26 Joshi Chala ayyapa

 General medicine assignment 

Monthly assignment

Question 1

Long case 

A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

Evolution of symptomatology is well described in the illness.Proper past ,personal ,family ,surgical, medical and immunization histories are provided. Differential diagnosis for the conditions he's been in are given . Classification criteria for rheumatoid arthritis is provided which gives us idea in which category patient is in based on points.The possible scenarios that can be are described in brief. Diagnostic approach is mentioned.After final diagnosis , further plan of treatment is given clearly.

Short case 

19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year,Abdominal distension and facial puffiness since 6 months.

Present illness with evolution of symptomology is perfectly described,Other histories with examinations done are given,Pictures provided clearly indicate it as a case of cushings syndrome, They also explained ruling out endogenous cushings syndrome and giving a final diagnosis of iatrogenic.

Question 2 

CASE 1:  First case: A case of acute glomerulonephritis, due to sec. Amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis. 

PROBLEM LIST : 

 Generalized edema 

( facial puffiness, pedal edema) 

bilateral symmetric, Pitting type pedal edema. 

breathlessness, palpitations or chest pain. 

Frothing of urine, decreased urine output. 

Severe joint pains. 

Burning sensation in his eyes with increased tearing. 

 Involuntary weight loss &loss of appetite. 

subcutaneous swelling in proximal joints of his fingers.

protinuria causing anasarca. 

DIAGNOSIS : 

Acute glomerulopathy (Glomerulonephritis / nephritis syndrome)  

Bilaterally symmetric  chronic progressive inflammatory peripheral polyarthritis. 

Acute Glomerulonephritis, likely due to secondary amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis. Dilutional hyponatremia secondary to anasarca due to glomerulonephritis .

Hyperuricemia likely due to decreased uric acid excretion precipitating gouty arthritis. 

Anemia of chronic disease secondary to poorly treated rheumatoid arthritis. 

TREATMENT: 

Free water restriction for hyponatremia. 

Tab. PREDNISOLONE P/O 20mg OD 

Tab FEBUXOSTAT P/O 80 mg OD

Haemodialysis for worsening renal dysfunction. 

Question 3 

Long case 

Investigations done are:-Current Admission - Blood testsBlood work from previous presentations to hospital. RA factor was negative24hrs urinary protein: 1500 mg24hrs urinary creatinine: Urine Microscopy - Freshly voided urine sample was centrifuged at high speed (> 2700 RPM) and sediment collected and fixed on glass slide and examined under microscope at 400 (10x * 40x) showed DYSMORPHIC RBCs (black circles) and occasional pus cells (red circles). Dysmorphic RBCs were those that had altered shape, microcytic or with membrane defects.

Efficacy of Treatment given:-Tab. PREDNISOLONE P/O 20 mg OD:-It is used to treat conditions such as arthritis, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies. It decreases your immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.

.

Question 4 

  I did not get chance to do elog this month 

 Question 5 

This project has taught me the fundamentals of clinical practise, such as taking a patient's history, presenting a case, and approaching a patient, among other things. Because we are unable to visit offline postings and meet the patients in person due to the pandemic, this form of eblogs has been of tremendous assistance, as we are able to take up a case and convey it in this manner even though we are not physically there in the hospital. I learned about taking a history, analysing a case, presenting a case, and a few diseases. Because it provides us with early clinical exposure, this style of learning will undoubtedly aid us in becoming better clinicians. Due to the lack of patient involvement, I have no such observations as of yet, but I anxiously anticipate them.

GENERAL MEDICINE ASSIGNMENT

2019 Batch (3rd semester)

Ch joshi Ayyappa

Roll no :26

I was given the assessment to review and analyse the elogs and clinical cases. 

QUESTION  1:    peer review

 Link: https://snehithachintala31.blogspot.com/

I chose my friend snehitha,roll no.31 as reference for reviewing a blog.

She took a neurology case and gave reviews to 10 random answers,even I studied the case thoroughly and also 10 random answers which was mentioned in her blog.

Neurology case details was given in following link:

https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html

My analysis of case:

The patient was talking,as well as laughing to himself. He was also unable to lift himself off the bed and move around,and had to be assisted.

