Bimonthly assessment june

 CASE - 1

.https://aniganikavya06.blogspot.com/

What is the reason for giving thiamine in this patient? 

I agree that thiamine should be given to the patient, as he is a chronic alcoholic, there is deficiency of thiamine due to reduced absorption at the level of intestine, as thiamine has many functions regarding the metabolism, lack of it creates imbalance and some neurological disturbances. So, in order to prevent this thiamine should be given to the patient

CASE - 2

https://blendedasessmentmadhukumar.blogspot.com/

 Why haven't we done pericardiocentesis in this patient?  

  I agree to the answer given, as there is less pericardial effusion and it is resolving on its own. In this case pericardiocentesis cannot be done, as it requires a large quantity of pericardial effusion. As there no cardiac tampanode in this patient which is an another reason we are not considering pericardiocentesis. 

CASE - 3

.https://amitsharma1996.blogspot.com/

What is the probable cause for the normocytic anemia?

 

 I agree to the explanation given, as there is kidney damage due to dehydration, there may be associated anemia because kidney secretes erythropoietin which plays a role in production of RBCs. There are also withdrawal symptoms in this patient. 

CASE - 4

.https://caseopinionsbyrollno05.blogspot.com/

What could be the causes for her electrolyte imbalance?

 

I do agree to the explanation given, the patient is having electrolyte imbalance due to renal dysfunction, worsening of hypoxia, according to the ABG report there may be respiratory or metabolic abnormalities causes electrolyte imbalance. 

CASE - 5

https://avulanikhil09.blogspot.com/

What is the probable cause for kidney injury in this patient?

 I agree to the explanation given, as the patient is a chronic alcoholic, there will be increased blood pressure and it will the main reason disturbing the normal kidney function. The kidney becomes less able to filter the contents and it may also disturb the electrolyte balance. 

CASE - 6

.https://08arshewarpavankumar.blogspot.com/

Could chronic alcoholism have aggravated the foot ulcer formation ? if yes and why ?

 

I agree to the explanation given, as the patient is suffering from diabetes, normally the healing power will be low and to that alcohol consumption would be other factor causing an impairment in the blood cells formation and iron absorption. 

CASE - 7

.https://divyaraju266.blogspot.com/

Hyponatremia seen can be because of more water retention compared to sodium retention?

 

 I agree to the explanation given, as the patient is suffering from respiratory acidosis, due to hypo ventilation there will be increased co2 levels, and so there is compensated metabolic alkalosis causing decreased sodium concentration

CASE - 8

.https://aishwaryagannoji35.blogspot.com/

What could be the causes of her sudden exacerbation? 

 I agree to the explanation given, the patient is suffering from respiratory problems COPD, in respiratory conditions there will be sudden exacerbation as they are more prone to it, any bacterial infection also attacks the respiratory system causing sudden exacerbation.

CASE - 9

https://harshithagoli9.blogspot.com/

Is there any relationship between occurrence of seizure to brain stroke. If yes what is the mechanism behind it?

 I agree to the explanation given, seizures do occur following a brain stroke or a hemorrhagic shock, this may be due to the irritation caused by the products of blood metabolism, as there is increased sodium and calcium levels, there is low level of Depolarization and some dysfunctions leading to seizures following stroke. 

CASE - 10

.

https://divyasree1999.blogspot.com/?m=1

Did the patients history of denovo HTN contribute to his current condition?

 I agree to the explanation given, there will be a cerebellar infarct only when there is a blockade in the blood vessels may be due to blood clots .Due to hypertension, there will be increased sheer stress on the blood vessels causing endothelial dysfunction, cerebellar small blood vessels disease leading to stroke.

Question - 2

CASE REPORT 

 

Question - 3

       

CASE -1 

Below is the link shared on multisystem case

https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

       

     Provisional diagnosis : acute viral hepatitis , Denovo DM type 1 , DKA .

By going through the E - log , the history of present illness , the past history , personal history , family history are well expressed . 

In General examination, the fever chart was graphically shown where all the minute details of the patient's condition can be understood .

The systemic examination of all the major systems are well depicted and also the patient's condition updated everyday

CASE - 2 

Below is the link shared on CNS case

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

      Diagnosis : Quadreparesis secondary to infectious spondylitis of C4 , C5 , C6 , C7 and D1 with epidural abscess at C5 - C6 level

       The case is described precisely , all the patient details regarding the history were expressed well. As the patient's main problem is regarding the central nervous system , all the examinations such as tone , power , reflexes are bilaterally done and pictures were also depicted . 

            Information regarding the patient's investigations are given in the E -log which helped us in analyzing the condition and come to a diagnosis. Treatment details were also appropriate to the condition .

CASE - 3

Below is the link shared on renal case

https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

      Provisional diagnosis : AKI on CKD (Hypertensive Nephropathy ) with Uremic Encephalopathy.

            

            The case presented in this E -log is appropriate , the history was well shown in a chronological order , which made us easy to analyze the case . It was not only purely based on renal system investigations but all other major systems were also covered . As it is a case of renal system , the hemodialysis results were also shown.

