July assesment

 All questions are around student driven patient centered case reports prepared by our students (including 2019 batch students in 3rd semester) over last one month. For the same students taking this exam, separate marks will be provided for their contribution to the questions. 

Question 1: Competency tested for Peer to peer review and assessment :

Please go through one student's entire answer paper from this link, the one who is closest to your own roll number 

http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

and share your peer review of each answer with your qualitative insights into what was good or bad about the answer. 

https://vinilabhavani.blogspot.com/2021/07/kanday-vinila-bhavani-roll-no-57.html

Case 1 

https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html

Diagnosis COPD secondary to Bronchiectasis

In my opinion  it could be due to allergy ie hypersensitivity due to weather conditions in January ... As patient has repeated episodes of symptoms at the same time every year..  

Case 2 

https://swathibogari158.blogspot.com/2020/09/chronic-decompensated-liver-disease.html

Diagnosis : cirrhosis of liver and ascites .

 In my opinion

   I agree with cirrhosis of liver  being the cause of hyperbilirubinemia

     Patient was chronic alcoholic suffering with ascites which caused hypoalbuminemia and reduced aldosterone synthesis .

 hypoalbuminemia  was rightly addressed with eating 2 eggs ..... If affordable can be given through injection too  

Were all good but was concentrating more  on medication

Cellulitis  might be due to immobilisation and salt restriction

   Case 3 

https://lasyamithrakandregula.blogspot.com/2021/05/medicine-cases.htmlhttps://lasyamithrakandregula.blogspot.com/ 

 Diagnosis : viral pneumonia with known case of hypothyroidism .

    In my opinion

The patient is presented with an abdominal pain and vomitings since 5 yrs and is a chronic alcoholic and he got treated temporarily in the past yrs .because of the continuation of alcohol intake his symptoms got worsen and he complained of constipation and burning micturition and throbbing pain radiating to back.

As the symptoms are severe for the early recovery they gave the antibiotics in the injectable form and also stated about his nutrition because as he is chronic alcoholic which lead to thiamine deficiency. As his pancreas are effected , to decrease the exocrine secretion of pancreas they have given octreotide inj. Their line of treatment has kept in the presentation in a good way

Case 4 

http://psaikrupasri175.blogspot.com/2021/05/medicine-case-discussion.html.

 Diagnosis : patient was diagnosed with Arthralgia and a known case of diabetes mellitus type 2 

 In my opinion

Here answers are more towards treatment part of why were the treatments given rather then evaluating cause or studing the case

Case 5 http://185meghanavarma.blogspot.com/2021/05/general-medicine-case-discussion-for.html

    Diagnosis : patient was diagnosed with Type 2 diabetes mellitus and a known case of acute kidney failure

In my opinion 

case is well evaluated with proper addressing of AKI causes

Case 7 https://kausalyavarma.blogspot.com/2021/05/a-52-year-old-male-with-cerebellar.html?m=1

Diagnosis : Denovo hypertension with cerebellar ataxia

In my opinion

The patient presented with chief complaints of slurring speech and deviation of mouth that lasted for 1 day. The patients history was taken in detailed and was diagnosed with Cerebellar ataxia to acute CVA with infarct in the right inferior cerebellar hemisphere. Systemic and motor examinations are shown properly in the video. CT Scan revealed the cerebellar infarct and2d echo showed diastolic dysfunction. They have included all the pictures of patient and the investigation reports and diagnosed it clearly. In overall it is a very good presentation

Case 8 https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html 

  Diagnosis: wernickes encephalopathy secondary to chronic alcohol dependence

In my opinion

Etiology is stated accurately i.e., alcohol withdrawal and symptomatology stands the same [seizures, tremors, restlessness]

 Thiamine, lorazepam, Kcl are standard medication in my view

Alcohol withdrawal symptoms will fit the best

It is right decision to give thiamine since it is majorly involved in ATP and NADH production 

dehydration is the only probable cause for dehydration in my view

The mentioned reason is appropriate i.e., alcohol decreases iron absorption and bleeding ulcer is cause for normocytic anaemia

yes aggrevated ulcer is due to both combined effect of diabetes and peripheral neuropathy

Case 9

 http://bejugamomnivasguptha.blogspot.com/2021/05/a-45-years-old-female-patient-with.html

 Diagnosis : cervical spondylitis with known case of hypokalemic paralysis 

In my opinion

The history of present illness,past illness are very clearly mentioned.The anatomical localisation of palpitations, dyspnea,pedal edema and chest pain are explained in flow charts which are very easy to understand.The ECG reports for hyperkalemia and hypokalemia are given in a diagram which can be ver effective for understanding.

