65 SUCHITHA KOLA, BIMONTHLY ASSESSMENT-JULY 2021
BIMONTHLY ASSESSMENT-JULY 2021
Greetings to one and all who are reading my blog.This is SUCHITHA.KOLA,RNO:65, a third Semester student.
I have been given this case with the theme of "Scholarship of integration in Medical education and Research" which is a primary tool to interact between the ongoing different systems or disciplines of knowledge, as being a part of health care system.
QUESTION NO 1:PEER TO PEER REVIEW:
This is the peer review of my nearest Roll No:
She has reviewed all the Cardiology, Pulmonology, Neurology, Gastroenterology and Infectious diseases Case of the below mentioned senior's blog:
My review:
1.All the comordities were very well explained, along with reference
2.Each drug was mentioned and explained in detail about the Medicine and action
3.The whole review was written in understandable way
4.The only thing is that it could be more understood if she could include some more flowcharts and pictures
5.Explanation for every treatment and cause are Written in a very coherent manner.
6.There is also a detailed view on the biochemical findings and Investigations.
•ONLINE TEACHING ANSWER REVIEW:
The way she expressed her words in the answer says that she is enjoying the online teaching rather than doing nothing other than listening to classes .
But she is also missing the virtual way of teaching ,where we can practically do every thing observing and analysing with our naked eye .
•QUESTION NO 2:
I didn't get an opportunity to an elog this month as our group members have not done an elog before our intern allotted the blogs to the ones who didn't get the chance to do last month.
As I already done one of the eblog last time I didn't get a chance to do it this time ..May be I can get it in next month .
•QUESTION NO 3:
(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
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 :
1.AKI :
- All the aspects like history, investigations, treatment have been presented well.
- History taking was done properly, treatment and Investigations were written properly.
- The way of presentation about the evolution of symptoms were very well presented.
2.Acute on CKD :
•All the data was arranged in a proper and systematic way
•It was written in a very coherent manner.
•All the biochemical investigations and Analysis is properly arranged so that the diagnosis was made easy to understand.
3.CKD :
• History taking was done in a proper way and in a sequential order.
• All the details and history was taken a good care even the minute ones .
• Totally ,the case was presented well
•Past E log similar to last case :
• Links are provided were ever felt necessary.
• The case explanation was good and in a detailed manner , helping to understand the Pathology in there.
• It was presented in chronological order making it easier to understand.
4.Patient with coma and renal failure :
• The way of presentation about the evolution of synonyms are very well presented.
• The Pictures are so clear explaining the condition of patient,like even the bed sores.
• Each drug was mentioned which was given to the patient from day 1 and it was so clear in understanding.
• History of the patient was very well taken even the minute details were included.
• Events of the diseases are added in a chronological order.
• Pictures are so clear and very helpful in understanding the condition of patient like the bed sores..etc.
5.Patients with acute on CKD :
• All the keywords are highlighted were ever necessary and by that making it easier to understand.
• X-rays are also so clear , along with the impression.
• Pictures surely made a very good impact.
b)
• The overall presentation was very good.
• Pre and Post Medication findings were included and made it easy in analysis.
• Links related to the cases were attached at the end of the blog making it more informative.
• Discharge summary is not written.
• History was taken very well and explained in a coherent manner with the seperate side headings.
• Everything was in a proper chronological order.
6)Patients with AKI :
• The history could be in a more detailed form.
• The day wise Medicines are mentioned making it more informative.
• History is taken in very well manner.
• The effects on each system are mentioned in a coherent manner.
• The biochemical investigations and Analysis is in a proper way.
C) http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
• History is taken in an informative manner.
• Examinations are arranged in a proper way.
• Summary at the end ,is given which I think is necessary to include in all the other blogs .
•QUESTION NO 4:
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.
Case 1:
•AKI :
•DIAGNOSIS:
•Acute Kidney injury, secondary to urinary tract infection.
•CHIEF COMPLAINTS:
•lower abdominal pain:1 week.
•burning micturition:1 week.
•low back ache after lifting weight.
•dribbling or decrease of urine output :1week.
•fever:1 week.
•INVESTIGATIONS:
•Hemogram,complete urine examination, complete blood picture ,2D echo, Chest X ray,renal and liver function tests ,HbA1c,ABG report,Bacterial culture and sensitivity report.
• These are helpful in the analysis of the case.
