Bimonthly blended assessment for july 2021
P. Nikitha
Roll no: 102
I, P. Nikitha, student of 3rd semester was given the following formative assessment for bimonthly blended assessment for July, 2021.
This is the link regarding assessment:
http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
Question 1: Competency tested for Peer to peer review and assessment :
Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :
and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.
Answer:
Link:
I reviewed the above answer given by roll no 103.
Q1) Giving qualitative and quantitative reviews is really good. Case details are also mentioned so it is easy to know which case he is referring to and finally it is an appropriate review.
Q3) He choose five different cases which belonged to different organ systems and coming to review he correctly mentioned about the completeness, correctness of data and about the leads in analyzing the data.
Q4) To this question, he mentioned about 5 different cases, he listed the problems in this cases and the diagnosis and treatment given. He mentioned the drugs given to patient, it would have been better if he also mentioned the mechanism of action of those drugs.
Q5) He explained his past month experience very clearly and in a genuine manner.
Question 3: (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.
Link 1 - CKD
In this presentation
Coming to correctness:- The history is not written in a proper order, everything else is perfect.
Coming to completeness :-
-It would have been better if they also mentioned normal values.
-It would have been better if they mentioned mechanism of actions of drugs.
-it would have been better if they explained clearly about treatment given, because I didn't understand why to give protein powder and also Neb c duolin respules for a CKD/multiple myeloma patient.
-It would be better if they added discharge summary too in the end.
- The images of investigations done and radiographs and histopathalogy slides are useful.
Link 2 :- Patient with coma and renal failure :
-I think history is not presented correctly, that is whether it's the patient's 2nd visit or 1st visit because they mentioned diagnosis which is done 15 days back and with complaints of 7 days back.
-images of all the investigations done are added along with echo videos and are very helpful.
-day wise treatment is mentioned.
-patient is suspected to have infective endocarditis based on the bacterial culture and sensitivity report.
-from echocardiogram we can see AV vegetations and severe AR.
-Based on MRI brain plain we can see patient has small acute infarcts involving bilateral cerebellar and cerebral hemispheres.
Patients with acute on CKD
-The history is detailed.Details about the surgery underwent are also given. And the no of times patient admitted into hospital with dates is also mentioned.
-images of all the investigations done are given.
- pictures of urine bag with pus cells also insered.
-Noraml KUB link is also refered for better understanding and for comparision.
-every day treatment is mentioned, but mechanism of action of drugs could also be mentioned.
- Discharge summary could also be mentioned.
- this presentation is really helpful for understanding the casecase with ease.
Link 4 :- https://rishikakolotimedlog.
-Case presentation is very well done.
- History is taken perfectly
- case investigations are provided with related deidentified images .
- important points and abnormalities are highlighted so it's more easier and faster to read and interpret this e-log .
- treatment is also mentioned, mechanism of action of drugs could have been mentioned.
- reference links are also given.
Patients with AKI :
Link 5:-
- History is presented well
- images of investigations are Inserted
-day wise treatment is mentioned.
- It would be better if abnormalities are mentioned well.
- The presentation could be better .
- clinical diagnosis is not mentioned.
- Discharge summary could be added.
Link 6:-
- History is presented well and in correct order.
- presentation is clean. Images of all the investigations done are inserted.
- explanation of some complications arised during treatment is also explained.
- In the end short and accurate summary is also mentioned which is really a good idea.
Question 4: 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.
Diagnosis:
CKD? Chronic interstitial nephritis secondary to plasma cell dyscariasis(multiple myeloma -70% plasmacytosis)
Problems:
1) generalized weakness
2) vomitings
3) anemia
4) acidosis
Treatment:
1) Tab PAN -D - for acidity
2) tab-zofer for nausea and vomitings
3) tab- Nodosis for acidity
4) inj erythropoietin 4000IVS weekly twice to treat anemia
5) tab -orofer XT for anemia
6) inj optineuron - combination of nutrient supplements for vit B12 deficiency anemia
7) protient powder is given with a glass of milk
8) Neb c Duolin 2 respules are given.
Link 2:-
Diagnosis:
INFECTIVE ENDOCARDITIS WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR WITH AKI WITH ?UREMIC ENCEPHALOPATHY ? SEPTIC ENCEPHALOPATHY WITH ULCER OVER SOLE OF RIGHT LEG WITH HYPOALBUMINEMIA ? ALCOHOLIC LIVER DISEASE WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES.
