90 Mutyapu Raghavendra
Medicine Department Bimonthly Blended Assessment - June 2021
This is the link to assignment/question paper :-
I have been given the following assessment in the theme of “scholarship of integration in medical education and research” which is a tool to facilitate connections between different systems or disciplines of “knowledge” or learning in healthcare.
Question 1 :-
1. Pulmonology:-
Review of :-
This is a case of acute exacerbation of COPD associated with right heart failure and bronchiectasis. The evolution of the symptomatology in this patient in terms of an event timeline is depicted well in a picture which is very easy to comprehend. I personally believe that a picture can depict more than a thousand words. The localisation of the problem along with its aetiology is addressed. Various mechanisms of action, indication and efficacy over placebo of each pharmacological and non pharmacological interventions used for this patient has been suggested. The cause for patients acute exacerbation and electrolyte imbalance has been addressed.
2. Neurology:-
Review of :-
This is a case of wernicke’s encephalopathy secondary to chronic alcohol dependence, uraemic encephalopathy along with alcohol withdrawal delirium.
The symptomatology of patient in terms of an event timeline has be noted in a paragraph. Anatomical localisation of the problem, that is lesions in different parts of brain, has been addressed. Mechanism of action of various pharmacological and non pharmacological interventions used for this patient such as thiamine, lorazepam, pregabalin, lactulose etc., along with their indications have addressed perfectly. The reason for kidney injury along with the cause of normocytic anemia in the patient has been given. Also how and why chronic alcoholism have aggravated the foot ulcer formation has been addressed.
3. Cardiology:-
Review of :-
The table of biomarkers in the heart failure with a reduced versus preserved ejection fraction has given of in a picture format which is very easy to comprehend and differentiate between them. Evolution of symptomatology and anatomical localisation of problem has been addressed, that is of course the cardiovascular system. The etiology of the patient has been addressed as atherosclerosis ie., build up of fatty and fibrous material inside the wall of arteries as plaque. Pharmacological interventions, their mechanisms, indications along with their contraindications has been well provided. Various provider and patient related factors have been noted.
4. Gastroenterology and pulmonology:-
Review of:-
Evolution of symptomatology has been addressed in an order. Anatomical localisation of the problem is noted as in pancreas and left lung. Primary etiology of patients problem has been addressed. Various pharmacological and non pharmacological treatment modalities have been noted which included drugs such as meropenam, amikacin, metrogyl along with their doses and routes of administration. All the above injections are used as antibiotics to control infection and to prevent septic complications of acute pancreatitis. Ing thiamine is also addressed to be given because due to long fasting and TPN usage, body may develop thiamine deficiency. Also B1 is used as a prophylactic supplementation of wernicke encephalopathy.
5. Gastrology:-
Review of:-
Answer has been presented well with various pictures and flow charts which made it easy to follow up and understand it. Anatomical localisation of the problem along with its primary etiology has been described. Various pharmacological interventions have been noted. Even though various routes of drug administration has been addressed, the doses have not been noted. Various pictures and flow charts has made it very convenient to understand.
6. Nephrology:-
Review of:-
Answer to each of questions has been addressed in a orderly manner. Pictures of pathogensis along with flow charts has made the answer easy to interpret and understand. Indications of various pharmacological along diagnostic procedures has been listed out. Indications of ultrasound guided aspiration of liver abscess have been noted.
7. Infectious disease( Hi virus,mycobacteria,gastroenterology,pulmonology)
Review of:-
Clinical history and physical findings which are characteristic of tracheo oesophageal fistula has been noted. Basis of immune reconstitution inflammatory syndrome (IRIS), a condition seen in some cases of AIDS or immunosuppression has been explained well.
8. Infectious diseases and hepatology:-
Review of:-
Answer has made it clear that amoebic liver abscess(ALA) is the common manifestation in consumption of toddy, a local alcoholic beverage consisting of fermented palm juice. The eitopathogenesis of liver abscess has been well explained. Detailed presentation of every question has been given well.
9. Infectious disease(mucormycosis):-
Review of:-
The evolution of the symptomatology in patient in terms of an event timeline has been presented well. The anatomical localisation along with the primary etiology of the patients problem has been addressed. Efficacy of various drugs used along with other non pharmacological interventions has been given such as inj liposomal amphotericin B, 200 mg of litraconazole and deoxycholate, which is based on article published in pubmed. Management of diabetes keto acidosis such as through fluid replacement, electrolyte replacement and insulin therapy has been well explained.
10. Infectious disease (COVID-19):-
Review of:-
Answer has been presented in a well orderly manner. The effect of administration of steroids for COVID on patients’s RA has been explained, although their effect on hypothyroidism has not been described. Also the reason why patient was prescribed with clexane has been described. The mechanism by which Covid 19 infection can precipitate diabetes has been explained well. Various other conditions and their association with Covid 19 has been described very well which made it easy to understand and comprehend.
Question 2:-
Question 3:-
https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1
This case a case of "Quadriparesis secondary to infectious spondylitis of c4, c5, c6, c7 and d1 with epidural abscess at c5 - c6 level". Details of general and systemic examination has been provided. All the necessary investigations such as blood urea, serum creatinine, complete blood picture, serum electrolytes, ECG and Chest X-ray have been done. These investigations are very important to assess a diagnosis.
Treatment given to the patient:-(On day 1)
1. Inj. Optineuron 1Amp in 100ml NS IV/OD
2. Inj. Thiamine 200mg in 100ml NS IV/TID
3. ATT - according to body weight 2 tab PO/OD
4. Bp/ PR/ Spo2/ Temp charting
Patient was also advised at discharge to be referred to higher center for neurosurgical decompression as MRI showed many other anomalies one of which is infectious spondylitis of C4, C5, C6, C7 and D1 vertebral bodies with significant erosion at C5-C6 level and the intervening disc space.
Day to day monitoring of patient has been done. Treatment for the patient in day2&3 was same as day1. On day 4 inj monocef was added.
At last, overall case presentation was great.
Question 4:-
This is a case of “Heart failure with reduced ejection fraction(HFrEF) with atrial fibrillation”. General and systemic examination of patient has been carried out systematically. Investigations done on the patient are ECG, 2D echo, troponin levels, complete blood picture, serum electrolytes, Hiv1/2 rapid test, glycated Hb, CRP, blood urea, HBdAg and serum creatinine. All theses investigations are definitely needed to assess the heart physiology.
Patient treatment plan:-
1.Inj. Amiodarone 150 mgIV stat (2 doses)
2.Inj.Amiodarone infusion
1mg/min till 6hr f/b 0.5 mg/min for next 18 hours
3.Inj.clexane 40mg Sc O
An attempt for defibrillation has been done on patient. But unfortunately we lost our patient.
Overall case presentation was great and all the necessary investigations have been done and presented well.
Question 5:-
My tele-medical learning experience:-
Honestly I was initially worried that in this lockdown I was going to miss the clinical aspects in the medicine. But, these online platforms along with immense help of our professors, PG’s and interns has made medicine to learn even from home during this lockdown.
This type of learning is not as good as compared to regular classes and posting as there we can physically see and interact with patients. Also this type of learning was not bad either as I was able to learn and understand clinical aspects with the help of our teachers. I honestly didn’t expect to learn this much from home.
I sincerely thank all my professors and everyone for their efforts to make us understand and learn from home during this pandemic.
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