125 Afrin sk,GM
GENERAL MEDICINE
125 AFRIN,3rdsem
BIMONTHLY BLENDED ASSESSMENT FOR AUGUST 2021
QUESTION 1: competency based peer to peer review and assessment :
FIRST CASE: A case of acute glomerulonephritis, due to sec. Amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis.
OVERVIEW :
The is complete in all factors it included chief complaints, present history past history, personal history, medical /surgical history, family history, social and educational history, immunization history.
REVIEW :
* The case was presented in detail, like a step to step detailed explanation.
* Evolution of symtomatology was described in detail manner.
* There was also a detailed explanation of the patient's acute and chronic problem.
* General examination was done much detail way in different positions with clear documentation.
* Clinical images of the patient and investigations were added with deidentification.
* Systemic examination with detail inspection palpation, range of movements explained.
* Diagnostic approach and treatment was aslo well explained .
SECOND CASE: idiopathic Parkinson's disease stage 1 with denovo HTN &multiple system atrophy - Parkinsonian type ( MSA-P)
OVERVIEW:
The is complete in all factors it included chief complaints, present history past history, personal history, medical /surgical history, family history, social and educational history, immunization history.
REVIEW:
* The case was beautifully presented in detail ,which is almost knit with his details,like step to step detailed explanation.
* Evolution of symptomatology was described in detail manner.
* CNS examination was described extremely well with all detailed documentation of reflexes etc.
* Clinical images of the patient and investigations were added with deidentification.
THIRD CASE : latrogenic Cushings syndrome secondary to tropical clobetasol application all over the body for approx 1 yr.
OVERVIEW :
This elog was little incomplete acc. to me as it didn't include his past history, family history, treatment history, personal history.
REVIEW :
* Evolution of current symptomatology was described beautifully.
* deidentified clinical images in the presentation, showed us the condition of the patient clearly.
*His follow up details were also neatly documented.
QUESTION -2 Test the scholarship competency of the examines .
Link to the cases to be reviewed :
https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
CASE 1: First case: A case of acute glomerulonephritis, due to sec. Amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis.
PROBLEM LIST :
* generalized edema
( facial puffiness, pedal edema)
* bilateral symmetric, Pitting type pedal edema.
* breathlessness, palpitations or chest pain.
* Frothing of urine, decreased urine output.
* Severe joint pains.
* Burning sensation in his eyes with increased tearing.
* Involuntary weight loss &loss of appetite.
*subcutaneous swelling in proximal joints of his fingers.
* protinuria causing anasarca.
DIAGNOSIS :
* Acute glomerulopathy (Glomerulonephritis / nephritis syndrome)
* Bilaterally symmetric chronic progressive inflammatory peripheral polyarthritis.
* 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.
TREATMENT:
* Free water restriction for hyponatremia.
* Tab. PREDNISOLONE P/O 20mg OD
* Tab FEBUXOSTAT P/O 80 mg OD
* Haemodialysis for worsening renal dysfunction.
CASE 2- Second case: idiopathic Parkinson's disease stage 1with denovo HTN &multiple system atrophy - parkinsonian type ( MSA-P)
PROBLEM LIST :
* Progressive asymmetrical involuntary movement of his right index and middle fingers.
* stiffness in wrist &elbows
* Walking difficult with small, short steps with forward sloop &also taking stair up .
* No morning erections & also loss of sexual desire.
* Speaking in monotonous deab.
* High BP -190/110 mm Hg
* Tone of right wrist - Hypertonia ( cog wheel rigidity).
* ECG - Sinus tachycardia.
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.
CASE -3 Third case : latrogenic Cushings syndrome secondary to tropical clobestasol application all over the body for approx 1 yr.
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
* poor healing over leg ulcers
*Acne present over face
* 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 :
*Ointment AMLORFINE
* FUSIDIC ACID CREAM.
* SALINE COMPRESS OVER LEISONS
*Tab.Telma 20 mg od - due to low cortisol level
* TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.
*0.4 ML OF ACTOM PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR @ 7am
*Tab Shelcal 500 OD and Tab Vit D 3 Od.
* Tab ULTRACET /PO/SOS.
* Tab Itraconazole 100 mg bd. And lulifin cream and tab levocitrixine 5mg od.
QUESTION 3 : Testing competency in evidence based medicine .
CASE 1 :
Investigations are done are :
Current Admission - Blood tests
Blood work from previous presentations to hospital. RA factor was negative
24hrs urinary protein: 1500 mg
24hrs urinary creatinine: 0.8
Urine Microscopy - Freshly voided urine sample was centrifuged at high speed (> 2700 RPM) and sediment collected and fixed on glass slide and examined under microscope at 400 (10x * 40x) 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, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies. 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.
CASE 2:
Investigations done are:-
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.
Efficacy of treatment given:
Tab. Syndopa Plus 125 mg QID:- is a combination of two medicines used to treat Parkinson's disease. It is one of the most effective medications to relives symptoms of Parkinson's disease such as tremor, muscle stiffness and difficulty moving.
Tab. Syndopa 125 mg CR OD:-is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors , stiffness and slowness of movement.
Tab. Telma 40 mg OD:- is a medicine used to treat high blood pressure and heart failure. Lowering blood pressure helps to prevent future heart attack and stroke.
CASE 3 :
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 given :
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.
QUESTION 4 : Share the link to your own case report of a patient that you connected with and engaged while capturing his/her life events before and after illness and clinical and investigational images along with your discussion of that case.
QUESTION 5 : testing scholarship competency in logging reflective observations on our concrete experiences of this month.
From the past 3 months ,we've been doing elogs for the patients case from home .I never came in direct contact nor did I see Any patient in person during the logging experience of last 3 months.
The intern who have passed the information regarding patients in deidentified way to make blog in appropriate method we also learned to take history in past 2 months.
The HOD of GM department has made classes compulsive during pandemic.
I thank the department of GENERAL MEDICINE for giving me this opportunity .
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