July assessment

July

July 26,2021

Question 1 

Competency tested for Peer to peer review and assessment : 

1) Pulmonology

link to the case 

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

insights -

the evolution of symptomatology was explained in a detailed manner, with all the possible explanations and flowcharts, and also an account was given on placebo effect. the mechanism of drugs was also discussed thoroughly.

2)Neurology 

link to the case 

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

A CHRONIC ALCOHOLIC PATIENT WITH DEVELOPED SEIZURES FOLLOWING CESSATION OF ALCOHOL FOR 24 HRS 

insights - 

the long-term effects of alcohol on neurotransmitters were explained in detail, investigations were done and treatment was given accordingly.

3) Cardiology 

link to the case 

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

A 78 YRS OLD MAN WITH SHORTNESS OF BREATH, CHEST PAIN, BILATERAL PEDAL EDEMA, AND FACIAL PUFFINESS 

insight -

 a thorough history taking has been done and the case is well explained using all the pictures of investigations and reports.

4)Gastroenterology 

link to the case

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

insights - 

the symptomatology was well  explained and presented .all the images necessary were provided properly

5 )Neurology 

A 55 YR OLD PATIENT WITH ALTERED SENSORIUM AND INVOLUNTARY MOVEMENTS 

link to the case 

https://rishikoundinya.blogspot.com/2021/05/55years-old-patient-with-seizures.html

insights - 

a detailed presentation of the case with all the necessary investigations, images, and was showing day-to-day proper observance.

6)Mucormycosis 

link to the case

 http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html

 insights -     

the evolution of the symptomatology in this patient in terms of event timeline and where are the anatomical location.the efficacy of the drugs used along with the nonpharmacological treatment modalities explained.

 7 )Cardiology 

link to the case

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

insights -

the detailed information is given with the indications and contraindication .very well-illustrated diagrams are present .

8)Infectious diseases 

link to the case 

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

A  40 YR OLD LADY WITH  DYSPHAGIA, FEVER, AND COUGH

insights -

the patient is asked a thorough history .also the various investigations are supported by the image and clips . the patient is well taken care of by prophylaxis measures, etc

9)Neurology

link to the case

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

insights =-

EVOLUTION OF SYMPTOMATOLOGY WAS MENTIONED INCLUDING tremors, sleep disturbances, sweating.Involuntary rolling of eyes, tongue biting, frothing, loss of consciousness.

10 )Nephrology 

link to the case

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

insights 

the reasons for shortness of breath and intermittent episodes of drowsiness were clearly explained in the case 

Question 2

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://siddharthcvs.blogspot.com/2021/07/a-38-year-old-female-came-with-chief.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

      OVERVIEW 

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  :1week  

     APPRAISAL

Case history was taken well and examination was very well done

    NEGATIVE POINTS

It would be better if fever chart is added as it was treated with strict temp 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

       OVERVIEW

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 

       APPRAISAL

History was taken well 

       NEGATIVE POINTS

There are no pictures of pedal edema .

Proper chronological order of symptoms apperance was not done 

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

       OVERVIEW

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.

       APPRAISAL

History was taken well.

Good lab work clear evaluation was done 

       NEGATIVE POINTS

There are no clinical pics of the symptoms 

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.

     APPRAISAL

With good fever charting with all the necessary information.

History was taken detailed way 

All the tests were properly done 

     NEGATIVE POINTS

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.

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