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GENERAL MEDICINE MONTHLY ASSIGNMENT(JULY 2021) BY Pranathi Reddy Zillella 3RD SEMESTER

                                     

                                     GENERAL MEDICINE   MONTHLY ASSIGNMENT(JULY 2021)

    BY Pranathi Reddy Zillella 3RD SEMESTER   

        This blog is an assignment that was given to us for the evaluation of our competencies that were observed in the last month. This month's assignment is focused on renal failure patients

        For link to questions for the assignment click here

       Q1) Peer review of previous month's assignment of a student closest to my roll no.

           I have selected the following assignment to review: Roll no- 102

         1)    Overall the assignment is good, and  complete .She  did a good work with  review of all the      10 cases that she selected. She not only gave an insight but has also given a brief review on the whole case as well.  A timeline of symptomology, pharmacological interventions and relevancy of each treatment  have  been  given higher importance. However, she could have used flowcharts and diagrams to explain it better.

         2) She did not come up with any case yet.

         3) Critical appraisal of patient data and analysis  -

     She took a case of Quadriparesis secondary to infectious spondylitis of C4,C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level. She  could have given a brief overview of the condition. There was mention of  investigations done  and treatment that was given. Overall presentation of the answer is good but use of flowcharts or diagrams to briefly explain the condition could have been done to understand the case better.


     Q2] ELOG

       I personally did not get any cases this month . I had gotten a case last month however which is            linked here    -https://pranathi105.blogspot.com/2021/07/e-log-of-cases.html

    Q3] Critical appraisal of captured patient data for the following 11 cases of renal failure:

       1)  Acute kidney infection case -  

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

          The patient presented due to abdominal pain and lower back after an injury while weightlifting.        The blog could have been better. However, format of the e-log is not good  to read making it        hard to arrive at a diagnosis. The conclusion of how they got to a conclusion AKI with UTI could be explained more clearly.

     2) Acute on CKD :

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

       This e-log is very well formatted. Timeline is clear regarding symptomatology and treatment.          Differential diagnosis has been confirmed by imaging. The overall presentation was good.

    3) CKD :

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

      All the necessary information was provided and even the investigation with reports and histology      slides of the plasma cells was also uploaded. Timeline of treatment is clear.

    Coma and renal failure cases 

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

     A 35 yr old female presented with chest pain abdominal pain, diarrheal with bloody discharge,        shortness of breath, she was a known case of diabetes. She also had bedsores and usg showed pyelonephritis The patient was comatose and put on a mechanical ventilator but she gradually        miraculously recovers. Diagnosed as AKI secondary to diabetic ketoacidosis.

           Format of the e-log is comprehensive. History and complaints were chronologically taken. In       overall , the case was  presented very well. Diagnostic images are clear.

 5).https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

    The case is well explained with nice images, and the videos of 2 d echoes were also provided. A          detailed treatment plan is given.

  Patients with acute onset of CKD Case:

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

        The e-log is very impressive , clear and precise. History is elaborate and relevant. The diagnostic     images are clear.

  7).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.

 8).https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

    The timeline of symptomatology and treatment were presented well. It still could have been well  formatted.

 9). Alcoholic hepatitis and AKI secondary to gastroenteritis :

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

   The case is done  very precisely with chronological history and day-wise observations and treatment. the case is clear and images also were added. The overall formatting was good.

 10). Acute kidney injury secondary to urosepsis :

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

  The case is very clearly presented. It is readable and  investigation, reports, symptoms,  treatment, were very well presented.

11).Pancreatitis in a chronic alcoholic with  AKI

 http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

   This is a very complete e-log which helps understand really better. The Timeline of symptomatology    and treatment is clear.

Q4] Problem list of each case along with diagnostic uncertainties :

   1) Acute kidney infection case-

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

           Problem list  :                                                                           

  •   Lower abdominal pain                       
  •   Burning micturition
  •   Dribbling urine
  •   Urinary tract infection
  •   Right heart failure
  •  GERD , Diarrhoea
          Treatment :
  • Salt restriction - This was done in order to prevent excess stress on the Kidneys
  • INJ. TAZAR -Antibiotic for UTI
  • INJ. Pantop- Reduces acid in the stomach
  • Tab. PCM - paracetamol for the fever
  • TabMyoril - Muscle relaxant

   2) Acute CKD - 

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

          Problem list                                                                      

  • Pedal Edema 
  • Hyperuricemia 
  • Dyspnoea
  •  Renal Failure
  •  multifocal spondolytis
              Treatment
  • Inj Tazar-Antibiotic
  •  Inj Lasix -for treatment of edema
  •  Nebulisation Salbutamol 
  • Inj Pantop 
  • Tab PCM 
  • Inj Piptaz 
  • Syrup mucaine gel 
  • Tab Febuxostat 
  • Inj Optineuron
  3)  CKD Case -

