GENERAL MEDICINE EXAM-1

           GENERAL MEDICINE EXAM-1

General Medicine E-Log

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

CASE:-

A 45yr old female presented with chief complaints of,

      •shortness of breath grade 3 and not                  associated with orthopnea

       •Vomiting 5-6 episodes,non projectile

       •Fever with chills(low grade)

HISTORY OF PRESENT ILLNESS:

Decrease in appetite since 3 days

Liver disease 3 months back

Vomiting with food particles as content

Abdominal pain

HISTORY OF PAST ILLNESS:-

Known case of 

Diabetes mellitus since 6years

Asthma since 4 years

Pulmonary Koch's 3 years back

TREATMENT HISTORY:

K/c/o Diabetes since 6 years and he took  medicne.

Used ATT drugs for pulmonary Koch's for 6 months.       

Not k/c/o hypertension,CAD.

PERSONAL HISTORY:

Married

Appetite-lost

Diet-nonveg

Bowel-irregular

Micturition-normal

Allergies-no

No relavent history for habits or addiction

#NORMAL ROUTINE of 45 yr old lady was waking up at 4:00a.m do all houseold work then cook and eat break fast(rice and curry).

Then goes out if needed for vegetables or stays in home and eat lunch(rice and curry) at 1-2p.m.Then eats dinner(rice and curry) after her husband comes home by 7-8p.m.

FAMILY HISTORY:

No family history of diabetes,Hypertension, heart disease,stroke,cancer, tuberculosis, asthma.

GENERAL EXAMINATION:-

Vitals:-

Temperature-98.4F

Pulse rate-121/min

Respiration rate-22/min

Bp-not recorded

Spo2 at room air-98%

Pallor-absent

Icterus-absent

Clubbing-absent

Cyanosis-absent

Oedema-absent

Lymphenopathy-absent

SYSTEMIC EXAMINATION:-

CVS:-

S1 and S2 heard

No thrills

No murmurs

Respiratory system:-

• Vesicular breath sounds heard
• Trachea is in central position
• No wheezing 
• Dyspnoea is present

Abdomen:-

• Scaphoid shaped abdomen
• No tenderness
• No palpable mass, no organomegaly
• Bowel sounds are heard-sluggish
• Liver and spleen not palpable 

 CNS:-

• Drowsy and normal speech
• No neck stiffness 

INVESTIGATIONS:-

ECG:-

2D-ECHO REPORT:-

HEMOGRAM:-

URINE ANALYSIS:-

PROVISIONAL DIAGNOSIS:-

Severe Metabolic acidosis with hypovolemic shock ? Secondary to dehydration.

TREATMENT:-

21/10/2021

Rx

IVF-4 ONS- BOLUS

Inj-NOR-ADR 8ml/hr (2 Ampin 47ml NS)

Inj- sodium bicarbonate 100 mEQ/IV STAT

IVF-NS,RL at 100ml/he continuous

Inj-pantop 40mg/IV/OD

Inj- Neomol 100ml if temp more than 101.1F

N/H DHA's

Inj- zofer 4 mg/IV/OD

Inj-Ceftriaxone 1gm/IV/BD

Inj-HAI (30ml NS)

Inj-Sodium bicarbonate one ampuole 100ml NS

Inj-Piptaz 4.5 gm/IV/STAT

22/10/2021

Patient is concious,drowsy and arousable

Vitals:

Bp-120/80mmHg

Temperature-97.8F

Pulse rate-118bpm,regular with normal vol

Respiratory rate-20/min

GRBS-208mg/dl

Spo2-99% at 4lit of oxygen

Rx

Inj-Piptaz 2.25gm/IV/BID

Inj-pantop 40mg/IV

Inj-zofer 40mg/IV/SOS

Inj-Neomol 100gm/ml

Inj-HAI 40 units in 49ml of NS at 6ml/hr

Tab-Dolo 650mg/PO/SOS

Inj-Dinametazone 8mg/IV/BD

Inj-thiamine 200mg/IV/TID

CASE OF CHRONIC KIDNEY DISEASE

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

CASE:-

A 40yr old male came with chief complaints of 

•Pedal edema

•Decrease in urine output

•Facial puffiness

HISTORY OF PRESENTING ILLNESS:-

•Fever with increase in temperature and slight chills especially at night.

