JULY ASSESSMENT

▪︎QUESTION 1

1) Pulnonology 

https://aniganikavya06.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html

My opinion:

Based on the timeline of events and examination findings, anatomical location of problem could be lungs (most probably airways) and primary etiology could be chulha gas. So, I agree with her answer.

2) Infectious disease 

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

50/Male came with altered sensorium

Insights:-PRIMARY ETIOLOGY- IMMUNO SUPRESSION by DIABETES 

diabetes is main drawback for mucomycrosis.

TREATMENT-

amphoterin b effective against most invasive fungal infections.

My review:

OVERVIEW:

• the case was presented well

• symptomology of events were given orderly

• pharmological efficacy is well described

Uncontrolled diabetes mellitus ---> immunosuppression---> increased susceptibility to infections

So, I'm convinced with her review.

4) case:

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

Insights:-all the examinations and vitals we checked. Required investigations were done.

Information based on the above investigations is suggestive of inferior wall MI with uncontrolled sugars with k/c/o DM since 8yrs.

treatment- patient was immediately administered with antiplatelets and anticoagulants STAT dose prophylactically and was advised for thrombolysis

My review:

Ecg showing elevations in lead 2 and lead 3 and AVF ---> indicating inferior wall MI and the treatment given here is standard to re-establish perfusion. I agree with her answer.

5) Case 

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

    Insights: Various pharmacological actions over the placebo is explained. Importance of nebulization in pharmacological and non pharmacological interventions is well described.

My review:

I agree with case that the patient was diagnosed with Acute exacerbation of COPD associated with right heart failure and bronchiectasis.

6)GASTRENTROLOGY

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

Insights: Mechanism of action was explained well.efficacy of each drug was mentioned, standard sources were used, and were mentioned in the answer. 

My review:

In this case, primary etiology for pancreatitis could be alcohol consumption. Mechanism of action and rationale for the usage of drugs were clearly mentioned in the blog.

7) NEUROLOGY https://amishajaiswal03eloggm.blogspot.com/2021/05/medicine-blended-assignment.html

Insights: case was very well presented and explained. All the keywords were highlighted which made it easier to get the concept and the mechanisms of treatment and the case were very well explained. 

My analysis:

Evolution of symptoms were very well presented. Flowcharts mentioned in the blog were very informative and easy to understand.

8) Rheumatolgy

https://sahithinalaboluelog.blogspot.com/

Insights: This is a case of COVID-19 Pneumonia in a preexisting case of interstitial lung disease.

 The etiology was very intellectually presented and the clearly described the usage of the drug clexane.

My analysis:

Pre-existing ILD significantly worsens the prognosis of this covid patient. Superimposed covid-19 infection in these cases can cause an acute exacerbation of symptoms such as dyspnea, decreasing levels of SpO2 further and faster than in Covid-19 patients without interstitial lung disease. 

Rationale for usage of clexane was correctly mentioned.

9) Cardiology 

https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html

Insights: It is case of 52yr old male came to OPD with cheif complaints of decreased urine output and SOD at rest since 1day.

The symptomology was presented in a very through a very informative flowchart .

And also the pharmacological intervention was briefly explained with effective visuals.

My analysis:

As she said, the above mentioned is blog is very informative. Because discussion about the case history and it's treatment was included in that.

10)case 

http://shivanireddymedicalcasediscussion.blogspot.com/2021/05/a-30-yr-old-male-patient-with-weakness.html

Insights: Answers given are very short and accurate.. Said there is no connection with past accident and all the warning signs of CVA are explained. And the drug rationale is mentioned. And the possibility of alcoholism leading to this condition is explained. Lipid profile is discussed as a reason for etiology of attack... Answers are short and clear. 

My analysis:

In this case, alcohol along with emotional factor aggavated the risk for stroke.

Low HDL level could also be one of the risk factor for stroke.

She correctly mentioned the etiology and risk factors for stroke in the above review.

Q 2:

Link to my cases:

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

Q 3 & 4:

*PATIENT WITH COMA AND RENAL FAILURE:

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

Problem list:

Fever 

Diarrhea

Abdominal pain

Chest pain, breathlessness

Backpain

Altered sensorium

Bed sores

Critical appraisal:

Events which occurred before she presented to the casualty were mentioned in an order.

