July

  

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 :

http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

and share your peer review of each answer with your qualitative insights into what was good or bad about the answer. https://42supriyagagireddy.blogspot.com/2021/07/bimonthly-blended-assessment-june-2021.html 

 Case1:

CASE:https://soumyanadella128eloggm.blogspot.com/2021/05/

In my opinion: As chief complaints are pedal edema, facial puffiness, and shortness of breath for the past 15 days. As far the examinations done and investigations revealed that she is suffering from an exacerbation of COPD along with right heart failure associated with bronchiectasis.

Case 2:

CASE:https://kausalyavarma.blogspot.com/2021/05/

In my opinion: Patient is a known case of Denovo hypertension. It is also true that the ataxia is the cause of loss of muscle control or coordination of voluntary movements. It is also true that blockage of bleeding in the brain which leads to deprived of nutrients in the brain and this leads to infract. The case is presented very well. It also tells about he impact of alcoholism on ischemic or haemorrhagic stroke. He is also given with tablets which treat his nausea, vomiting, to prevent clot formation, to treat wernickes encephalopathy and also to treat b12 deficiency. The case presentation is point to point and presented very well

Case 3 : CASE:https://muskaangoyal.blogspot.com/2021/05/

 In my opinion: The difference between preserved ejection fraction and reviewed ejection fraction have been presented every clearly. The reason for performing cardioperentesis have also been clearly explained . The risk factors which cause the heart failure have also been clearly explained . The flow charts, diagrams, tables have made an impact in understanding.

 

Case 4 : 

CASE:https://63konakanchihyndavi.blogspot.com/2021/

 

  This is a case of pancreatitis pseudocyst and left broncho pleural fistula. symptoms include pain in the abdomen, constipation and burning micturiton. Amikacin , metrodinazole and meropenem are given to control the infection. Inj octrotide is given to decrease the secretion of pancreas. TPN is given so Inj thiamine is given as B1 supplement.

 

Case 5:

CASE:https://kavyasamudrala.blogspot.com/2021/05

This is a case of renal AKI secondary to bilateral hydroureteronephritis with known history of diabetes mellitus since 5 years with diabetic neuropathy with anaemia secondary to CKD with  grade 1 bed sore. The chief complaints of the patient  are pus in urine and fever. The patient has SOB due to acidosis that is caused by diuretics. May be his hyponatremia was the cause of his drowsiness and plenty of pus  is  seen in urine and difficulty in Mictutration and he had raised creatinine levels also. All necessary investigations and good analysis is made. The patient is treated very well to relieve his from all his symptoms .

 

Case 6: 

CASE:https://vyshnavikonakalla.blogspot.com/2021/05

 My opinion: 

The peer got up with the exact findings that is RVD positive as the patient had a high-grade fever for 2 months, dysphagia for 2months, cough on eating/drinking for 2 months, hoarseness of voice and TB positive.so i agree with the peer findings.

Case 7: 

CASE:https://kavyasamudrala.blogspot.com/2021/05/l

 My opinion:

Due to consumption of local alcohol (toddy) ,it is the factor for liver abscess.alcohol consumption has more effect in liver.right lobe of liver is more effected due to more blood supply to it .

Indications are

.large abscess more than 6 cm

.Left lower abscess

.abscess not responding to drug 

Case 8 : CASE:https://143vibhahegde.blogspot.com/2021/05

I agree with the probable cause given by peer as their is consumption of alcohol by the patient will cause changes in the kidney and liver functions which will cause the retention and decrease in filtration which will cause increase in the pressure of blood.

 

Case 9 

CASE:https://nikhilasampathkumar.blogspot.com/2021

My opinion 

I agree with her review 

This is a case of Generalized tonic-clonic seizures secondary to acute hemorrhage in the frontal, temporal, and parietal lobes.he developed involuntary jerky movements on all four limbs. He has a history of binge drinking 3 hours prior to the onset of drowsines. CT scan showed an acute cerebral hemorrhage of the frontal, parietal and temporal lobes.these conditions say that he had come up with hemorrhage in lobes.All the investigations are done and possible treatment was given. 