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

           Problem list                                                                              

  • Acidosis
  •  Hb - lower than normal
  •  Anisopokilocytosis with macrocytes, macrocytes, maco ovalocytes, and a few teardrop cells
  •  Elevated serum creatinine and blood urea
  •  Plasma cell dyscrasia, multiple myeloma 
  • Bilateral grade 2 Renal Parenchymal disease
         Treatment
  • Tab. PAN 
  • Fluid and salt restriction
  •  Tab Zoffer Tab 
  • Nodiosis 
  • Iron supplementation
  •  INJ. Optineuron

  4)  Coma and renal failure cases-1

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

            Problem list                                                                             

  • Diabetic ketoacidosis
  •  Electrolyte imbalance 
  • altered sensorium
  •  bed sores 
  • AKI
  •  Pyelonephritis 
  • UTI- E.Coli 
  • Bedsore - acinetobacter growth
          Treatment 
  • Inj Norad 
  • Inj. Piptaz 
  • Inj. Dopamine
  •  Inj Hai 
  • Inj Clexane      

  5)  Coma and renal failure case 2

        https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

             Problem list                                                                            

  • Infective endocarditis secondary to UTI klebsiella pneumonia infection 
  • Acute infarcts in bilateral cerebral and cerebellar hemispheres 
  • Ulcer over the sole of the right leg 
  • CKD
           Treatment
  •  Inj Monnocef 
  •  Inj Vancomycin
  •  Inj Pan
  •  Inj, Thiamine
  •  Inj. Augementin 
  • TAb. Ecospirin

  6)  Patients with acute onset of CKD Case -1

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

              Problem list                                                                             

  • Bilateral Hydroureteronephrosis
  •  AKI secondary to urosepsis
  •  Diabetic Nephropathy 
  • Anemia
  •  Bedsores
            Treatment
  • Inj. Pantop 
  • Inj Piptaz 
  • Inj. Lasix
  •  Inj Optieuron
  •  Inj. Nedmol 
  • Tab . Pcm 
  • Insulin Human actrapid

  7)   Patients with acute onset of CKD Case -2

       https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

              Problem list                                                                              

  • Heart Failure with reduced ejection fraction secondary to CAD
  •  Chronic Renal Failure
  •  Bilateral grade 1 RPD
  •  Mild Pleural effusion
  •  elevated serum glucose
  •  deranged Renal function test
            Treatment
  • Tab. Bisoprolol 
  • Tab. Nitrohart 
  • Tab. Nicardia 
  • Tab. GLiciazide 
  • TAb. Nodiosis 
  • Cap. Gemsoline 
  • Tab . Ecospirin

  8)   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

             Problem list                                                                               

  • Pedal Edema 
  • decreased urine output 
  • Vomiting 
  • loose motions
  •  right heart failure 
  • serum creatinine is elevated 
  • hypercapnia
            Treatment    
  • hemodialysis
  •  fluid restriction
  •  Tab Pan 
  • Inj Lasix 
  • Thiamine Inj 

  9)   AKI  case 1                                                                                    

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

             Problem list                                                                                

  • Alcoholic Hepatitis 
  • AKI secondary to Acute Gastroenteritis
  •  HF r EF secondary  to CAD
  •  Alcoholic and tobacco Dependence Syndrome
  •  Mallory Weiss tear Healing Phase - Gastroduedenitis
           Treatment
  • INJ - Thiamine
  •  Inj Optineunon
  •  Inj Lasix 
  • Tab . Aldactone

 10)   AKI case 2

       https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

            Problem list                                                                                 

  • AKI secondary to urosepsis
  •  Hyperkalemia 
  • Anemia
  •  Renal Parenchymal disease
  •  Pedal edema
            Treatment
  • Tab Nodiosis 
  • Tab . Orofer 
  • Inj Lasix 
  • Inj - Magnexforte 
  • Tab  Ultracet

 11)   AKI case 3

   http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

            Problem list                                                                                  

  • Acute Pancreatitis 
  • Raised serum creatinine levels
  •  Pedal edema, 
  • Scrotal, and penile edema 
  • AKI
          Treatment
  • iv fluids 
  • IV Lasix
  •  Tab Nodosis
  •  IV PIPTAZ 4.5 Gms. BD
  •  Iv 25%Dextrose. 100 ml BD


Q5] Telemedicine experience for the month of July.

     It has been a great experience learning actively with help of research based studies on cases we got in our hospital. It gave me the much needed motivation and helped me to understand the clinical subjects better by integrating different domains of medicine. Though the online practical cannot replace live practical , we are still trying our best to understand the cases better. Earlier, this month we got a case of Transverse myelitis, this made me,  the one who has always been fascinated by Neurosciences,  to understand  the case in-depth and that was a great experience for me. I am very excited to learn more about the cases in future. 

I will always be grateful to  Dr. Rakesh Biswas sir for giving us this amazing opportunity.  







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