BIMONTHLY ASSESSMENT JULY 2021
E-LOGS GENERAL MEDICINE
BIMONTHLY ASSESSMENT- JULY 2021
NAME : SRI LASYA AKULA
ROLL NO : 04
This blog is an assessment for questions linked below :
ANSWER 1:
REVIEW FOR ANSWERED QUESTIONS IN :
1) Links to the cases which are reviewed are provided and the insights are well explained.
Each of the neurology , Pulmonology and cardiology cases are given insights which are also given reasons where necessary .
2)He still didn't take up any case as far .
3&4)
He took a case of Heart failure with atrial fibrillation. Also associated with hyperthyroidism.relating to refractory atrial fibrillation .
https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1
She came with complaints of shortness of breath and distension of abdomen .
She was on thyronorm 100mg OD for hypothyroidism.
5) It was perfectly described about how it effected our way of learning in this pandemic and though it's tough the department ensured in every possible way to make sure we understood cases and by giving monthly assignments .
Well described .
ANSWER 2 :
Link for my case report
ANSWER 3:
Case 1:
A 58 year old with complaints of burning micturition , Lower abdominal pain and backache after lifting weights , decreased urine output and fever SOB. The provisional diagnosis for the case according to the investigations done is AKI SECONDARY TO UTI . associated with other conditions such as DM 2 and hypertension .
The serological investigations , cue , culture are being done properly and are in sequence accordingly. Investigations ordered are also mentioned which makes the view easy .
The history of patient is also in a sequential manner and point wise making it look clear .
Case 2 :
A 75 yr old man with complaints of dribbling of urine , lower backache , pedal oedema , increased involuntary movements of upper limbs ,SOB . The evolution of symptomatology could've been in order . Treatment is given in order date by date which makes it easier to look for . And the history of patient is described well . Treatment history could've been mentioned. Investigations done are proper and the provisional diagnosis also is being explained well by them .
Case 3 :
A 49 yr old female with complaints of mass per anum with bleeding . History of presenting illness mentioning would've made it easy to go through the case. Personal history is well explained .
Menstrual , obstetric and birth history are also being mentioned. Investigations done are properly given , with pictures where needed.
Discharge date and summary mentioning must also be considered important.
Case 4 :
The case report In brief starts with 'a 35 yr old female ' which is not mentioned here .with complaints of fever , diarrhoea, back pain , chest and abdominal pain . Headings could've been mentioned properly such as systemic examination past history presenting illness. Etc ..,
Investigations done are put up day to day accordingly. With mention of prognosis and pictures if necessary . Bed sores development picture is also put up. Discharge summary is described well .
Case 5 :
A 52 yr old man with complaints of the abdominal distension. History of patient , investigations done , provisional diagnosis and treatment are described properly . Along with discharge summary. Which made the log look complete .
Easy read . And perfect . Because it also includes final diagnosis of patient's problem.
Case 6 :
A 52 year old male With complaints of fever and pus in urine. History of patient is discussed well .
With highlights.
Investigations ordered and done are proper explained along with pictures and reference .
Discharge summary could've made the log complete. Treatment is given but it would be good to save it date wise .
Case 7 :
A 48 year old with complaints of shortness of breath . History and investigations Are given which explains the provisional diagnosis.
Treatment is mentioned and reference links are provided which makes it easy to understand .
Case 8 :
A 60 yr old female with complaints of decreased urine output , pedal oedema , vomitings and loose stools . History of patient and investigations done are put up along with pictures . Discharge summary is described well.Headings such as past history and treatment history could've been mentioned.
Case 9 :
A 43 yr oldman with complaints of loose stools, pedal oedema, abdominal distension.
History is well explained. Investigations done are in order accordingly.systemic effects are being monitored almost daily , which are mentioned clearly . Expected date of discharge and summary could've made it complete.
Case 10 :
A 60 yr old female with complaints of fever , pedal oedema , decreased urine output.
Histories , investigations and examinations done are properly given .
Comparison of urea, creatinine, serum electrolytes are done which makes it easier for quick review .
Treatment is mentioned in date wise manner and is basically conveyed in a helpful way.
Case 11 :
A 31 yr old male with complaints of pain in abdomen , vomitings , SOB .
Subheadings mentioning must have been proper otherwise good explanation. Investigations done are proper which explains DIAGNOSIS .
Summary is given in short which gives us a quick review .
ANSWER 4 :
Case 1 :
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
Diagnosis :
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 body.
Treatment :
)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
6)INJ HAI S/C ACC TO SLIDING SCALE
8AM - 2PM - 8PM
7)SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]
8) GRBS - 6th Hourly
9) BP/PR/TEMP - 4th Hourly
10) I/O - CHARTING
Consequently , Foley's is removed and ultracet tablet , input of 2 liters only and output monitoring is done .
Csse 2 :
A 75yr old male patient ,labourer by occupation ,came to casuality with Cheif complaints of
• Lower backache since 10days
• dribbling of urine since 10days
• Pedal edema since 3days
• SOB at rest since 3days
• Increased involuntary movements of both upper limbs since 10days .
