04 KAVYASREE (OLD BATCH)-BIMONTHLY ASSESSMENT AUG-2021
04 KAVYASREE(OLD BATCH)
3rd SEMISTER.
Hi This is K.KAVYASREE, a 3rd semester medical student ."This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs"
Medicine paper for Aug 2021 bimonthly blended assessment
Q1) (Testing peer review competency in the active reader of this assignment) :
Please go through the long and short cases in the first link 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.
https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
Answer:
👉 Long case :
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
The document is well listed but could have been enhanced with the help of diagrams and highlighting the important points. the content of the document is explained well in a language that is easy to understand. the readability of the document could have been increased .
The Bangladesh case study provided more information regarding the case.
(A review of literature was done to evaluate the sensitivity and specificity of dysmorphic RBCs for glomerular disease pathologies - One study conducted in Bangladesh showed that urinary dysmorphic RBCs were 92.7% sensitive and 100% specific for a biopsy confirmed diagnosis of glomerulonephritis. )
👉short case1
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.
The data provided is correct . But lack the discharge summary.
The case has been presented very clearly and to the point . All the data pertaining to the case has been provided .
👉Short case 2
19 year old male resident of Nalgonda
- The entire document is very well-formatted, the organization of the data makes it very easy to look through.
- Symptomatology has been given in chronological order.
Q2: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):
Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems.
Answer:
👉long case
A 44 year old man
Problem list:
- 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
- presented with a 3 day history of anasarca
- frothy urine
- gradually decreasing urine output, on a background of a 10 year history of chronic bilaterally symmetric polyarthritis (evidenced by severe pain, edema and limitation of joint movements).
With a provisional diagnosis of Acute Glomerulopathy on the background of bilaterally symmetric chronic progressive erosive peripheral polyarthritis, features supporting the diagnosis of glomerulonephritis were -
- Secondary Hypertension
- Oliguria (360 ml urine in the last 24 hours)
- Hypoalbuminemia (Serum Albumin 2.5g/dl) and Anasarca
- Dysmorphic RBCs in Urine
👉short case1
A 49 year old English and Telugu language lecturer
Problem list:
- a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
- Findings - The movements in the right lower limb is slower than the movements in the left lower limb.
- ECG
- Shows Sinus Tachycardia with pseudo infarct pattern in leads I and aVL with dagger q waves in the same leads.
👉 Short case 2
19 year old male resident of Nalgonda
problem list:
-Itchy Ring leisons 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 .
Treatment:
- Dermatologist opinion for tenia corporis where they advised
- Ointment AMLORFINE
- FUSIDIC ACID CREAM.
- SALINE COMPRESS OVER LEISONS.
- FINAL DIAGNOSIS :
- IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
- TINEA CORPORIS
- DENOVO HTN .
Q3) 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.
Answer:
👉long case
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
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.
- This patient has >10 joints involved with multiple small joints involvement - 5 points; Symptom duration 10 years - 1 point; RA Factor - NEGATIVE; CRP elevated & ESR - 120 mm/hr - 1 point; Total Score - 7/10
- Thus, a diagnosis of Rheumatoid Arthritis is likely.
👉short case1
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.
A middle aged man presenting with a 6 months history of gradually progressive, asymmetric rest tremor with autonomic features is provisionally diagnosed with
1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.
2. Multiple System Atrophy - Parkinsonian Type (MSA-P).
2 D Echo
✓ Grade II diastolic dysfunction.
Treatment
1. Tab. Syndopa Plus 125 mg QID
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD
👉 Short case 2
19 year old male resident of Nalgonda
- FINAL DIAGNOSIS :
- IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
- TINEA CORPORIS
- DENOVO HTN .
Q4) Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :
Share the link to your own case report this month 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.
Q 5) Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month : (10 marks)
Answer:
Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. Reflective logging enable the student to stay up to date and keep a track of their progress . They enable one to apply their theoretical knowledge into practical application. In the times of COVID when we are unable to physically attend clinical posting and acquiring practical knowledge , logs enable us to keeping a track of the patient assigned and practice important skills like history taking .
This helped me to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.
Reflective logging give us an opportunity to know the patient and study the case, inspite of us not being in the hospital.
K.KAVYASREE
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