All the above things are signs of mental confusion.

He was alcoholic, had stopped drinking .he

developed seizures following cessation of alcohol for 24 hrs, which was associated with restlessness, sweating and tremors.

All the above are signs of alcohol withdrawal delirium.

Albumin is decreased,this may indicate liver or renal problems.

Most probable diagnosis would be 

1.Wernicke's encephalopathy secondary to chronic alcohol dependence.

2.Alcohol withdrawal delirium.

The 10 random answers of the above case reviewed by my friend were correct and had valid points.

Another case was also mentioned by her.

Link:https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1

She provided all the useful leads to analyse the diagnostic and therapeutic uncertainties around the case.

The efforts made by my friend were really admirable. I really appreciate her work in understanding and making the elog appropriately.

QUESTION  2:

I haven't yet got the chance to do the elog. I will try best to do elog when I get a chance

QUESTION  3:

I studied few renal failure cases.

Case 1 :AKI Link to the case is below :

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

 After reading the case,my analysis is

- patient is suffering from burning micturition,chills,back pain and decreased output of urine.All these are symptoms of UTI and AKI.

This shows acute kidney injury, secondary to UTI.

Evidence of infection for diagnosing urinary tract infection:

Bacterial culture and sensitivity report shows presence of polymicrobial flora and plenty of pus cells in urine.

 Case 2: Patient with acute on CKD Link to the case is below :

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

As given patient is diagnosed initially  with diabetes mellitus- 2,gradually develops severe diabetes and is on insulin treatment. Severe diabetes causes damage to filtrating system and blood vessels of kidney. As filtrating system is damaged creatinine and urea levels are altered. Severe diabetes leads to diabetic nephropathy, which causes water 

retention leading to hydroureteronephrosis.

By examination of urine sample as it contains pus cells it is diagnosed with pyuria, caused due to bacterial infection leading to urinary tract infection which leads to urosepsis.This causes burning micturition. Fever is due to infection.

This urosepsis leads to AKI(Acute kidney injury)

Case 3:   patient with AKI Link to the case is below :

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

The patient is alcohol addict. Due to increased alcohol intake liver cannot process it which leads to inflammation causing to alcohol hepatitis,

He is diagnosed with acute gastroenteritis.the virus infects the small intestine lining and increase its permeability causing watery diarrhoea.It also leads to low blood flow to kidney causing AKI.

Urine output decreases.

The inflammation of liver slows down the blood flow through it,thus there is increase in pressure in veins which bring blood to liver.

The increased pressure in portal vein causes fluid to accumulate in legs(edema)pitting type and also causes ascites(fluid accumulation in abdomen).

As he is alcohol addict having high blood pressure can have a high risk of coronary artery diseases.

Case 4 :  Patient with coma and renal failure    Link to the case is below :

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

⇒This is also a case od diabetic with breathlessnes. The pt. was diagnosed with Type 2 Diabetes 3 years ago and was put on some oral hypoglycemic agents.

QUESTION  4:

Case 1: 

Diagnosis : AKI secondary to UTI, associated with Denovo - DM -2 

Treatment : 

1)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

Case 2:

Diagnosis: Renal AKI secondary to urosepsis with b/L hydroureteronephrosis

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

Case 3:

Diagnosis:  Chronic interstitial nephritis secondary to plasma cell dyscariasis

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  

Case 4:

Diagnosis: DKA with AKI 

Treatment:

Inj. NORAD 2amp in 50ml NS

Inj. PIPTAZ 2.25gm.

Inj. DOPAMINE 2amp in 50ml

Inj. HAI 1ml in 39ml NS

QUESTION  5:

This project has taught me the fundamentals of clinical practise, such as taking a patient's history, presenting a case, and approaching a patient, among other things. Because we are unable to visit offline postings and meet the patients in person due to the pandemic, this form of eblogs has been of tremendous assistance, as we are able to take up a case and convey it in this manner even though we are not physically there in the hospital. I learned about taking a history, analysing a case, presenting a case, and a few diseases. Because it provides us with early clinical exposure, this style of learning will undoubtedly aid us in becoming better clinicians. Due to the lack of patient involvement, I have no such observations as of yet, but I anxiously anticipate them.