Case 10 : 

5/medicine-blended-assignment-may-2021.html CASE:https://preityarlagadda.blogspot.com/2021/05/bia

My opinion :

I agree with her review 

This is a case of Atrial Fibrillation and Biatrial Thrombosis.Patient has come up with complains of decreased urine output and Anuria since morning.He has past history of shortness of breathe ,facial puffiness and surgery.He is also a chronic alcoholic. All the possible investigations are done and all possible treatment is given to him.so the case was eplained so well. 

Q2-4

Patient centered data around the theme of renal failure patients with AKI, CKD and acute on CKD, 

captured by students from 2016 and 2019 batch in the links below

Patients with low back ache and renal failure

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. 

https://keerthireddy42.blogspot.com/2021/06/aki-kn-ckd.html

Q3) (Testing peer review competency of the examinees) :

Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.

AKI:

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

      OVERVIEW 

A 58 year old male patient came to casualty with chief complaints of:

 lower abdominal pain: 1 week ,burning micturation:1week ,

low back ache after lifting weights

dribbling / decrease of urine out put:1week

fever :1 week

SOB  :1week  

     Appraisal :

Case history was taken well and examination was very well done 

    Negative points :

It would be better if fever chart is added as it was treated with strict temp monitoring as it would be better understood improvement of the case was not well mentioned

    My analysis :

 This is a case of Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

With ? Right HEART FAILURE,

With K/C/O - HTN ( Not on Rx)

-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 bodyand return of creatinine to the base line and symptoms less then 3 months indicating it to be a AKI

Acute on ckd : 

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

       Overview :

A 75yr old male patient ,labourer by occupation ,came to casuality with Cheif complaints of 

• 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 

       Appraisal :

History was taken well 

       Negative points :

There are no pictures of pedal edema .

Proper chronological order of symptoms apperance was not done 

No IO charting was done though it was told it should be strictly monitored

      My analysis: 

This is case of 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)

CKD: 

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

       Overview :

A 49 yr old female , mother of 2 children, who is a house wife, apparently asymptomatic 13 yrs ago and then she noticed mass per anum with bleeding , went to hospital and diagnosed as haemorrhoids and got operated.

- 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.

       Apprisal: 

History was taken well.

Good lab work clear evaluation was done 

       Negative points : 

There are no clinical pics of the symptoms 

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitoredit would have been better if urine was sent for eosinophils for interatial disease

      My analysis:

This is  case of CKD ?

 Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).

PATIENT WITH COMA AND RENAL FAILURE :

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

      Overview : 

A 35 yr old female with 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.

     Appraisal: 

With good fever charting with all the necessary information.

History was taken detailed way 

All the tests were properly done 

     Negative points : 

I could not find the negative data in the elog  

      My analysis : 

It could be the hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen. Hospitalisation has increased the infection to the bed sore it would have been better if discharged early as it was permanent damage and was impossible to treat anyway.

Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):

Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also 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. 

Analysis the data

 https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html 

Analysis of  A 35 yr old female with 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

Vegetative state of the patient could be due to  hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen.

Link supporting the data 

Intermittent Fever spikes can be explained due to the bed sores clearly explained through culture of the sores 

Sepsis might be the reason for encephalopathy by altering the blood brain barrier 

https://www.hindawi.com/journals/amed/2014/762320/

Q 5) Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. 

The telemedical learning from the hospital has been a new experience and we  learnt quite lot of things through reflective observation during lockdown.  it's a bit challenging as we have just entered internship ,We have learnt elogging of the cases in a very short span of time and made juniors do so. I could answer the questions from juniors easily as I have been part of many discussion in ICU and wards . By doing this assignment I could view many cases and many case scenarios through which I learned many  things