BIMONTHLY BLENDED ASSESSMENT - JULY 2021

 BIMONTHLY BLENDED ASSESSMENT - JULY 2021

-114 Sai Ajay Bompalli 

BELOW IS THE LINK TO THE QUESTIONS ASKED TO US :

http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1

QUESTION 1:

-Below is the link of the student assignment for which I am sharing my peer review.

https://saicharithareddym.blogspot.com/2021/07/charitha-reddy-m-roll-115-i-have-been.html

Reviews to all the Questions answered :-

1.The quantitative and qualitative insights(reviews) were given genuienly according to the deservance of E-Log case.

2.The clear cut appraisal is given by mentioning both pros and cons.

3.There is even more possibility for more case depicting points which can be selectively described.

4.The peer review is written on shortness of breath, pedal edema and facial puffiness. A good and well described appraisal has been provided regarding the important aspects of the case. 

5.The symptomatology, etiology and the anatomical localisation of the problem were clearly described. Which helps us in understanding the diagnosis of the patient in a precise manner.

6.Even though the peer reviews giving are short they are well described for all the questions.

7.The diagnostic intervention is one of the important aspects which is very well described.

8.The overall review and personal experience review is quite good. The usage of elog's is giving them a helping hand. Though the time for each individual is the same not all of us are able to use the given amount of time to the fullest which is an observable fact.

QUESTION 2:

Below is the link of my case report of a patient that I've 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://casescape.blogspot.com/

QUESTION 3 & 4 :

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.

&

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. 

1. Patients with low back ache and renal failure :

AKI :

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

Chief complaints:

  • Lower abdominal pain and burning micturation since 1 week, 
  • lower back ache after lifting weights, 
  • dribbling/ decrease of urine output since 1 week, 
  • fever and SOB, rest since 1 week.

Investigations ordered: 

  1. Hemogram
  2. CUE  
  3. RFT 
  4. LFT 
  5. ECG  
  6. 2D Echo 
  7. Chest X-ray 
  8. FBS 
  9. PLBS 
  10. HbA1C
Provisional diagnosis:
  • Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2
  • With ? Right HEART FAILURE,

Treatment given:

  1. IVF : -RL @ UO+ 30ml/hr - NS
  2. SALT RESTRICTION < 2.4gm/day
  3. INJ TAZAR 4.5gm IV/TID - 2.25gm IV/ TID ( For urinary tract infection )
  4. INJ PANTOP 40mg IV/OD
  5. INJ THIAMINE 1AMP IN 100ml NS IV/TID ( It is a supplement of vitamin B1. Vitamin B1 is essential for breaking down the glucose in the body and plays a key role in nerve muscle and heart function )
  6. INJ HAI S/C ACC TO SLIDING SCALE  (8AM - 2PM - 8PM) - ( For diabetes mellitus - 2 )
  7. SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]
  8. T. ULTRACET PO 1/2 TAB QID ( It is a narcotic pain reliever. It’s used to treat aches. As the patient has complaints of back ache)
2. Acute on CKD : 

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

Chief complaints:
  • 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 . 
Investigations ordered:
  1. ECG
  2. RFT
  3. CUE
  4. Hemogram
  5. ABG
  6. Serum electrolytes
  7. Blood urea 
  8. USG Abdomen 
  9. LFT
Provisional diagnosis:
  • 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)
Treatment given:
  1. Inj. Tazar 2.25gm I.V -TID ( Used for urinary tract infection )
  2. Inj. Lasix 40mg I.V -BD ( Used for edema )
  3. Nebulization Salbutamol - 4th hourly 
  4. Inj. Pantop 40mg I.V -OD 
  5. Tab. PCM 650mg -TID 
  6. Foleys catheterization ( Used to pass urine from bladder )
  7. INJ. Neomol 1mg -I.V -SOS ( Painkiller used to treat pains and aches )
  8. Inj. PIPTAZ 2.25gm -I.V -TID ( An Antibiotic used for urinary tract infection )
3.  Patient with coma and renal failure :

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

Chief complaints:
  • 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.
  •  "History"(as told by the patient's daughter because she was unconscious at the time) 
Provisional diagnosis: 
  •  DKA with AKI ( ? Pre renal ) 
Treatment given:

Day 1
  1. Inj. NORAD 2amp in 50ml NS
  2. Inj. PIPTAZ 2.25gm.
  3. Inj. DOPAMINE 2amp in 50ml
  4. Inj. HAI 1ml in 39ml NS
 
Day 2 
  1. Inj.HAI 1ml in 39mlNS
  2. Inj. PIPTAZ 2.25gm.
  3. Inj. CLEXANE 40gm. 
  4. Iv infusion NS RL @100ml/hr.

Day 3 
  1. Inj.HAI 1ml + 34ml NS
  2. Inj. PIPTAZ 2.25gm
  3. Iv infusion NS (urine output + 40ml/hr)
  4. Inj. NORADRENALINE(2 amp+46ml NS) 
  
Day 4,5 same as day 3

Day 6
  1. Inj. PIPTAZ
  2. Inj. LEVOFLOX
  3. Inj. VANCOMYCIN
Day 7 and 8 same as day 6.

Day 9
  1. Inj. MEROPENEM
  2. Inj. LEVOFLOX
  3. Inj.VANCOMYCIN
Day 10 and 11 same as day 9

Day 12
  1. Inj. MEROPENEM
  2. Inj. FOSFOMYCIN
  3. Inj. CLEXANE

Day 13 and day 14 same treatment as of day 12 additionally Inj. LASIX was given. 

4) Patients with acute on CKD :

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

Chief complaints:
  • Fever since 4 days
  • Pus in the Urine
Investigations ordered:
  1. CBP
  2. Chest X-ray
  3. ECG
  4. ABG Analysis 
  5. NCCT KUB 
Provisional diagnosis: 
  • Renal AKI secondary to urosepsis with b/l hydroureteronephrosis with K/c/of DM -2 since 5 hrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed score. 
Treatment given:
  1. Injection PANTOP 40mg IV/OD
  2. Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
  3. Injection LASIX 40mg IV/BD
  4. Injection optineuron 1AMP in 100ml NS slow IV/OD
  5. Injection NEDMOL 100ml IV/SOS
  6. Tab PCM 650mg TID
  7. Insulin Human actrapid - 16 IU/TID
5) Patients with AKI :

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

Chief complaints:
  • loose stools since 20 days.
  • pedal edema since 20 days
  • abdominal distension since 20 days.
Investigations ordered:
  1. Hemogram
  2. CUE
  3. CBP
  4. RFT
  5. LFT
  6. ECG
  7. CXR PA VIEW
  8. USG ABDOMEN
  9. PT/ INR
  10. APTT
  11. BT/CT
Provisional diagnosis: 
  • Alcoholic Hepatitis 
  • AKI Secondary to Acute Gastroenteritis 
  • HFrEF Secondary to CAD 
  • Alcoholic And Tobacco Dependence Syndrome
Treatment given:
  1. INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
  2. INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
  3. INJ LASIX 40 mg
  4. TAB. ALDACTONE 50 mg PO / BD
  5. INJ PANTOP 40 mg IV/ OD
  6. ABDOMINAL GIRTH MEASUREMENT DAILY
  7. BP /PR/TEMP/ RR -4 hourly 
  8. I/O CHARTHING
QUESTION 5:

This platform of doing e-logs and reviewing assignments has been very useful in learning and knowing many disease and their treatment. It helped to understand patients pain and need. Solving each patients problem along with the guidance of our interns was very interesting this way and very informative. Hoping to learn much more in coming days. I thank everyone who is guiding us through this difficult process of learning. 
















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