LEKHANA 64

BIMONTHLY BLENDED ASSIGNMENT FOR JUNE 2021 

I am K.Lekhana 3rd sem

Roll no 64

I have been given the following formative assessment for bimonthly blended assessment for June 2021 .This is the link regarding assessment: .https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1

QUESTION; 01

CASE 01: PULMONOLOGY 

https://aitharaveena.blogspot.com/

55 year old female with shortness of breath ; pedal edema and facial puffiness.

Diagnosis: Acute exacerbation of COPD associated with right heart failure and bronchiectasis. 

Review on answered questions :

I completely agree with diagnosis  of the patient.As she worked in paddy field she had severe episodes of shortness of breath and lead to COPD. Pedal edema and facial puffiness is due to right heart failure. 

.HEART FAILURE--- increase in SNS activation --- leads to increase in ANGIOTENSIN II activity and ALDOSTERONE and ADH ..leads to vasoconstriction and increase in water reabsorption and  decrease in water excretion  and increase in water retention which leads to EDEMA.

CASE 02; NEUROLOGY 

https://aitharaveena.blogspot.com/

A 40 Year old male  with complaints of irrelevant talking and decreased food intake

Diagnosis: WERNICKE ENCEPHALOPATHY  due to thiamine deficiency due to alcohol withdrawal.

My review for answered questions:

Disease  is explained clearly with signs and symptoms diagramatically with easy tips to remember symptoms "COAT RACK " means Confusion,Opthamalgia,Ataxia, Thymine deficiency; Retrograde amnesia,Anterograde Amnesia,Confabulation,Korsakoff syndrome.

All drugs given to patient for increase in thymine  levels in body are clearly mentioned. FLOWCHART is used to explain for reasons for Thymine deficiency in alcoholic person and GRAPH is drawn for withdrawal symptoms.DIAGRAM is used to represent why patient kidney failure .I really appreciate this way of presentation as it is really easily understanding.

CASE 3: NEUROLOGY 

https://aitharaveena.blogspot.com

A 52 Yeàr old male with cerebellar ataxia and stroke.

Diagnosis : Denovo hypertension and presence of infract in inferior cerebellar hemisphere.

My review for answered question: 

I agree with medication given to this patient and mechanism of action of drug is properly explained.As patient is given ZOFER to reduce vomitings and tabEcsprin and clopidogrel is used to prevent platelet aggregation and clot formation .so infract can be reduced in cerebellum.ataxia will be releaved. 

I also agree to this point ..as because as he is chronic alcoholic which make him susceptible to hemorrhagic shock.This is explained clearly using diagram.

Case 4:NUEROLOGY

https://aitharaveena.blogspot.com/

45 year old female with palpitations ,pedal edema ,radiating pain along left upper limb

Diagnosis: HYPOKALEMIA causing palpitations, chest heaviness and generalized weakness. Radiating pain due to cervical spondylitis.

Review for answered questions are: 

Many Cause for hypokalemia are clearly explained for this patient.As this patient has episode of bilateral limb paralysis. May be drugs used to treat this paralysis  or due to inadequate intake has lead to hypokalemia in this patient.ECG changes are shown in diagramatically. I agree with findings ..T wave amplitude decreased,ST depression,prolong PR interval are seen in hypokalemia.

Case 5 : CARDIOLOGY 

https://aitharaveena.blogspot.com/

73 year old Male patient with pedaledema,shortness of breath and decreased urine output.

Diagnosis: patient is diagnosed with diabetic triopathy exhibiting sequence of neuropathy, retinopathy and nephropathy. 

My review for answered questions:

I agree with patient diagnosis. As he had diabetic since 30 years.Diabetic complications lead to neuropathy (as he had signs of numbness), retinopathy and nephropathy (as he has Chronic kidney disease stage 4) . So there is any increased risk for heart failure. 

*He had hypertension since 19 years . This is also important risk factor for heart failure.

*He also had elevated creatinine levels,CKD AST/ALT greater than 2 all of this are important risk factors for heartfailure.

All symptoms are perfectly diagnosed.The reasons  for blebs and non healing ulcer in legs are also properly explained.