Case 10

https://amishajaiswal03eloggm.blogspot.com/2021/05/a-50-year-old-patient-with-cervical.html

Diagnosis:Mylopathy hand

In my opinion

The symptomatology has been very well explained with the help of a hand-drawn diagram, the etiology is very well supported with the help of a flowchart that appeals to the reader each subquestion has been made visible which enhances the readability of the document

Each pharmacological intervention has been explained in-depth with comprehensive language

Q2-4

Patient centered data around the theme of renal failure patients with AKI, CKD and acute on CKD, 

captured by students from 2016 and 2019 batch in the links below

Patients with low back ache and renal failure

Q2) Share the link to your own case report of a patient that you 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://kusumageddada58.blogspot.com/2021/07/aki.html

Q3) (Testing peer review competency of the examinees) :

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.

AKI 

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

Over view 

A 58 year old male patient came to casualty with chief complaints of:

- lower abdominal pain: 1 week

 -burning micturation:1week

- low back ache after lifting weights

-dribbling / decrease of urine out put:1week

-fever :1 week

- SOB , rest :1week  

  Apprisal

Case history was taken well and examination was very well done... Sequential evaluation of case is apprisiable 

Negative points 

It would be better if fever chart is added as it was treated with strict temp and IO monitoring as it would be better understood improvement of the case was not well mentioned

My Analysis

 This is a case of Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

With ? Right HEART FAILURE,

With K/C/O - HTN ( Not on Rx)

-AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your bodyand return of creatinine to the base line and symptoms less then 3 months indicating it to be a AKI

Acute on CKD :

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

Over view 

A 75yr old male patient ,labourer by occupation ,came to casuality with Cheif complaints of 

• 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 .

Apprisal

I would not find any points to be highlighted . History was taken well 

Negative points

There are no clinical pics of the symptoms like pedal edema.

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitored

My Analysis

This is case of 

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)

CKD :

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

Over view

A 49 yr old female , mother of 2 children, who is a house wife, apparently asymptomatic 13 yrs ago and then she noticed mass per anum with bleeding , went to hospital and diagnosed as haemorrhoids and got operated.

- Since 3 yrs she has history of muscle aches, for which she is using NSAIDs.

- She has h/o fever 20 days back, got treated in the local hospital, and 

- Since 20 days she has generalized weakness.

- She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.

Apprisal

History was taken well.

Good lab work clear evaluation was done 

Negative points

There are no clinical pics of the symptoms like pedal edema.

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitoredit would have been better if urine was sent for eosinophils for interatial disease

My Analysis

This is  case of CKD ?

 Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).

Patient with coma and renal failure 

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

Overview

A 35 yr old female with 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.

Apprisal

Very well presented 

With good fever charting with all the necessary information.

History was taken detailed way 

Follow up was good 

All the tests were properly done 

Negative

I could not find the negative data in the elog 

My analysis

It could be the hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen. Hospitalisation has increased the infection to the bed sore it would have been better if discharged early as it was permanent damage and was impossible to treat anyway.

Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):

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. 

Analysis the data

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

Analysis of  A 35 yr old female with 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

Vegetative state of the patient could be due to  hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen.

https://pubmed.ncbi.nlm.nih.gov/19362767/

Link supporting the data 

Intermittent Fever spikes can be explained due to the bed sores clearly explained through culture of the sores 

Sepsis might be the reason for encephalopathy by altering the blood brain barrier 

https://www.hindawi.com/journals/amed/2014/762320/

Q 5) Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. 

