23 Divya.B

Divya.B 

Roll no 23 

3rd Semester

        Bimonthly blended assessment.

           GENERAL                         MEDICINE 

           I have been the formative assessment for August 2021 in an attempt to to read analyse, comprehend, discuss and reflect upon the discussed patient-centered data which is required to achieve and understand the medical skills by a physician.

 This blog is made in response to the following question. 

 Refer to the link below regarding assessment:

 

https://2018-

21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

 

Reference video link: https://youtu.be/953auU42R0k 

 QUESTION 1: - Peer to peer review:

 Long case: 

 Qualitative insight 

              The case presentation is very well done by the presentater. The case is clear cut with all the required test reports ,relevant scans and required pictures of a patient. The case is about the patient suffering from acute glomerulopathy (glomerulonephritis.). The patient self-centered data is presented relevantly including past history, medical history ,present history ,personal history , family history and socioeconomic status .All these histories give us a clear cut medical history of the patient. Clinical examination presented was thorough in a very detailed manner. In addition to renal dysfunction details they have also presented the rheumatoid arthritis along with it's pictorial representation. All the mentioned details can lead a physician to diagnose the disease very clearly. The overall blog of this link is relevant ,clear-cut and detailed in a comprehensive manner.

 Pedagogic Questions: 

 Sub question 1:

it was clearly mentioned about abdominal fat pad biopsy and the renal biopsy but the differences of these both should have been mentioned in a tabular form so that there could be clear cut understanding of this both biopsies.  

Sub question 2:

 it's given appropriately in a tabular form mentioning each one in detail. 

 Sub Question 3:

 the details should be mentioned clearly so that it would not be difficult for understanding. 

 Sub question 4:

 the description about the rheumatoid arthritis and the gout must have been mentioned individually and the comparison should have done to get a clear cut idea.

 Sub question 5: 

efficacy of febuxstat is given clearly with required methods.

 Qualitative marking:10/10

 Short case 1 

 Qualitative insight: 

              The details of the patient taken was taken from his attendant appropriately since the patient is not mentally stable. The short case presentation is done with all the required clinical data and all the motor and systemic examination was done and details were also mention very clearly it was a really appreciable work done and very well presented. The required ECG and 2d echo scan was done and represented through the reports. Processing all the test reports and physical examination the person was diagnosed as a case of Parkinson's disease which is also associated with hypertension and multisystem atrophy. The overall case presentation was informative,detailed and presented comprehensively so that we can have a better understanding and knowledge about diagnosing the clinical cases. The overall block presentation was accurate and well organised. 

 Quantitative marking:9/10 

 Short case 2: 

           This is a case of young male patient who came to OPD the complaints of facial puffiness abdominal distension rings lesions over the arm and purple stretch marks over the abdomen since one and half year. Patient was apparently examined and detailed clinical picture was taken into consideration and it was finally diagnosed as Iatrogenic Cushing syndrome secondary to topical clobetasol application for about 1 year. The importance of the mentioned past drug history can be clearly known in this case. The usage of clobetasol for about an year caused some more clinical issues,so that we definitely require the past drug history in order to diagnose the problem accurately.I felt the overall blog was with excellent presentation and useful clinical pictures. 

 QUESTION 2: - problem - solution list 

 Long case: 

Patient's problem: 

 •Generalized edema 

 •facial puffiness

 •Dilutional hyponatremia 

 •increased urine output 

 •hyperuricemia

 •pain in finger joint and wrist joints

 •pain in subcutaneous swellings in the     proximal  joints of the finger 

 •erosive rheumatoid arthritis

 •burning sensation in eyes with increased tearing. 

 Solution: 

        The oedema occurred is due to levels of water and sodium retention in the body indicating some renal pathology which should be eliminated. The presence of frothy urine and indicates glomerular pathology which is also a reason for decreased urinary output. So these pathological complications should be treated. 

Treatment:

 1)Free water restriction for Hyponatremia 

2)Tab. PREDNISOLONE P/O 20 mg OD

  3)Tab FEBUXOSTAT P/O 80 mg OD in

4)Haemodialysis for worsening renal dysfunction

     Short case 1) 

 Patients problem 

 •Stiffness 

 • slowness of movements 

 • involuntary movements with rhythmic to and fro oscillatory movements

  • hypertension

  Solution:

         Since this is a problem of CNS that can't be restored by any physiological changes appropriate treatment of the Particular diseases will be the only solution. 

 Treatment: 

 1. Tab. Syndopa Plus 125 mg QID 2. Tab. Syndopa 125 mg CR OD 3. Tab. Telma 40 mg OD Short case 

2) Patient's problem 

• Itchy ring lesions 

• pedal edema

• puffiness of the face

• purple stretch marks 

• abdominal distension 

• lower back ache 

• hypertension 

• feeling low 

• weight gain 

• low cortisol levels 

 Solution:

            The solution is to treat the underlying cause one of which is known to be usesage of clobetasol that should be withdrawn and appropriate drug therapy to be given to reduce all his clinical conditions.

 Treatment 

 •Ointment AMLORFINE 

 •FUSIDIC ACID CREAM. 

 •SALINE COMPRESS OVER LEISONS. 

 •Plan to start anti fungals on next visit once dose of steroids is reduced 

 •BY INJECTING 0.4 ML OF ACTOM

•PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR @ 7am 

 •Dose of Tab hizone was reduced to 10 mg per day in divided doses for one month.

 •Tab Shelcal 500 OD and Tab Vit D 3 Od. Tab ULTRACET /PO/SOS. 

 QUESTION 3 -Therapeutic Interventions 

 Long case:

 Free water retention to treat hyponatremia 

 Tab Predisolone to reduce the inflammation 

Tab febuxstat used to treat hyperuricemia 

 Short case 1: 

 1. Tab. Syndopa Plus 125 mg QID to treat symptoms of parkinsonism like tremor's, rigidity and slowness of movements 

 2. Tab. Syndopa CR OD -antiparkinsonic agent. 

3. Tab. Telma 40 mg OD- to treat Hypertension

  

Short case 2: 

 •Ointment AMLORFINE - antifungal 

 •FUSIDIC ACID CREAM.- to treat bacterial infection 

•SALINE-to compress over lesions 

 •Dose of Tab hizone to treat symptoms of skin allergy like itching, swellings,rashes.

 •Tab Shelcal 500 OD and Tab Vit D 3 Od for calcium and vitamin D deficiency 

•Tab ULTRACET /PO/SOS to relieve pain. 

QUESTION 4)

 I haven't done a case report yet.   

QUESTION 5) -Reflective writing 

        

          This is my third assignment.I Think I have made a few improvements by learning through my previous blogs .All these activities give us experience to learn and acknowledge the clinical based data and knowledge and aquire the clinical skills required for a Doctor.We are learning alot through these assignments.As we have only online postings things are hard to understand but these assignments made them easier,I am also able to learn about diagnosis treatment of Various diseases though everything is not clear.I am able to learn patient history taking,general examination and doctor patient relationship and basic ethical and empathical relation that a Doctor should have.I am really thankful and appreciate all the efforts of my management helping us to learn a lots of clinical information . 

                         THANK YOU