JULY BIMONTHLY ASSESSMENT

QUESTION 1

https://30hansikareddy.blogspot.com/ 

Case reviews- Srilekha has analysed all the cases after reading both the case report and the assessment and has come to varied conclusions on the cases, their prognosis, their treatments and the post discharge care received by the patient. She has gone into great detail about the causes and the solutions for the majority of the cases but has fallen short of criticism and has not provided valuable input and feed back that will help the doctors writing these cases improve their methodology. She has gone into detail of the cases after they have come to the op but has missed the root causes like alcoholism which could have caused the cases in the First place. Overall she has done very well and I have learnt a lot from his assessment.

QUESTION 2

http://budigammadhumithagm.blogspot.com/2021/07/75-y-old-male-with-left-hemiparesis.html

http://budigammadhumithagm.blogspot.com/2021/07/60y-old-male-with-uti-with-aki-on-ckd.html

http://budigammadhumithagm.blogspot.com/2021/06/20-year-old-female-with-anemia-under.html

QUESTION 3

1)AKI 

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

Over view 

A 58 year old male patient came to casualty with chief complaints of:

- lower abdominal pain: 1 week

 -burning micturation:1week

- low back ache after lifting weights

-dribbling / decrease of urine out put:1week

-fever :1 week

- SOB , rest :1week  

  Apprisal

Case history was taken well and examination was very well done... Sequential evaluation of case is apprisiable 

Negative points 

It would be better if fever chart is added as it was treated with strict temp and IO monitoring as it would be better understood improvement of the case was not well mentioned

My Analysis

 This is a case of Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

With ? Right HEART FAILURE,

With K/C/O - HTN ( Not on Rx)

-AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your bodyand return of creatinine to the base line and symptoms less then 3 months indicating it to be a AKI.

2) CKD 

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

The blog was made very clear with diagnosis and symptoms along with secondary manifestations . Details about entire treatment were provided

3) CKD

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

 Case is well presented patients obstetric , menstrual and previous birth histories were well explained .

4) patient with renal failure 

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

This blog was so impressive with pictures and proper treatment details along with previous history and family history 

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

In this blog details of all the treatment and treating faculty were included and insights were also provided with all the lab reports and pictures .

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

All the details were included in a precise way . but discharge summary was not included and all the other investigations were in order .

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

This log has entire provisional diagnosis and treatment procedure was included .blog has links of reference .

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

This blog was made so perfect by including discharge summary and all the investigations but treatment procedure would have made it complete.

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

This blog consists of pictures of general examinaation and all the other histories like family , previous history etc.

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

Log is so impressive with all the details and diagnosis was very well mentioned. 

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

This blog gives a quick review about the entire case and its details and it's subheadings were also good.

QUESTION 4

✱Case 1

Diagnosis : AKI secondary to UTI, associated with Denovo - DM -2 

Treatment : 

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

✱Case 2

Diagnosis : Hyperuricemia 2° to Renal failure 

Treatment:

• IVF - NS-0.9% @100ml/hr

• Inj. Tazar 2.25gm I.V -TID 

• Inj. Lasik 40mg I.V -BD 

✱Case 3

Diagnosis: Chronic interstitial nephritis secondary to plasma cell dyscariasis

Treatment:   

- T. PAN 40mg /PO / OD

- oral fluids upto 1.5 - 2 lit / day

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

✱Case 4 

Diagnosis: DKA with AKI 

Treatment:

Inj. NORAD 2amp in 50ml NS

Inj. PIPTAZ 2.25gm.

Inj. DOPAMINE 2amp in 50ml

Inj. HAI 1ml in 39ml NS

✱Case 5

Diagnosis:INFECTIVE ENDOCARDITIS

Treatment:

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

✱Case 6 

Diagnosis: Renal AKI secondary to urosepsis with b/L hydroureteronephrosis

Treatment: 

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

✱Case 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

✱Case 8

Diagnosis: Acute on CKD 

Treatment: 

1. Tab. Augmentin 625 mg ×7 days

2. Tab. Wysolone 40 mg ×10 days.

    30 mg × 10 days 

    20 mg ×10 days

    10 mg ×10 days.

3. Tab . Lasix 20 mg × 1 month.

✱Case 9

Diagnosis: Alcoholic Hepatitis and aki sec to 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  

     

✱Case 10

Diagnosis: Acute Kidney Injury secondary to Urosepsis

Treatment:

 Inj LASIX 40mg (8am- 2pm -8pm)

IVF - NS @ UO + 50 ml/hr

✱Case 11

Diagnosis: pancreatitis in a chronic alcoholic 

Treatment:

IV lasix 40 mg BD .

Tab Nodosis .

IV PIPTAZ 4.5 Gms. BD 

Iv 25%Dextrose. 100 ml BD 

Iv fluids : NS 40 ml /hr.

QUESTION 5

Testing scholarship competency in logging reflective observations on your concrete experiences of this last month write an essay for 10 marks on the above topic:

We have started our internship program on 2nd June, due to the covid pandemic we have been struck in our homes for the last 1 year , and completed our final year in online, because of which we lost the valuable 1 year of practical classes in which we could learnt something. With all these fears of not seeing patients for one year and suddenly coming in touch with patients was quite exciting and with all new hopes we started our internship and posted in the general medicine department in which we are having a lot of exposure to different kinds of patients, we have had experiences of seeing patients suffering and all the efforts done by PG's and us to save them arose a quite doctor in me. I have experienced both the feelings of being successful in saving the patient which filled me with immense happiness and failure which filled me with grief. The most important thing then I realised was the world was grey and not black and white. I understood the feeling of being a doctor. Our HOD sir in every day rounds explained about each and every case and asked me to film it and asked to know about every patient, in the process of I got the valuable information from sir and which ignited a sense of learning in me. It helped me understand about a lot of topics which I couldn't understand by reading books, and the interactive sessions in the afternoon also helped me a lot to learn how to present cases and understood how discussion helps in solving the cases. I will also learn to ask questions in which I am lacking and try to be a good and active member of medical team. I thank general medicine department for the opportunity.