•TREATMENT:
• IVF:RL@UO+30ml/hr.
• Salt restriction <2mg/day.
• Inj.TAZAR 4.5 gmIV/TID-2.25gm.
• lnj PANTOP 40 mg IV/OD.
• Lactulose 15 ml PO/TID.
•Case 2:
•Acute on CKD :
•DIAGNOSIS:
•Acute renal failure, Hyperuricemia secondary to renal failure.
•CHIEF COMPLAINTS:
• Lower back ache :10 days.
• dribbling of urine:10 days.
• Pedal edema:3 days.
• SOB at rest since 3 days.
• Increased involuntary movements of both upper limbs :10 days.
•INVESTIGATIONS:
•ECG,RFT,CUE,Hemogram,ABG,serum electrolytes (creatinine,uric acid,etc..),Blood urea,LFT,USG of abdomen and pelvis ,urine culture ,blood culture.
• These helped in the analysis of the case.
•TREATMENT:
•IVF NS-0.9%@100ml/hr.
• Inj.Tazar 2.25mg I.V-TID.
• Inj.lasik 40 MG I.V-BD.
• Nebulization salbutamol-4th hourly.
• Foley's catheterization.
• Inj.piptaz 2.25 gm I.V-TID.
• Inj.Ciprofloxacin ...so on
•Case 3:
•CKD:
•DIAGNOSIS:
•Chronic interstitial nephritis ,secondary to plasma cell dyscariasis.
•CHIEF COMPLAINTS:
•Generalized weakness.
•Vomitings since 3 days.
•INVESTIGATIONS:
•ABG ,CUE ,LFT ,ECG , Blood urea, serum electrolytes, serum creatinine,serum calcium,Thyroid function tests, Hemogram,x rays ,2D echo,BONE MARROW ASPIRATION, SERUM ELECTROPHORESIS..
•TREATMENT:
•T.PAN 40mg
•Oral fluids upto 1.5 to 2 lit/day
•T.Zofer 4mg/PO/SOS
•Tab NODOSIS 550BD etc..
•Case 4:
•Patients with Coma.
A).
•DIAGNOSIS:
• DKA with AKI
•CHIEF COMPLAINTS:
•Fever and diarrhea since 5 days( 4 to 5 times a day with blood discharge).
•Back pain with abdominal pain and chest pain .
*NOTE: This history was told by Patient's daughter because patient was unconscious at the time.
•INVESTIGATIONS:
•ABG analysis ,complete blood picture, LFT, KFT, Bacterial culture and sensitivity report, hemogram ,X rays ,MRI scan ,2D echo, CBP..
•Biochemical investigations in the case were helpful.
•TREATMENT:
•Inj.NORAD 2 amp in 50 ml NS.
• Inj.PIPTAZ 2.25 gm.
• Inj dopamine 2 amp in 50 ml.
• IV infusion.
• Inj Nor Adrenaline.
• Inj.vancomycin.
• Inj Lasix etc are given.
B).
•DIAGNOSIS :
• Infective endocarditis with AV Vegetations with moderate as severe AR with AKI .
•CHIEF COMPLAINTS:
•Abdominal distension from past 7 days.
•Constipation from past 5 days.
•INVESTIGATIONS:
•CUE,Hemogram, RFT, LFT, ECG, 2D echo, ABG, serum electrolytes, urinary sodium,chloride,potassium, Bacterial culture and sensitivity report, CBP, MRI Brain etc...
•TREATMENT:
• Inj.Monocef 1gm IV/BD.
• Inj.vancomycin .
• Inj.Thiamine 200 mg in 100 ml NS /BD.
• Tab.Ecospirn 150 mg .
• Inj .Augmentin 1.2 gm IV/TID etc...
•Case 5:
• Patients with Acute on CKD.
A)
•DIAGNOSIS:
• Renal AKI secondary to urosepsis .
•CHIEF COMPLAINTS:
-Fever since 4 days.
-pus in the urine.
•INVESTIGATIONS:
•Hemogram ,X rays ,ECG ,Fever Chart ,Bacterial culture and sensitivity report, CBP, Serum creatinine, serum sodium,potassium,chloride .Blood urea ,ABG,2D echo ...
•TREATMENT:
• Inj.pantop 40 mg ,inj Piptaz...
• Inj Lasix 40mg .