The telemedical learning from the hospital has been a new experience and we  learnt quite lot of things through reflective observation during lockdown.  it's a bit challenging as we have just entered internship ,We have learnt elogging of the cases in a very short span of time and made juniors do so. I could answer the questions from juniors easily as I have been part of many discussion in ICU and wards . By doing this assignment I could view many cases and many case scenarios through which I learned many  things 

AKI

 CASE OF A 60YR OLD FEMALE WITH PEDAL EDEMA

 

ACUTE KIDNEY INJURY SECONDARY TO UROSEPSIS

June 19, 2021

A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

History of present illness:

The patient was apparently asymptomatic 10years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)

Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.

History of past illness:

Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.

Personal history:

Married 

Mixed diet

Normal Apetite 

Adequate sleep

Bowel movement is regular

Decreased urine output and burning micturition

With no known allergies.

Consumes alcohol occasionally.

Family history:

No significant family history

General examination:

There is Pallor 

There is no Icterus, cyanosis, clubbing

Generalized Lymphadenopathy

Edema is seen bilaterally witch is Pitting type pedal edema. 

Vitals:

Temperature afebrile

Pulse rate is 111 beats per minute

Respiratory rate is 24 cycles per minute

Blood pressure measured on the left hand is 170/110 mm of Hg

Oxygen saturation at room air is 90 arm per mm Hg

Systemic examination:

Abdominal system:

No scars, sinuses, or any engorged veins.

Hernial orifices intact

Tenderness or guarding absent

No enlargement of liver, kidneys, or spleen

No ascites

Bowel sounds were normal.

Cardiovascular system:

cardiac sounds S1 S2 heard.

No cardiac murmurs

Thrills absent

Respiratory system:

No chest wall deformity 

Trachea central

Expansion is symmetrical

Percussion note is resonant

Breath sounds normal, no wheeze or crackles heard.

Vocal resonance normal and symmetrical

Central nervous system:

No focal abnormality detected

Higher mental functions intact 

Cranial nerves intact 

reflxes normal

Speech normal

Provisional diagnosis:

Acute kidney injury secondary to urosepsis

Investigations ordered:

14/06/21

1. Complete urine examination: 

2. ECG:

15/06/21:

1. Serum creatinine:

2. Blood sugar Fasting:

3. Blood sugar Random:

4. Blood Urea:

5. Serum Electrolytes:

6. Serum Potassium:

7. Urinary Chloride:

8 URINARY POTASSIUM

9. Urinary Sodium:

16/06/21

1. Serum Electrolytes:

2. Serum Creatinine:

3. Haemogram:

4. Blood urea:

5. ABG:

18/6/21

1. Serum creatinine:

2. Serum Electrolytes:

3.Haemogram:

4.Blood urea:

21/6/21

1. Complete Blood Picture (CBP)

Blood urea:

15/6/21 - 65 mg/dl

16/6/21 - 62 mg/dl

18/6/21 - 76 mg/dl

21/6/21 - 81mg/dl

Serum creatinine:

15/6/21 - 3.4 mg/dl

16/6/21 - 3.4 mg/dl

18/6/21 - 3.2 mg/dl

21/6/21 - 3.1 mg/dl

Total leukocytes count:

16/6/21 - 24700

18/6/21 - 26500

21/6/21 - 31700

Serum Electrolytes:

15/6/21 - Na: 139 ; K: 5.2 ; Cl: 106

16/6/21 - Na: 138 ; K: 5.1 ; Cl: 105

18/6/21 - Na: 136 ; K: 4.9 ; Cl: 102

21/6/21 - Na: 134 ; K: 5.5 ; Cl: 98

Diagnosis:

Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)

With anenmia of chronic disease 

Treatment:

15/06/21:

Treatment:

Inj LASIX 40mg (8am- 2pm -8pm)

IVF - NS @ UO + 50 ml/hr

15/6/21, 5:30 p.m.

