General Medicine monthly assignment(July 2021) by Riddhi Bhalla 3rd semester (Roll no: 111)
General Medicine monthly assignment(July 2021) by Riddhi Bhalla 3rd semester (Roll no: 111)
For link to questions for the assignment click here.
The theme for this assignment is "Scholarship of integration in
medical education and research" in keeping with this theme I have
tried to include my knowledge from multiple streams into the following answers.
Being a 3rd semester student I found my understanding to be limited in many
cases so I have provided links for further reading incase you would like to do
so. Any criticism is much appreciated to better myself and my understanding.
This month the cases were of AKI and CKD mainly.
Q1] Peer review of previous month's assignment of a student closest to my roll no.
A1] I have selected the following assignment to review: Rishika Koloti roll no: 112
Overall the assignment is authentic, complete and very well formatted. Coming to the review of each individual answer:
A. Peer review has been done for a pulmonology case and its related questions. Both qualitative and quantitative rating has been given for each answer and the rating is justified by giving further comments on the positives and negatives of each answer.
Note has been made of answers citing sources and diagrams or flowcharts which makes the standard of review clearly understandable. A timeline of symptomology, pharmacological interventions and relevancy of each treatment have been given higher importance, thus answers including these are rated higher.
B. Case study is of a 52 year old man with infective endocarditis secondary to UTI. History is well charted and very elaborate. Standard format of case sheet has been followed. Diagnostic tests have been mentioned clearly and have been adequately deidentified. Video has been added for 2D echo. Treatment method is largely pharmacological.
Day wise treatment plan can be included for a better ELOG. Also some rehabilitation treatment plans can also be included in discharge summary.
C. Critical appraisal of patient data and analysis. Very elaborate answers have been written. Each case has been reviewed under its positives and negatives. Each aspect of the question ie. completeness, correctness, and ability to assess leads has been mentioned seperately.
D. Problem list is highly detailed and comprehensive. See as follows:
- Low-grade backache
- vomiting episodes and loose stools
- blood-tinged urine
- polyuria , polydypsia ,noctunuria
- burning micturation
- lost apetite
- Temperature - 100.5degree celcius
- respiratory rate -24cpm- higher than normal
- abdomen schaphoid
- icterus present
- Creatinine levels in the urine - 0.6 mg/dl which is lower than the normal range
- SOdium level 132 mEq/L in the urine which is lower than the normal range.
- ABG shows PCO2- 17.4 mmHg which is lower than the normal range and PO2 - 119mmHG which is higher than the normal Range, PH - 7.26 that is acidic
- Hemogram - MCV, and MCHC of the patient are lower than the normal range while the MCHC is higher than the normal range. The patient also presents with increased RBC count
- Prothrombin time is increased -24 seconds
- ketone bodies are present in the urine that indicates -DIABETIC KETOACIDOSIS
- glycated hemoglobin is 6.6percent which is higher than the normal range
- serum iron is increased is 150, while serum ferritin is .1500
- T3 and T4 are both reduced
- The urine is slightly acidic, contains excessive albumin, and an increased level of sugar
- C-Reactive proteins are elevated -2.4mg/dl
- APTT test has a higher value than the normal range
- Right renal calculus
- Right mild hydroureteronephrosis
- COVID -19 antibodies are positive
- Total bilirubin, Direct Bilirubin-HYPERBILIRUBINEMIA, Liver enzymes are normal
- Total serum proteins are low
- not responding to visual stimuli and acute retention of urine Bizzare starey looks- ABSENCE SEIZURES?
- no passing of stools since 2 days -
- Retention of urine
- Hepatic encephalopathy, multisystem inflammatory failure (post covid)
Followed by critical review of the treatment plan and drugs used.
E. Log on telemedicine is satisfactory and expresses her views clearly.
Q2] ELOG
A2] I personally did not get any cases this month under my intern. I had gotten a case last month however which is linked here http://riddhibhalla25.blogspot.com/2021/06/general-medicine-monthly-assignmentjune.html
However I spent time understanding my friend's case this month which is linked here https://rishitha35.blogspot.com/2021/07/28-year-old-presenting-with-pain-in.html
Q3] Critical appraisal of captured patient data for the following 11 cases of renal failure
A3] Acute kidney infection case https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
History taken is very detailed and us relevant to current complain. Diagnostic images are clear and precise. However, format of the elog is cumbersome to read making it hard to arrive at a diagnosis
Acute CKD http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
This elog is very well formatted. Timeline is clear pertaining to symptomatology and treatment. Differential diagnosis has been confirmed by imaging.
CKD Case here https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
All patient data is sufficiently deidentified. History is elaborate and relevant. Diagnostic imaging section is clear and precise. Timeline of treatment is clear.
Coma and renal failure cases here, case 1: https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
History is elaborate and relevant. Diagnostic section is clear. Format of the elog is comprehensive
Coma and renal failure case 2 here: https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
This elog is very well formatted. Timeline is clear pertaining to symptomatology and treatment. Differential diagnosis has been confirmed by imaging.
Patients with acute onset of CKD Case 1:https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
All patient data is sufficiently deidentified. History is elaborate and relevant. Diagnostic imaging section is clear and precise. Timeline of treatment is clear.
Patients with acute onset of CKD Case 2 : https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
All patient data is sufficiently deidentified. History is elaborate and relevant. Diagnostic imaging section is clear and precise. Timeline of treatment is clear.
Patients with acute onset of CKD Case 3:https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
This elog is very well formatted. Timeline is clear pertaining to symptomatology and treatment. Differential diagnosis has been confirmed by imaging.
AKI cases here case 1: https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
Formatting of the elog can be better. All patient data is sufficiently deidentified. History is elaborate and relevant. Diagnostic imaging section is clear and precise. Timeline of treatment is clear.
AKI case 2:https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
This elog is very well formatted. Timeline is clear pertaining to symptomatology and treatment. Differential diagnosis has been confirmed by imaging.
It would be good to include a conclusion line after each diagnostic test
AKI Case 3:http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
History is elaborate and relevant. Diagnostic section is clear. Format of the elog is comprehensive. Discharge summary is also provided making it the most complete and clear elog
Q4] Problem list of each case along with diagnostic uncertainities
A4] Acute kidney infection case https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
Acute CKD http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
CKD Case here https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
Coma and renal failure cases here, case 1: https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
Coma and renal failure case 2 here: https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
Patients with acute onset of CKD Case 1:https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
Patients with acute onset of CKD Case 2 : https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
Patients with acute onset of CKD Case 3:https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
AKI cases here case 1: https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
AKI case 2:https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
AKI Case 3:http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
Q5] Telemedicine experience for the month of July.
A5] Learning clinical subjects online has definitely been a very different experience which at times has been overwhelming. While nothing can replace in person rotation telemedicine is a close second. The cases this month were largely of UTI, Chronic kidney failure and acute kidney infections. The topic is vast and has many many aspects to be considered when coming to a conclusion. It was great seeing so many patients with similar conditions but with such varied manifestations.
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