JULY ASSESSMENT
July assesment
All questions are around student driven patient centered case reports prepared by our students (including 2019 batch students in 3rd semester) over last one month. For the same students taking this exam, separate marks will be provided for their contribution to the questions.
Question 1: Competency tested for Peer to peer review and assessment :
Please go through one student's entire answer paper from this link, the one who is closest to your own roll number
http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1
and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.
https://shreyagoli.blogspot.com/2021/07/medicine-assignment-2021-name-goli.html.
QUESTION-1
1)NEUROLOGY
ink to case;- https://kausalyavarma.blogspot.com/2021/05/a-52-year-old-male-with-cerebellar.html?m=1
below showing insight reviews of shreyagoli
(Insights:- Efficacy of each drug was well mentioned.
evolution of symptomology well explained. it was well comprehensable, easy to understand )
IAgree with her insights
according to me ;
The patient presented with chief complaints of slurring speech and deviation of mouth that lasted for 1 day. detailed history and was diagnosed with Cerebellar ataxia to acute CVA with infarct in the right inferior cerebellar hemisphere. Systemic and motor examinations are shown properly in the video. CT Scan revealed the cerebellar infarct and2d echo showed diastolic dysfunction. They have included all the pictures of patient and the investigation reports and diagnosed it clearly. In overall it is a very good presentation
2)PULMONOLOGY:
Patient details: ttps://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html
below showing insight reviews of shreyagoli
(Insight :-
event timeline of symptom occurrences in the patient were very well explained
It was clear and comprehensible. )
I Agree with her insights and i would like to point that repeated patterns occuring at the same time every yr points towards allergic hypersensitivity
3)CARDIOLOGY:
Link to case-
https://muskaangoyal.blogspot.com/2021/05/a-73-year-old-male-patient-with-pedal.html
below showing review of shreyagoli
(Insights:- The provided information was very reasonable and flow charts and diagrams made it more clear.)
I Absolutely agree her review ,
According to my opinion,The difference between preserved ejection fraction and reviewed ejection fraction have been presented every clearly. . The risk factors which cause the heart failure have also been clearly explained . The flow charts, diagrams, tables have made an impact in understanding.
4)GASTROLOGY:
Link to case https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html
below showing insight review of shreyagoli
(Insights :-
• Efficacy of drugs well explained .
• Neat work to the point.)
i agree with her review . i would like point that the efficacy of the drug was well explained in the blog
5)NEPHROLOGY:
Link to case
A 55 year old female patient, a resident of Miryalaguda and farmer by occupation came to the hospital on 17/5/21 with the chief complaints of shortness of breath, pedal edema and facial puffiness
https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html
Insight :answering has been done in a point wise manner, with nice detailing & information.Reference links to answer information are appreciated.
6)INFECTIOUS DISEASE(MUCORMYCOSIS,OPTHALMOLOGY, OTORHINOLARYNHOLOGY)
Link:http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html
below showing review of shreyagoli
(Insights: The reasons for the sudden rise in the mucormycosis incidence is explained. It can be triggered by steroids.)
i clearly agree with shreya goli reasoning is clear
7)GASTROENTEROLOGY
Link:-https://sannithreddykasala.blogspot.com/2021/06/general-medicine-blended-assignment.html
below shopwig review of shreyagoli
(Insights:The evolution of symptamology was compactly explained. And well presented with appropriate information. )
in my opinion, the history part is well explained and the symptomatology clearly defined
8)INFECTIOUS DISEASE &HEPATOLOGY
link to case- https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html
(Insights :- The pathopyshiology was clearly explained with beautiful flow charts and what is the primary etiology of the patient's problem was clearly explained.)
i agree with the review of shreyagoli
9)COVID CASE
Link to case- https://nikh ilasampathkumar.blogspot.com/2021/05/covid-pneumonia-in-pre-existing-case-of.htmls
below showing insight of shreyagoli
(Insights -detailed explanation hasnot been provided.. Must have added more information and explained a little more. )
according to me,detailed information regarding history and events related are not provided in a detailed way ..it could be more detailed and can be clearly explained.