Treatment:

Inj LASIX 40mg (8am -2pm -8pm)

IVF - NS @ UO + 50 ml/hr

16/6/21

Treatment:

 Inj LASIX 40 mg IV/TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj MAGNEXFORTE 1.5 gm/IV/BD

 Tab NODOSIS - XT PO/OD

 Inj HAI s/c

 Neb plain Asthalin 4 respules 1 - 1 - 1 - 1

17/6/21

Treatment:

 Inj LASIX 40 mg IV/TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj MAGNEXFORTE 1.5 gm/IV/BD

 Tab NODOSIS - XT PO/OD

 Tab OROFEA - XT PO/OD

 Inj HAI s/c

 Neb plain Asthalin 2 respules

 Strict I/O charting

18/6/21

Treatment:

 Inj LASIX 40 mg IV/TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj MAGNEXFORTE 1.5 gm/IV/BD

 Tab NODOSIS - XT PO/OD

 Tab OROFEA - XT PO/OD

 Inj HAI s/c

 Neb plain Asthalin 2 respules QID

 Strict I/O charting

Tab ULTRACET 1/2 tab QID 1/2 - 1/2 - 1/2 - 1/2

19/6/21

Treatment:

 Inj LASIX 40 mg IV/TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj MAGNEXFORTE 1.5 gm/IV/BD

 Tab NODOSIS - 500 mg PO/OD

 Tab OROFEA - XT PO/OD

 Inj HAI s/c

 Neb plain Asthalin 2 respules QID

 Strict I/O charting

 Tab ULTRACET 1/2 tab QID 1/2 - 1/2 - 1/2 - 1/2

Expected discharge summary:-

A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

History of present illness:

The patient was apparently asymptomatic 10 years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)

Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.

History of past illness:

Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.

Personal history:

Married 

Mixed diet

Noamal Appetite 

Adequate sleep

Bowel movement is regular

Decreased urine output and burning micturition

With no known allergies.

Consumes alcohol occasionally.

Family history:

No significant family history

General examination:

There is Pallor 

There is no Icterus, cyanosis, clubbing

Generalized Lymphadenopathy

Edema is seen bilaterally witch is Pitting type pedal edema. 

Vitals:

Temperature afebrile

Pulse rate is 111 beats per minute

Respiratory rate is 16 breaths per minute

Blood pressure measured on the left hand is 170/110 mm of Hg

Oxygen saturation at room air is 90 arm per mm Hg

Systemic examination:

Abdominal system:

No scars, sinuses, or any engorged veins.

Hernial orifices intact

Tenderness or guarding absent

No enlargement of liver, kidneys, or spleen

No ascites

Bowel sounds were normal.

Cardiovascular system:

cardiac sounds s1 and s2 heard normally

Apex beat located in 5th ICS, medial to the mid-clavicular line.

No cardiac murmurs

Thrills absent

Respiratory system:

No chest wall deformity 

Trachea central

Expansion is symmetrical

Percussion note is resonant

Breath sounds normal, no wheeze or crackles heard.

Vocal resonance normal and symmetrical

Central nervous system:

No focal abnormality detected

Higher mental functions intact 

Cranial nerves intact 

Speech normal

Provisional diagnosis:

Acute kidney injury secondary to urosepsis

Course in the hospital:-

Day 1:-

Treatment:

Inj LASIX 40mg (8am- 2pm -8pm)

IVF - NS @ UO + 50 ml/hr

Day 2:-

 Inj LASIX 40 mg IV/TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj MAGNEXFORTE 1.5 gm/IV/BD

 Tab NODOSIS - XT PO/OD

 Inj HAI s/c

 Neb plain Asthalin 4 respules [ 1 - 1 - 1 - 1 ]

Day 2:-

same treatment was continued

 Tab OROFEA - XT PO/OD

 Strict I/O charting was advised

Day 3:-same treatment was continued

Tab ULTRACET 1/2 tab QID [ 1/2 - 1/2 - 1/2 - 1/2 ] was added.

Day 4 and day 5:-same treatment was continued

Day 6:-

Same treatment was continued

 Tab Norflox 200 mg PO/OD was added

Day 7:-

Same treatment was continued

 Tab SHELCAL-CT PO/OD was added

Day 8:-same treatment was continued

June Assesment

 VIRTUAL MEDICAL LOG BOOK OF ROLL NO.57

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

MONTHLY SUMMATIVE ASSESSMENT

I have been given the following questions to answer in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment, to assess the quality of treatment given and to suggest improvisations. 

 Question 1: Competency tested for Peer to peer review and assessment :

After going through one particular answer of ten students in this l

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

Here are my qualitative insights into what was good or bad about the answer. 