Problems:
1) known type 2 DM
2) icterus and pedal edema on examination
3) ejection sysyolic murmur is heard
4) distended abdomen
5) constipation
Through investigations
5) Infective endocarditis
6) acute multiple infarcts in bilateral cerebral and cerebellar hemispheres
Treatment:-
1) inj monocef - to treat bacterial infections
2) inj vancomycin - in combination with monocef to treat severe bacterial infections.
3) procto clysis enema- to treat constipation.
4) inj pan - for acidity
5) inj thiamine
6) inj HAI - for management of diabetes
7) inj augmentin - for bacterial infections
8) tab ecospirn - to prevent heart strokes
9) tab clopidogrel- to prevent blod clots(antiplatelet)
10) tab atorvas - to lower cholesterol levels to prevent heart attacks.
Link 3 :
Patient came to OPD with chief complaints of fever and pus in urine.
Diagnosis:
Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore.
Problem:)
1) fever
2) pus in urine
3) anaemia (CBP)
Through investigations
4) urosepsis due to bacterial infections. Persons who undergne TURP surgery are more prone to UTI
5) bilateral hydrouteronephrosis found through KUB xray cause for it isn't explained.
6) phlebolith is seen in pelvis.
7) known diabetic
Treatment:
1) inj pantop - for acidity control.
2) Inj piptaz - antibiotics to treat UTI.
3) inj lasix - to treat fluid retention
4) inj optineuron - to treat anemia
5)inj NEDMOL - antipyretic
6) tab PCM - antipyretic
7) insulin human actrapid - for diabetes management
Link 4:-
Patient came to OPD with chief complaints of shortness of breath.
Diagnosis:-
HFrEF secondary to CAD; CRF
Problems:-
1) known diabetic
2) known case of hypertension
3) irregular bowel movements
4) edema of feet
5) dyspnoea is present
6) HFrEF secondary to coronary artery disease.
Treatment:-
1) tab bisoprolal to treat hypertension and heart failure.
2) tab nitrohart is vasodilator to treat heart failure.
3) tab nicardia - to treat hypertension and prevent angina.
4) tab gliciazide- to treat type 2 DM
5) tab nodosis-antacid
6) cap bio D3 -to treat low ca levels
7) cap gemsoline - prevents ca and vit D deficiency.
8) tab ecosprin - lowers bad cholesterol and prevents heart attacks and strokes .
9) tab lasix to treat edema
10) syp lactulose is a laxative
Link 5:-
Patient came to OPD with chief complaints of loose stools, pedal edema, abdominal distension since 20 days.
Problems;-
1) loose stools(diarrhoea possibly due to gastroenteritis which is due to bacterial infections)
2) pedal edema
3) abdominal distension
4) anemia
5) alcoholic hepatitis
Treatment:-
1) inj thiamine - for anemia
2) inj optineuron- For anemia
3) inj lasix for pedal edema
4) tab aldactone for pedal edema
5) inj pantop - to maintain acidity
6) daily abdominal girth measurement.
7) inj metrogyl as antibiotics
8) inj ciproflox to treat bacterial infections
9) tablet sporlac ds - to treat diarrhea
10) consumption of ORS and plenty of fluids initially and decreased on later days of treatment.
Link 6 :-
Patient came to OPD with abdominal pain, SOB and vomitings.
Diagnosis:
Acute pancreatitis with AKI with B/L pleural effusion and moderate ascitis .
Problems:-
1) abdominal pain
2) vomitings
3) shortness of breath
4) pedal edema
5) developed scrotal and penile edema during treatment so hemodialysis is done
Treatment:-
1) IV fluids
2) IV lasix for pedal edema
3) tab nodosis - antacid
4) IV piptaz is used to treat pneumonia
5) IV 25% dextrose
6) hemodialysis is done.
Question-5 :-Testing scholarship competency in logging reflective observations on your concrete experiences of this last month.
- In this pandemic where we are devoid of our clinical postings and knowledge. We are trying to get something with this telemedical learning
- Its been 2 months into these telemedical learning .
- we are exposed to many different kinds of patients and their problems.
- It is helping us in developing our technical skills also.
- By making e-logs and by reading e-logs we are learning many new things.
- We are using internet and online articles for better understanding and treatment also.
- Tele medicine is a boon in this pandemic because we can talk to patients over phones also and we can assure them something.
- Tele medicine helps us to connect to vast people , many people from different medical colleges and universities can be connected through blogs.
- Finally tele medical learning is good in these circumstances. But we are eagerly waiting for our physical presence there in the wards.
I want to thank Dr. Rakesh biswas sir and all pgs, interns of general medicine department for helping and guiding us.
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