General medicine department - June 2021 bimonthly blended assessment .

 QUESTION 1

Please go through one particular answer of ten students in this link-

https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1

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

ANSWER 1 

Q.What is the reason for giving Thiamine in this patient?(NEUROLOGY CASE)

Link 1- https://aitharaveena.blogspot.com/2021/05/online-blended-medicine-assignment-may.html

Quantitative - 7/10

Qualitative- Mechanism of action of each drug has been written in a concise and articulate form .Efficacy over placebo and non pharmacological interventions have not been mentioned . A flowchart would be helpful.

Link 2- https://aniganikavya06.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html

Quantitative - 8/10

Qualitative -Mechanism of action has been written in a concise and lucid form . Flowcharts have been provided that help in understanding the mechanism .Non pharmacological interventions have not been mentioned  .

Link 3- https://rishikoundinya.blogspot.com/2021/05/general-medicine-assignment-online.html

Quantitative - 8/10

Qualitative - Mechanism of action of the drugs has been given in a clear and concise form . Non pharmacological interventions have also been mentioned .Flow charts would be helpful to understand .

Link 4- https://08arshewarpavankumar.blogspot.com/2021/05/a-40-year-old-male-with-complaints-of.html

Quantitative-7/10

Qualitative - Mechanism of action has been given in a concise form . Non pharmacological interventions and efficacy over placebo have not been included.

Link 5- https://avulanikhil09.blogspot.com/2021/05/pulmonology_45.html

Quantitative- 8/10

Qualitative - Mechanism of action has been given in a concise form. Non pharmacological interventions and efficacy over placebo have not been included. Flow chart has been included which is helpful.

Link 6- https://02shishirareddy.blogspot.com/2021/05/assignment-45-year-old-female-patient.html

Quantitative- 9/10

Qualitative- Mechanism of action has been given in detailed and concise form. Pharmacological dosage of the drugs used and indication for the drug have been mentioned.

Link 7- https://amishajaiswal03eloggm.blogspot.com/2021/05/medicine-blended-assignment.html

Quantitative - 9/10

Qualitative- Mechanism of action has been presented in a clear and lucid form . Flowchart and non pharmacological interventions have been provided.

Link 8- https://amitsharma1996.blogspot.com/2021/05/medicine-assignment-may-2021.html

Quantitative - 7/10

Qualitative - Only a few of the drugs used have been mentioned . Indication has been included .

Link 9- https://caseopinionsbyrollno05.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html

Quantitative - 9/10

Qualitative - Mechanism of action has been given in a clear form . Information about the drug and numerous interventions have been provided. Non pharmacological interventions have also been included .Indication has not been included.

Link 10- https://preethicheera.blogspot.com/2021/05/general-medicine-case-presentation-may.html?m=1

Quantitative - 9/10 

Qualitative - Mechanism of action has been explained clearly . Indication for drug use and dosage have been included.

QUESTION 2

Share the link to your own case report of a patient that you connected with while capturing his or her sequential life events before and after illness and share the clinical images with the discussion of your case.

Answer- https://113riyagupta.blogspot.com

QUESTION 3

Q3) (Testing peer review competency of the examinees) :

Please go through the cases in the links shared below 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.

MULTISYSTEM:


CNS :


Renal :


Captured by one student from 2017 batch in the link below :

CVS :


Captured by one student from 2019 batch in the link below :

Abdominal : 


ANSWER-
MULTISYSTEM- The case has been presented very clearly . The history taking and examination has been done precisely , providing all required information for the reader to understand the case . All the associated clinical pictures have also been provided.The data provided is correct and complete.

CNS-The case has been written precisely and in separate paragraphs , that make it easy to understand . All the required information pertaining to the case has been included.It is well organised and updated.The data provided is correct.

RENAL-The data provided is correct . But lack the discharge summary.
 
CVS- The case has been presented very clearly and to the point . All the data pertaining to the case has been provided . History taking and all the other investigations carried out have been done and presented meticulously .

ABDOMINAL -The data provided is correct . The discharge summary has not been provided and the case has not been updated after 23 June 2021.

QUESTION 4

Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):

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-

MULTISYSTEM CASE

Problem list-

Chief complaint- Lower back pain . fever , yellowish discolouration of the eyes, 2 episodes of vomiting , three episodes of loose stool and blood in urine .