Case 6:CARDIOLOGY 

https://aitharaveena.blogspot.com/

67 year old patient with acute coronary syndrome.

Diagnosis: Atherosclerosis due to presence of diabetes. 

My review for answered questions:

I agree with diagnosis and mechanism of drug actions are explained clearly.MetXl ( beta blocker) slows down heart rate ,TELMA (angiotensin receptor blocker)  which decreases BP,GLIMI which increases insulin release .But no drugs are mentioned for clot prevention and to decrease cholesterol levels.

Indications and contraindications for PCI ( angioplasty with stunt) are mentioned which is useful for  proper treatment .Harms of overtesting and overtreatment are explained by taking example.

Treatment ie..angioplasty with stunt is represented diagramatically. 

Case 7: GASTROENTEROLOGY

https://aitharaveena.blogspot.com/

25 Year male with epigastric pain.

Diagnosis: Severe Pancreatitis with pleural effusion. 

My review for answered questions:

I agree with diagnosis.Due to Pancreatitis there is lot of inflammatory chemicals secreted into blood.These chemicals create inflammation throughout body including lungs.That is why patient has plural effusion and patient experience an inflammatory type of reaction in lungs called ARDS.This is explained diagramatically. 

Treatment with medication are mentioned clearly to relieve pain.In this condition electrolyte balance must be maintained .This is done by IVF; 125ml/hr

Due to damage of pancreatic betacells---- hypoinsulinemia and hyperglucagonemia occurs which results in hyperglycemia. 

Case 8: NEPHROLOGY

https://aitharaveena.blogspot.com/

52 year male patient with shortness of breath,burning micturation and fever.

Diagnosis: Acidosis caused by renal failure because of hydronephroureterosis.

My review : condition is explained properly with diagrams.He had necrosis of kidney due to inflammation. That is why fleshymass is seen in urine .His shortness of breath is due to acidosis.All the diagnosis is proper.

Case9: INFECTIOUS DISEASES

https://aitharaveena.blogspot.com/

50 Year male with fever,facial puffiness and periodontal edema.

Diagnosis: Mucormycosis / Black fungus

My review: This is true that post covid patients are effected by mucormycosis mainly in people who are diabetic and whose are using lots of steroids in covid treatment and patients kept on humidified oxygen.

In India these cases are more because In India type 2 diabetes is epidemic,and fungal spores will be present in all conditions in this tropical country and due to unregulated steroid usage.so mainly diabetic people with covid are taken care attentively . Presently we are using Ampothericin B for treatment. 

Case 10 : Covid case

https://aitharaveena.blogspot.com/

A 50 year old female with viral pneumonia SECONDARY to covid 19 

My review on case: 

There is a bidirectional relationship between covid 19 and diabetes. severe acute respiratory syndrome corona virus binds to ACE 2 receptors present in major organs.SARS Cov2 may cause pleotropic alterations of glucose metabolism that could complicate the pathophysiology of preexisting diabetes . This hyperglycemia supports viral proliferation which influences the progression of her pneumonia. 

QUESTION .2

https://lekhanakeetha64.blogspot.com/p/lekhana-64.html

QUESTION 3.

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

A 18 year old male came to the hospital with chief complaints of 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.

CASE HISTORY AND CLINICAL FINDINGS-

Patient was apparently asymptomatic 6 months ago,then he noticed gradual loss of weight since 6months,patient had history of polyuria, nocturnal,polydypsia since 2 months. 10 days ago, patient attended a function outside and after 2 days he developed low backache and 2 episodes of vomitings and 3 episodes of loose stools for one day which subsided on its own.

Next day,patient developed fever, intermittent,high grade,subsided with medication. Patient went to RMP and got treated for fever.patient noticed yellowish discolouration of eyes and urine 3 days ago.Nausea and loss of appetite +

Diagnosis: ACUTE FULMINANT HEPATIC FAILURE SECONDARY TO POST INFECTIOUS(VIRAL/ BACTERIAL)  TOXIN MEDIATED ,COAGULOPATHY,DENOVO TYPE 1 DM WITH THROMBOCYTOPENIA 

PT WAS ADVISED TO TAKE EGG WHITES ,TO PASS STOOLS 2-3 TIMES /DAY AND REVIEW AFTER 1 WEEK WITH CBP,LFT,PT INR AND APTT.

