BIMONTHLY BLENDED ASSESSMENT - JULY 2021
BIMONTHLY BLENDED ASSESSMENT - JULY 2021
- 96 P SRI SAI SANJANA
The following is a link to the assignment which I have been given for a monthly progress evaluation scheme.
Link to the assignment:
QUESTION 1:
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.
ANSWER 1:
Each question has been answered accurately and in detail.
Question 1: A qualitative and quantitative assessment has been given for each case. Plus points and suggestions have also been added.
Question 3: The critical appraisal for the given case was done is a comprehensive, orderly manner. Additional details that could have been taken from the patient were suggested. A note on the discussions of the case could have been included.
Question 4: A problem list has been included along with the therapeutic possibilities to solve the chief complaints. This has been done in a systemic manner and would help understand the case better. Links could have been provided supporting the data.
Question 5: It was well answered. Suggestions on how online learning can be enriched could have been provided.
QUESTION 2:
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.
ANSWER 2:
https://96sanjanapalakodeti.blogspot.com/2021/07/a-48-yo-male-with-bl-pedal-edema-facial.html
QUESTION 3:
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.
ANSWER 3:
The case sheet has tried to capture all the relevant details. The information could have been presented in a more understandable and systemic manner. The reports of the lab investigations conducted have been deidentified and shared with the dates of the investigations. No discussions regarding therapeutic and diagnostic uncertainties were shared.
The case sheet has captured all the relevant details in a orderly and comprehensive manner. The history of present and past illness gives detailed information on the duration and nature of the problems. The day-to-day list of investigations has been deidentified and shared. The treatment given has been logged in daily. A list of provisional diagnosis has been given. No therapeutic uncertainties have been discussed.
All the relevant data has been captured. A clear chief complaint has not been mentioned. The duration and nature of present and past illness has been mentioned. The day-to-day list of investigations has been deidentified and shared. The details of investigations and medications given previously were also shared. The vitals and treatment given everyday has been logged in. No diagnostic and therapeutic uncertainties have been mentioned.
All the required data has been included in the chronological order. A detailed and comprehensive history has been included. Pictures of the patient were given which help better understand the condition. Details on the daily treatment, investigation and prognosis has been mentioned.
The relevant medical history of the patient has been shared in a comprehensive and systematic manner. Correct terminology was used. Advice at discharge was mentioned which provided an insight on what can be done. No diagnostic uncertainty was present. There were no discussions/links regarding the line of treatment followed.
The case sheet has captured all the relevant data in the right order. Correct terminology was used. The reports of all the lab investigations conducted were deidentified and shared. Prognosis after treatment was given, which helped understand the case better. Links and discussions were given to explain the radiological findings.
The relevant medical history of the patient has been shared in a comprehensive and systematic manner. The reports of all the lab investigations conducted were deidentified and shared. Pre and post medication findings were explained. Links were provided to discuss the diagnosis and medications used.
The case sheet has captured all the relevant details in a orderly and comprehensive manner. The history of present and past illness gives detailed information on the duration and nature of the problems. The day-to-day list of investigations has been deidentified and shared. The treatment given has been logged in daily. Provisional diagnosis has not been mentioned clearly. No therapeutic uncertainties have been discussed.
All the required data has been included in the chronological order. A detailed and comprehensive history has been included. Pictures of the patient were given which help better understand the condition. Details on the daily treatment and investigation has been mentioned.
The case sheet has captured all the relevant data in the right order. Correct terminology was used. The reports of all the lab investigations conducted were deidentified and shared. The treatment given has been logged in daily. No diagnostic and therapeutic uncertainties have been mentioned.
All the required data has been included in the chronological order. A detailed and comprehensive history has been included. Pictures of the patient were given which help better understand the condition. Details on the daily treatment, investigation and prognosis has been mentioned.
QUESTION 4:
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.
ANSWER 4:
Problem list:
- Lower abdominal pain
- Burning micturition
- Low back ache after lifting weights
- Dribbling / decrease of urine out put
- Fever
- SOB
- Burning micturition with high fever : grade associated with chills and rigor
- Decrease urine output associated with SOB
Diagnosis:
- Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2
- With ? Right HEART FAILURE,
- With K/C/O - HTN ( Not on Rx)
Treatment:
- SALT RESTRICTION < 2.4gm/day
- INJ. TAZAR
- INJ. PANTOP
- INJ. THIAMINE
- INJ. HAI S/C ACC TO SLIDING SCALE
- SYP. LACTULOSE
Problem list:
- Lower backache since 10 days
- Dribbling of urine since 10 days
- Pedal edema since 3 days
- SOB at rest since 3 days
- Increased involuntary movements of both upper limbs since 10 days
Diagnosis:
- Acute renal failure (intrinsic)
- Grade 1 L4-L5 Spondylodiscitis, Multifocal infectious Spondylodiscitis
- Hyperuricemia 2° to Renal failure
- Uremia induced tremors
- Delirium 2° to septic /Uremic encephalopathy
Treatment:
- IVF - NS-0.9% @100ml/hr
- Inj. Tazar 2.25gm I.V
- Inj. Lasik 40mg I.V
- Nebulization Salbutamol
- Inj. Pantop 40mg I.V
- Tab. PCM 650mg
- Inj. 25% D with 10units of insulin IV
Problem list:
- History of muscle aches
- H/o fever 20 days back
- Since 20 days she has generalized weakness.
