GENERAL MEDICINE ASSIGNMENT -2021


Hi, I'm Tejaswi enduri, a medical student (3rd sem).

E-log is a platform for patient-centered care in learning medicine. Hope this will be informative! 


we have been given 5 questions to assess the ability to connect with and capture patient-centered data and the ability to connect with and engage in shared learning with their peers through peer review feedback.


Q1) QUESTION 1  

 This is a peer  review of the previous assignment by JAGADEESH ( 37 )

https://gouthajagadeesh37.blogspot.com/

Q)1

He did a very impressive work did a thorough review of all the 10 cases that he selected. He not only gave an insight but have a brief review on the whole case as well. He managed to take different cases and also added pictures and needed info under each case link.

Q)2

He did not come up with any case yet. 

Q)3 and 4

He took a case of heart failure due to left ventricular dysfunction.

A 70-year-old patient presented with a distended abdomen and shortness of breath.

 https://60shirisha.blogspot.com/

Reviewed by - https://gouthajagadeesh37.blogspot.com/2021/07/nameg.html

He gave a brief overview of the condition and investigations done and treatment that was given. He also supported his statements with the reports of investigations.

Also, he suggested and kept his forward stating if thyronorm was used think she would have not passed away.

 https://gouthajagadeesh37.blogspot.com/2021/07/nameg.html

Q) 5

He gave a genuine review and his honest feeling.

Q) Question 2 

It is a case of transverse myelitis. patient presented with pain in epigastrium and pain on passive movement sideways, not able to move the legs and absence of sensations below the umbilicus .http://tejaswienduri.Blogspot.com/2021/07/36-tejaswi-enduri.Html



Upon investigating the MRI inflammation is seen in the spinal cords and classical features of transverse myelitis were presented.

Q)3 


1) AKI


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

A patient with acute kidney injury 

The patient presented due to abdominal pain and lower back after an injury while weightlifting D

Diagnosed as AKI secondary to UTI

insights

The blog is not soo clear. The conclusion of how they got to a conclusion AKI with UTI could be explained more clearly. How was the lower back pain ruled out is also not explained. 

2) Acute on CKD 

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

The patient presented with lower back pain and dribbling of urine for 10 days .he also had bilateral pedal edema and shortness of breath.

He was diagnosed with acute renal failure associated with multifocal spondylitis. 

insights

The blog is very impressive all the symptoms like the cause of seizures and delirium are explained and day-wise treatment update.

3)

CKD 

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

49 yr old female with generalized weakness and vomiting .she was operated on previously for hemorrhoids and was on NSAIDs 

She was diagnosed with chronic interstitial nephritis secondary to plasma cell dyscrasias ( multiple myeloma - 70 % plasmacytosis ).

insights

The case was comprehensive and concise and we'll be excreted. All the necessary information was provided and even the investigation with reports and histology slides of the plasma cells was also uploaded.

 4)acute renal failure with lower back pain 

casereports.bmj.com/content/2009/bcr.03.2009.1726

A  47 yr old man presented with uremic symptoms and oliguria, lower back pain, and altered sensorium .renal biopsy showed moderate tubulointerstitial nephritis with mild global glomerular sclerosis.

Altered sensorium was because of uremic encephalopathy .lower back pain due to osteolytic lesions due to plasma cell dyscrasias.

The bone marrow findings are suggestive of Waldenstrom’s macroglobulinemia (WM).

insights

The blog is exceptionally done explaining each symptom and gradually diagnosis and treatment. The case scenario and complaints were explained in detail with duration.

5) patient with coma and renal failure 


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

A 35 yr old female presented with chest pain abdominal pain, diarrheal with bloody discharge, shortness of breath, she was a known case of diabetes.

She also had bedsores and usg showed pyelonephritis 

The patient was comatose and put on a mechanical ventilator but she gradually miraculously recovers.

Diagnosed as AKI secondary to diabetic ketoacidosis.

insights

The case is very well done, history and complaints were chronologically taken .it is very detailed and day-wise investigations treatment and even images are uploaded of every investigation done.

6) patient with coma and renal failure 

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

52 yr old presented with chief complaints of abdominal distension, constipation, pedal edema, hiccups since morning  .he is a known case of diabetes. he was an alcoholic

The patient is diagnosed and infective endocarditis wait AKI assisted with alcoholic liver disease with multiple infarcts in the bilateral cerebral and cerebellar regions.

Might be septic or uremic or diabetic encephalopathy.

insights

The case is well explained with pictorial depictions, and the vedioes of 2 d echoes were also provided. A detailed treatment plan is given.

7) patinets on acute in CKD

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

52 yr old man presented with fever and pus in the urine. He is a known case of diabetes mellitus type 2.

He had suffered from Burning micturition which was due to prostomegaly and was corrected by a surgery TURP.

But complications developed do it and the patient reported generalized weakness and decreased appetite, drowsiness, SOB respectively on his consecutive visits.

The diagnosis was renal AKI secondary to urosepsis secondary to b/l hydroureterosepsis.

Diabetic nephropathy was secondary to CKD.

insights

The log was exceptionally done .it is clear and precise. Comparisons between before and after treatment were done and the diagnosis was made clear.

8) 

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

48 yr old man with SOB .he is a known case of HT and DM.2 yrs back diagnosed with chronic renal failure .he also had issues of orthopnea and bend opener in the past.

