GM Assignment 2
Medicine paper for July 2021 bimonthly blended assessment
I am Tvisha D., a second year medical student (3rd semester).
This is an assignment that I've been given. It focuses on student driven patient centered case reports.
Here's the link to the 5 questions that I've answered below:
http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
Q1) Peer to peer review and assessment.
A1) Link to the blog I reviewed:
My review:
This assignment has 5 answers.
• Answer 1 has reviews on 10 assignments on neurology, pulmonology and cardiology cases. They explain both the positives and negatives of how the answers were presented very well. However, no comments have been made on the diagnoses and content of the answers. This addition would be appreciated.
• Answer 2 is an E-log of a patient diagnosed with quadriplegia secondary to infectious spondylitis.
The case was presented well under the subheadings of history of present and past illness(es). Both general and systemic examination results were well recorded and presented in a point wise manner. Organized presentation made going through the log easier. Pictures relevant to the case were attached while keeping in mind the need to protect the patient's identity.
• Answer 3 includes the critical appraisal of clinical cases. Here too, different aspects of case presentation were discussed and suggestions were made.
• Answer 4 had a problem list, explainantion for how the diagnosis was made and treatment for each case reviewed in answer 3. It was very informative and well presented. In a way, each case was summarized with a problem-solution approach.
• Answer 5 was a short passage on how logging and online clinical exposure helped experience the practice aspect of medicine virtually. It was short and explained the positives well.
Q2) Share the link to your own case report of a patient.
A2) Here's the link to my E-log on a patient diagnosed with dengue fever.
Working on this e-log has helped me understand the pathogenesis, prognosis and fever pattern of dengue.
Q3) provide your critical appraisal in terms of completeness, correctness and ability to provide useful leads to analyze ths diagnostic and threapeutic uncertainties around the case shared.
A3)
Case 1) Acute on Chronic kidney disease
• Completeness: the case logged is complete with presentation of examination & investigation results and treatment plan in chronological order.
• Correctness: the information presented and diagnosis made are correct.
• Leads provided: leads were provided through the investigations conducted and diagnosis made. They helped understand the complications and associated disorders caused by CKD in the patient.
Case 2) Chronic kidney disease
• Completeness: case logged was complete but presentation was not very organized.
• Correctness: diagnosis made and investigations performed were correct.
• Leads provided: though investigations helped diagnose the disorder, they didn't provide any leads for the uncertainties.
Case 3) Renal failure and coma
•Completeness: the case logged it well presented and complete with relevant images and investigation results attached. However, final diagnosis was not mentioned.
• Correctness: investigations performed and provisional diagnosis made seem correct.
• Leads provided: not many leads are provided for the uncertainties around the case.
Case 4) Acute kidney injury
• Completeness: the case is complete and presentation was well organized. Relevant images of the patient and investigation results were attached.
• Correctness: the information compiled, investigations conducted and diagnosis made were correct.
• Leads provided: leads were provided through investigations and provisional and final diagnosis.
Case 5) Acute on CKD
• Completeness: information compiled was complete and presented in an organized manner.
• Correctness: the information provided and diagnosis made was correct.
• Leads provided: leads were provided through comparisons and images attached.
Case 6) Acute on CKD
• Completeness: the log was complete and well organized.
• Correctness: provisional diagnosis and investigations made are correct, however, final diagnosis was not mentioned.
• Leads provided: links to site with information on renal disorders were attached which were helpful.
Case 7) Acute on CKD
• Completeness: information was compiled and presented in an organized manner but diagnosis made was not mentioned.
• Correctness: investigations performed were correct.
• Leads provided: no significant leads were provided for the uncertainties around the case.
Case 8) Acute kidney injury
• Completeness: the E-log was complete and well presented in a chronological order with relevant images attached.
• Correctness: the investigations conducted and diagnosis made were correct.
• Leads provided: leads to analyze uncertainties of the case were not provided.
Case 9) AKI secondary to urosepsis
• Completeness: the case log was complete. Information was well recorded and presentation was organized with relevant pictures.
