General Medicine Bimonthly Blended Assessment July 2021
Name : Ch.Srilekha
Roll.no : 32, 3rd semester (2019 Batch)
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.
https://30hansikareddy.blogspot.com/
The reviews given for question 1 are very genuine and clear. And a quick review of all the cases are explained clearly in a simple way. In question 3 is answered up to the point with detailed description. Question 4 is answered well with all the required points. In Question 5 clearly explained how this blogs are useful and how we are learning and gaining knowledge through this assessments.
Question 2 :
Iam really sorry for not answering this question sir. I didn't get the chance to take any case yet.
Question 3 :
Patient centered data around the theme of renal failure patients with AKI, CKD and acute on CKD,
captured by students from 2016 and 2019 batch in the links below:
Refer to the link below on Acute on CKD :
The case is well presented with all the required details. The details of the patient are very clear with past and present history explained very well. The vitals of the patient are normal. All the required examinations are done . And the probable diagnosis was made as Acute renal failure. Treatment details of everyday are explained very neatly. The case is covered very well in overall in all aspects.
Refer to the link below on CKD :
The case is presented very clearly with all details. Past History, present History and all the required details are explained clearly. All the investigations are done . The diagnosis was made as chronic interestitial nephritis
secondary to plasma cell dyscariasis. Treatment details are explained clearly.
Refer to the link below on patient with coma and renal failure:
The case is presented in very clear way. Past History and Previous Drug history are explained clearly which are very crucial for further treatment. All the required examinations and investigations are done . The Provisional diagnosis was made as Diabetic Ketoacidosis with Acute Kidney Injury. Treatment details are also given in a very clear way. The case presentation was very nice in all aspects in a detailed manner.
Refer to the link below on patient with coma and renal failure :
The case presentation was very nice. History taking details are explained clearly. All the examinations and investigations are done and reports are provided with all details clearly. The probable diagnosis was made as
FINAL 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
Refer to the link below on Acute CKD :
The case was presented very clearly with all the required details. All the examinations and investigations are done. Necessary investigations are updated everyday. The Final diagnosis was made as Renal Acute Kidney Injury secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM-2 since 5yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed score.
Refer to the link below on Acute CKD :
The case was presented in a clear way. Past history, Drug history and present history are given clearly. All the examinations and investigations are done. All the required details are given clearly with reports . The Final diagnosis was made as Heart failure with reduced ejection fraction (HFrEF) secondary to CAD ; CRF. Treatment details are given clearly. The case is covered in detailed manner in all aspects.
Refer to the link below on Acute CKD :
The case is presented well with all the required details. Past history, present history details are explained clearly. All the required examinations and investigations are done. The case was explained clearly.
Refer to the link below on AKI :
The case presentation was very nice.All the appropriate information has been taken in detail . All the examinations and investigations are done. And the provisional diagnosis was made as Alcoholic hepatitis, AKI secondary to acute gastroenteritis , HFrEF secondary to CAD , Alcoholic and tobacco dependence syndrome.
Refer to the link below on AKI :
This case is well presented with all the required details of the patient. All the appropriate information has been taken in detail. General examination , vitals and systemic examinations are accurate. After thorough investigations the final diagnosis was made as Acute kidney injury secondary to urosepsis with hyperkalaemia
with anemia of chronic disease.
Question 4 :
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.
Diagnostic :
The probable diagnosis of this case was made as acute renal failure. Based on the investigations ECG , RFT, CUE, Hemogram , ABG, serum electrolytes, Blood urea, USGabdomen, LFT.
USGabdomen : Abdominal Ultrasonography is a form of medical ultrasonography visualise abdominal anatomical structures. It uses transmission and reflection of ultrasound waves to visualise internal organs through the abdominal wall.
CUE : Complete Urine Analysis.
HEMOGRAM:Hemogram also referred to as complete blood count or complete hemogram test is a group of test performed on sample of blood. Hemogram serves as broad screening panel that checks for the presence of any diseases and infections in the body.
ABG : An arterial blood gas analysis measures the balance of oxygen and carbondioxide in the blood to see how well lungs are working.
Therapeutic :
Tazar : It is a combination of two antibiotics. It fights against the infection by killing the microorganisms.
Nebulization salbutamol: Indicated for use in the routine management of chronic branchospasm unresponsive and conventional therapy and the treatment of acute severe asthma.
