110 Gopal Krishna Ramavath

 

BIOMONTHLY ASSIGNMENT AUGUST Roll no:110 GOPAL KRISHNA

August 25, 2021

 Question paper link https://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html?m=1

QUESTION 1: competency based peer to peer review and assessment : 

FIRST CASE:  A case of acute glomerulonephritis, due to sec. Amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis.

 OVERVIEW : 

   The is complete in all factors it included chief complaints, present history past history, personal history, medical /surgical history, family history, social and educational history, immunization history. 

 REVIEW :

* The case was presented in detail, like a step to step detailed explanation. 

* Evolution of symtomatology was described in detail manner. 

* There was also a detailed explanation of the patient's acute and chronic problem. 

* General examination was done much detail way in different positions with clear documentation. 

* Clinical images of the patient and investigations were added with deidentification. 

SECOND CASE:  idiopathic Parkinson's disease stage 1 with denovo HTN &multiple system atrophy - Parkinsonian type ( MSA-P) 

OVERVIEW: 

The is complete in all factors it included chief complaints, present history past history, personal history, medical /surgical history, family history, social and educational history, immunization history.

REVIEW: 

* The case was beautifully presented in detail ,which is almost knit with his details,like step to step detailed explanation. 

* Evolution of symptomatology was described in detail manner. 

* CNS examination was described extremely well with all detailed documentation of reflexes etc. 

* Clinical images of the patient and investigations were added with de-identification. 

THIRD CASE :  latrogenic Cushings syndrome secondary to tropical clobetasol application all over the body for approx 1 yr. 

OVERVIEW :

 This elog was little incomplete acc. to me as it didn't include his past history, family history, treatment history, personal history. 

REVIEW :

* Evolution of current symptomatology was described beautifully. 

* deidentified clinical images in the presentation, showed us the condition of the patient clearly. 

*His follow up details were also neatly documented.      

        Question 2:

Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):-
Long Case:

Problem:
*Generalized edema :- it was due to glomerulonephritis.

*Joint pains:- it was due to rheumatoid arthritis.

INVESTIGATIONS:
*X ray of peripheral joints to conclude the severity of arthritis usually by observing the osteolytic lesions.

*X ray of chest to rule out any pleural effusion due to excess fluid retention.

*ECG to to rule out any cardiac abnormalities.

*CUE for checking the severity of  glomerulonephritis by quantifying the amount of albumin and glucose present in  urine.

*CBC for grading the extent of blood infection and prognosis of inflammation caused due to arthritis. 

*ESR usually gets elevated in active inflammation in body.

*KFT for grading the severity of kidney damage due to glomerulonephritis.

Treatment:
*Free water restriction for Hyponatremia.

*Tab. PREDNISOLONE P/O 20 mg OD -Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders.

*Tab. FEBUXOSTAT P/O 80 mg OD Febuxostat, sold under the brand names Uloric and Adenuric among others, is a medication used long-term to treat gout due to high uric acid levels. 

*Hemodialysis for worsening renal dysfunction.


Short Case:

Problems:
1. Patient complained of involuntary movements with resting tremors and denied sensation in the lower limb along with muscle stiffness.

2. Decreased tension in major groups of muscle suggesting hypotonia. 

3. Difficulty in speaking.

#All this points to the diagnosis of Parkinson's Disease.

Investigations:
*Superficial reflexes absent on the left side.
 
*Deep tendon reflexes are reduced showing hypotonia.

*Micrographia is present i.e, suggestive of Parkinson's disease.

*ECG suggestive of Sinus Tachycardia with pseudo infarct pattern in leads-I and aVL with dagger q waves in the same leads.
 
*No late intrinsicoid deflection of R wave with modified Cornell criteria showing LVH.

*2D Echo shows Gade-2 Diastolic dysfunction.

Treatment:

*Tab. Syndopa Plus 125 mg QID increasing the dopamine levels in the brain.

*Tab. Syndopa 125 mg CR OD. 

*Tab. Telma 40 mg OD used as an antihypertensive drug.

Short Case:2

Problems:

1. Itchy lesions .
2. Purple striation over the anterior abdominal wall.
3. Weight gain along with edema. 
4. lower back ache. 
5. loss of libido.

Investigations:
*ECG done to rule out any cardiac abnormalities (NORMAL).

*In view of low back ache X-ray LS spine was done which was normal.
Treatment:
1.Ointment Amorolfine ,is a morpholine antifungal drug that inhibits Δ-sterol reductase and cholestenol Δ-isomerase, which depletes ergosterol.

2.Tab Shelcal 500 OD and Tab Vit-D3 Od, Shelcal for treatment low calcium levels.

3.Tab ULTRACET /PO/SOS for inflammation.



Question:3
Testing competency in "Evidence based medicine": 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.
Long Case:

Investigations:

X -ray:

X-rays can help detect bone damage (erosions) that occurs as a result of long-standing rheumatoid arthritis. They can also detect a narrowing of the joints space, which occurs when cartilage degrades and the bones in the joint get closer together. Magnetic resonance imaging (MRI).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837821/

ESR:

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body.


Treatment:
*Tab. PREDNISOLONE  Low doses of prednisone are safe and effective in the management of RA. Yet, some clinicians continue to manage their RA patients with glucocorticoid doses that are too high or avoid them altogether. Glucocorticoids in low doses have proven to be very effective in suppressing the inflammation associated with RA.


*Tab FEBUXOSTAT
Febuxostat (Uloric) is a medication that lowers the levels of uric acid in the body. It is used for the chronic management of gouts. It blocks the active site on xanthine oxidase, preventing the conversion of hypoxanthine and xanthine to uric acid.



Short Case:

Investigations:

*Micrographia, or small handwriting, is a common sign of Parkinson's disease. Over 65 percent of patients exhibit micrographia. Patients often notice the difference in their handwriting themselves and a neurologist can confirm the diagnosis by the size of the handwriting in a writing test.

https://parkinsonsdisease.net/symptoms/micrographia-handwriting

Treatment:

*Syndopa Plus Tablet is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors (shaking), stiffness and slowness of movement.

https://medlineplus.gov/druginfo/meds/a601068.html 


Short Case:2

Investigations:

*The 24-hour urinary cortisol test measures the amount of cortisol being produced within the urine over the course of an entire day. Levels higher than 50-100 micrograms per day in an adult suggest the presence of Cushing's syndrome.

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cushings-Disease

Treatment:

*Shelcal  as calcium supplement as there's increase in bone resorption.


Question 4:

Below is the link of my case report of a patient that I have gone with personal investigations, and I mentioned every detail based on the information given by the patient and gone up with all the investigations that should be needed.
https://gopalkrishnaramavath.blogspot.com/2021/07/110-gopal-krishna-ramavath.html

QUESTION 5 : Please reflect on and share  your telemedical learning experiences from the  hospital as well as community patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.
ANSWER :                                                                               This platform of doing e-logs and reviewing assignments has been very useful in learning and knowing many case studies. It helped to understand patients pain and need. Solving each case was very interesting this way. 

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