•Lower back pain

•I could observe slight hump at back of neck with pain.

•Cough with phlegm

HISTORY OF PAST ILLNESS:-

Not a known case of diabetes mellitus, hypertension,asthama.

TREATMENT HISTORY:-

No relavent history

PERSONAL HISTORY:-

 He is married and a farmer by proffesion.

Diet-nonveg

Bowel movements-regular

Micturition-decreased in output.no burning sensation

He is a non alcoholic and doesn't smoke.

#Normal daily routine of 40yr old male is he wakes up at 5:00a.m and finish his daily activities and have idly at 6:30a.m and eats his breakfast at 10:00a.m(rice and curry) goes out does farming in feilds and then comes back home at 6:00p.m and take his dinner(rice and curry).He occasionally goes to market for vegitables and things and chit chat with freinds and neighbors.He sleeps by 8-9:00pm.

FAMILY HISTORY:-

No relavent family history.

GENERAL EXAMINATION:-

Patient was consious, coherent and cooperative.

VITALS:-

Temperature-98.4F

Pulse rate-84/mm

Respiratory rate-24/mm

Blood pressure-130/70mmHg

Spo2-98% at room air

GRBS-136mg/do

Pallor-present

Ictrus-present

Clubbing-absent

Cyanosis-absent

Oedema-pesent in feet(pitting type)

Lymphadenopathy-absent

SYSTEMIC EXAMINATION:-

ABDOMEN:-

Scaphoid shaped abdomen

No tenderness

No palpable mass

No organomegaly

Bowel movements are heard-sluggish

Liver and spleen not palpable.

CVS:-

S1 and S2 heard

No thrills

No murmurs

RESPIRATORY SYSTEM:-

Dyspnoea absent

Wheeze absent

Position if trachea is center

Breath sounds central

INVESTIGATIONS:-

COMPLETE BLOOD PICTURE:-

Hepatitis B

Hepatitis C

Serum electrolytes:-

Serum creatinine:-

Blood urea:-

Haemogram:-

ULTRA SOUND OF ABDOMEN:-

PROVISIONAL DIAGNOSIS:

Chronic kidney disease on haemodialysis.

GENERAL MEDICINE MONTHLY ASSIGNMENT

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 case reports in the links 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.

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.

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):

https://vamsikrishnarollno16.blogspot.com/2021/10/a-case-of-64yrs-old-male-patient-with.html?m=1

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):

 https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

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) :

https://elogformedicalcase.blogspot.com/2021/10/homozygousthalassemia-e-female-with.html?m=1

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) :

https://muskaanmenghwani.blogspot.com/2021/10/blurring-of-vision-mystery-to-slove.html?m=1

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):

https://87tharunkumar.blogspot.com/2021/10/38-yr-old-male-presented-with-lower.html

(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 :

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

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 :

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

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.

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.

GENERAL MEDICINE-2

GENERAL MEDICINE MONTHLY ASSIGNMENT

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 one student's entire answer paper from this link, the one who is closest to your own roll number :

http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

and share your peer review of each answer with your qualitative insights into what was good or bad about the answer. 

ANSWER-1

https://vagisharani.blogspot.com/

I have gone through one of my friends blog which is close to my roll number.

*My review on the blog is;

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.

Patient centered data around the theme of renal failure patients with AKI, CKD and acute on CKD, 

captured by students from 2016 and 2019 batch in the links below:

Patients with low back ache and renal failure :

AKI :

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

Acute on CKD :

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

CKD :

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

Patient with coma and renal failure  :

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

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

Patients with acute on CKD :

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

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

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

Patients with AKI :

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

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

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

QUESTION-2:-

Share the link to your own case report 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-2

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

QUESTION-3

Please go through the cases in the links 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.

ANSWER-3

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.

