68 Naga Meghana

Bimonthly blended assessment June 2021

68 Naga meghana

I have been given the following cases to solve in an attempt to understand the topic of 'patient  clinical data analysis' to develop my competency in reading and comprehending clinical data including history,clinical findings, investigations, diagnosis and treatment plans.

Link to following cases :

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

Below are my answers to the given  assessment bases on my comprehension of the cases.

Question 1

1.Pulmonology:
Review:
https://181sagivikas.blogspot.com/
Case:
https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html

Case of acute exacerbation and respiratory  diseases.she is presented with shortness of breath  past 12 yrs, generalized weakness ,pedel edema,facial puffiness.she is also diagnosed with diabetes  8 yrs back and hypertension 20 days back.The problem is seen in lungs.Primary etiology is due to paddy dust inhalation.
Indications are head injury,pneumoniae etc.the history of patient is very clear.
2.Neurology:
Review:
https://divyasree1999.blogspot.com/?m=1
Case:
https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html
 
Case of Seizures.He developed seizures along with restlessness,sweating,tremours.
Primary etiology is due to alcohol intake.
He also had short term memory.
The patient is given inj.Lorazapem,inj 1 amp thiamine,tab pregamblin 75 mg,IVF NS and RL.
Decreased level of thiamine after withdrawal of alcohol shows symptoms .chronic alcoholism leads to peripheral neuropathy and foot ulcer  formation.

3.Cardiology:
Review:
https://63konakanchihyndavi.blogspot.com/
Case:
https://muskaangoyal.blogspot.com/2021/05/a-73-year-old-male-patient-with-pedal.html

Case of chronic heart failure and anaemia.
The causes are old age ,type 2 diabetes ,
Hypertension,Alcohol etc.
Chronic kidney disease,heart failure,anaemia are interlinked with each other.  There is non healing ulcer in leg due to ddiabetes.
This patient is in stage 4 type 2 diabetes mellitus with established end stage micro and macro vascular complications.

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

Case of acidosis caused by diuretics.
She is presented with shortness of breath, hyponatremia which causes drowsiness.
Complications are difficulty micturition,electrolyte imbalances,turp syndrome.

5.Infectious diseases 
Review:
https://anuragreddy72.blogspot.com/
Case:
https://vyshnavikonakalla.blogspot.com/2021/05/a-40-year-old-lady-with-dysphagia-fever.html
 
Case of tracheo-oesophageal fistula.
By doing investigations and clinical examination the following findings like hoarseness of voice,laryngeal crepitus,cough on consumption of food and dysphagia.
Since the patient is being treated with HIV and TB she may have risk of immunity reconstitution inflammatory syndrome.
To prevent IRIS ART should be started at time.

6.Infectious diseases and hepatology
Review:
https://sandhyamudavath89.blogspot.com/
Case:
https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html

Case of liver abscess.

Due to consumption of local alcohol (toddy) ,it is the factor for liver abscess.alcohol consumption has more effect in liver.right lobe of liver is more effected due to more blood supply to it .
Indications are
.large abscess more than 6 cm
.Left love abscess
.caudate love abscess
.abscess not responding to drugs

7.Gastrology
Review:
https://111sriharsha.blogspot.com/:
Case:
https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html

Case of  pancreatitis.
She stopped alcohol for 3 yrs due to advice of physician and started again 20 days back.
She is  suffering with pain in abdomen,vomtings, fever,constipation,burning micturition.
The anatomical position is pancreas.
Cause is due to alcohol consumption.
Patient is given inj.ocreotide,inj pantop,inj.thiamine,opioid analgesics are given to relieve pain .

8.Neurology
Review:
https://186akshithareddy.blogspot.com/
Case:
http://bejugamomnivasguptha.blogspot.com/2021/05/a-45-years-old-female-patient-with.html

Case of hypokalemia and associated syndromes.
Paralysis occured and bilateral pedal edema is seen,blood infection,numbness , difficulty in breathing,chest pain, palpation are also observed .Dur to increase urine output hypokalemia occurs.
Due to this ECG wave pattern is altered.

9.Neurology
Review:
https://164sasiharshithjasthi.blogspot.com/
Case:
https://neerajareddysingur.blogspot.com/2021/05/general-medicine-case-discussion.html?m=1
 Case of cortical vein thrombosis.
Due to this meningitis,nephrotic syndrome,head trauma, dehydration ,malignancy occurs.
Drugs given are oral contraceptives, steroids.cbemotheraoy is recommended.
Seizures are resolved due to medical treatment.
The case is clearly given and presentation is good .

10.Cardiology:
Review:
https://manaswinibhootharaju.blogspot.com/
Case:
https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html

 Case of atherosclerosis.
Anatomical site is blood vessels,due to arterial
Thrombosis,arteries become harden and narrow,hypertension is observed.cardiorenal syndrome type 4 is observed.
Drugs like tab dytor,tab cardivas,tab digoxin are recommended.The presentation is clear and good.

Question 3 and Question 4:
https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

A 70 Year old female presented to casuality with  complaints of distension of abdomen and Shortness of breath grade 3 since 5 days.
The diagnosis  is HFrEF  and known by ECG and 2D echos.  ECG Investigation revealed atrial fibrillation and 2 D echo revealed akinetic segment in LAD territory With EF 35% and RVSP 100 mm Hg.B/L Pleural effusion and mild pericardial effusion.several investigations are done which are normal.
The patient has heart failure due to ventricular dysfunction.she came to the hospital with chief complaint of abdominal distension .she is asymptomatic since 5 days.
Shortness of breath grade 3 is observed  since 5 days and she has a history of hypothyroidism since 5 years.there is no history of diabetes , hypertension.when she was admitted to hospital she is conscious,well built,coherant,moderately nourished.
She has low BP and she is given some injections as the treatment. 
Due to hyperthyroidism during the treatment this lead to refractory atrial fibrillation  and immediately defibrillation was done but unfortunately the pateint passed away .the treatment given to the patient is accurate but if the thyroid problem is known before and given accurate treatment she might not have passed.
During the treatment if along with other investigation to thyroid tests are done it could be more helpful.

Question 5:
As the clinical postings started in this month earlier  I am learning things day by day better.
Due to pandemic online postings are going on and this is a bit difficult to understand the cases.Our HOD and PGs ,interns are trying very hard in these times to explain the cases clearly and showing the case along with its e blog  clearly.preparing blogs from 3 rd semester onwards is a good idea to understand the situation and by doing  blogs I am able to understand the case and present it in a detailed way.I am thankful to each person for providing the details of case clearly.some disccusions are also going on as a group for the treatment of the patient.several investigations are done which relates to different topics and different systems analysis is helpful for clear concept.clinical based  learning is very helpful and I thank to each person who is supporting to do these things 

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