Diagnosis :
Acute renal failure (intrinsic)
Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis
Hyperuricemia 2° to Renal failure
Uraemia induced tremors( resolved)
Delerium 2° to septic /Uremic encephalopathy (resolving)
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
Nebulization is reduced consequently and daily monitoring of vitals is being done . And oral fluids restricted to 2 to 3 liters per day .
Case 3 :
A 49 yr old female noticed mass peranum with bleeding , diagnosed as haemorrhoids , got Operated. History of muscle aches , uses NSAIDs .Fever got treated at local hospital
Since 20 days she has generalized weakness.
- She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.
Diagnosis :
CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
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
- Donot give IV fluids unless instructed
- T. ZOFER 4mg / PO / SOS
- Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved )
- TAB NODOSIS 550 BD
No fresh complaints are registered ,
Daily monitoring of vitals and systematic examination is done.
Case 4 :
A 35 yr old female was admitted to the hospital with
"Chief complaints"
Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).
Back pain( 5 days ago) with abdominal pain and chest pain.
Diagnosis :
DKA with AKI ( ? Pre renal)
- Pyelonephritis.
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. NORADRENALINE(2 amp+46ml NS)
Inj. LEVOFLOX
Inj. VANCOMYCIN
Inj. MEROPENEM
Inj. FOSFOMYCIN
Inj. LASIX was given.
Case 5 :
A 52-year-old man presented to the OPD with Cheif Complaints of abdominal distension from the past 7 days.
2 yrs back he complained of tingling in upperlimbs upto palms lowerlimbs upto knees .
Presented to casualty recently with abdominal distension.
diagnosed with
Alcoholic Liver Disease,
AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,
Hepatic encephalopathy grade 2
he complains of Constipation and has not passed stools since 5 days.
He also complains of altered Sleep patterns from the past 5 Days
He had hiccups.
He also Complains of pedal edema grade 2.
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. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
Same treatment followed except Inj. Monocef.
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
he had sudden cardiac arrest. CPR was initiated, intubation was done, but couldn't be revived.
Case 6 :
A 52 yr old male with complaints of fever and pus in urine on his 4th admission to the hospital. He had prostatomegaly and underwent TURP before.
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 bed sore
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
Injection NEDMOL 100ml IV/SOS
Tab PCM 650mg TID
Insulin Human actrapid - 16 IU/TID
Case 7 :
A 48-Year-old male presented to the OPD with chief complaints of Shortness of Breath grade -II from the past 1 week, which converted into grade -III-IV from the past 4 days .
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. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml
Case 8:
A 60 yr old patient came to the opd with chief complaints of..
Pedal edema since 3 days.
Decreased urine output since 3 days.
H/o vomitings and loose stools 5 days ago lasted 3 days and subsided.
Patient was apparently asymptomatic 15 yrs back.. then she developed
Shortness of breath;-
since 15 years..
10-15 episodes per year and she was taking medication during the episodes ..
2 months back....
pneumonitis with Type 1 Respiratory Failite,
? Interstial lung disease,
? Right heart failure .
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.
4. Pantop
5. Montek FX -- 1 month.
6.Oxygen inhalation.
Present complaints are:
Pedal edema
since 3 days, which is pitting type.. which gradually progressed to anasarca.
Decreased urine output..
since 3 days..
There is no h/o burning micturition.
Vomitings
since 5 days , food as content and 2 episodes per day.
Loose motions
5 days ago 5 episodes lasted for 1 day.
There is no complaints of fever, cold and cough.
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.Grbs 6 th hrly
8.I/o charting, temp. Charting
Case 9 :
A 43 yr old male ,resident of nalgonda came to casuality with chief complaints of
loose stools since 20 days
Pedal edema since 20 days
Abdominal distension since 20 days
Diagnosis :
ALCOHOLIC HEPATITIS ,
AKI SECONDARY TO ACUTE GASTROENTERITIS
HFrEF SECONDARY TO CAD
ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME
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 PANTOP 40 mg IV/ OD
ABDOMINAL GIRTH MEASUREMENT DAILY
BP /PR/TEMP/ RR -4 hourly
I/O CHARTHING
Case 10 :
A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.
Diagnosis:
Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease
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 ]
GRBS charting is introduced and daily monitoring of vitals is done .
Case 11 :
31 yr male farmer by ocupation,resident of Miryalguda Came with cc of
pain in abdomen since a week
Vomiting since a week
Sob since 2 days.
Diagnosis :
Acute pancreatitis with AKI
with ?B/L pleural effusion and moderate ascitis .
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.
D A Y W I S E U P D A T E S:
Day 1and 2 =Urine output 1500ml,
Fluid intake 3000ml
ANSWER 5 :
To have a good understanding in case taking and making e-log of patient's data , it is necessary to have a practice of history taking ,which for us is complicated because of this pandemic . Though it's tough time , our general medicine department is putting efforts in making us understand every case possible. And my experience towards this type of learning online was really good and made it more interesting. This type of learning would definitely make it more effective offline. And I hope it will be easier when we attend offline postings .
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