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