CASE-2:

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-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 histolgy information regarding the case made it easy 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.

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.                Can add some more details about terapautic investigations.

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 links were attached from where the info was collected.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 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-4

Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also 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-4

CASE-1:

Problem list:

•lower back ache 

•burning micturition

•Fever with chills

•trauma to head

•mild hepatomegaly with grade 1 fatty liver

•high serum creatinine

•high blood urea

•pus cells in urine

Solution:

1)IVF : -RL  @ UO+ 30ml/hr

            -NS

2)SALT RESTRICTION  < 2.4gm/day

3)INJ    TAZAR    4.5gm  IV/TID

                             2.25gm IV/ TID

4)INJ     PANTOP 40mg  IV/OD

5)INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID

6)INJ     HAI  S/C  ACC  TO   SLIDING SCALE

              8AM  -  2PM  -  8PM

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

8) GRBS  - 6th Hourly

9) BP/PR/TEMP - 4th Hourly

10) I/O - CHARTING

ON 10/7/21 :

1)IVF : -RL  @ UO+ 30ml/hr

            -NS

2)SALT RESTRICTION  < 2.4gm/day

3)INJ    TAZAR     2.25gm IV/ TID

4)INJ     PANTOP 40mg  IV/OD

5)INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID

6)TAB.   PCM   500mg    PO/ SOS

7)INJ     HAI  S/C  ACC  TO   SLIDING SCALE

              8AM  -  2PM  -  8PM

8)INFORM  GRBS 

9)GRBS  - 6th Hourly

10) BP/PR/TEMP - 4th Hourly

11) I/O - CHARTING (STRICT)

12)T. ULTRACET  PO 1/2 TAB  QID

-Foley's removed,

13)INPUT   UPTO   2 Liters only

CASE-2:

•lower back ache

•Dribble of urine

•Pedal edema

•High blood urea

•High serum creatinine

•Anemia

•Spondylodiscitis

•Tremours

Solution:

13/7/21

• 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 

14/7/21

• IVF -NS  0.9% & DNS  -continous infusion @100ml/hr
• Inj.Piptaz 2.25gm I.V -TID
• Inj.Lasix 40mg I.V -BD
• Inj.Pantop 40mg I.V -OD
• Nebulization budecort -8th hourly 
• T.PCM 650mg -TID
• INJ. Neomol 1mg -I.V -SOS 
• Temperature charting 4th hourly 
• Monitor Bp,PR 
• Left U/l elevation 
• strict I/O charting 
• Nebulization Salbutamol 2 repluses -6th hourly 
• INJ. MAI 10u in 25% D over 45min I.V 

15/7/21
• IVF -NS 0.9% &DNS U.O + 30ml/hr
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Lasix 40mg I.V -BD
• Inj.Pantop 40mg I.V -OD
• Nebulization Salbutamol 2 repluses -6th hourly 
• T.PCM 650mg TID-after checking Temp.
• Temperature charting 4th hourly 
• Monitor Bp,PR 
• strict I/O charting 
• Syp. Mucaine gel 10ml -BD 


16/7/21
• IVF -NS 0.9% &DNS U.O + 30ml/hr
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Lasix 40mg I.V -BD
• Oral fluids upto 2-3liters/day 
• Monitor Bp,PR ,Temperature 
• strict I/O charting 
• Limb elevation- Crepe bandage 
• Syp.mucaine gel 15ml -TID 


17/7/21
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Pantop 40mg I.V -OD
• Syp.mucaine gel 15ml -TID 
• Limb elevation- Crepe bandage 
• Monitor Bp,PR ,Temperature ,spo2%
• Tab.Febuxostat 40mg -OD
• Inj.Optinueron 1 ampule in 100ml NS /I.V/ OD 

18/7/21
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Pantop 40mg I.V -OD
• Inj.Optinueron 1 ampule in 100ml NS /I.V/ OD 
• Syp.mucaine gel 15ml -TID 
• Limb elevation- Crepe bandage 
• Monitor Bp,PR ,Temperature ,spo2%
• Tab.Febuxostat 40mg -OD
• Oral fluids upto 2-3L/day 