Pedal edema present.

Diagnosis-HFrEF secondary to CAD, CRF 

insights

The case is comprehensive and well presented .consise research was done and even links of very such cases were presented.

9) 

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


60 yr old female with anasarca and SOB.complaints of pedal edema and decreased urinary output .she has 10-15 episodes of an SOB in a yr.

She is having cor pulmonale. Might have suffered uremic nephropathy.

insights

The case was not so clear as there were many assumptions in the condition and the patient was symptomatically treated.

10) 

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

Alcoholic hepatitis and AKI secondary to gastroenteritis 


A 43 yr old man presented with chief complaints of loose stools, edema, and abdominal distension 

insights

The case is done precisely with chronological history and day-wise observations and treatment. the case is clear and pictorially assisted well. 

11) 

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

Acute kidney injury secondary to urosepsis

A 60 yr old female with decreased urinary output, pedal edema, burning micturition, and fever. Happened before as well treated with dialysis.

insights

The case is very clearly presented. It is well explained and understandable. all the necessary information is given, like the investigation, reports, symptoms, pics, treatment.

12) 

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

Pancreatitis in a chronic alcoholic with  AKI 

A 31 yr male was presented with pain in the abdomen, SOB, and vomiting. hard liquor, and tahini addict. diagnosis as acute pancreatitis with AKI and b/l pleural effusion.

insights

The log was clear and precise. the case summary has been provided which helps in easier understanding.


Q)4 

1)

Diagnosis

Acute kidney injury( AKI)  2° to UTI,

Treatment

1)IVF : -RL  @ UO+ 30ml/hr
2)SALT RESTRICTION  < 2.4gm/day
3)INJ    TAZAR     2.25gm IV/ TID
4)INJ     PAN TOP 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
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

2)

Diagnosis-

Acute renal failure (intrinsic)
 Grade 1 L4-L5 Spondylodiscitis, Multifocal infectious Spondylodiscitis


Treatment

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 

3) 

  Diagnosis

CKD?  Chronic interstitial nephritis is secondary to plasma cell dyscrasias, (multiple myeloma - 70% plasmacytosis).

Treatment

T. PAN 40mg /PO / OD
- oral fluids up to 1.5 - 2 lit / day
- Protein - x ( plant-based ) 2 tablespoons 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

4) 

Diagnosis-

DKA with AKI ( ? Pre renal) 

Treatment

Inj. NORAD 2amp in 50ml NS
Inj. PIPTAZ 2.25gm.
Inj. DOPAMINE 2amp in 50ml
Inj. HAI 1ml in 39ml NS
 Inj. CLEXANE 40gm. 
Iv infusion NS RL @100ml/hr.
Inj. LEVOFLOX
Inj. VANCOMYCIN

5) 

Diagnosis-

INFECTIVE ENDOCARDITIS
WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR WITH AKI
WITH?UREMIC ENCEPHALOPATHY? SEPTIC ENCEPHALOPATHY
WITH ULCER OVER SOLE OF RIGHT LEG
WITH HYPOALBUMINEMIA? ALCOHOLIC LIVER DISEASE
WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES

Treatment


1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Proctor lysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
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

6) 

Diagnosis

Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bedsore

Treatment 

Injection PAN TOP 40mg IV/OD
Injection PIPTAZ  4.5 stat  and 2.25 gm  IV/ TID
Injection LASIX 40mg IV/BD
Injection optineurin 1AMP in 100ml NS slow IV/OD
Injection NEDMOL 100ml IV/SOS
Tab PCM 650mg TID
Insulin Human actrapid - 16 IU/TID

7) 

Diagnosis

HFrEF secondary to CAD; CRF

Treatment


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. GASOLINE OD
8.TAB. ecosprin-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml

8) 

Diagnosis

Interstitial lung disease, 
? Right heart failure.
Acute kidney disease.

Treatment:-

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.Grabs 6 the July
8.I/o charting, temp. Charting

9)

 Diagnosis

ALCOHOLIC HEPATITIS,
AKI SECONDARY TO ACUTE GASTROENTERITIS  

Treatment 

  • 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 PAN TOP 40 mg IV/ OD
  • ABDOMINAL GIRTH MEASUREMENT DAILY
  • BP /PR/TEMP/ RR -4 hourly 
  • I/O CHARTING
10)

Diagnosis - 

  • Acute kidney injury secondary to urosepsis

Treatment 

  • 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 ]
11) 

Diagnosis -


Acute pancreatitis with AKI 
with ?B/L pleural effusion and moderate ascites. 
Currently in ? Alcohol withdrawal.

Treatment

 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.


5)  

I have learned many things during the online clinical sessions. I  got a chance to log for a case the experience was quite helpful for me to understand how the system works.
 Our assigned interns were very cooperative and helpful in making the elogs.
General Medicine department has put in lots of efforts to make the online teaching process much more effective and productive. 
This online experience will definitely make our offline postings easier. This way of learning helped us in getting exposure to different cases , their diagnosis and treatment. I am very thankful to the GM department for their efforts in making our learning process easier and more interesting.
It’s a new experience for us as we actually never experienced this before . Though we could not be present personally still GM department helped us to feel that we are actually reviewing the case 
We could actually correlate the symptoms and the diagnosis. We got a broad view of what investigations to be done and what treatment to be given . 

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