GENERAL MEDICINE JULY MONTH ASSESSMENT

NAME- M.SNEHA

ROLL NO-74

3RD SEMISTER


 QUESTION-1

Competency tested for peer to peer review -

My review on this elog

https://73myashwitha.blogspot.com/

➡ Her review is nice on the cases done by our seniors.

➡ The cases were clearly understood by her.

➡ The review is clear regarding presentation, pathophysiology, flowcharts, investigations, diagnosis, treatment.

➡ The review of all other infectious diseases, gastroenterology, mucormycosis should have been done.

➡ She presented her own case report well.

➡ She discussed appropriately about the diagnostic and therapeutic uncertainities regarding the cases.

➡ Her point of view regarding clinical postings is reliable.


QUESTION-2

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


QUESTION-3

Case-1 :

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

The given case diagnosis is Acute kidney disease secondary to UTI with associated denovo DM.

  • Investigations and treatment are well mentioned
  • Microbiological examination is also clearly done
  • The case presentation is good.
Case-2 :

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

The given case diagnosis is Acute renal failure with hyperuricemia secondary to renal failure.

  • The case history should have been mentioned in the chronological order. 
  • The day to day treatment history was well mentioned.
  • The examinations were well highlighted.
Case-3 :

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

The given case diagnosis is Chronic interstitial nephritis secondary to plasma cell dyscariasis.

  • The personal history should have been well mentioned with the menstrual history in an appropriate order.
  • The clear findings are mentioned for the examinations done.
  • Overall the case presentation is nice.

Case- 4 :

http://casereports.bmj.com/content/2009/bcr.03.2009.1726

The given case report is of Acute renal failure following a low back ache.

  • CT Scan images of spine and are nice.
  • Bone marrow histology is also done to check for any infections.

Case- 5 :

Patient with Coma and Renal failure.

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

The given case diagnosis is  DKA with AKI.

  • Every investigation of the patient is clearly mentioned.
  • The patients is presented with bed sores
  • She was in a vegetative state.

Case- 6 :

Patient with Coma and Renal failure.

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

The given case diagnosis is Infective Endocarditis.

  • Investigations are present day to day.
  • All the examinations are well mentioned.
  • Discharge summary is also kept.

Case- 7 :

Patient with Acute on CKD.

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

The given case diagnosis is Renal AKI Secondary to Urosepsis.

  • The important details of patient with the diagnosis are well highlighted.
  • Fever chart and Creatinine levels are well mentioned graphically.
  • The case presentation is very good.
Case- 8 :

Patient with Acute on CKD.

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

The given case diagnosis is HFrEF Secondary to CAD;CRF

  • Investigative reports are presented day to day.
  • Pre and post medicational findings are noted which is very good point.
  • Management details are also given.

Case- 9 :

Patient with Acute on CKD.

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

  • The edema of the patient is clearly seen.
  • The pCO2 trend is shown in the graph.
  • All the investigations are clearly mentioned.
  • The course of patient in the hospital is also detail.

Case- 10 :

Patient with AKI

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

The given case diagnosis is Acute Kidney Injury Secondary to Urosepsis.

  • Pallor is seen in the lower palpebral conjunctiva.
  • Day to Day history of Stools, Edema, Tremors are mentioned
  • The case is well presented.

Case- 11 :

Patient with AKI

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

The given case diagnosis is Acute Kidney Injury Secondary to Urosepsis.

  • Investigations are mentioned in order.
  • Bacterial culture test is done.
  • The case presentation is nice.

Case- 12 :

Patient with AKI

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

The given case diagnosis is Acute pancreatitis with AKI.

  • The examinations should be highlighted.
  • The Summary is mentioned for clear cut review.


QUESTION - 4

Case- 1 :

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

The given case diagnosis is Acute kidney disease secondary to UTI with associated denovo DM.

A 58 year old male came with

CHIEF COMPLAINTS :

- Lower abdominal pain , burning micturition from 1 week.

- Decreased urine output- 1 week

- Fever- 1 week

- SOB- 1 week

INVESTIGATIONS :

-RBS , Serum and Urine Examination.

-CBP , Bacterial culture and sensitivity test

- ABG Report

- Hemogram

TREATMENT :

- IVF : -RL  @ UO+ 30ml/hr

- SALT RESTRICTION  < 2.4gm/day

- INJ    TAZAR    4.5gm  IV/TID

                             2.25gm IV/ TID

- INJ     PANTOP 40mg  IV/OD

- INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID

- INJ     HAI  S/C  ACC  TO   SLIDING SCALE

              8AM  -  2PM  -  8PM

- SYP    LACTULOSE   15ml    PO/TID [ To maintain stools less than or equal to 2]

- GRBS  - 6th Hourly

- BP/PR/TEMP - 4th Hourly

- I/O - CHARTING

Case- 2 :

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

The given case diagnosis is Acute renal failure with hyperuricemia secondary to renal failure.

A 75 year old male came with

CHIEF COMPLAINTS :

- Lower back ache, Dribbling of urine, Increased involuntary movements of both upper limbs since 10 days.

- Pedal edema and SOB since 3 days.

INVESTIGATIONS :

- ECG, RFT, CUE

- Hemogram, ABG , Serum electrolytes

- Blood urea ,USG Abdomen ,LFT.

TREATMENT :

- IVF -    NS-0.9%  @100ml/hr
- Inj. Tazar 2.25gm I.V -TID 
- Inj. Lasik 40mg I.V -BD 
- Nebulization Salbutamol -4th hourly 
- Inj. Pantop 40mg I.V -OD 
- Tab. PCM 650mg -TID 
- Foleys catheterization 
- Temperature ,Bp, PR Charting  hourly 
- Strict IO Charting
- GRBS -12th hourly 
- Inj.25% D with 10units of insulin IV -slow for 1hr 

Case- 3 :

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

The given case diagnosis is Chronic interstitial nephritis secondary to plasma cell dyscariasis.