19/7/21
• Inj. PIPTAZ 2.25gm -I.V -TID
• Inj.Pantop 40mg I.V -OD
• Inj.Optinueron 1 ampule in 100ml NS /I.V/ OD 
• Syp.mucaine gel 15ml -TID 
• Limb elevation- Crepe bandage 
• Monitor Bp,PR ,Temperature ,spo2%
• Tab.Febuxostat 40mg -OD
• Oral fluids upto 2-3L/day

 

20/7/21

• Tab.Pantop 40mg  -OD
• Tab.Febuxostat 80mg -OD
• Tab.Neurobion forte -OD 
• Syp.mucaine gel 15ml -TID 
• Limb elevation- Crepe bandage 
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day 

21/7/21
• Tab.Pantop 40mg  -OD
• Tab.Febuxostat 80mg -OD
• Tab.Neurobion forte -OD 
• Syp.mucaine gel 15ml -TID 
• Limb elevation- Crepe bandage 
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day
• Inj.Ciprofloxacin 500mg-OD 

22/7/21
• Inj. Ciprofloxacin 500mg-OD
• Tab.Febuxostat 40mg -OD
• Tab.Neurobion forte -OD 
• Tab.pantop 40mg-OD
• Syp.mucaine gel 15ml -TID 
• Limb elevation- Crepe bandage 
• Monitor Bp,PR ,Temperature ,spo2
• Oral fluids upto 2-3L/day

•Tab.Ultracet 1/2 tab.-QID

CASE-3:-

Problem list:

•Haemorrhoids

•Muscle aches

•Fever

•Generalized weekness

•Vomiting

•Pedal oedema

•Dimorphic anaemia

•High serum creatinine

•High blood urea

•Multiple myeloma

Solution:-

 on 9/07/2021

- 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

10/07/2021

- oral fluids upto 1.5 - 2 lit / day 

- T. PAN 40mg /PO / OD 

-  T. ZOFER 4mg / PO /SOS 

- TAB NODOSIS  550 mg / PO/BD 

- Protein - x ( plant based ) 2 tablespoon   in 1 glass of  milk 

- I/O charting

- BP / PR / Temp  - 4th Hrly 

- Neb c Duoun 2 respules 8th hrly

★11/7/2021 

- oral fluids upto 1.5 - 2 lit / day 

- Tab PAN-D  PO/OD ( 8AM)

- T. ZOFER 4mg / PO /SOS 

- TAB NODOSIS  550 mg / PO/BD 

- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk 

- Inj ERYTHROPOIETIN 4000IVS/C weekly twice 

- BP / PR / Temp  - 4th Hrly  

- T. OROFER - XT PO/BD 

- Inj OPTINEORON 1 AMO IN 500ml NS IV/OD 

- IVF -NS  UO +30ml/hr 

          - RL 

- I/O - CHARTING 

★12/7/21

-inj.optineuron 1 amp in 500ml NS IV/OD

-ivf. NS RL @ uo + 30 ml/hr

-inj. erytropoitin 4000 iv s/c weekly twice

-tab.pan-d po/od (8 am)

-tab.orofer-xt PO/BD

-tab.nodosis 500mg PO/BD

-protein- x powder 2 tsp in 1 glass of milk PO/TID

-tab. zofer 4mg PO/sos

-BP/PR/Temp - 4th hrly

- I/o - charting 

★13/7/2021

- Inj.optineuron 1 amp in 500ml NS SLOW/ IV/OD

-tab. pantop 40 mg RO/OD

-tab.nodosis 500mg PO/BD

-Protein- x powder 2 tsp in 1 glass of milk PO/TID

-I/o charting 

- T.OROFER  XT/OD

14/07/2021

- Inj.optineuron 1 amp in 500ml NS SLOW/ IV/OD

-tab. pantop 40 mg RO/OD

-tab.nodosis 500mg PO/BD

-Protein- x powder 2 tsp in 1 glass of milk PO/TID

-I/o charting 

- T.OROFER  XT/OD

CASE-4:-

•Problem list:

•Fever

•Diarrhea

•Back pain

•Diabetes mellitus type 2

•Vomiting

•Loose stools

•Metabolic acidosis

•Bed sores

•Left kidney increase in size

•Acute polynephritis

Solution:-

Ventilator

Dialysis

Physiotherapy

Treatment for sores

Day 1

Inj. NORAD 2amp in 50ml NS

Inj. PIPTAZ 2.25gm.

