GENERAL MEDICINE ASSIGNMENT

             

                                              NAME  : Anga sanvith, 3rd semester

                                              ROLL NO:09

                  

   we have been given 5 questions to assess the ability to connect with and capture patient centered data and ability to connect with and engage in shared learning with their peers through peer review feedback.

Below is the link for the given questions for us :

https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1)

question 1

pulmonology:

REVIEW:

https://blendedasessmentmadhukumar.blogspot.com/2021/05/medicine-blended-assesment-may.html

CASE 1:

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

This the case of acute exacerbation of COPD associated with right heart failure and bronchiectasis. As the patient is admitted with the symptoms of shortness of breathing, pedal edema and facial puffiness.

As the patient is undergone with shortness of breathing in the past 20 years, lasted for one week , in the month of january in that month she worked in paddy field. As she relieved by taking medication. 

In the next 8 years she again come up with SOB in every one year lasting for 1 week, and relieved upon taking medication.

12 years ago she had another episode of SOB. This one lasted 20 days and she had to be hospitalized. The SOB decreased upon treatment at the hospital.

Later she not relieved her SOB even at rest.

1 month back she was experiencing generalized weakness for which she was administered IV fluids (3 pints in 2 days) by a local RMP 

20 days ago due to the ongoing COVID 19 pandemic she had an HRCT outside which showed signs of bronchiectasis.

She was diagnosed with Hypertension 20 days ago and is being treated for the same.

Pedal edema since 15 days up to the level ankle and pitting type.

Facial puffiness since 15 days.

After every examination they got the diagnosis that the patient is suffering from Acute exacerbation of COPD associated with right heart failure and bronchiectasis.

MY REVIEW ON THIS CASE:

I agree with case that the patient was diagnosed with Acute exacerbation of COPD associated with right heart failure and bronchiectasis as the peer gone with every examination and well explained about the patient history and got up with a provisional diagnosis.

2)NEUROLOGY

REVIEW:

http://aishwaryagannoji35.blogspot.com/2021/05/medicine-blended-assignment-may.html

CASE:

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

QUESTION:

what is the evolution of the symptomology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

MY REVIEW:

I agree with the peer as the patient taking alcohol 3~4 quarters a day. so due to long term consumption of alcohol there is a lot of change in signal transmission.

Mainly the two main important brain communications systems affected by alcohol involve the neurotransmitters 1)GAMMA AMINOBUTYRIC ACID AND 2) GLUTAMATE.

DUE TO THIS,

The symptoms include  irrelevant talking, decreased food intake, tremors, sleep disturbance is due to the following reason: chronic alcohol consumption causes thiamine deficiency due to impaired absorption of thiamine from the intestine, a possible genetic predisposition, inadequate diet, reduced storage of thiamine in the liver and other nutritional deficiencies.

PATHOPHYSIOLOGY:

The deficiency of thiamine and increase in levels of toxins in the body due to renal disease is the primary etiology of the patient.

3) CARDIOLOGY:

REVIEW:

https://gumudalavishal.blogspot.com/2021/06/medicine-blended-assignment.html

CASE:

https://muskaangoyal.blogspot.com/2021/05/a-78year-old-male-with-shortness-of.html

OUESTION:

What is the difference btw heart failure with preserved ejection fraction and with reduced ejection fraction?

MY REVIEW:

I agree with the answer given by the peer he explained it in very good way;

People with heart failure with reduced ejection fraction (HFrEF) have an EF that is 40 to 50 percent or lower. This is also called systolic heart failure. 

 People with heart failure with preserved ejection fraction (HFpEF) do not have much of a change in their ejection fraction. This is often called diastolic heart failure.

 

4)GASTROENTEROLOGY:

REVIEW:

https://kausalyavarma.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html

CASE:

https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html

OUESTION:

 What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

MY REVIEW:

I agree with the answer given by the peer , as the patient took alcohol and gone with abdominal pain after medications he stopped taking alcohol and got relieve from the pain , later he started alcohol consumption after 2 years and got up with pain in abdomen and vomiting . and 1 year ago 5-6 episodes of pain abdomen and vomiting.

and next anatomical localisation is  pancreas and left lung.

Etiology: as the patient is chronic alcoholic it indicates as the primary cause.

The peer is explained it in a very good way with proper understanding of the patient problem.

