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.
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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.
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