• Tab.PCM 650 mg TID.
• Insulin Human actrapid -16 IU/TID.
• Inj. Optineuron etc.
B).
•DIAGNOSIS:
• HFrEF secondary to CAD;CRF.
•CHIEF COMPLAINTS:
•shortness of breath..
•INVESTIGATIONS:
• Fasting blood sugar.
• Post lunch blood sugar.
• Glycated Haemoglobin.
• ESR ,CBP ABG ,LFT, Lipid profile ,USG report ,RFT ,2D Echo ,ECG .
• AFB culture and sensitivity report.
• PULMONARY FUNCTION TESTS.
•TREATMENT:
• Tab.Bisoprolol 5mg OD.
• Tab.Nitrohart 20/37.5mg 1/2 T/D.
• Tab.Nicardia XL 30 mg OD.
• Tab.Gliciazide 80 mg BD.
• Tab Nodosis 500 mg TD.
• Syp.Lactulose 15 ml.
C).
•DIAGNOSIS:
•CHIEF COMPLAINTS:
• Shortness of breath.
• Pedal edema.
• Decreased urine output.
• Anasarca.
•INVESTIGATIONS:
• Ultrasound abdomen ,2D echo ,ECG ,Hemogram, CUE.
• Urinary chloride ,sodium ,potassium.
• Serum creatinine, electrolytes.
• Blood urea, X ray .. etc
•TREATMENT:
• IV fluids.
• Tab.Pan 40 mg .
• Inj.Lasix 80 mg.
• Liquid paraffin for LIA.
• Tab.Levocet.....etc
•Case 6:
•Patients with AKI.
A).
•DIAGNOSIS:
• Alcoholic Hepatisis,AKI secondary to acute gastroenteritis.
• CHIEF COMPLAINTS:
• Loose stools,
• Pedal edema .
• Abdominal distension.
• INVESTIGATIONS:
• Hemogram,CUE ,CBP ,RFT ,LFT ,ECG .
• CXR PA view,X ray .inj.Thiamine 100 mg
• USG Abdomen ,APTT ,BT /CT.
• TREATMENT:
• Inj.Thiamine 100 mg .
• Inj.Lasix 40 mg.
• Inj.Optineuron .
• Tab.Aldactone 50 mg .
• Inj.pantop 40 mg .
B).
•DIAGNOSIS:
• Acute Kidney injury secondary to urosepsis.
•CHIEF COMPLAINTS:
• Pedal edema.
• Decreased urinary output.
• Fever.
•INVESTIGATIONS:
• CUP ,ECG , ABG ,Ultrasound ,serum electrolytes.
• Blood urea ,serum creatinine and potassium.
• Blood sugar Random and fasting .
• Hemogram ,CBP etc...
•TREATMENT:
• Inj Lasix 40 mg.
• IVF -NS @UO+50 ml/hr.
• Tab. NODOSIS .
• Inj.Magnefortev1.5 gm .
• Tab.Orofea.
C).
•DIAGNOSIS:
• Acute pancreatisis with AKI.
•CHIEF COMPLAINTS:
• Pain in abdomen .
• Vomitings .
• SOB.
•INVESTIGATIONS:
• LFT, ECG, X ray ,Bacterial culture and sensitivity report, ABG, serum creatinine, CT scan ,CBP etc..
•TREATMENT:
• IV fluids:NS 40 ml /hr.
• IV Lasix 40mg.
• IV piptaz .
• Tab.Nodosis.
•QUESTION NO 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.
My Review:
In my point of view, Online teaching has played a key role in medical education in recent times .
Probably these assignments are helping us a lot to understand the basics of clinical practice like History taking, presentating the case,How to deal with a patient ,and a lot more.
I'm glad that beside all these pandemic demerits ,we are able to do some part of our work through these e-blogs indeed these are helping us to know different cases and different examinations.
Iam very overwhelmed to watch the tests and examinations that I have learned just virtually in my earlier classes to watch them directly and performing them indeed.
Beside All these ,I always have a thought of we not being present there physically in the college to take up the cases and our postings,which is probably an unfortunate thing for us .
To conclude with ,Thank you DR.RAKESH BISWAS SIR,for giving us this opportunity and for helping us grow knowledge even in these dark times and also the interns and pgs who are boosting up with the new knowledge we are getting as of now.
----------THANKYOU----------
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