BIMONTHLY BLENDED ASSESSMENT - JUNE 2021

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BIMONTHLY BLENDED ASSESSMENT - JUNE 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 particular answer of ten students in this link:
and share your peer review of each answer with your quantitative marking input as well as qualitative insights into what was good or bad about the answer. 

ANSWER 1:
I will be reviewing the pulmonology case in each link.

Qualitative: 7/10
Quantitative: The etiology is mentioned and a flowchart is given for the evolution of symptomatology. It would be more informative if the timeline of the symptoms is specifically mentioned. The flowchart makes it easier to understand and comprehend.

Qualitative: 8/10
Quantitative: The timeline of the symptomatology, the anatomical location and the primary etiology are mentioned clearly under separate headings. This makes it easier to analyze and keep track of the case. No continuity of symptomatology is seen. A flowchart or an explanation of how the symptoms might have progressed would be helpful.

LINK 3: GM assignment (avulanikhil09.blogspot.com) - CASE OF PULMONOLOGY
Qualitative: 10/10
Quantitative: The symptomatology is listed in chronological order and in detail. The primary etiology is mentioned and explained very clearly with the help of a flowchart and a diagram. This makes it easier to understand and comprehend.

Qualitative: 8/10
Quantitative: The symptomatology is given in detail. The anatomical localization is given as 'Right paracardiac localization of COPD". A flowchart or a diagram to understand the progression of the symptoms would be helpful. 

Qualitative: 7/10
Quantitative: The symptoms are given in a chronological order. All the details on history of the patient's symptoms has not been included. The etiology is clearly explained with the help of a diagram.  It is informative and easy to comprehend.

LINK 6: General Medicine (budigesaikiran14.blogspot.com) - CASE OF PULMONOLOGY
Qualitative: 8/10
Quantitative: The symptoms and their progression has been explained in a chronological order with the help of a diagram. The flowcharts make it easier to follow. It is comprehensive and informative.

Qualitative: 7/10
Quantitative: The evolution of symptomatology is given in detail in a chronological order. The anatomical location is not specific. There is no explanation for the primary 
etiology of the patient and how it might have caused the symptoms.

Qualitative: 7/10
Quantitative: The history of the patient's symptoms are listed clearly. The anatomical location is not specific. There is no explanation for the primary etiology of the patient and how it might have caused the symptoms.

Qualitative: 9/10
Quantitative: The evolution of symptomatology is given in the form of a diagram. It is comprehensive and easy to analyze. The anatomical localization and the primary etiology has been explained in a very comprehensive manner. It is very detailed and informative. 

Qualitative: 9/10
Quantitative: All the sub-questions have been answered in a detailed and comprehensive manner. Diagrams and flowcharts have been used to make it easier to comprehend. The concepts are explained clearly.


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. 



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.

Links to the cases: 

ANSWER 3:
MULTISYSTEM
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. Updates were logged in so that the case could be followed easily. No discussions on diagnostic and therapeutic uncertainties were given.

CNS:
The relevant medical history of the patient has been shared in a comprehensive and systematic manner. 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.

RENAL:
All the required data has been included in the chronological order. All investigations (and their dates) were logged in. No leads, links or discussions were given. No diagnostic or therapeutic uncertainties were given.

CVS:
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. Links/leads/discussion regarding the diagnostic hallmark of the provisional diagnosis and therapeutic uncertainties were not mentioned.

ABDOMINAL:
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. No discussions on diagnostic and therapeutic uncertainties were given.


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: 

MULTISYSTEM:

Problem list: 
  1. Gradual loss of weight
  2. Polyuria, nocturia, polydypsia
  3. Low backache
  4. Vomiting
  5. Loose stools
  6. High grade, intermittent, fever
  7. Yellow discolouration of eyes and urine 
  8. Nausea & Loss of appetite
  9. Burning micturition
  10. DKA

Day 1 - IV fluids, Insulin, Vit K - Insulin is an accepted therapeutic drug for treatment of DKA.

Day 3 -  Syp Lactulose was given for constipation

Day 4 - Inj. Lorazepam was given as absence seizures were suspected. 

Day 5 - Cerebral malaria was suspected and Inj. FALCIGO, Inj. LEVIPIN, and Inj. DOXYCYCLINE was given. 

Cerebral malaria (nih.gov) - The provisional diagnosis is consistent with the symptoms and their progression. A peripheral blood smear can be done to confirm the diagnosis (Presence of Plasmodium falciparum in the smear will confirm it)

Other diagnosis that can be supported by the symptoms are:

Treatment:

  • FALCIGO - is an anti-malarial drug.
  • LEVIPIL - is an anti-epileptic.
  • DOXYCYCLINE - is an anti-malarial

The therapeutic interventions were specific and highly effective for the assumed diagnosis.



CNS:

Problem list:

1. Weakness of both lower limbs

2. Loss of hand grip

3. Bowel and bladder incontinence

4. Generalised weakness and myalgia

The diagnosis was Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level. This diagnosis was supported by an MRI of the brain with cervical spine. The specificity and sensitivity of MRI in diagnosing such an acute case of spondylitis was found to be very high, as compared to a CT scan. 

Infectious Spondylodiscitis: Diagnosis and Treatment (nih.gov)

Treatment given:

  • Optineuron
  • Thiamine
  • ATT

RENAL:
Problem list:
  1. Lower back and neck pain
  2. Altered sensorium
  3. Shortness of breath (grade 4)
  4. Loss of appetite
  5. Lethargy
  6. Anasarca
Uraemic encephalopathy is a diagnosis of exclusion. Differential diagnosis include:

Reference: Uremic Encephalopathy - StatPearls - NCBI Bookshelf (nih.gov)

Treatment: Inj. LASIX was given to manage Anasarca. The other treatments were not specific to the symptoms. 


CVS:

Problem list:

  1. Abdominal distension
  2. Shortness of breath
  3. Hypothyroidism

This was diagnosed as HFrEF with Atrial Fibrillation based on the ECG. ECG has very low specificity in diagnosing ECG. Left-ventricular ejection fraction is the diagnostic hallmark. Heart failure with reduced ejection fraction: A review of clinical status and meta-analyses of diagnosis by 3D echocardiography and natriuretic peptides-guided heart failure therapy (oatext.com)

Treatment: 

Amiodarone is highly effective in treating arrythmia Clinical efficacy of amiodarone as an antiarrhythmic agent - PubMed (nih.gov)

Clexane is an anticoagulant. Since patients with AF have a higher risk of thromboembolism and stroke, anticoagulants are used to reduce the risk. Clexane is an effective and safe drug.


ABDOMINAL:

Problem list:

  1. High grade fever
  2. Bilateral pitting type pedal edema
  3. Decreased urine output
  4. Burning micturition

The diagnosis is consistent with the symptoms. The treatment given is appropriate. 


QUESTION 5:

Please reflect on and share  your telemedical learning experiences from the  hospital as well as community  patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.

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 realised 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. 










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