ADVICE AT DISCHARGE-

ORAL FLUIDS 2-3 LTS/DAY

TAB LEVIPIL 500 MG BD

TAB.UDILIV 300 MG BD FOR 5 DAYS

TAB.RIFAGUT 550 MG  BD

TAB PANTOP 40 MG OD

SYP. HEPAMERZ 10 ML BD

SYP LACTULOSE 10 ML BD( TO PASS 2-3 STOOLS /DAY)

INJ. HAI SC  6U TID

My review: This is very critical case.Almost 15 days patient is treated by using different drugs.I really appreciate this work.

Question 4: 

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

A CASE OF A 45 YEAR OLD MALE WITH ACUTE KIDNEY INJURY ON CHRONIC KIDNEY DISEASE(HYPERTENSIVE NEPHROPATHY) WITH URAEMIC ENCEPHALOPATHY.

This is case of old male came to the hospital with complaints of  Altered Sensoriun(hypo active).later history of fever 10days which is followed by pedal edema with anasarca with Shortness of breath even at rest. The present illness of the patient includes lower back pain and neck pain.He is known case HYPERTENSION  5yrs and also known case of CHRONIC KIDNEY DISEASE since 5 years. 

Diagnosis : AKI ON CKD(HYPERTENSIVE NEPHROPATHY) WITH UREMIC ENCEPHALOPATHY.

1.HYPERTENSIVE NEPHROPATHY: has been used to describe the clinical syndrome Characterised long-term essential hypertension. HN is the leading cause of ESRD in Africans in the second leading cause of ESRD worldwide.

 -Two physiological mechanisms have been proposed for the development of hypertensive nephropathy:

i) Glomerular ischaemia- chronic hypertension results in narrowing of pre-glomerulus arteries and arterioles with the consequent reduction in glomerular Blood flow

ii) Glomerular hypertension and glomerular hyperfiltration.

Most of the patients with hypertension, the condition present for many years as in this case it was present for the past five years because of the periods of accelerated or poorly controlled BP. Hence the patient also witnessed mental status changes which are also the symptoms of Uremia. This caused Uremic Encephalopathy. 

2.UREMIC ENCEPHALOPATHY:It’s an organic brain disorder which occurs due to the buildup of toxins which are normally cleared by kidneys.  It develops in patients with renal failure usually when creatinine clearance levels fall and remain below 15 mL/min.Uremia is final stage of progressive renal insufficiency and result in multiorgan failure.

Results from accumulating metabolites of proteins in amino acids and concomitant failure of renal catabolic, metabolic and endocrinologic processes. Uremic encephalopathy  is one of many manifestations of Renal failure. Accumulation of diamethylarginine leads to Vasoconstruction inducing hypertension.

Treatment:

IVF-NS(0.0+30ml/hr)

INJ.LASIX(40mg/IV/TID)

INJ.NaHCO3(100meq in 100ml NS/IV/Stat)

T.NODOSIS 550mg/P.O/TID

BP/PR/Strict I/O Charting.

Question 5: 

This assignment has helped me learn the basics of clinical practice like the history taking, presentation of a case, how to approach a patient etc,. This pandemic had a major impact on education, we are unable to attend the offline postings and meet the patient in person, in such situation, this method of eblogs has been of great help, as we are able to take up a case, and present it in this way even though we are not present  physically in the hospital. i have leant history taking, analysis of a case, presentation of the case and also about few diseases.this method of learning will definitely help us become better clinicians as it is giving us early clinical exposure. by reviewing the work of my peers, i have learn what mistakes should be avoided while presenting a case/writing a blog, i have also learnt how a given case should be presented, what points should be included and what points should be omitted . i have also learnt how to analyse the given data about the patient. overall, this has been a very great experience, we have learn a lot form the postings, and are hoping to learn more and more in the coming days. i am really glad that our college had come up with eblog idea, which is encouraging and inspiring us to learn more.

Thank you so much for all the ones who are helping us to do this work successfully.