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.
CASE-2:
The history taking of the patient was written so orderly manner.As it has more pictures it was easier to understand the context.The important points were highlighted.The daily timeline routine helped in understanding the case in a better way.
CASE-3:
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.The radiological information regarding the case made it easy to understand.The x-rays were made it better to understand.
CASE-4:
It has been elaborated in very good manner. The main points have been highlighted clearly.The pictures of investigation are posted in the elog which made it easier to follow up the case.The timely updates were also mentioned.The soap notes and plan of care was clearly mentioned.
CASE-5:
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 understand.
CASE-6:
Very clean presentation and very well explained.It was easy to understand.Time line of treatment gave a huge help to understand the progression of patients situation.The pictures and x-rays and MRI scan pictures made it easy.
CASE-7:
The summary of the patient was mentioned which made it easier to understand.The presentation was neat, but certain points can be elaborated.The important words were highlited which made easier to understand the case.
CASE-8:
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-9:
The patients case has been summarized it is easily understandable,the presentation was very neat and easy to understand.Main points were not highlighted.The time line events were posted with progress of patient's symptoms which is very well done.
CASE-10:
The case is presented well.The time line graph of vitals had helped to understand his progress clearly.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.
CASE-11:
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-2,3:-
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.
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.
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
Gastroenterology :
(Captured by 2018 batch student final year MBBS):
Problem list:
History of low grade fever, intermittent, not associated with chills and rigor.
Patient also complaints of yellowish discoloration of urine since 1 month, passing of clay colored stools since 1 month.
He also complaints of itching all over the body since 1 month, decreased appetite, loss of weight and generalised weakness since 1 month
Diagnostic approach and treatment
Antibiotic therapy (if indicated for infection)
- Endoscopic retrograde cholangiopancreatography (ERCP),
- Intravenous fluids and pain medications
(Captured by 2017 batch student final year MBBS):
Problem list: * History of pedal edema, in both lower limbs since 10-15 days which is incidious in onset and gradual in progression and worsened to the present size.
* History of abdominal distension, since 10-15 days which is progressively increasing.
* Endoscopy was done and grade 1 varices are present and ultrasound showing mild splenomegaly.
* History of decreased urine output since 10-15 days, with normal stream & post voidal residue with urgency and hesitency presence.
Diagnosis
CHRONIC LIVER FAILURE
&
HEPATO RENAL SYNDROME OR
CHRONIC KIDNEY DISEASE ??
(Captured by 2016 batch intern post final year mbbs) :
Problem list:
on 15th Feb 2021 isg abdomen
IMPRESSION:
1)Post cholecystectomy status with mildly altered texture of hepatic bed at gall bladder fossa region & prominent bilobar IHBR.
2) Mildly dilated CBD with stent in situ & mild focal wall thickening at lower part
3) Normal size pancreas with heterogeneous texture.
4) Few mildly enlarged retro peritoneal lymph nodes.
5) Chronic cervicitis with PID.
Diagnostic approach:
7th October 2021
Cytology study indicated- Benign Ductal Epithelial Cells. Negative for malignancy
CNS :
(Captured by 2016 batch intern post final year mbbs) :
Problem list
GIDDINESS UNDER EVALUATION SECONDARY TO ? HYPERTENSION? WITH U/L OPTIC DISC EDEMA WITH PYEREXIA UNDER EVALUATION WITH K/C/O HYPERTENSION.
Diagnostic approach
Treatment:
INJ. MANNITOL 100ml IV/ TID
INJ. ZOFER 4MG IV/ BD
INJ. OPTINEURON 1AMP IN 100ML NS IV/ OD
INJ. CIGXANE 60MG SC/OD
INJ. NEOMOL 100ML IV/ SOS
TAB. VERTIN 16 MG PO/ BD
TAB. PCM 650 MG PO/ TID
Strict temperature monitoring 4th hourly
Strict BP monitoring 2nd hourly
(Captured by 2017 batch student final year MBBS):
(Captured by 2016 batch intern post final year mbbs) :
38 year old male who works as a real estate agent came to the opd with chief compliants of giddiness and blurring of vision since 4 days.
Pulmonology, Cardiology :
Problem list:
CKD ON MHD WITH HTN WITH B/L TRANSUDATIVE PLUERAL EFFUSION SECONDARY TO HD
Treatments
Salt and water restriction
Inj.augmentin 625mg od
Tab nicardia10mg tid
Tab.pantop 40mg od
Tab.lasix 40mg bd
Tab.orofer xt od
Tab shelcal.hs od
Tab nodosis 550mg od
Tab zofer 4mg tid
Nebulisation with budecort and salbutomol 8th hrly
Bp/pr/temp/spo2 and I/O charting monitoring
Nephrology :
Patient first came 14 days back with a complaint of pedal edema, pitting type, since 3 years. At first it was intermittent and aggregated on standing and when working and then since the past one month it has become continuous and unbearable
Not associated with pain, pruritus
3 years ago he was diagnosed with hypertension for which he is taking medication and from then he says he has developed pedal edema.
QUESTION-4:-
Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent
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:-http://uakanksha.blogspot.com/2021/10/case-of-chronic-kidney-disease.html
QUESTION-5:-
Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month.
ANSWER-5:-
A week ago was the first time I entered into the hospital.I felt like a new child in the block.I got a case in intensive care unit on the first day.That was my first time entering into some strictly permitted area like intensive care unit.I was a bit exited because I was doing it for the first time and bit nervous as well do be honest.That was the first time I was talking to patient,the care takers and taking the history was a complete new experience.
Admist the pandemic and talking necessary precautions General medicne department staff and my seniors helped a lot how to interact with patients and their care takers what to ask and what not to ask how to approach a patient what to examine and what not to and observe what my fellow seniors are injecting to the patient and what all the procedures are to be followed.I felt it for the first time how it feels to play a doctor.
Overall I had a really great experience in the last month especially last week I learnt a lot more than I expected.
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