- H/o vomitings since 3 days, with food as content, non - projectile , non bilious.
Diagnosis:
CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
Treatment:
- T. PAN 40mg /PO / OD
- oral fluids upto 1.5 - 2 lit / day
- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk
- T. ZOFER 4mg / PO / SOS
- TAB NODOSIS 550 BD
Problem list:
- 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.
Diagnosis:
DKA with AKI ( ? Pre renal) Pyelonephritis
Treatment:
- Inj. NORAD 2amp in 50ml NS
- Inj. DOPAMINE 2amp in 50ml
- Iv infusion NS RL @100ml/hr.
- Inj. HAI 1ml + 34ml NS
- Iv infusion NS (urine output + 40ml/hr)
- Inj. NORADRENALINE(2 amp+46ml NS)
- Inj. PIPTAZ
- Inj. LEVOFLOX
- Inj. VANCOMYCIN
- Inj. MEROPENEM
- Inj. FOSFOMYCIN
- Inj. CLEXANE
Problem list:
- Abdominal distension from the past 7 days.
- Constipation and has not passed stools since 5 days.
- Altered Sleep patterns from the past 5 Days
- Hiccups since today morning
- Pedal edema grade 2
Diagnosis:
- INFECTIVE ENDOCARDITIS
- AV VEGETATIONS WITH MODERATE AS SEVERE AR
- AKI
- ?UREMIC ENCEPHALOPATHY ? SEPTIC ENCEPHALOPATHY
- ULCER OVER SOLE OF RIGHT LEG
- HYPOALBUMINEMIA ? ALCOHOLIC LIVER DISEASE
- ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES
Treatment:
- Inj. Monocef 1gm IV/BD
- Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
- Proctoclysis enema
- Inj. Pan 40 mg Iv/OD
- Inj. Thiamine 200mg in 100ml NS /BD
- Inj. HAI 6U S/C TID
- Inj. Augmentin 1.2 gm IV/TID
- Tab. Ecospirn 150mg PO/HS/SOS
- Tab. Clopidogrel 75mg PO/HS/SOS
- Tab. Atorvas 20mg PO/HS/OD
Problem list:
- Fever since 4 days
- Pus in the Urine
- Decreased Appetite and Generalized weakness
- Drowsiness
- High grade fevers associated with chills and rigor
- Burning micturition
Diagnosis:
Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed soreTreatment:
- Injection PANTOP 40mg IV/OD
- Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
- Injection LASIX 40mg IV/BD
- Injection optineuron 1AMP in 100ml NS slow IV/OD
- Injection NEDMOL 100ml IV/SOS
- Tab PCM 650mg TID
- Insulin Human actrapid - 16 IU/TID
Treatment:
- TAB. BISOPROLOL 5mg OD
- TAB. NITROHART 20/37.5mg 1/2 T/D
- TAB NICARDIA XL 30mg OD
- TAB. GLICIAZIDE 80mg BD
- TAB. NODOSIS 500 mg TD
- Cap. BIO-D3 OD
- Cap. GEMSOLINE OD
- TAB. ECOSPRIN-AV 150/20mg OD
- TAB.LASIX 40mg BD
- SYP. LACTULOSE 15ml
Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review (hindawi.com)
Problem list:
- loose stools since 20 days
- Pedal edema since 20 days
- Abdominal distension since 20 days
Diagnosis:
ALCOHOLIC HEPATITIS ,
AKI SECONDARY TO ACUTE GASTROENTERITIS
HFrEF SECONDARY TO CAD
ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME
Treatment:
- INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
- INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
- INJ LASIX 40 mg
- TAB. ALDACTONE 50 mg PO / BD
- INJ PANTOP 40 mg IV/ OD
ANSWER 5:
Telemedical learning, though limited in its level of exposure and involvement, was an interesting experience. It proved to be a tough task to interact with the patients and/or their attenders regarding the case. It took efforts to Elog the case, understand it relate it to the patient and raise questions about it instead of just doing it mechanically. I realized just how important it is to look at and interact with the patients and their attenders in order to develop a good doctor-patient relationship and empathize with them. I also understood the importance of effective and efficient communication when it comes to the patient, and how far it can affect our perception of their problems. I believe this experience would help me gain a better perspective in the future.