Pantop : Used for treatment of gastro-esophageal reflux disease, heart burn, euophageal inflammation, stomach ulcers.
Patient with coma and renal failure :
Diagnostic:
The provisional diagnosis of this patient was made as DKA with AKI . Based on the investigations 2D echo, ABG, CBP, LFT, RFT, Hemogram.
2D echo: 2D echo, is a non-invasive investigation used to evaluate the functioning and assess the sections of heart.
CBP : Complete Blood Picture , it is done as a routine screening test , when there are signs and symptoms related to the conditions that affect the blood cells.
Therapeutic:
NORAD : Used to treat hypotension.
LEVOFLOX : Used to treat bacterial infections.
Vanomycin : used to treat an infection of the intestine caused by clostridium difficile, which can cause watery or bloody diarrhea.
Patients with acute on CKD :
Diagnostic:
The diagnosis of this patient was made as Renal AKI secondary to urosepsis with b/L hydroureteronephrosis . Based on the investigations X-ray, ABG, serum electrolytes, Blood urea, Hemogram, 2D-echo , ECG.
X-ray : used to examine the bones and joints.
Blood urea : BUN test measures the amount of nitrogen in blood that comes from the waste product urea.
Therapeutic:
Piptaz : used to treat bacterial infections.
Lasix: used as a strong diuretic to treat excessive fluid accumulation.
Nedmol : helps in relieving moderate pain and reducing fever.
Insulin human actrapid : short acting insulin used to treat type 1and type 2 DM.
Patients with acute on CKD :
Diagnostic:
The diagnosis of this patient was made as HFrEF secondary to CAD;CRF. Based on investigations GTT, ESR, CBP, ABG, Renal function test, LFT, USG, 2D echo .
GTT : test done to assess the body response to glucose.
ESR : test that indirectly measures the degree of inflammation in the body.
USG : Ultrasonography helps to predict the internal organ structural abnormalities like tumors or cysts.
Therapeutic:
Bisoprolol : used to treat hypertension heart failure.
Nitrohart : used to treat heart failure.
Nodosis : used to treat acid indigestion, heart burn, sour stomach , stomach upset , metabolic acidosis, severe diarrhea, poisoning and drug intoxications.
Gemsolin : used to treat low blood calcium levels.
Ecosprin : used as anti inflammatory and analgesic .
Patients with AKI :
Diagnostic:
The diagnosis of this patient was made as
Alcoholic hepatitis, AKI secondary to acute gastroenteritis, HFrEF secondary to CAD , Alcoholic and tobacco dependence syndrome. Based on the investigations
Hemogram , CUE, CBP, RFT, LFT,ECG, CXR PA view, USG abdomen, PT/ANR, APTT, BT/CT
RFT : blood test used assess the renal function.
LFT : profile of blood test that provide useful information about the state of the liver.
APTT : one of several blood coagulation tests .
BT/CT : Bleeding time (BT ) test and Clotting time (CT) test.
Therapeutic:
Metrogyl : used to treat certain infections caused by bacteria and other organisms in different parts of the body.
Loperamide : used to decrease the frequency of diarrhea.
Optineuron : used to treat nutritional deficiencies and as well as vitamin B12 deficiency.
Thiamine : used to treat beri-beri .
Diagnostic:
The diagnosis of this patient was made as Acute kidney injury secondary to urosepsis. Based on investigations complete urine examination , ECG, ultrasound, GTT, serum creatinine, serum electrolytes, ABG, Blood urea.
Complete urine examination : helps to detect diseases or conditions such as diabetes , liver or kidney problems, urinary tract problems.
ECG : records the electrical signal from heart to check for different heart conditions.
Serum creatinine : used to assess the normal function of kidneys.
Therapeutic:
Magnefortex : used for the treatment of bacterial infections.
Orofer : used for the treatment of anemia, chronic blood loss, poor diet, folate deficiency, iron deficiencies.
Ultracet : used to treat muscle aches, back pain , joint pain, menstrual cramps.
Norflox : used to treat bacterial infections.
Question 5:
This assessment helped me learn the basics of clinical practice. This pandemic has a major impact on study due to which we cannot attend the offline postings and we cannot interact directly with patients. This way of clinical exposure helped us to learn history taking and writing case sheets. As , Iam new to clinical postings , Iam very glad to learn these from the data collected by our department which is encouraging to learn and get more knowledge on clinical postings.
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