General Medicine Assessment

MADAM SNEHA [ 3RD SEMISTER ] 
ROLL NO - 74

1) PULMONOLOGY CASE

My review in the pulmonology case of a 55 year old female who is presented with shortness of breath,pedal edema and facial puffness is 

✱ She had first episode of this shortness of breath 20 years ago and had yearly episodes for 8 years lasting one week.

  • This could be due to the use of chulha which lead to allergy.
  • The Anatomical location which effected is bronchioles.

✱ She was Diagnosed with Diabetes 8 years ago

• Anemia and took iron injection:- 5 years ago
• Generalized weakness :- 1 month ago
• Diagnosed with Hypertension:- 20 days back
• Pedal edema is seen from 15 days
•Facial puffiness:- 15 years back
 LOCALISATION OF PROBLEM: Lungs

✱ Head end elevation is done to improve oxygenation.
  • BiPAP (Bilevel positive airway pressure) is a type of ventilator used to treat used to treat chronic canal that affect breathing. It also helps in improvement of sleep quality.
  • Azithromycin, pantop tablets are used. Hydrocoisitone , lasix , Augumentin injections are given.Vital chart examination is done for continuous monitoring.

✱ Cause for acute exaceiboation is due to respiratory infection



✱ Anti tubercular therapy may report pnemonitics or any other lung disease.ATT also causes weakness

✱ Electrolyte imbalance is due to the disease process,respirator acidosis and metabolic alkalosis,steroid therapy.

CARDIOLOGY CASE

73 year old male patient with pedal edema and shortness of breath with decreased urine output.

✱ Possible causes of hear failure in the patient are due to 

  • Diabetes since 30 years.
  • Hypertension since 19 years.
  • Diabetic neuropathy retinopathy nephropathy 
  • Alcohol consumption(chronic alcoholic since 40 years)
↓

Decreased left ventricular ejection factor.

↓ 

Left ventricular dysfunction

  • Chronic kidney disease 


✱ Cause of anaemia in this patient 

  • Chronic alcoholism lead to poor nutrition,liver dysfunction, ineffective erythropoiesis.Alcohol causes bone marrow toxicity leading to erythroblastic changes resulting in anaemia

✱ Blebs and non healing ulcers are seen in the legs of this patient

  • Diabetes 
↓
Ischemia(decreased blood flow),Peripheral neuropathy

↓

Leads to Ulceration

  • Alcohol toxicity causes poor nutrition leading to non healing ulcer.

✱ Sequence of stages of diabetes in this patient are insulin resistance, prediabetes,type 2 diabetes and vascular complications including retinopathy neuropathy nephropathy and related microvascular events

 

In my first question I took review from the following links

https://aitharaveena.blogspot.com/2021/05/online-blended-medicine-assignment-may.html 
  • The pulmonology case presentation is very good
  • The questions are answered to the point
  • Flow chart is well explained
  • The neurology case presentation was good
  • Proper treatment is mentioned
  • Few flowcharts were required for better understanding
  • The neurology case presentation is so nice
  • It is clear with mechanism of action
  • Mind maps are easy
  • Cardiology case presentation is good 
  • Proper therapeutic use of drugs mentioned
  • Diagrams are required
  • The gasrtoenterology case presentation was nice
  • The case history was well presented
  • Treatment is related correctly
https://jahnavichatla.blogspot.com/2021/05/Jahnavi%20Online%20blended%20Bimonthly%20Assessment-%20May.html
  • The hepatology case presentation is good
  • The uses of drugs is specified as required
  • The hematological findings are well mentioned
  • The case presentation of COVID 19 is nice
  • The challenges of home isolation, harms of hospitalisation of this pandemic are clearly mentioed 
  • Cause of death is also mentioned
  • The case presentation nephrology is very good
  • The important points were highlighted which enabled me to get into the case easily
  • The case presentation of mucormycosis is explained in a good way
  • The present situation in the country is reflected this case
  • Treatment moralities are mentioned
  • The case of pulmonology is well presented
  • Flowcharts mentioned are easily understandable

2) https://madamsneha74.blogspot.com/2021/07/case-of-covid-19.html

3),4) DIAGNOSTIC AND THERAPEUTIC APPRAISAL 


✱ In the case related to Quadreparesis secondary to spondylitis of C4-7 and T1 with Epidural abcess act C5-6 level [CNS]. The diagnosis was reached by doing the examination of speech, motor system and cranial nerves.Inititially optineuron andThiamine are used further monocef is added to treat any bacterial infection.


✱ In the case of patient with hypertensive nephropathy with uraemic encephalopathy [renal] the urine examination , Ultrasound and ECG are done to know the underlying cause whether it is a cause of heart or kidney as edema is seen in the patient.
- The patient is treated with 
IVF-NS(0.0+30ml/hr)
INJ.LASIX(40mg/IV/TID)
INJ.NaHCO3(100meq in 100ml NS/IV/Stat)
T.NODOSIS 550mg


✱ The patient with HFrEF with atrial fibrillation [CVS] is treated with amrodarone which is an antiarrhythmic agent.An ECG and 2D echo are mainly done to get the provisional diagnosis.


✱ In the case of Acute Kidney injury which is secondary to urosepsis with hyperkalemia [abdominal] the cause of pedal anaemia and decreased urine output is ruled out by investigating the ECG, Ultrasound, Serum creatinine, Blood urea, Serum electrolyte whivh help to check th kidney function.
- Treatment is done by
 Inj LASIX 40 mg IV/TID    1 -1 - 1
 IVF - NS @ UO + 50 ml/hr
 Inj MAGNEXFORTE 1.5 gm/IV/BD
 Tab NODOSIS - 500 mg  PO/OD
 Tab OROFEA - XT  PO/OD
 Inj HAI s/c
 Neb plain Asthalin 2 respules  QID
 Strict I/O charting
 Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ] 

The diagnosis and theraupetics are very well corelated in all these cases
I got to know some of the drug names and their uses by these cases .I also got to know the mechanism of their action.

5) REFLECTIVE LOGGING

- I have seen a few cases of  Jaundice,Right heart failure, Acute renal failure,Ascites in my online clinical postings.I have learnt about the basic diagnosis and treatment regarding these cases.


One of them was that a patient was febrile with pedal edema, Ascites was identified due to protuding umbilicus . On examination it was found that it is a case of Renal failure which was leading to heart failure.Treatment was by Dialysis.


It is great to have these sessions of clinical postings so that learning doesn't stop even in this pandemic.
I would like to thank general medicine department especially our HOD sir for giving us these interactive sessions so that we can learn more about the clinical cases

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