July assessment

 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 :

http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.

Peer to peer review considering the following blog 

https://bhavanag39.blogspot.com/2021/07/general-medicine-assignment.html?m=1

 

Case -1

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

In my opinion 

As patient was having episodes of SOB she was put on BIPAP to increase Spo2 levels . 

    Patient was having electrolyte imbalance like hyponatremia hypokalemia hyperbilirubinemia  . This is because of usage of steroids and diuretics .

Case 2:

CASE:https://muskaangoyal.blogspot.com/2021/05/a-78year-old-male-                                                              with-shortness-of.htmlFr 

In my opinion 

The patient was presented with shortness of breath, chest pain and B/L Pedal edema. The patient is a chronic smoker and alcoholic but assymptomatic since 1 month and suddenly developed SOB-Grade3.They did 2Decho and ECG and found out some abnormalities. As the patient had no improvement in symptoms he was advised for higher investigations. The video of the patient reveals the complete picturisation to analyse the disease. I feel the presentation was very accurate and complete information is analysed.

Case :3

https://143vibhahegde.blogspot.com/2021/05/wernickes-                                                                            encephalopathy.html

In my opinion 

I find that all the symptomatology is well explained clearly. This helps in the identification of the particular problem. The etiology and anatomical location of the problem are well identified and mentioned. The flow charts and diagrams included made it easy to assess the case.

After lab investigations and radiological reports, the person is diagnosed with Wernicke's encephalopathy secondary to chronic alcohol dependence. WERNICKES area is located in the temporal lobe on the left side of the brain and is responsible for the comprehension of speech.

Case :4 

https://rishikoundinya.blogspot.com/2021/05/55years-old-patient-                                                            with-seizures.html

In my opinion 

The reason for the dyspnea and its relation to pancreatitis are valid. Reasons are good enough to prove the clinical symptoms.

Case :5 

CASE:https://mohammedwahaaj11.blogspot.com/2021/07/a-55yr-old-male-                                                       with anasarca-secondary.html

In my opinion I agree with him 

The patient is presented with absolutely no chest pain and even family history clearly shows no chest pain so after several examinations are done, he was diagnosed with anasarca and right heart failure with bilateral hydrocoele. Chief complaints of the patient are pedal edema since 1-month Abdominal Distension, Decreased Urine Output, Facial Puffiness since 1 month.

Case :6 

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

In my opinion 

Chief complaints of the patient were fever for 10 days facial puffiness and periorbital edema for 4 days and altered sensorium since 2 days as of investigations done the patient is diagnosed with mucormycosis and diabetic ketoacidosis. the patient is suffering from diabetes type2 and hypertension for 2years and radiological investigations revealed mucormycosis

Case ;7

https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html

Case of liver abscess.

Due to consumption of local alcohol (toddy) ,it is the factor for liver abscess.alcohol consumption has more effect in liver.right lobe of liver is more effected due to more blood supply to it .

Indications are

.large abscess more than 6 cm

.Left liver abscess

.caudate love abscess

.abscess not responding to drugs

Case 8: 

https://shubankarkandukuri.blogspot.com/2021/05/general-medicine-                                                    assignment-may-2021_77.html

In my opinion 

This is a case of acute renal failure secondary to urosepsis in a patient who is a known case of DM. After lab investigations are done it was shown of bilateral hydronephrosis and dilated ureter with a thickened wall of the urinary bladder. As it is chronic disease recovery process could a while.

Case :9  

https://nehapradeep99.blogspot.com/2021/05/a-50-year-old-female-with-                                                viral.html

I’m my opinion 

I agree  The patient came to the OPD with chief complaints of fatigue since 2week and fever since 1 week with shortness of breath and low oxygen levels. After nasal swab test and investigations were done it was seen that the patient is COVID positive.

Case :10 

https://daddalavineeshachowdary.blogspot.com/2021/05/67-year-old-                                                      patient-with-acute-coronary.html?m=1

The symptomatology of the patient was mentioned and the series of the events which took place after the appearance of the 1st symptom were mentioned.

The primary etiology of the patient was not identified with precision but an attempt has been done.

