General Medicine Monthly Assessment

135 UMR.AKANKSHA

"This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs"

Question-1:-

Please go through the long and short cases in the first link 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.

Please provide your peer review assessment on not only the the student's written case report but also the reading of the cases followed by the question answer session linked above in the video and share your thoughts around each answer by the student along with your qualitative insights into what was good or bad about the answer. 

Answer-1:-

CASE-1:

Evolution of symptoms were very well presented. Explanation for every treatment and causes were written in a very coherent manner.Overall it was very well explained and easy to understand.The history taking of the patient was written so orderly manner.It would have been better if more pictures were given directly which would make it easier to understand the context.

CASE-2:-

The case was very well presented and explained.All the keywords were highlighted which made it easier to get the concept and the mechanisms of treatment and the case were very well explained. It has been elaborated in very good manner. The main points have been highlighted clearly.If the pictures of investigation are posted in the elog it would be easier to follow up the case.The timely updates were also mentioned.

CASE-3:-

The explanation was good, but the certain points could have been highlighted.                  If a summary of patients details is given which made it much easier to understan.Very clean presentation and very well explained.It was easy to understand.Can add some more details about terapautic investigations.The summary of the patient was mentioned which made it easier to understand.The presentation was neat, but certain points can be elaborated.The links were attached from where the info was collected.The important words were highlited which made easier to understand the case.time line events were posted with progress of patient's symptoms which is very well done.

Question-2:-

Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. 

Answer-2:-

Case-1:-

Problem list:-

•Facial puffiness

•pedal oedama(bilateral symmetric pitting type)

•frothing of urine

•Decreasing output of urine

•Severe joint pains

•Involuntary weight loose

•Loss of appetite

•Anasarca

•Proteinuria

•Hypoalbuminemia

•Dysmorphic RBC in urine

Solution:-

1. Free water restriction for Hyponatremia
2. Tab. PREDNISOLONE P/O 20 mg OD
3. Tab FEBUXOSTAT P/O 80 mg OD
4. Haemodialysis for worsening renal dysfunction

Case-2:-

Problem list:-

•assemetric involuntary movements in fingers

•Difficulty in walking and taking stairs up

•Feeling of loosing balance

•Erratic bowel movements

•Decreased movements in right lower limb   than that of left limb

•Idiopathic Parkinsonism stage-1

Solution:-

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD

Case-3:-

Problem list:-

•Itchy ring lesions over arms, abdomen, thigh, groin regions.

•Purple marks all over abdomen,lower back, upperlimbs,thigh

•Abdominal distension

•Facial puffiness

•Pedal edema

•Lower back ache

•Weight gain

•Decreased libido

•Easy fatigue

•Weaknesses

•Moon face 

•Pink striae noted over anterior abdominal wall and on low back and on upper arms and thighs.

•Thin skin 

•Poor healing noticed over leg ulcers and easy bruising noted 

•Acne present over face

•Acanthosis nigrans noted over neck

•GYNECOMASTIA

•Buffalo hump

•Sparse scalp hair

•Multiple itchy erythematous annular leisons 

•Multiple hyperpigmented plaques noted over bilateral lower limbs .

•Depression

•Excoriation over striae 

Solution:-

Ointment AMLORFINE 

FUSIDICACIDCREAM

tabtelma 20 mg od .

TABHIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.

TabShelcal 500 OD and Tab Vit D 3 Od.

Tab ULTRACET /PO/SOS.

TELMA DOSE WAS INCREASED TO 40 MG OD.

Tab Itraconazole 100 mg bd. 

Question-3:-

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-3:-

Case-1:-

The case is well presented and explained. The important points were highlighted.

It was explained in coherent manner.

The symptamology are clearly listed.

Pictures are given clearly about investigation.

Complete drug history and treatment is not clearly given.

The patient history could have been elaborated to understand the case even more easily.The discharge summary was not given. Other than that everything is nicely presented.The scan reports were attached in orderly manner and time is mentioned regarding the investigation which is good.

Case-2:-

The patients case has been summarized it is easily understandable,the presentation was very neat and easy to understand.Main points were highlighted.The time line events were posted with progress of patient's symptoms which is very well done.Thecase is presented well.The time line graph of vitals had helped to understand his progress clearly.

Case-3:-

Time line of laboratory  investigations is give.This made me easy to understand whether he is reacting and getting better with the the medications given to him.The case was presented well.The summary at the end was a good idea it end with.The laboratory investigations well presented in coherent manner.

Question-4

Share the link to your own case report this month 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-4:-

I did not get a chance to take up any case.

Question-5:-

Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 

Answer-5:-

In the midst of the pandemic medical school taking the online approach which is primarily a practical sector. This is the educational set up where doctors interact with the patients and try to gather history and knowledge and try to provide their expertise. But still our medical schools are working and they have brought the clinical rotation for which we had always as a medical student being excited about right in front of our mobile/laptop screens. The general medicine faculty have been doing great and also are helping us to acquire knowledge and helped us learn to use the Internet and motivate us to read research papers and old cases about a topic. This has been a great learning session for all of us , looking forward to attend the clinical postings in the hospital.