General Medicine Bimonthly Blended Assessment August 2021

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GENERAL MEDICINE BIMONTHLY BLENDED ASSESSMENT AUGUST 2021 

 32 SRILEKHA CHITTI 


QUESTION 1 :

Peer to Peer review 


LONG CASE :

A 44 year old male presented with a history of bilaterally symmetrical rapidly progressive generalized edema. 
This case is very well presented with each and every minute details. Present history is clearly explained with all details. Medical / surgical history and personal history also explained clearly. All the required investigations are done. General examination and systemic examination are done. In Systemic examination all the examinations are done and very well presented. Based on all the investigations , he was finally diagnosed with :
  • Acute Glomerulonephritis , likely due to Secondary Amyloidosis due to chronic poorly treated Seronegative Erosive Rheumatoid Arthritis.
  • Dilutional Hyponatraemia 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. 

SHORT CASE - 1 :

This is a case of a 49 year old male presented with a history of progressive asymmetric involuntary movements of his right index and middle fingers . The case is presented clearly with all the required details. Present Illness is very clear with each and every minute details and very well presented. Immunisation history is also mentioned. All the required investigations are and examinations are done. Treatment is also explained clearly. Based on the investigations done he was provisionally diagnosed 
  • Idiopathic parkinsons disease stage 1 with denovo  HTN. 
  • Multiple system atrophy -  Parkinsonian Type (MSA-P).
SHORT CASE - 2 :

This case is very well presented with all the required details . Present history , Past history , Treatment history are explained clearly with all the required details. Allergic history is also mentioned . All the investigations and examinations are done . Skin examination also done and very well presented with clear information . Treatment details are mentioned clearly. Final diagnosis was :
  • Iatrogenic Cushings Syndrome Secondary to topical. Clobetasol application all over body for approximately 1 year.
  • Tinea Corposis.
  • Denovo HTN.
QUESTION  2 :

PROBLEM SOLUTION LIST 

Long case

Patient's problem                                                     

Generalized edema

Facial puffiness

Dilutional Hyponatremia

Decreased urine output

Hyperuricemia

Pain in finger joints and wrist

Sub cutaneous swellings in the proximal joints of fingers

Erosive Rheumatoid arthritis

Burning sensation in eyes with increased tearing


Solution 

Free water restriction for hyponatremia to treat edema

                Hyponatremia in presence of edema

indicates increased total body sodium and water levels resulting in edema

Tab.Febuxostat for Hyperuricemia and pain in finger joints and wrist

Tab Prednisolone for Rheumatoid arthritis and inflammatory conditions


Treatment

Free water restriction for hyponatremia

Tab Predisolone P/O 20mg OD

Tab Febuxostat P/O 80mg OD

Haemodialysis for worsening renal dysfunction


Short Case 1 


Patient's problem

Stiffness

Slowness of movements

Involuntary movements rhythmic to and fro oscillations

Hypertension


Solution 

Tab Syndopa Plus for stiffness and involuntary movements

Tab Telma for Hypertension


Treatment

Tab Syndopa Plus 125mg QID

Tab Syndopa 125mg CR OD

Tab Telma 40mg OD


Short Case 2


Patient's problem

Itchy ring lesions

Pedal edema

Facial puffiness

Purple stretch marks

Abdominal distension

Low back ache

Hypertension

Feeling low

Weight gain

Low cortisol levels


Solution

Inj Actom prolongatum for low cortisol levels

Tab Telma for hypertension

Tab Hizone for hypertension,anxiety etc

Saline compress and antifungals for itchy ring lesions


Treatment

Ointment Amorolfine

Fusidic acid cream

Saline compress over lesions

Tab Hizone 10mg/day

Tab Telma 40 mg OD

Tab Shelcal 500 OD

Tab Vit D3 OD

Tab Ultracet/PO/SOS

Inj Actom prolongatum 0.4ml IM


QUESTION 3 :

Therapeutic and diagnostic  interventions


Long Case 

Therapeutic interventions :

Free water restriction for hyponatremia to treat edema

Tab Predisolone helps to reduce inflammation

Tab Febuxostat used to treat hyperuricemia


Diagnostic interventions :

 ECG : used to check hearts rhythm and electrical activity .

Urine microscopy : useful diagnostic tool which meets all the requirements that can be made of an ideal prognostic test. 


Short Case 1

Therapeutic interventions :

Tab Syndopa plus 125 mg QID used to treat the symptoms of parkinson's disease like tremors,stiffness and slowness of movements,poor muscle control.

Tab Syndopa 125mg CR OD - antiparkinson agent

Tab Telma used to treat hypertension


Diagnostic interventions :

2D Echo : used to see the actual motion of the heart structure.


Short Case 2 

Therapeutic interventions :

Ointment Amorolfine - anti fungal

Fusidic acid cream used to treat bacterial infections

Tab Telma used to treat hypertension

Tab Hizone used to treat symptoms of skin allergy like itching,swelling and rashes

Tab Shelcal and Tab Vit D3 for calcium and Vit D deficiency

Tab Ultracet - pain relieving medicine

Inj Actom prolongatum - used to diagnose problems with adrenocortical function.


Diagnostic interventions :

CBP : it is done as a routine screening test, when there are signs and symptoms related to the conditions that effect the blood cells. 

USG abdomen : it is used to look at organs in the abdomen , including the liver, gallbladder, spleen, pancreas, and kidneys. 

RBS : A random blood sugar test is the testing of the blood sugar level at any time or random time of the day.

RFT : useful to assess the renal function. 


QUESTION 4 : 


Own case report :

https://32srilekhachitti.blogspot.com/2021/08/general-medicine-e-log.html


QUESTION 5 : 


Reflective writing : 

This assessment is helping a lot to learn the basics of clinical practice. Its been a great experience taking my first patients history by directly interacting with the patient. And I have learned how to take history and how to do elog under the guidance of our assigned intern. Iam very glad to learn these from the data collected by our department which is encouraging to learn and get more knowledge.I thank Dr.Rakesh Biswas sir our HOD and general medicine department for giving us this opportunity.






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