            By going through such an E - log we gain knowledge of how to approach a given case and come to a diagnosis .

CASE - 4

 Below is the link shared on CVS case

https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

      Diagnosis : HFrEF with atrial fibrillation 

             The case is based on the cardiovascular system , the history of present illness , past history , personal history , family history were given showing the cause of disease. 

             The ECG investigations were also graphically represented .Videos were also linked to it showing the atrial fibrillations thereby increasing our understanding capacity regarding the case. The treatment plan was appropriate to the condition satisfying the case

CASE - 5

Below is the link shared on abdomen related case

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

  Diagnosis : Acute injury secondary to urosepsis with hyperkalemia (resolved) with anemia of chronic disease .

         

           The case is well presented with all the required details of the patient , there was a fever chart depicted graphically , showing us all the minute details .All the major system are covered, as there was a kidney related issue ,complete urine examination report was also shown with ECG and ultrasound 

        The patient's condition every day was updated along with the treatment plan . This showed the effort put in order to make this E - log.

Question - 4

 

CASE - 1  

Below is the link shared on multisystem case  

https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

       

      My analysis and reflection on the above case ,

                A 18 years old male came with complaints of low backache 1 week ago ,fever since 5 days , yellowish discoloration of eyes since 3 days , vomiting ( 2 episodes ) and loose stools ( 3 episodes ) and blood tinged urine yesterday morning.

            loss of weight, had a history of polyuria, nocturia, polydypsia, burning micturition present, there is tenderness present in the right hypochondrium, epigastrium, bowel sounds present.

             According to the investigations, there is decreased creatinine and sodium levels, prothrombin time is slightly raised, increased C - reactive proteins, showed positive for ketone bodies in urine, decreased albumin concentration.

            From the above details, they came to a provisional diagnosis as to be acute viral hepatitis, denovo DM type 1, diabetic ketoacidosis . 

CASE - 2

Below is the link shared on CNS case

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

            

               My analysis and reflection on the above case,

            A 28 year old male came with complaints of sudden fall followed by weakness of both the lower limbs ( paraplegia ) and loss of hand grip 10 days back , associated with bowel and bladder incontinence .

       The patient in the past had productive cough, low grade fever , tested positive for AFB bacilli, the treatment given to this is started ATT-HRZE regimen, 2 tab according to weight / PO/OD, developed generalized weakness and myalgia.

        According to the investigations , there is altered lymphocytes count and sodium and chloride electrolytes were also altered, on MRI ,there is epidural abscess at C5 and C6 , T2/STIR hyperintensity and T1 hypo intensity of C4 , C5 , C6 , C7 , D1.

         From the above details, they came to a correct diagnosis that is quadreparesis secondary to infectious spondylitis of C4, C5, C6 , C7 ,D1 with epidural abscess at C5 - C6 level.

CASE - 3

Below is the link shared on renal case

https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

  Here's my analysis and reflection on the above case 

                 A 45 year old male with complaints of altered sensorium since morning, lethargy , fever 10 days back, pedal edema with anasarca, shortness of breath present even at rest.

             The patient is a known case of Hypertension, chronic kidney disease . pallor is present, generalized edema is present, bilateral air entry and dyspnea present 

             

                According to the investigations, there is decreased hemoglobin, total count and lymphocytes. ECG findings are also altered .

                  

                    From the above mentioned details , they came up with the correct diagnosis that is AKI on CKD ( hypertensive nephropathy ) with uremic encephalopathy  

      

CASE -4 

Below is the link shared on CVS case         

 

https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

Here's my analysis and reflection on the above case

         A 70 year old female came with complaints of abdominal distension , shortness of breath grade -3 since 5 days , had a history of hypothyroidism since 5 years ,she was on thyronorm 100 mg OD for hypothyroidism.

         According to the investigations , ECG showed atrial fibrillations , there is bilateral pleural effusion and mild pericardial effusion, showed decreased hemoglobin ,increased total count, decreased PCV, MCV , MCH , decreased random blood sugar . Due to atrial fibrillations ,the biochemical report showed hyperthyroidism .They made an attempt for defibrillation.

         

         From the above mentioned details , they came with the correct diagnosis that is HFrEF with atrial fibrillation 

CASE -5

Below is the link shared on abdomen based case

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

Here's my analysis and reflection on the above case

             A 60 year old female came with complaints of pedal edema ( bilateral ,pitting type ) , decreased urine output ,burning micturition , fever since 10 days . she had a history of DM2 ( on teneligliptin 20 mg ).

             There is increased blood pressure ( 170/110 mm Hg ),oxygen saturation at room temperature is slightly less ( ventilator )

             According to the investigations, showed raise in serum creatinine and blood urea levels, decreased random blood sugar, increased serum potassium ( hyperkalemia ), decreased hemoglobin concentration ( anemia)  

             From the above mentioned details , they came to the correct diagnosis that is acute kidney injury secondary to urosepsis with hyperkalemia ( resolved) and anemia.

Question - 5

       We entered into a new method platform (competency based medical education) of analyzing and understanding, which helped to improvise ourselves, made us better and competent doctor.