June assessment

 

June 

July 25, 2021

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

MONTHLY SUMMATIVE ASSESSMENT

I have been given the following questions to answer in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment, to assess the quality of treatment given and to suggest improvisations. 

 Question 1: Competency tested for Peer to peer review and assessment :

After going through one particular answer of ten students in this l

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

Here are my qualitative insights into what was good or bad about the answer. 

Q 1)Cause for current acute excerbation ?

it could be due any infection

In my opinion it could be due to allergy ie hypersensitivity due to weather conditions in January ... As patient has repeated episodes of symptoms at the same time every year.. 

Q 2) 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/2021/07/38-year-old-male-with-chief-complaints.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 share       

Q 4) 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.

MULTI SYSTEM 

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

    Overview 

18 year old male came with the chief complaints of back pain since 1 week ,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 

    Appraisal

Examination was very well done from  head to toe and Temperature charting with the complete information was good 

     My analysis 

In my analysis as the patient has got covid antibodies positive it could me multi system inflammation - covid 

As he has Diabetes . Whole time it was seen as DKA and infection rather than MIS-C 

CNS 

https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1

       Overview 

A 28 year old male came with history of TB 1 month back came with  chief complaints of sudden fall followed by weakness of both the lower limbs (paraplegia) and loss of hand grip 10 days back, associated with bowel and bladder incontinence.

      Appraisal

The fact that the patients relative was also infected with TB solidifies the diagnosis.

The approach to the cause of the paralysis through a detailed history of case was done well

    Negative points

 Tuberculosis affecting the nerve root through a cold abscess can be clinically found by examination rather than going through an advanced techniques like CT

The history was inadequate about the abscess 

      My analysis

 The  spine will be secondarily affected in the TB..

Proper examination for the local deficits of the involved region ... Is need 

If it is just due to compression of cold abscess will the draining of abscess helps him to continue his normal life 

Renal 

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

Captured by one student from 2017 batch in the link below 

      Overview

  A 45 yr old male with cheif complaints of : Altered Sensorium (Hypo active) and lethargy since  Morning

History of fever 10 days back,lasted for 3 days, followed by Pedal edema with Anasarca with Shortness of breath present even at rest .

Appraisal

Well monitoring of  creatinine and halting the damage to kidney without going to irreversible failure.

Also dialysis which helped the patient's encephalopathy was good .

Case was taken correctly including all systems . All the problems like infection, hypertension and chronic proteinuria causing kidney failure were addressed well and treated

Negative points

Personal history about addiction was not taken properly which might help diagnosis and liver cirrhosis

Patient was not warned or given medication for hypertension or pedal edema which might be first sign of renal failure

The liver failure was not explained which had lead to cirrhosis , damage to liver was not know as LFT was not done

My analysis

I think case history was taken incompletely and it would be better if LFT was taken .

It's better to prevent disease than cure so proper management of initial  symptoms like pedal edema or hypertension should be properly done and review examination should be done frequently

CVS 

https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

Overview

 A 70 year old female presented to casuality with complaints of Distension of abdomen and shortness of breath Grade-3 since 5days

Appraisal

  Diagnosis and tests were adequate. The problem in the heart was localised with 2D echo. The wall abnormality and the chamber affected were seen. 

Negative points

the cause for abdominal distention was not addressed properly

 the cause for atrial fibrillation in a hypothyroidism patient was not solved.

My analysis

The diagnosis must also should have taken the age of the patient into consideration as she is of 70yrs of age were any interventions are not successful and the problem lies in the degeneration of tissue due to old age.

Captured by one student from 2019 batch in the link below :

Abdominal 

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

Overview

A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

Appraisal

Case was take in detailed format 

Every day follow up was very well done

Examination and investigations were done as needed 

Negative points 

 There are no pus cells or markers of inflammation in the due report.

  The fact that the patient was a diabetic was not taken into consideration in suggesting the acute kidney injury secondary to infection

Why she has bp of 170/90

Why there is no sign of infection in CUE??

My analysis 

   I think it could be diagnosed as  urinary tract infection with diabetes mellitus which is leading to acute kidney injury.

Q5)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.