3. Cause for current acute excerbation ?

it could be due any infection

In my opinion it could be due to allergy ie hypersensitivity due to weather conditions in January ... As patient has repeated episodes of symptoms at the same time every year.. 

Q 2) Share the link to your own case report of a patient that you 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://kusumageddada58.blogspot.com/2021/06/cns-case.html

 Q3)Testing peer review competency of the examinees) :

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 share

         

Q 4)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.

MULTI SYSTEM 

https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

Overview: 

18 year old male came with the chief complaints of back pain since 1 week ,low backache 1 week ago,fever since 5 days ,yellowish discolouration of eyes since 3 days ,vomitings (2 episodes) and loose stools(3 episodes)and blood tinged urine yesterday morning 

Appraisal:

Examination was very well done from  head to toe .

Temperature charting with the complete information at one glance was commendable

Negative points: 

Diagnosis was not clear,there are way more differential rather then a particular diagnosis even to the end

Treatment was on broad way instead of particular diagnosis.

My analysis:

In my analysis as the patient has got covid antibodies positive it could me multi system inflammation - covid 

As he has Diabetes ... Whole time it was seen as DKA and infection rather than MIS-C 

CNS 

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

Overview

A 28 year old male came with history of TB 1 month back came with  chief complaints of sudden fall followed by weakness of both the lower limbs (paraplegia) and loss of hand grip 10 days back, associated with bowel and bladder incontinence.

Appraisal

The fact that the patients relative was also infected with TB solidifies the diagnosis.

The approach to the cause of the paralysis through a detailed history of case was done well

Negative points

 Tuberculosis affecting the nerve root through a cold abscess can be clinically found by examination rather than going through an advanced techniques like CT

The history was inadequate about the abscess 

My analysis

 The  spine will be secondarily affected in the TB..

Proper examination for the local deficits of the involved region ... Is need 

If it is just due to compression of cold abscess will the draining of abscess helps him to continue his normal life 

Renal 

https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

Captured by one student from 2017 batch in the link below :

Overview

  A 45 yr old male with cheif complaints of : Altered Sensorium (Hypo active) and lethargy since  Morning

History of fever 10 days back,lasted for 3 days, followed by Pedal edema with Anasarca with Shortness of breath present even at rest .

Appraisal

Well monitoring of  creatinine and halting the damage to kidney without going to irreversible failure.

Also dialysis which helped the patient's encephalopathy was good .

Case was taken correctly including all systems . All the problems like infection, hypertension and chronic proteinuria causing kidney failure were addressed well and treated

Negative points

Personal history about addiction was not taken properly which might help diagnosis and liver cirrhosis

Patient was not warned or given medication for hypertension or pedal edema which might be first sign of renal failure

The liver failure was not explained which had lead to cirrhosis , damage to liver was not know as LFT was not done

My analysis

I think case history was taken incompletely and it would be better if LFT was taken .

It's better to prevent disease than cure so proper management of initial  symptoms like pedal edema or hypertension should be properly done and review examination should be done frequently

CVS 

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

Overview

 A 70 year old female presented to casuality with complaints of Distension of abdomen and shortness of breath Grade-3 since 5days

Appraisal

  Diagnosis and tests were adequate. The problem in the heart was localised with 2D echo. The wall abnormality and the chamber affected were seen. 

Negative points

the cause for abdominal distention was not addressed properly

 the cause for atrial fibrillation in a hypothyroidism patient was not solved.

My analysis

The diagnosis must also should have taken the age of the patient into consideration as she is of 70yrs of age were any interventions are not successful and the problem lies in the degeneration of tissue due to old age.

Captured by one student from 2019 batch in the link below :

Abdominal 

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

Overview: 

A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

Appraisal

Case was take in detailed format 

Every day follow up was very well done

Examination and investigations were done as needed 

Negative points 

 There are no pus cells or markers of inflammation in the due report.

  The fact that the patient was a diabetic was not taken into consideration in suggesting the acute kidney injury secondary to infection

Why she has bp of 170/90

Why there is no sign of infection in CUE??

My analysis 

   I think it could be diagnosed as  urinary tract infection with diabetes mellitus which is leading to acute kidney injury.

Q5)Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. 

Here are the pictures of the log notes I've done during the postings for better understanding the patient symptoms and to reach a correct diagnosis.