• Correctness: the investigations performed and diagnosis made were correct.
• Leads provided: leads to analyze uncertainties of the case were not provided.
Case 10) AKI
• Completeness: the log was complete. Information presentation could've been more organized.
• Correctness: investigations and diagnosis were correct. Relevant images were attached.
• Leads provided: leads to analyze uncertainties of the case were not provided.
Q4) Prepare a problem list for each patient and discuss the diagnostic and therapeutic uncertainty around solving these problems.
(Cases are in the same order as in answer 3)
A4)
Case 1) Acute on Chronic kidney disease
• Problem list:
1. Lower back pain
2. Dribbling of urine
3. Pedal edema
4. Shortness of breath
5. Normocytic normochromic anaemia
6. Increased blood urea, serum creatinine, serum uric acid and phosphorus levels.
7. Multifocal infectious spondylodiscitis
• Diagnostic uncertainty: The diagnosis seems to be accurate.
• Therapeutic uncertainty: Administration of febuxostat decreses uric acid levels but also decreases urine output. Tazar inj. (antibiotic) was found to worsen renal function.
Case 2) CKD
• Problem list:
1. Muscle ache and generalized weakness
2. Non bilious, non projectile vomiting
3. Dimorphic anaemia
4. Increased serum creatinine and blood urea
5. Bone marrow suppression
Case 3) Renal failure and coma
• Problem list:
1. Fever and diarrhea
2. Abdominal, chest and back pain
3. Metabolic acidosis
4. Microcytic hypochromic anaemia
5. Coma
6. Bed sores
Case 4) Acute kidney injury
• Problem list
1. Abdominal distention
2. Constipation
3. Icterus
4. Pedal edema
5. Normocytic normochromic anemia
6. Infective endocarditis
7. Uremic encephalopathy
8. Ulcer of sole of right leg
9. Hypoalbuminemia
10. Alcoholic liver disease
11. Acute infarcts in bilateral cerebral and cerebellar hemispheres.
Case 5) Acute on CKD
• Problem list:
1. Burning micturition caused by prostomegaly
2. Decreased appetite and generalized weakness (1st admission)
3. Drowsiness (2nd admission)
4. Shortness of breath (3rd admission)
5. High grade fever and pus in urine (4th admission)
6. Increased creatinie and blood urea
7. Normocytic normochromic anaemia
8. Bilateral hydroureteronephrosis
9. Diabetic nephropathy
Case 6) Acute on CKD
• Problem list:
1. Shortness of breath
2. Pedal edema
3. Normocytic normochromic anaemia
4. Increased urea and creatinine levels
Case 7) Acute on CKD
• Problem list:
1. Pedal edema
2. Vomitings and loose stools
3. Decreased urine output
4. SOB
5. Pneumonitis with type 1 respiratory falaite
6. Thrombocytopenia
7. Increased serum creatinine and blood urea
8. Pulmonary congestion/ pulmonary edema
Case 8) Acute kidney injury
• Problem list:
1. Pedal edema
2. Loose stools
3. Abdominal distention
4. Gastroduodenitits
5. Tremors
Case 9) AKI secondary to urosepsis
• Problem list:
1. High grade fever
2. Bilateral pedal edema of pitting type
3. Burning micturition
4. Decreased urine output
5. Urosepsis with hypokalemia (resolved)
6. Normocytic normochromic anaemia
Case 10) AKI with acute pancreatitis
• Problem list:
1. Pedal edema of pitting type
2. Non projectile, bilious vomiting
3. Abdominal pain
4. Acute pancreatitis
5. Mild pleural effusion
Q5) Log reflective observations on your concrete experiences of this last month.
A5) The month of july was also spent away from the hospital and clinicals were conducted online. Though the experience was virtual, it was helpful. Clinicals were interesting and informative. Making E-logs and going through E-logs of our batch mates and seniors helped us understand how to compile the patient's information. They also gave an insight into the investigations performed for the complaints, signs and symptoms of the patient and how the results are analyzed to diagnose the disease.
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