Inj. DOPAMINE 2amp in 50ml

Inj. HAI 1ml in 39ml NS

 

Day 2 

Inj.HAI 1ml in 39mlNS

Inj. PIPTAZ 2.25gm.

Inj. CLEXANE 40gm. 

Iv infusion NS RL @100ml/hr.

Day 3 

Inj.HAI 1ml + 34ml NS

Inj. PIPTAZ 2.25gm

Iv infusion NS (urine output + 40ml/hr)

Inj. NORADRENALINE(2 amp+46ml NS) 

  

Day 4,5 same as day 3

Day 6

Inj. PIPTAZ

Inj. LEVOFLOX

Inj. VANCOMYCIN

Day 7 and 8 same as day 6.

Day 9

Inj. MEROPENEM

Inj. LEVOFLOX

Inj.VANCOMYCIN

Day 10 and 11 same as day 9

Day 12

Inj. MEROPENEM

Inj. FOSFOMYCIN

Inj. CLEXANE

Day 13 and day 14 same treatment as of day 12 additionally Inj. LASIX was given. 

CASE-5:-

Problem list:-

•Diabetes mellitus type 2

•Hepatic encephalopathy grade2

•Abdominal distension

•Pedal edema grade 2

•Pus cells in urine

•Anemia

•Abnormal increase in urea in urine

•Increase in levels of alakaline phosphate

•Multiple acute infarcts in bilateral cerbral and Cerebellar hemispheres

Solution:-

Day 1:

1. Inj. Monocef 1gm IV/BD

2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr

3. Procto clysis enema

4. Inj. Pan 40 mg Iv/OD

5. Inj. Thiamine 200mg in 100ml NS /BD

6. Inj. HAI 6U S/C TID

Day 2&3:

Same treatment followed

Day 4:

Same treatment followed except Inj. Monocef.

Inj. Augmentin 1.2 gm IV/TID

Tab. Ecospirn 150mg PO/HS/SOS

Tab. Clopidogrel 75mg PO/HS/SOS

Tab. Atorvas 20mg PO/HS/OD added

Advice at Discharge:

1. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr

2. Inj. Pan 40 mg Iv/OD

3. Inj. Thiamine 200mg in 100ml NS /BD

4. Inj. HAI 6U S/C TID

5. Inj. Augmentin 1.2 gm IV/TID

6. Tab. Ecospirn 150mg PO/HS/SOS

7. Tab. Clopidogrel 75mg PO/HS/SOS

8. Tab. Atorvas 20mg PO/HS/OD added

CASE-6:-

Problem list:-

•Fever 

•Pus in Urine

•Prostomegaly

•Hypnoatremia

•High creatinine levels

•High grade fever with chills and rigor

•Anemia

•Bilateral hydroureteronephrosis more on right 

•Urinary bladder with diffuse circumferential wall thickness

•Phlebolith

Solution:-

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-7:-

Problem list:-

•Shortness of breath

•Deranged RFT

•Chronic renal failure

•Orthopnea

•Diabetes mellitus type 2

•Hypertension

•Edema

•Hemoglobin level less

Solution:-

1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml

CASE-8:-

Problem list:-

•Pedal edema

•Loose stools

•Vomitings

•Pneumonitis with time 1

•Grade 1 fatty liver

•Increased serum creatinine

•Increased blood urea

•Right heart failure

Solution:-

1. IV fluids

2. Tab. Pan 40 mg po OD 

3. Inj. Lasix 80 mg IV BD

4. Thiamin 200 mg in 100 ml NS IV BD

5.Tab. Levocet 5 mg Po BD

6.Liquid paraffin for LIA

7.Grbs 6 th hrly

8.I/o charting, temp.charting

CASE-9:-

Problem list:-

•Loose stools

•Abdominal distension

•Pedal edema

•Alcoholic hepatitis

Solution:-

• 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
• ABDOMINAL GIRTH MEASUREMENT DAILY
• BP /PR/TEMP/ RR -4 hourly 
• I/O CHARTHING

