90 Mutyapu Raghavendra

Medicine Department Bimonthly Blended Assessment - August 2021

This is the link to assignment/question paper :

https://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html?m=1

Q1) (Testing peer review competency in the active reader of this assignment) :

Please go through the long and short cases in the first link 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.
Please provide your peer review assessment on not only the the student's written case report but also the reading of the cases followed by the question answer session linked above in the video and share your thoughts around each answer by the student along with your qualitative insights into what was good or bad about the answer.

Answer:

1. Long case

This is a case of “Acute Glomerulopathy” (Glomerulonephritis / Nephrotic syndrome) 

Case was excellently presented by covering all the aspects. History taking was perfect. All the relevant investigations were done with respective to the case. Patient’s privacy was well respected and relevant images was posted after being cropped. Treatment plan was also noted well. All the pedagogic questions were well answered, by quoting from different journals.

2.  Short cases

A. Short case 1:

History was very well noted. All the relevant investigations were done. Treatment plan was also noted.

B. Short case 2:

History was noted well although subheading were missing. All the relevant investigations were done. Treatment plan was also noted.

Q2: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):
Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. 

Answer:

1. Long case

Problem list:

1. Facial puffiness
2. Bilaterally symmetric pitting type pedal edema 
3. Decreasing urine output since 3 days
4. Burning sensation in eyes with increased tearing but no visual deficits
5. Bilateral periorbital puffiness
6. Pallor +
7. Leukonychia
8. Severe pain on active movements of flexion and extension of elbow of both sides
9. Mild pain with supination and pronation of elbow of both sides
10. Mild active and passive limitations of all range of movements of shoulders of both sides
11. Severely limited and extremely painful active movements of flexion, extension, radial  deviation and ulnar deviation of wrists of both sides
12. Severe pain and severe limitation of active movements of flexion, extension and ulnar and radial deviation of MCP joints; severe pain and limitation of active and passive movements of flexion and extension at PIP joints of both the hands
13. Limitation of passive movements of flexion and extension of hip joints of both the sides
14. Swelling and erythema of knee joints of both the sides
15. Mild pain and limitation of active and passive movements of plantar flexion and dorsiflexion; Mild pain and limitation of movements of inversion and eversion of ankles of both the sides
16. Mild pain and limitation of passive movements of flexion and extension of MTP joints of foot of both the sides

2. Short cases:

A. Short case 1:

Problem list:

1. Progressive asymmetric involuntary movements of his right index and middle finger
2. Stiffness in wrists ( Right > left )
3. Difficult walking with small, short steps and a forward stoop 
4. Loss of sexual desire
5. Great difficulty to walk in dark since 2 months
6. Prosody impaired 
7. Resting tremors of right upper limb
8. Gait - reduced arm swing
9. The movements in the right lower is slower than the movements in the left lower limb
10. Postural hypotension
11. Erectile dysfunction +

B. Short case 2:

1. Itchy ring lesions over arms, abdomen, thigh and groin since 1 and half year 
2. Purple stretch marks all over the abdomen, lower back, upper limbs, thigh since 1 year
3. Abdominal distension
4. Facial puffiness
5. Pedal edema
6. Low back ache
7. Feeling low
8. Weight gain
9. Loss of libido
10. Erectile dysfunction
11. Gynecomastia
12. Buffalo hump
13. Sparse scalp hair

Q3) Testing competency in "Evidence based medicine": 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. 

Answer:

1. Long case:

Diagnostic interventions:

All the relevant investigations were done -

X ray of hands and wrist, Chest X ray,  X ray of foot, ECG, CUE, ESR, CBP, Urine analysis

Therapeutic interventions:

1. Free water restriction for Hyponatremia

2. Tab. PREDNISOLONE P/O 20 mg OD

3. Tab FEBUXOSTAT P/O 80 mg OD

4. Haemodialysis for worsening renal dysfunction

2. Short cases:

A. Short case 1:

Diagnostic interventions:

ECG, 2 D Echo

Therapeutic interventions:

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD

B. Short case 2:

Diagnostic interventions:

CBP, LFT, RFT, CUE, RBS, USG Abdomen, ECG, 

Therapeutic interventions:

All the Necessary therapeutic interventions were done.

Q4) Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :

Share the link to your own case report this month 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.

Answer:

https://mutyapuraghavendra.blogspot.com/2021/08/a-70-year-old-female-with-chief.html

Q5) Testing scholarship competency in logging reflective observations on your concrete experiences of this last month : (10 marks)

Please reflect on and share your telemedical learning experiences from the hospital as well as community patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.

Answer:

My Telemedical learning experience:

This month login experience was fun. I had got a case which was very interesting. I had learned many things from this case. Also by going through many e blogs and also with this assessment I learned many clinical related aspects.

Although we were in campus we haven’t still got the clinical postings time table. And compared to last month, this month login experience was not than good in my opinion because in last month at least we have seen patients through online sources but this month we have seen none.

Nevertheless, our intern Dr Roshini ma’am has guided me very well during my elog preparation and I also have learnt many other clinically related things from her. I’m really thankful to her for all her time and efforts.

I really thank Dr. Rakesh Biswas sir and all other PGs, interns and everyone for their time and efforts to teach us.