10)NEPHROLOGY
Link:https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html
below showing insight of shreyagoli
(Insight:The reasons for shortness of breath,intermittent episodes of drowsiness were clearly explained in the case.)
according to me,i agree with shreyagoli,i also thought that the history was taken in well detailed manner but the treatment and followed can be done in more detailed fashion
OVERALL REVIEW OF SHREYAGOLI WAS GOOD.SHE POINTED THE DETAILED INFORMATION OF HISTORY AND ALSO CHARTING AND ALSO MENTIONED THE DETAILING THAT COULD HAVE BEEN ADDED TO THE BLOGS.THE REVIEW IS GENUINE AND PERFECT
Q2-4
Patient centered data around the theme of renal failure patients with AKI, CKD and acute on CKD,
captured by students from 2016 and 2019 batch in the links below
Patients with low back ache and renal failure
Q2) Share the link to your own case report of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case
http://sreejaellanthakuntarollno49.blogspot.com/2021/07/a-case-of-anaemia-under-evaluation-with.html
http://sreejaellanthakuntarollno49.blogspot.com/2021/06/a-45-yr-old-male-presented-with.html
Q3) (Testing peer review competency of the examinees) :
Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.
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 :1week
Apprisal
Case history and examination was good enough and done in a detailed fashion
Negative points
It would be better if fever chart is added as it was treated with strict temp 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
Acute on CKD :
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
Over view
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
Apprisal:
History was taken well
Negative points
no pictures of pedal edema .
Symptoms are not mentioned chronologically
No i/ocharting was done though it was told it should be strictly monitored
My Analysis
This is case of
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)
CKD :
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
Over view
A 49 yr old female , mother of 2 children, who is a house wife, apparently asymptomatic 13 yrs ago and then she noticed mass per anum with bleeding , went to hospital and diagnosed as haemorrhoids and got operated.
- Since 3 yrs she has history of muscle aches, for which she is using NSAIDs.
- She has h/o fever 20 days back, got treated in the local hospital, and
- Since 20 days she has generalized weakness.
- She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.
Apprisal
History was taken well.
Good lab work clear evaluation was done
Negative points
no clinical pics of the symptoms
Proper chronological order of symptoms apperance was not done
Fever chart was not included.
No IO charting was done though it was told it should be strictly monitoredit would have been better if urine was sent for eosinophils for interatial disease
My Analysis
This is case of CKD ?
Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
Patient with coma and renal failure
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
Overview
A 35 yr old female with 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.
Apprisal
Very well presented
With good fever charting with all the necessary information.
History was taken detailed way
Follow up was good
All the tests were properly done
Negative
I could not find the negative data in the elog
My analysis
It could be the hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen. Hospitalisation has increased the infection to the bed sore it would have been better if discharged early as it was permanent damage and was impossible to treat anyway.
Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):
Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also 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.
Analysis the data
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
Analysis of A 35 yr old female with 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
Vegetative state of the patient could be due to hypoxia which could have caused the permanent brain damage which was the reason for her vegetative state . Subjectively she was told better but objectively no improvement was Seen.
Link supporting the data
Sepsis might be the reason for encephalopathy by altering the blood brain barrier
Q 5) Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month : (10 marks)
Reflective logging of one's own experiences is a vital tool toward competency development in medical education and research.
. By doing this assignment I could view many cases and many case scenarios through which I learned many things . i feel sad that the medicine postings are endings i learned many skills in these two months and i would like to specially thank medicine department for properly guiding us .I also learned how to interact with patients.. I had been taken part in discussions occured in wards icu and and also 2-4sessions i learned the importance of making elogs and i also made my jrns do. There were little ups and downs as this is the beginning of the internship.I would like to thank GM dept for this opportunity to explain our thoughts.
