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GENERAL MEDICINE MONTHLY ASSIGNMENT( AUGUST 2021)

 GENERAL MEDICINE   MONTHLY ASSIGNMENT  (AUGUST  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

Question 1 : 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 -

link 1: 

link 2:

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

ANSWER :

LONG CASE :

POSITIVES :

  •   The case report is NOVEL
  • It is very well formatted and follows the structure of an ideal case report.
  • The case is completely deidentified.
  • The X-Rays Findings, urine microscopy findings have been explained under the image.
  • The section on diagnostic approach is provided with a number of links that justify the treatment.
  • Localisation of problems has been added.
NEGATIVES :
  • History could have been written in a chronological order 
SHORT CASE 1

POSITIVES :
  • The examination is complete and accurate
  • The history is very detailed , and explains the progression of the signs and symptoms.
  • X- RAY and 2-D echo findings have been explained
NEGATIVES :
  • Therapeutic leads can be linked . 
SHORT CASE 2 :

POSITIVES:
  • Clinical images of the of previous and current striae have been mentioned , helps in showing the progression of the disease.
  • The signs that are mentioned for Cushing's syndrome and can be appreciated in the clinical imaging done
NEGATIVES:
  • Therapeutic leads can be linked .

Question 2 : Please analyse the above linked long and short cases patient data in order of perceived priority and then discuss the therapeutic and diagnostic uncertainty around the solving those problems

LONG CASE : PROBLEM LIST

  • Mildly dilated right heart border and aortic knuckle.
  • anasarca
  • Hyponatremia
  • Gout
  • Frothy urine
  • osteopenia
  • Dysmorphic  RBC in the urine.
  • Decreasing urine output
  • Pain and edema of the joints
Therapeutic interventions :
  • Water restriction - hyponatremia
  • Prednisolone : used to treat arthritis
  • Hemodialysis - for renal dysfunction
  • Febuxostat - USed for lowering the uric acid levels in patients with gout
SHORT CASE 1: PROBLEM LIST
  • Stiffness and rythmic to and fro oscillations of the index and middle fingers of both hands
  • Difficulty in walking
  • erratic bowel habits
  • difficulty climbing up stairs
  • decreased libido
  • monotonous drab

5) Telemedicine 

 This month was a great experience to me as I got a chance to general medicine ward and the case history taking was a really good experience. This made me realize that practical . 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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