5)NEPHROLOGY AND UROLOGY:

REVIEW:

https://sowjanyareddypalakurthy130.blogspot.com/2021/05/general-medicine-assignment.html

CASE:

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html

QUESTION:

What could be the reason for his SOB ?

MY REVIEW:

As the answer given by the peer is absolutely right it is due to transurethral resection of prostate and also due to metabolic acidosis.so the patient is got up with SOB.

6)INFECTIOUS DISEASE(HI VIRUS, MYCOBACTERIA, GASTROENTROLOGY, PULMONOLGY)

REVIEW:

https://sreelekhatondapuelog.blogspot.com/2021/05/bimonthly-assignment-may.html

CASE:

https://vyshnavikonakalla.blogspot.com/2021/05/a-40-year-old-lady-with-dysphagia-fever.html

QUESTION:

1.Which clinical history and physical findings are characteristic of tracheoesophageal fistula? clinical history and physical findings are characteristic of tracheoesophageal fistula are:

MY REVIEW:

The peer got up with the exact findings that is RVD positive as the patient had a high-grade fever for 2 months, dysphagia for 2months, cough on eating/drinking for 2 months, hoarseness of voice and TB positive.so i agree with the peer findings.

7)INFECTIOUS DISESASE AND HEPATOLOGY:

REVIEW:

https://manvithayechuri169.blogspot.com/2021/05/medicine-case-discussion.html

CASE:

https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html

QUESTION:

do you think drinking locally  made alcohol cause liver abscess in this patient due to predisposing factors present in it ? What could be the cause in this patient? 

MY REVIEW:

Yes i agree with answer given by peer it is due to intake of contaminated toddy. its main cause is due to contamination.

8)PULMONOLOGY

REVIEW:

http://54tejasreekandregula.blogspot.com/2021/05/general-medicine-assignment.html

CASE:

http://54tejasreekabdregula.blogspot.com/2021/06/70-year-old-male-with-fever.hmtl

this is the case of viral pneumonia secondary to COVID-19. Given the ongoing pandemic situation, this patient got corona positive and admitted in the ward.

MY REVIEW:

As the peer gone with the further investigations and revealed impaired CBP and respiratory exam was abnormal with vesicular sounds. and I agree with the treatment that the patient should be in quarantine to get negative report.

9)NEPHROLOGY:

REVIEW:

http://vishnubharathchippa189.blogspot.com/2021/05/general-medicine-assignment.html

CASE:

 Why does he have intermittent episodes of  drowsiness ?

MY REVIEW:

yes I agree with the answer given by the peer that their is the decrease in the renal clearance of waste nitrogenous products accompanies with their continuous generation leads to diverse uremic retention products such as urea, creatine, guanidine and homocysteine so many of this toxins affect functioning of cells and organs , neurotoxicity and congestive dysfunction. this reasons causes the drowsiness. 

taken from article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312775/

10) NEUROLOGY:

REVIEW:

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

CASE:

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

QUESTION:

what is the probable cause for kidney injury in this patient?

I agree with the probable cause given by peer as their is consumption of alcohol by the patient will cause changes in the kidney and liver functions which will cause the retention and decrease in filtration which will cause increase in the pressure of blood.

QUESTION 2:

I haven't got a chance to present a case.

QUESTION 3 and 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.

As the case presented by peer is very well and well explained.

 As the peer gone up with the provisional diagnosis after their analysis,  AKI ON CKD(HYPERTENSIVE NEPHROPATHY) WITH URAEMIC ENCEPHALOPATHY.

they gone with general examination where the patient showing pallor and anasarca positive it indicates that their is increase in fluid retention in the body where whole body swells up. this not indicates edema. swellings occurs for different reasons in the body. due to generalized swelling of fluid in tissues. 

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:

 

The assignment given by  ( DR Rakesh biswas HOD of general medicine ). Thank you very much sir for giving us this assignment. As I got a clarity that how to prepare an E blog and how to present a case details of given patient.

In this pandemic their is lot of impact on education, like we can not approach for clinical postings and  direct interaction with the patient to assess about the case. 

In this situation our HOD sir helped us a lot by making E blog group . by making this blogs we got  a clarity about the case presentation. with this blogs I can understand about a case even at home by making a number of case presentations.