A 49 year old female came with

CHIEF COMPLAINTS :

- Muscle aches since 3 years.

- Muscle weakness from 20 days

- Vomitings since 3 days.

INVESTIGATIONS :

- Hemogram, ABG, LFT

- Serum electrolytes, Creatinine

- Blood urea, Bone marrow aspiration.

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  
- Donot give IV fluids unless instructed
- T. ZOFER 4mg / PO / SOS
- Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved )
- TAB NODOSIS  550 BD

Case- 4 :

http://casereports.bmj.com/content/2009/bcr.03.2009.1726

The given case report is of Acute renal failure following a low back ache.

A 47 year old man came with

PRESENTATION :

- Nausea, Vomtings

- Oliguria.

INVESTIGATIONS :

- CT scan

- Bone marrow Examination

TREATMENT :

- Chemotherapy

- Steroids.

Case- 5 : 

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

The given case diagnosis is  DKA with AKI.

CHIEF COMPLAINTS :

- Back pain with abdominal and chest pain 5 days ago.

- Fever and diarrhea since 5 days.

INVESTIGATIONS :

- ABG, 2-D Echo

- CBP, LFT

- Kidney function test.

- Bacterial culture and sensitivity.

TREATMENT :

- Inj. NORAD 2amp in 50ml NS
- Inj. PIPTAZ 2.25gm.
- Inj. DOPAMINE 2amp in 50ml
- Inj. HAI 1ml in 39ml NS

Case- 6 :

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

The given case diagnosis is Infective Endocarditis.

A 52 year old man presented with

CHIEF COMPLAINTS :

- Abdominal distension past 7 days

- Constipation since 5 days

- Altered sleep patterns from past 5 days.

INVESTIGATIONS :

- CUE, RFT, LFT

- 2-D ECHO

- Hemogram.

TREATMENT :

- Inj. Monocef 1gm IV/BD
- Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
- Procto clysis enema
- Inj. Pan 40 mg Iv/OD
- Inj. Thiamine 200mg in 100ml NS /BD
- Inj. HAI 6U S/C TID

Case- 7 :

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

The given case diagnosis is Renal AKI Secondary to Urosepsis.

A 52 year old male came with

CHIEF COMPLAINTS :

- Fever since 4 days

- Pus in urine.

INVESTIGATIONS :

- RBS, CBP

- Hemogram.

TREATMENT :

- 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

Case- 8 :

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

The given case diagnosis is HFrEF Secondary to CAD;CRF

A 48 year old male

CHIEF COMPLAINTS :

- SOB past 1 week

INVESTIGATIONS :

- Fasting and Postprandial blood sugar

- ESR, CBP, ABG, LFT

- Lipid profile, USG

- RFT, 2D ECHO.

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

Case- 9 :

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

Patient with Acute on CKD.

A 60 year old female with

CHIEF COMPLAINTS :

- Pedal edema since 3 days

- Deceased urine output from 3 days.

INVESTIGATIONS :

- USG Abdomen, 2D ECHO

- CUE, Blood examination.

TREATMENT :

 - IV fluids
- Tab. Pan 40 mg po OD 
- Inj. Lasix 80 mg IV BD
- Thiamin 200 mg in 100 ml NS IV BD
- Tab. Levocet 5 mg Po BD
- Liquid paraffin for LIA
- Grbs 6 th hrly
- I/o charting, temp. Charting

Case- 10 :

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

The given case diagnosis is Acute Kidney Injury Secondary to Urosepsis.

A 43 year old male with

CHIEF COMPLAINTS :

- Loose stools since 20 days

- Abdominal distension and pedal edema from 20 days.

INVESTIGATIONS :

- Hemogram
- CUE, CBP
- RFT, LFT
- ECG, CXR PA VIEW
- USG ABDOMEN, PT/ INR
- APTT, CT

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

Case- 11 :

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

The given case diagnosis is Acute Kidney Injury Secondary to Urosepsis.

A 60 year old female came with

CHIEF COMPLAINTS :

- Pedal edema, Fever from 10 days

- Decreased urine output since 10 days.

INVESTIGATIONS :

- CUE, ECG, USG

- RBS, Serum examination

- Urine examination, Hemogram.

TREATMENT :

- Inj LASIX 40mg (8am- 2pm -8pm)

- IVF - NS @ UO + 50 ml/hr

Case- 12 :

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

The given case diagnosis is Acute pancreatitis with AKI.

A 31 year old male patient with

CHIEF COMPLAINTS :

- Pain in abdomen, Vomiting from 1 week

- SOB since 2 days.

INVESTIGATIONS :

- LFT, Serum lactase and amylase

- USG.

TREATMENT :

- Iv fluids : NS 40 ml /hr.
- IV lasix  40 mg BD .
- Tab Nodosis .
- IV PIPTAZ 4.5 Gms. BD 
- Iv 25%Dextrose. 100 ml BD 
- Tab . Nicardia 10 mg  TID

The treatment and investigations of all the above mentioned cases are suitable and appropriate

QUESTION - 5:

I have seen a few cases of Kidney failure ,Heart failure, Haepatomegalie ,Anasarca ,Neurological disorders etc in my online clinical sessions.Learning them offline would be more interesting with direct interaction with patient.
- One of such case is that a patient presented with pedal edema has chronic kidney disease which lead to the left ventricular failure.
- Like this many cases were presented to us. This integrated course of learning is enthusiastic and diagnoising patient in future will be easy for us 
- Thank you for engaging us in these online sessions.

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