On 06/07/2021  : 

1)PLENTY OF ORAL FLUIDS 

2)INJ.METROGYL 400mg /IV/TID 

3)INJ .CIPROFLOX 500mg /IV//OD 

4)INJ.PANTOP 40mg iv/OD

5)INJ.THIAMINE 1amp in 100ml NS IV/TID 

6)INJ.OPTINEURON 1ampin 100ml NS IV/od

7)TAB .SPORLAC DS PO/TID 

8)ORS SACHET 1 in 1L OF WATER 

9)TAB LOPERAMIDE.  2mg /po / SOS

10)BP/PR/TEMP/ RR 4 th hrly 

11)I/O CHARTING.  

On 07/07/2021 :

1. PLENTY OF ORAL FLUIDS 
2. INJ.METROGYL 400mg /IV/TID 
3. INJ .CIPROFLOX 500mg /IV//OD 
4. INJ.PANTOP 40mg iv/OD 
5. INJ.THIAMINE 1amp in 100ml NS IV/TID 
6. INJ.OPTINEURON 1ampin 100ml NS IV/od
7. TAB .SPORLAC DS PO/TID 
8. ORS SACHET 1 in 1L OF WATER 
9. TAB LOPERAMIDE.  2mg /po / Sos
10. BP/PR/TEMP/ RR 4 th hrly 
11. I/O CHARTING.  

On 08/07/2021 

1)PLENTY OF ORAL FLUIDS 

2)INJ.METROGYL 400mg /IV/TID 

3)INJ .CIPROFLOX 500mg /IV//OD 

4)INJ.PANTOP 40mg iv/OD

5)INJ.THIAMINE 1amp in 100ml NS IV/TID 

6)INJ.OPTINEURON 1ampin 100ml NS IV/od

7)TAB .SPORLAC DS PO/TID 

8)ORS SACHET 1 in 1L OF WATER 

9)TAB LOPERAMIDE.  2mg /po / SOS

10)BP/PR/TEMP/ RR 4 th hrly 

11)I/O CHARTING.  

  *12)TAB ECOSPIRIN 75mg/po/od 

 On 09/07/2021 :

1)PLENTY OF ORAL FLUIDS 

2)INJ.METROGYL 400mg /IV/TID 

3)INJ .CIPROFLOX 500mg /IV//OD 

4)INJ.PANTOP 40mg iv/OD

5)INJ.THIAMINE 1amp in 100ml NS IV/TID 

6)INJ.OPTINEURON 1ampin 100ml NS IV/od

*7)TAB LORAZEPAM 2mg OD 

8)ORS SACHET 1 in 1L OF WATER 

*9)TAB ECOSPORIN 75 mg OD 

10)BP/PR/TEMP/ RR 4 th hrly 

11)I/O CHARTING. 

On 10/07/2021 :

1)PLENTY OF ORAL FLUIDS 

2)TAB PANTOP 40mg iv/OD

3)INJ.THIAMINE 1amp in 100ml NS IV/TID 

4)INJ.OPTINEURON 1ampin 100ml NS IV/od

5)TAB ECOSPORIN 75 mg OD 

6)TAB LORAZEPAM 2mg OD

7)BP/PR/TEMP/ RR 4 th hrly 

8)I/O CHARTING 

On 11/07/2021 :

1)PLENTY OF ORAL FLUIDS 

2)TAB PANTOP 40mg iv/OD

3)INJ.THIAMINE 1amp in 100ml NS IV/TID 

*4)TAB NEUROBION FORTE OD 

5)TAB ECOSPORIN 75 mg OD 

6)TAB LORAZEPAM 2mg OD 

6)BP/PR/TEMP/ RR 4 th hrly 

7)I/O CHARTING. 