The mechanism of action was very well explained with the action of the pharmacological drugs administered.

The answers for the given questions were commendable and precise.

Q2) 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://goudigamapreethi3036.blogspot.com/2021/06/a-case-of-56-year-old-female-with.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 shared.

AKI 

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

Over view 

A 58 year old male patient came to casualty with chief complaints of:

- lower abdominal pain: 1 week

 -burning micturation:1week

- low back ache after lifting weights

-dribbling / decrease of urine out put:1week

-fever :1 week

- SOB , rest :1week  

  Apprisal

Case history was taken well and examination was very well done... Sequential evaluation of case is apprisiable 

Negative points 

It would be better if fever chart is added as it was treated with strict temp and IO monitoring as it would be better understood improvement of the case was not well mentioned

My Analysis

 This is a case of Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

With ? Right HEART FAILURE,

With K/C/O - HTN ( Not on Rx)

-AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your bodyand return of creatinine to the base line and symptoms less then 3 months indicating it to be a AKI

Acute on CKD :

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

Over view 

A 75yr old male patient ,labourer by occupation ,came to casuality with Cheif complaints of 

• Lower backache since 10days

• dribbling of urine since 10days

• Pedal edema since 3days 

• SOB at rest since 3days 

• Increased involuntary movements of both upper limbs since 10days .

Apprisal

I would not find any points to be highlighted . History was taken well 

Negative points

There are no clinical pics of the symptoms like pedal edema.

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitored

My Analysis

This is case of 

Acute renal failure (intrinsic)

 Grade 1 L4-L5 Spondylodiscitis, Multifocal infectious Spondylodiscitis

Hyperuricemia 2° to Renal failure 

Uraemia induced tremors( resolved)

Delerium 2° to septic /Uremic encephalopathy (resolving)

CKD :

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

Over view

A 49 yr old female , mother of 2 children, who is a house wife, apparently asymptomatic 13 yrs ago and then she noticed mass per anum with bleeding , went to hospital and diagnosed as haemorrhoids and got operated.

- Since 3 yrs she has history of muscle aches, for which she is using NSAIDs.

- She has h/o fever 20 days back, got treated in the local hospital, and 

- Since 20 days she has generalized weakness.

- She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.

Apprisal

History was taken well.

Good lab work clear evaluation was done 

Negative points

There are no clinical pics of the symptoms like pedal edema.

Proper chronological order of symptoms apperance was not done 

Fever chart was not included.

No IO charting was done though it was told it should be strictly monitoredit would have been better if urine was sent for eosinophils for interatial disease

My Analysis

This is  case of CKD ?

 Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).

Patient with coma and renal failure 

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

Overview

A 35 yr old female with Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).

Back pain( 5 days ago) with abdominal pain and chest pain.

Apprisal

Very well presented 

With good fever charting with all the necessary information.

History was taken detailed way 

Follow up was good 

All the tests were properly done 

Negative

I could not find the negative data in the elog 

My analysis

It could be the hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen. Hospitalisation has increased the infection to the bed sore it would have been better if discharged early as it was permanent damage and was impossible to treat anyway.

Q4: 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. 

Analysis the data

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

Analysis of  A 35 yr old female with Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).

Back pain( 5 days ago) with abdominal pain and chest pain

Vegetative state of the patient could be due to  hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen.

https://pubmed.ncbi.nlm.nih.gov/19362767/

Link supporting the data 

Intermittent Fever spikes can be explained due to the bed sores clearly explained through culture of the sores 

Sepsis might be the reason for encephalopathy by altering the blood brain barrier 

https://www.hindawi.com/journals/amed/2014/762320/

5) 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. 

The telemedical learning from the hospital has been a new experience and we  learnt quite lot of things through reflective observation during lockdown.  it's a bit challenging as we have just entered internship ,We have learnt elogging of the cases in a very short span of time and made juniors do so. I could answer the questions from juniors easily as I have been part of many discussion in ICU and wards . By doing this assignment I could view many cases and many case scenarios through which I learned many  things 

https://youtu.be/YGHGwJF5kR0