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GENERAL MEDICINE MONTHLY ASSIGNMENT (JUNE 2021)

     June 30, 2021                      

                                                                                                                GENERAL   MEDICINE

  BIMONTHLY ASSIGNMENT  ( JUNE 2021 )


I have been given the following assignment to analyze , and review, in an attempt to understand the topic of 'Patient clinical  data analysis' to develop my competency in reading and to comprehending clinical data including history, clinical findings, investigations and diagnosis, 

This is the link of questions asked in the bimonthly assignment:

https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1

Here are my answers to these questions :

Q1) Peer to peer review of case histories

1) Case by : https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html

Diagnosis: Congestive cardiac failure at presentation (resolved ),Atrial fibrillation with rapid ventricular response (RVR), Biatrial thrombus with atrial septal defect with PAH , de-novo DM-2

Review :  Patient came to the OPD with chief complaints of decreased urine output and shortness of breath at rest since one day. His blood pressure was reduced.In the complete blood picture : Neutrophilia and thrombocytopenia was observed . In the urine examination : Albumin was excreted       In Renal function test- Urea was found to be more than the normal range .In CT Angiogram :Main pulmonary trunk and left pulmonary arteries were dilated and thrombi  was seen in left atrial appendages and left atrium. Severe Left Ventricular dysfunction was observed in 2D-echo.

Loss of contraction of atria and dilation of left atrium causes stasis of blood in the Left atrium and may lead to Thrombus formation in the Left Atrial Appendage. This predisposes patients to stroke and other forms of systemic embolism. Dobutamine was given to reduce the fall of BP. D- dimer is a protein fragment that's made when a blood clot dissolves in your body. So, as the patient's d- dimers were high , Anticoagulants were started and planned for CPTA. Carvedilol , a beta blocker was given. Infusion of heparin was also given. The overall data capture of the case was good and discussion of the involved case was good too..

.

Reviews:

1) https://amishajaiswal03eloggm.blogspot.com/2021/05/medicine-blended-assignment.html

     Quantitative input : 4/5                                                                                                                                     The use of flowchart for timeline of symptomatology was a good idea. The most likely cause of arterial thrombosis is artery damage due to atherosclerosis. This etiology was explained in great detail by her .The picture of cardiorenal connectors and  consequences was explanatory. The pharmacological actions of drugs were also nicely presented.

2) https://chennabhavana.blogspot.com/2021/05/general-medicine-blended-assignment.html

   Quantitative input : 4.5/5                                                                                                                                  This answer is very lucid. The timeline of symptomatology was very well done with clear description. The mechanism of action ,indication and efficacy over placebo of each of the pharmacological and non-pharmacological interventions used for the patient was described well. A very clear explanation of the pathogenesis of renal involvement due to cardiac failure was given.  The flowcharts or diagrams could be added to the answer.

3) https://saichennuru.blogspot.com/2021/05/online-blended-medicine-assignment.html

  Quantitative input : 3/5                                                                                                                                         The  pathogenesis of renal involvement due to heart failure in the flowchart was great. The five different cardiorenal syndromes were explained.The risk factors for atherosclerosis are hypertension, high cholesterol and triglyceride, DM-1, obesity, physical inactivity, smoking, high saturated fat diet. This patient has Hypertension, physical inactivity and obesity but the answer to the question of why the patient is asked to get APTT,INR tests for review could have been explained a bit more clearly.

4) https://divyaraju266.blogspot.com/2021/05/answers.html

   Quantitative input : 3.5/5                                                                                                                                      The  answer is very well presented and the use of flowchart added to it. To risk factors, they could have added cardiorenal syndrome type 4.

5) https://rishithareddy30.blogspot.com/2021/05/covid-cases-elog.html

   Quantitative input : 3/5                                                                                                                                          The Time line of symptomatology, etiology was not clearly mentioned. There was a lucid mention of the pharmacological actions of drugs. The use of APTT was mentioned very well. the presentation could have been a bit more creative with use of flowcharts.

6) https://rishithareddy30.blogspot.com/2021/05/covid-cases-elog.html

   Quantitative input : 4/5                                                                                                                                           The timeline of symptomatology, etiology and pharmacological interventions were explained in great detail, but the pathogenesis of renal involvement in heart failure  should have been explained in detail . The overall presentation of answers was impressive

7) https://aniganikavya06.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html

   Quantitative input : 3.5/5                                                                                                                                       The answer was very creative. Even the pharmacological and non-pharmacological actions were depicted in the form of flowchart. However, the etiology could have been clearly mentioned. There was also a mention about the use of APTT.

8) https://33manogna.blogspot.com/2021/05/general-medicine-assignment-for-month.html

    Quantitative input : 3/5                                                                                                                                          The work is appreciable for the effort put in for the information but it could be a little bit creative with use of diagrams, flowcharts.

9) https://vijaykumarkasturi.blogspot.com/2021/05/medicine-blended-assignment-month-of.html

    Quantitative input : 4.5/5                                                                                                                                          The description of the answers were in depth and in detail. The pharmacological interventions could have been explained in detail. The pathophysiology of the case was described in great detail. The overall presentation is very nice.

10) https://73varunsaim.blogspot.com/2021/06/medicine-blended-assignment-may-2021.html

   Quantitative input : 3.5/5                                                                                                                                           The answers were informative . However, pharmacological interventions, timeline was not clearly mentioned. The presentation could have been better in terms of both information and creativity. 


Q3 and 4. Here is the link to e-log of case:

   https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

 https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1Thoughts :  The e-log was on the case of Heart failure with reduced ejection fraction with Atrial fibrillation. The management of HFrEF has seen significant scientific breakthrough in recent decades, and the ability to alter the natural history of disease has never been better. Its morbidity and mortality remains high . The data capture of the above case is very good but there was no mention of CHIEF COMPLAINT which has to be written in words of patient in chronological order. The chief complaint is one of the main elements of history taking.   The patient's biochemical reports showed severe hyperthyroidism possibly relating to her refractory atrial fibrillation. The complete blood picture, serum electrolytes, Glycated Hb, Hiv1/2rapid test were done. The overall management of the patient was very well done but the patient unfortunately passed away : uncertainties around heart failure with reduced ejection fraction still prevail.



5.  Logging reflective observations on my concrete experiences  of  a month of  June

Reflective writing is one of the most powerful and concrete ways for a student to learn the art of   reflection. With this process of telemedicine,  I got  an opportunity to sharpen my clinical skills of history  taking which is very much vital in this field of medicine. We got to know about wide range of cases , their clinical presentations. This process of e- logging helped us to discuss the cases virtually due to presence of pandemic. We even found a  new case where there was hepatic derangement in co-vid patient because of which we got research about involvement of liver in co-vid patients.  It was a great experience of patient centered learning through research based studies .














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