On 12/07/2021 

1)FLUID RESTRICTION <1.5L/ day 

SALT RESTRICTION <2gm/day

2)Tab PAN 40mg iv/OD

*3)TAB. BENFOMETPLUS OD 

*4)TAB NEUROBION FORTE OD 

5)TAB ECOSPORIN 75 mg OD 

*6)TAB LIVOGEN OD 

*7)INJ. VITCOFOL 500mg IM/OD 

*8)TAB. LASIX 20mg OD 

*9)TAB. RIFAXIMINE 550mg BD 

6)BP/PR/TEMP/ RR 4 th hrly 

7)I/O CHARTING. 

CASE-10:-

Problem list:-

•Pedal edema pitting type

•Fever

•Diabetes mellitus

•Acute kidney injury secondary to urosepsis

•Shortness of breath

•Increased serum creatinine

•Increased blood urea

•Hemoglobin lower than normal

Solution:-

15/06/21:

• Inj LASIX 40mg (8am- 2pm -8pm)
• IVF - NS @ UO + 50 ml/hr

16/6/21

•  Inj LASIX 40 mg IV/TID          1 -1 - 1
•  IVF - NS @ UO + 50 ml/hr
•  Inj MAGNEXFORTE 1.5 gm/IV/BD
•  Tab NODOSIS - XT PO/OD
•  Inj HAI s/c
•  Neb plain Asthalin 4 respules    [ 1 - 1 - 1 - 1 ]

17/6/21

•  Inj LASIX 40 mg IV/TID    1 -1 - 1
•  IVF - NS @ UO + 50 ml/hr
•  Inj MAGNEXFORTE 1.5 gm/IV/BD
•  Tab NODOSIS - XT  PO/OD
•  Tab OROFEA - XT  PO/OD
•  Inj HAI s/c
•  Neb plain Asthalin 2 respules
•  Strict I/O charting

18/6/21

•  Inj LASIX 40 mg IV/TID   1 -1 - 1
•  IVF - NS @ UO + 50 ml/hr
•  Inj MAGNEXFORTE 1.5 gm/IV/BD
•  Tab NODOSIS - XT  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 ]

19/6/21

•  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 ]

20/6/21

•  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 ]
•  BP/PR/SO2/Temperature monitoring
•  GRBS charting

21/6/21

•  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 TID  [ 10U - 8U - 8U ]
•  Neb plain Asthalin 2 respules QID
•  Tab Norflox 200 mg PO/BD
•  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
•  BP/PR/SO2/Temperature monitoring
•  GRBS charting
•  Strict I/O charting

22/6/21

•  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
•  IVF - NS @ UO + 50 ml/hr
•  Tab Norflox 200 mg PO/BD
•  Ing OPTINEURON 1amp in 100 ml  NS IV/OD
•  Tab OROFEA - XT PO/OD
•  Tab SHELCAL-CT PO/OD
•  Inj HAI s/c TID [ 10U - 8U - 8U ]
•  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
•  BP/PR/SO2/Temperature monitoring
•  GRBS charting
•  Strict I/O charting

23/6/21

•  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
•  Tab Norflox 200 mg PO/BD
•  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
•  Tab OROFEA - XT PO/OD
•  Tab SHELCAL-CT PO/OD
•  Inj HAI s/c TID [ 10U - 8U - 8U ]
•  BP/PR/SO2/Temperature monitoring
•  GRBS charting
•  Strict I/O charting

CASE-11:-

Problem list:-

•pain in abdomen in epigastric redion 

•Vomiting 

•Increased serum creatinine levels

•Pedal edema pitting type

•Distended abdomen

•Tremors

•Acute pancreatitis

Solution:-

Dialysis is done to correct serum creatinine levels and urea levels

 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.

D A Y  W I S E  U P D A T E S: 

Day 1and 2 =Urine output 1500ml, 

       Fluid intake 3000ml

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.