Investigations-

Icterus present

Creatinine in urine - 0.6mg/dl (normal -0.9-1.3mg/dl)

Sodium in plasma - 132mEq/L (normal -136-145mEq/L)

pCo2- 17.4 mmHg (normal-35-45mmHg)

pO2- 119 mmHg (normal-85-95 mmHg)

pH- 7.26 (normal - 7.35-7.45)

Hemogram -MCV-73.2fl (normal -83-101fl)

MCH-25.7pg(normal-27-32pg)

MCHC-35.1%(normal - 31.5-34.5%)

RBC count- 6.39millions/cumm (normal- 4.5-5.5 million / cumm)

Prothrombin time - 24 seconds

Ketone bodies present in urine 

HbA1c- 6.6%

Urine- acidic , excess albumin content, and sugar.

C reactive proteins- elevated 

COVID 19 antibodies - present 

Total and direct bilirubin are elevated .

Liver enzymes are elevated .

Total serum proteins are low.

DIAGNOSIS-Acute fulminant hepatic failure secondary to post infection with hepatic encephalopathy .


CNS CASE

Chief complaint- Sudden fall followed by weakness of both the lower limbs, loss of hand grip 10 days ago, bowel and bowel incontinence.

Examination-

Known case of tuberculosis infection

Tone of the lower limbs -bilaterally increased 

Reflexes -reduced bilaterally in supinator muscles of the lower limb 

Investigations-

serum sodium -134 mEq/L

serum chloride- 96 mEq/L

Lymphocytes - 14% (normal- 20-40 percent) 

MRI of the brain with cervical spine -

There is significant erosion of the inferior endplate of C5 and superior endplate of C6 along with intervening disc. 

An epidural abscess is seen at the level of C5-C6 that is causing the spinal cord compression and posterior displacement of the cord. 

Cord oedema is present  

Prevertebral collection extending from C2 to D3 - suggestive of anterior sub ligamentous spread.

DIAGNOSIS-Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1with epidural abscess at C5- C6.


RENAL CASE

Chief complaint- Altered sensorium, morning lethargy, fever 10 days ago, Pedal oedema with anasarca and shortness of breath even at rest. 

Investigations-

History of hypertension .

Known case of chronic kidney disease .

ECG -  Sinus Rhythm 

Nonspecific T wave abnormality 

Borderline echo 

Hb - 12 g/dl (normal - 13- 17 g/dl)

Lymphocytes- 11% which is much less than the normal range 

Urine examination- Albumin seen 

Ultrasound report  - 

CMD partially lost in the right kidney

 Grade II fatty liver

Simple renal cyst

Grade II -III Renal parenchymal disorder

DIAGNOSIS-Hypertensive nephropathy with uremic encephalopathy.


CVS CASE

Chief complaint-Distension of abdomen and shortness of breath since 5days

Investigations-

Hypothyroidism 

Bradycardia

Hb - 10.3 gm/dl (normal-

PCV-32.1vol% (normal- 36- 46 vol%)

MCV-80fl (83-101fl)

MCH - 25.8 pg(27-32pg)

 HbA1c- 6.7 percent 

ECG abnormal -

2d- ECHO - Pleural effusion , Mild Pericardial effusion

DIAGNOSIS- HFrEF with atrial fibrillation secondary to IHD.


ABDOMINAL CASE

Chief complaint- pedal edema since 10 days, decreased urine output and burning micturition since 10 days and fever since 10 days.

Investigations- 

Known case of DM type 2, acute kidney injury secondary to urosepsis 

High Blood Pressure - 170-110 mmHg

Pulse rate - 111 beats per minute - Tachycardia

on complete urine examination - albumin levels were present 

Ultrasound Examination - Right kidney had grade I Renal parenchymal disease , Left kidney had Grade II Renal parenchymal Disease 

Raised serum creatinine - 3.4 mg/dl

Raised Blood Urea- 65 mg/dl

Serum electrolytes - Potassium level raised - 5.3 mEq  /L

DIAGNOSIS-Acute kidney injury secondary to urosepsis with hyperkalemia.


QUESTION 5

Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month :  

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

ANSWER-

Reflective logging enable the student to stay up to date and keep a track of their progress . They enable one to apply their theoretical knowledge into practical application.In the times of COVID when we are unable to physically attend clinical posting and acquiring practical knowledge ,elogs enable us to keeping a track of the patient assigned and practice important skills like history taking .

Reflective logging give us an opportunity to know the patient and study the case, inspite of us not being in the hospital.


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