(3 years ago: diagnosed with type 2 DM, 2 years ago: amputation of little finger was done as she developed an infection in the little finger, 1 year ago: developed back pain for which she took antibiotics, which worsened her pain, now : presented with above mentioned complaints)

Course in the hospital was mentioned in detail (CPR & Post CPR status, day wise medications along with GCS)

Fever chart mentioned in the blog was very informative (fever spikes --> ? Sepsis ---> source ? Bed sores/ pyelonephritis)

Her creatinine levels are decreasing day by day ----> so, it could be an AKI secondary to infection/inflammation, responding to antibiotics

Diagnostic and therapeutic uncertainties:

How does an infection trigger dka?

An infection or other illness can cause your body to produce higher levels of certain hormones, such as adrenaline or cortisol. Unfortunately, these hormones counter the effect of insulin — sometimes triggering an episode of diabetic ketoacidosis.

(Source: https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551#:~:text=An%20infection%20or%20other%20illness,an%20episode%20of%20diabetic%20ketoacidosis)

These are some studies showing correlation between infection and DKA.

source : 

(https://academic.oup.com/cid/article/32/1/30/3101)

*PATIENT WITH AKI:

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

Critical appraisal:

Summary mentioned at the end of case was short and informative. We were able to understand the entire case just by reading that summary.

Documentation of creatinine and urea levels in the tabular form was very easy to understand.

But the fever chart seems to be incomplete.

Problem list:

Pain abdomen

Vomitings

Sob

Pedal edema

In this case, creatinine levels rapidly increased from 3.8 to 8.9 over 3 days and there is one fever spike on the day of admission ---> indicating sepsis induced AKI (source of infection could be pancreatitis)

Diagnostic and therapeutic uncertainties:

Diagnosis of AKI is currently based on an increase serum creatinine concentration and/or a decrease in urine output.

In sepsis, oliguria appears to carry increased significance, and even by 3 to 5 hours, an association between oliguria and AKI may be detectable.

The value of biomarkers has been established and may be complementary to clinical judgment, functional tests, and current criteria to improve early detection, potentially guide management, and monitor recovery. 

Biomarkers for S-AKI:

NGAL:

Patients with S-AKI generally have higher detectable plasma and urinary NGAL levels than do patients with AKI from other causes.

Plasma NGAL may increase in systemic infection and inflammation without evidence for AKI. 

Distinguishing AKI from CKD by NGAL was also limited by low sensitivity and specificity.

KIM-1:

A meta-analysis suggested that urinary KIM-1 was a good predictor of AKI (area under the curve of 0.86, sensitivity of 74%, specificity of 86%

One prospective study showed that using urinary KIM-1 at 24 hours for prediction of early AKI in patients with sepsis had an area under the curve of 0.91, and the nonsurvivors had significantly higher level of urinary KIM-1 at 24 and 48 hours.

*PATIENT WITH CKD:

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

Critical appraisal:

Timeline of events were mentioned clearly.

Documentation of investigations and their findings/interpretation was done very well.

Respiratory system findings were incomplete ( ? crepitations)

Causes of pedal edema i.e albuminuria was not ruled out (as cue was not mentioned in the investigations)

Problem list:

Shortness of breath

Orthopnea

Pedal edema

Diabetes mellitus

Hypertension

Diagnostic and therapeutic uncertainties:

As CKD is an irreversible event, even if the cause is known, it doesn't change the treatment options (hemodialysis and renal replacement therapy).

*PATIENT WITH CKD:

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

Critical appraisal:

History was taken in depth (she also included her birth history, childhood history and obs history)

She also documented previous investigations, which were done outside. It is helpful to understand the course of disease.

Problem list:

Muscle aches ( for which she took NSAIDS)

Fever

Vomitings

Anemia

Diagnostics and therapeutic uncertainties:

Tests to diagnose multiple myeloma:

https://www.google.com/amp/s/amp.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/testing.html

* ACUTE ON CKD:

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

Problem list:

Lower backache

Sob at rest

Pedal edem

Involuntary movements

Critical appraisal:

Investigations and treatment were documented in day wise manner.

In this case, cause for renal failure could be ? multiple myeloma/ ? Infection (spondylitis)

Q 5:

In this posting, l learnt about in depth evaluation of various systems, interpretation of corresponding investigations and management of few cases.

Interaction with the juniors, helped us to learn more through their doubts. Even 2-4 discussions and rounds in the ward and icu helped us to know more about different cases.

Procedures that I learnt in this month:

Foleys catheterization

Insertion of rules tube, iv cannula

Samples for blood tests and ABG

Swab for Covid 19