patient presents with cog wheel type of rigidity in the wrist with hypotonia in major group of muscles. Patient presents with resting tremors which are characteristic feature of Parkinson's disease. Also the patient is hypertensive.
TREATMENT
1. Tab. Syndopa Plus 125 mg QID first line drug in parkinsons
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD used for the hypertension
SHORT CASE-2:-
19 year old male resident of Nalgonda and currently studying intermediate , came to OPD with complaints of
-Itchy Ring lesions over arms ,abdomen ,thigh and groin since 1 and half year .
-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .
-Abdominal distension and facial puffiness since 6 months.
- Pedal edema since 3 months.
- Low back ache since 3 months .
- Feeling low , not feeling to talk to anyone.
- Weight gain and decreased libido since 3months.
- Loss of libido and erectile dysfunction since 2 months .
purple striation over the anterior abdominal wall along with buffalo hump , thin skin are suggestive of increasing corticosteroid levels that leads to Cushing syndrome.
The patient also complaints of itchy ring lesions which are suggestive of Tinea corporis fungal infection.
Treatment:-
*Ointment Amorolfine ,is a morpholine antifungal drug that inhibits Δ-sterol reductase and cholestenol Δ-isomerase, which depletes ergosterol
* Tab Shelcal 500 OD and Tab Vit D 3 Od, Shelcal for treatment low calcium levels.
*Tab ULTRACET /PO/SOS for inflammation.
QUESTION 2:- Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):
LONG CASE :-
COMPLAINTS
Generalized edema :- it was due to glomerulonephritis
Joint pains:- it was due to rheumatoid arthritis
INVESTIGATIONS
X ray of peripheral joints to conclude the severity of arthritis usually by observing the osteolytic lesions.
X ray of chest to rule out any pleural effusion due to excess fluid retention.
ECG to to rule out any cardiac abnormalities.
CUE for checking the severity of glomerulonephritis by quantifying the amount of albumin and glucose present in urine.
CBC for grading the extent of blood infection and prognosis of inflammation caused due to arthritis
ESR usually gets elevated in active inflammation in body.
KFT for grading the severity of kidney damage due to glomerulonephritis
TREATMENT
- Free water restriction for Hyponatremia
- Tab. PREDNISOLONE P/O 20 mg OD -Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders
- Tab FEBUXOSTAT P/O 80 mg OD Febuxostat, sold under the brand names Uloric and Adenuric among others, is a medication used long-term to treat gout due to high uric acid levels.
- Haemodialysis for worsening renal dysfunction and removal of excess fluid from body.
SHORT CASE-1
COMPLAINTS
Patient complained of involuntary movements with resting tremors and denied sensation in the lower limb along with muscle stiffness
Decreased tension in major groups of muscle suggesting hypotonia
Difficulty in speaking
All this points to the diagnosis of Parkinson's Disease.
INVESTIGATIONS
Superficial reflexes absent on the left side
Deep tendon reflexes are reduced showing hypotonia
Micrographia is present is suggestive of Parkinson's disease
ECG suggestive of Sinus Tachycardia with pseudo infarct pattern in leads I and aVL with
dagger q waves in the same leads.
No late intrinsicoid deflection of R wave with modified Cornell criteria showing LVH.
2D Echo shows Grade 2 Diastolic dysfunction
TREATMENT
1. Tab. Syndopa Plus 125 mg QID increasing the dopamine levels in the brain
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD used as an antihypertensive drug
SHORT CASE-2
COMPLAINTS
Itchy lesions
Purple striation over the anterior abdominal wall
Weight gain along with edema
Lower back ache
Loss of libido
INVESTIGATIONS
ECG done to rule out any cardiac abnormalities (NORMAL)
In view of low back ache X-ray LS spine was done which was normal
TREATMENT
1.Ointment Amorolfine ,is a morpholine antifungal drug that inhibits Δ-sterol reductase and cholestenol Δ-isomerase, which depletes ergosterol
2.Tab Shelcal 500 OD and Tab Vit D3 Od, Shelcal for treatment low calcium levels.
