Bimonthly blended assessment Aug-2021
Long case
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
The presentation of the case is complete.
Because they started with
Chief complaint, and mentioned about history of present illness, history of past illness, personal history,family history.
General examination, systemic examinations are done, they also inserted the de-identified
Pictures of patient, reports of other investigations done and the ecg reports, x rays are also uploaded. They also mentioned about the medicines used. They also given clear information about the treatment done each day.
-The investigations done are very important leads in diagnosing the disease and in ruling out things.
Short case -1
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
-Case presentation is complete.Present illness is described very well with each and every detail explained properly.All the histories and examinations done are mentioned.Problem presentation with treatment are provided.All the nerve examinations are done properly and reflexes testing is also done. Source for resting tremor is also given at the last.
Short case-2
19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year,Abdominal distension and facial puffiness since 6 months.
-Present illness with evolution of symptomology is perfectly described,Other histories with examinations done are given,
patient photographs are posted accordingly before one year and when the patient is presented in op.The dermatologist opinion is taken and treatment is given accordingly and the condition was taken till date.
Question-2
Problem list for each patient and the diagnostic and therapeutic uncertainty around solving those problems as follows:-
Long case
Problem list:-
-Generalized edema
-Facial puffiness with pedal edema
-Bilaterally symmetric, pitting type pedal edema
-Breathlessness, palpitations or chest pain
Frothing of urine
-Decreasing urine output
-Severe joint pains
-Weight loss and loss of appetite
-Subcutaneous swellings in proximal joints of his fingers
-Proteinuria causing anasarca
Final diagnosis:
-Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
-Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis
-Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
-Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis
Differential diagnosis:
Rheumatoid arthritis
Treatment:
1.Free water restriction for Hyponatremia
2.Tab. PREDNISOLONE P/O 20 mg OD
3.Tab FEBUXOSTAT P/O 80 mg OD
4.Haemodialysis for worsening renal dysfunction.
Short case-1
Problem list:-
A 49 year old patient presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.cant able to move those fingers and the wrist is stiffened.walking became difficult with short steps.difficlty in staring up with loss of sexual desire.. irregular bowel habits are seen.not speaking properly since two months.
Diagnosis:-
Idiopathic parkinson's disease stage - 1 with denovo HTN
Multiple system atrophy - parkinsonian type (MSA - P)
Treatment:-
Tab. Syndopa Plus 125 mg QID
Tab. Syndopa 125 mg CR OD
Tab. Telma 40 mg OD
Short case-2
Problem list:-
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .
-purple stretch marks all over abdomen,lower back ,upper limbs ,thighs since 1 year.
-Abdominal distension and facial puffiness since 6 months.
-Pedal edema since 3 months.
-Low back ache since 3 months .
Feeling low , not feeling to talk to anyone.
-Weight gain and decreased libido since 3months.
-Loss of libido and erectile dysfunction since 2 months .
-Multiple hyperpigmented plaques over lower limbs and abdomen
-Easy fatigue, weakness and lower backache
-Moon face present, thick skin
-Acanthosis nigrans noted over neck
-GYNECOMASTIA PRESENT
-Buffalo hump present
-Sparse scalp hair
-Difficulty in getting up from chair.
Diagnosis:
IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
TINEA CORPORIS
DENOVO HTN
Treatment:
-Tab telma 20 mg od .
-INJECTING 0.4 ML OF ACTOM -PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR.
-TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.
Question-3
Review of literature around sensitivity and specificity of the diagnostic interventions mentioned and efficacy of the therapeutic interventions mentioned for each patient.
Long case
Investigations done are:-
- Blood tests
-Blood work from previous presentations to hospital. RA factor was negative
24hrs urinary protein, 24hrs urinary creatinine.
-urine Microscopy - Freshly voided urine sample was taken and it showed DYSMORPHIC RBCs (black circles) and occasional pus cells (red circles). Dysmorphic RBCs were those that had altered shape, microcytic or with membrane defects.
Efficacy of Treatment given:-
-Tab. PREDNISOLONE P/O 20 mg OD:-It is used to treat conditions such as arthritis, immune system disorders etc. It decreases your immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.
-Tab FEBUXOSTAT P/O 80 mg OD:-class of medications called xanthine oxidase inhibitors. It works by decreasing the amount of uric acid that is made in the body. -Febuxostat is used to prevent gout attacks but not to treat them once they occur.
-Haemodialysis for worsening renal dysfunction
Short case-1
Investigations done are:-LVH
-ECG:-Shows Sinus Tachycardia with pseudo infarct pattern in leads I and aVL with dagger q waves in the same leads,No late intrinsicoid deflection of R wave with modified Cornell criteria showing LVH.
-2 D Echo :-Grade II diastolic dysfunction
-examinations of brain are done in order to check whether cerebrum , cerebellum are involved in this.there are no intentional tremors and absence of knee jerk.the coordination tests are done which are normal.the rhombergs sign is negative.micrographia a test to elicit the bradykinesia component of Parkinson is positive.
Efficacy of treatment given:
1.syndopa plus is a combination of two medicines Levodopa and carbidopa used to treat the symptoms of Parkinson disease such as tremors, stiffness and slowness of movements
2.tablet telma is used to treat high blood pressure and heart failure
Short case-2
Investigations done are:-
CBP - HB - 13.4 g/dl
TLC - 6,800
PLT - 1.5 lakhs.
RBS - 139 mg/dl
CUE - ALBUMIN - +1
SUGARS - NIL .
PUS CELLS - 3-4
RBC - NIL .
LFT - TB -1.03
DB-0.21
ALBUMIN - 3.9
RFT - UREA - 22
SERUM CREATININE -0.6
ELECTROLYTES - NA - 136
K- 4
CL-98
USG ABDOMEN - NORMAL.
ECG - SINUS TACHYCARDIA
LVH PRESENT.
Efficacy of treatment:
-Tab.Telma 20 mg od - due to low cortisol level
-TAB HIZONE 15 mg:- is prescribed for Severe allergic reactions,Allergic conditions,Cancer,Skin disorders,Eye disorders.
-Tab Shelcal 500 OD and Tab Vit D 3 Od:-To treat vitamin D and Calcium deficiency.
-tab ULTRACET /PO/SOS:-is a combination of two medicines that are used for short term relief of pain, inflammation, and swelling in conditions that affect joints and muscles.
-Tab Itraconazole 100 mg bd.:-to treat a variety of fungal infections.
-Tab levocitrixine 5mg od.:-relieve runny nose, sneezing, and redness, itching.
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