JUNE ASSESSMENT

JUNE ASSESSMENT:
Q 1:
What is the reason for anaemia in this case?
Ans:
When you have kidney disease, your kidneys cannot make enough EPO. Low EPO levels cause your red blood cell count to drop and anemia to develop. Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO
Link: https://www.kidney.org/atoz/content/what_anemia_ckd

My analysis:
In this case, the most probable reason for anemia could be CKD---> due to reduced erythropoietin production. I agree with his answer.

Ans 2:
Link to my cases:
http://pallavi191.blogspot.com/2021/06/gm-cases_30.html

Ans 3&4:


*MULTISYSTEM:

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

My analysis:
Problem list:
Vomitings
Diarrhea
Fever 
Icterus
Hematuria
Low backache

Critical appraisal:
Events which occurred before & after the presentation were mentioned in an order
Fever chart was very informative.
Documentation of investigations in the tabular form was very easy to understand.
Clinical images mentioned in the blog were helpful in understanding the symptoms (like hematuria)

Diagnostic and therapeutic uncertainties:
(source:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244417/)

* ABDOMEN:

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

Problem list:

Critical appraisal:
Case history and examination of each system was mentioned in depth.
Presentation of day wise investigations and treatment was good.

Negative points:
History of oliguria was not mentioned at the time when she was first diagnosed with acute kidney injury.
History regarding treatment (post dialysis) was not mentioned.

My analysis:
Based on the clinical symptoms (fever, oliguria, b/l pedal edema), examination findings and investigations (high TLC, high urea and creat)---> Diagnosis could be AKI secondary to UROSEPSIS

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

Critical appraisal:
Examination of each system was done in detail.
Course in the hospital was mentioned in detail.

Negative points:
History regarding lower backache and neck pain was not taken properly.
History regarding symptomatic treatment was not not mentioned.
Cardiac causes of dyspnoea were not ruled.
History regarding fever is not mentioned clearly as sepsis could one of the cause for AKI

*CVS:
Problem list:
Shortness of breath (grade 3)
Distension of abdomen
Hypothyroidism

Critical appraisal:
Examination findings (like feable pulse), ecg and 2d echo videos in the blog were very helpful in correlating with the diagnosis (atrial fibrillation)
Course in the hospital like her vitals (bp, PR) during the treatment (amiodarone infusion) were not mentioned (because these are useful to know her response to the given treatment)

Diagnostic and therapeutic uncertainties:
Ablation therapy is an alternative option for the AAD in rhythm control therapy. 2014, the HRS guidelines of evaluation and management of AF recommend ablative therapy for symptomatic AF refractory or intolerant to at least one AAD and for symptomatic AF prior to initiation of AAD therapy with an AAD.

(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4759971/#!po=37.6543)

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



Comments

Post a Comment

Popular posts from this blog

GM CASES

Image
Date of Admission: 28-06-2021 A 52-year-old man presented to the OPD with Cheif Complaints of abdominal distension from the past 7 days. HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 2 years back, then he had a non healing injury to the right foot which raised a suspicion of Diabetes mellitus. Then they went to neatest medical care and diagnosed with Diabetes mellitus type 2 and was started on Tab. GLIMI M2 OD.  2 years back he complained of Tingling in the upper limbs up to the palms, in the lower limbs up to the knee.   15 Days back patient presented to the casualty with Abdominal Distension NOT associated with pain, No nausea, No Vomiting, No loose stools and was diagnosed with  Alcoholic Liver Disease, AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy, Hepatic encephalopathy grade 2 From the past 7 Days, He Complains of Abdominal Distension. From the past 5 days, he complains of Constipation and has not passed stools since 5 days. He also complain
Read more

42 Year old woman with multiple health events since birth

Image
I've been given this case to solve in an attempt 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 come up with a diagnosis and treatment plan.  You can find the entire real patient clinical problem in this link here..https://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html?m=1 Following is my analysis of this patient's problem: The problems in order of priority I found are  1) Headache 2) Swelling 3) Sleep disturbances 4) Mood disorders 1.Headache: -present since age 2 years -became worse with menarche and with the usage of nuvaring -associated with visual aura before the attack(scotomas, flashes of light,seeing rainbow colors) -associated with giddiness, weakness/numbness of left half of the body So,the cause for headche could be HEMIPLEGIC MIGRAINE. Differential diagnosis:      Stroke, Brain tumors   
Read more

Heart failure

Image
I've been given this case to solve in an attempt 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 come up with a diagnosis and treatment plan.  You can find the entire real patient clinical problem in this  https://madhur116.blogspot.com/2020/05/on-1452020.html?m=1 Complaints:   * Shortness of breath:     - since 2weeks     - initially NYHA 3 after treatment now grade 2     - h/o paroxysmal nocturnal dyspnea     - generalised weakness from 2weeks     Causes:     - cardiac     - respiratory     - renal     - metabolic     - anemia     - neuromuscular     - drugs          - we can exclude  respiratory causes as there is no h/o cough, phlegm, pleuritic pain    - renal diseases are associated with facial puffiness; in this case, facial puffiness was not there, so we can rule out renal causes    - no h/o ptosis and fatiguability; so neuromuscu
Read more