3.Tab ULTRACET /PO/SOS for inflammation.
QUESTION 3
Testing competency in "Evidence based medicine": Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient.
LONG CASE :-
INVESTIGATIONS
X-rays can help detect bone damage (erosions) that occurs as a result of long-standing rheumatoid arthritis. They can also detect a narrowing of the joints space, which occurs when cartilage degrades and the bones in the joint get closer together. Magnetic resonance imaging (MRI).
https://www.arthritis-health.com/types/rheumatoid/rheumatoid-arthritis-ra-diagnosis#:~:text=X%2Drays%20can%20help%20detect,Magnetic%20resonance%20imaging%20(MRI).
ESR
People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sedimentation rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653#:~:text=People%20with%20rheumatoid%20arthritis%20often,inflammatory%20process%20in%20the%20body.
TREATMENT
Tab. PREDNISOLONE Low doses of prednisone are safe and effective in the management of RA. Yet, some clinicians continue to manage their RA patients with glucocorticoid doses that are too high or avoid them altogether. Glucocorticoids in low doses have proven to be very effective in suppressing the inflammation associated with RA.
https://pubmed.ncbi.nlm.nih.gov/12386945/#:~:text=Low%20doses%20of%20prednisone%20are,the%20inflammation%20associated%20with%20RA.
Tab FEBUXOSTAT
Febuxostat (Uloric) is a medication that lowers the levels of uric acid in the body. It is used for the chronic management of gout. It blocks the active site on xanthine oxidase, preventing the conversion of hypoxanthine and xanthine to uric acid.
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Febuxostat-Uloric
SHORT CASE-1
INVESTIGATIONS
Micrographia, or small handwriting, is a common sign of Parkinson's disease. Over 65 percent of patients exhibit micrographia. Patients often notice the difference in their handwriting themselves and a neurologist can confirm the diagnosis by the size of the handwriting in a writing test.
https://parkinsonsnewstoday.com/parkinsons-disease-symptoms/micrographia/#:~:text=Micrographia%2C%20or%20small%20handwriting%2C%20is,handwriting%20in%20a%20writing%20test.
TREATMENT
Syndopa Plus Tablet is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors (shaking), stiffness and slowness of movement.
https://www.1mg.com/drugs/syndopa-plus-tablet-66734#:~:text=Syndopa%20Plus%20Tablet%3F-,Syndopa%20Plus%20Tablet%20is%20a%20combination%20of%20two%20medicines%3A%20Levodopa,usually%20found%20in%20the%20brain.
SHORT CASE-2
INVESTIGATIONS
The 24-hour urinary cortisol test measures the amount of cortisol being produced within the urine over the course of an entire day. Levels higher than 50-100 micrograms per day in an adult suggest the presence of Cushing's syndrome.
https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cushings-Disease#:~:text=The%2024%2Dhour%20urinary%20cortisol,the%20presence%20of%20Cushing's%20syndrome.
TREATMENT
shelcal as calcium supplement as theres increase in bone resorption
https://pubmed.ncbi.nlm.nih.gov/2627828/
QUESTION 4
Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :
A 60 years old female presented in the casualty with complaints of vomiting and altered sensorium.
QUESTION 5
Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month
Nation wide lock down due to COVID-19 posed great challenges in all quadrants of our lives, majorly affecting education sector.
Fortunately after a long gap we're back to campus and steadily thing seems coming back to track.
Now we can have face to face synchronized interaction with the patients and their attendants and this can surely help us to pace up with competent and active learning in history taking .
As my break through experience ,I went general medicine ward where I actually interacted with patient and her attendants and that was really an amazing moment and moreover an opportunity to learn.
However, to a down stream back to online era aka digital era had emerged as a powerful medium to support the education and helped us to be on track amid the pandemic.
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
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 me with this valuable opportunity for patient-centered active learning.
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