July assessment
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.
Considering this case, I've reviewed 10 cases.
https://34vijayaratnadande.blogspot.com/2021/07/bimonthly-blended-assessment-june-2021.html?m=1
Case 1
Pulmonology
Diagnosis : COPD secondary to Bronchiectasis
In my opinion
It could be due any infection. In my opinion it could be due to allergy ie hypersensitivity due to weather conditions in January ... As patient has repeated episodes of symptoms .
Case 2
Neurology case
http://bejugamomnivasguptha.blogspot.com/2021/05/a-45-years-old-female-patient-with.html
In my opinion
Patient was diagnosed with cervical spondylosis and recurrent hypokalemic paralysis.
About the answers given..anatomical localisation is mentioned and primary etiology is discussed deeply.. And causes of the symptoms are explained and possibility of other diseases are mentioned. Tables are used to explain clearly.. Risk factors of hypokalemia are mentioned and ecg changes in hypokalemia are explained with diagram. Usage of tables and diagrams made this presentation a bit more effective.
Case 3
Neurology
https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html
Diagnosis: wernickes encephalopathy secondary to chronic alcohol dependence .
In my opinion
GRBS - general random blood sugar test was done in this patient to have a check on his Diabetes . He was a chronic alcoholic so in order to prevent neurological symptoms patient was given Thiamine . Ringers lactate was given for treating Dehydration
Case 4
https://kausalyavarma.blogspot.com/2021/05/a-52-year-old-male-with-cerebellar.html?m=1
In my opinion
Patient had infarct in inferior cerebellar hemisphere due to which he developed bilaterally hearing loss and was treated with vertin tab. Thiamine was administered as the patient was alcoholic which may result in wernickes encephalopathy . He was also given MVT tab as he was a known case of vit B12 deficiency
Case 5
https://muskaangoyal.blogspot.com/2021/05/a-78year-old-male-with-shortness-of.html
In my opinion
The patient was presented with shortness of breath, chest pain and B/L Pedal edema. The patient is a chronic smoker and alcoholic but assymptomatic since 1 month and suddenly developed SOB-Grade3.They did 2Decho and ECG and found out some abnormalities. As the patient had no improvement in symptoms he was advised for higher investigations. The video of the patient reveals the complete picturisation to analyse the disease. I feel the presentation was very accurate and complete information is analysed.
Case 6
https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html
Case of atherosclerosis.Anatomical site is blood vessels,due to arterialThrombosis,arteries become harden and narrow,hypertension is observed.cardiorenal syndrome type 4 is observed.
Drugs like tab dytor,tab cardivas,tab digoxin are recommended.The presentation is clear and good.
Case 7
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html
In my opinion
Case of acidosis caused by diuretics.she is presented with shortness of breath, hyponatremia which causes drowsiness.
Complications are difficulty micturition,electrolyte imbalances,turp syndrome.
Case 8
https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html
In my opinion
The patient was diagnosed with pancreatitis, pseudocyst and left bronchopleural fistula. They have clearly explained his symptamology in a sequence and did the necessary investigations required in this case. Clinical examination is shown clearly in the video. They clearly stated the indications and mechanism of action. The efficacy of the drugs was mentioned and standard sources were used. The presentation was very clear and comprehensive
Case 9
https://nehae-logs.blogspot.com/2021/05/case-discussion-on-25-year-old-male.html
In my opinion
For diagnosis of any case, history taking and timeline of the patient plays a key role which is highlighted here.Also after the case diagnosis etiology plays a pivotal role which is explained here with many beautiful flow charts for both timeline and the etiology of the case.
Case 10
http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html
In my opinion
Primary aetiology: Diabetic ketoacidosis promoting infection with mucormycosis is given.The efficacy of drugs is given and mechanism of action of drugs is given
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 , rest :1week
Apprisal
Case history was taken well and examination was very well done... Sequential evaluation of case is apprisiable
Negative points
It would be better if fever chart is added as it was treated with strict temp and IO 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
I would not find any points to be highlighted . History was taken well
Negative points
There are no clinical pics of the symptoms like pedal edema.
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 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
There are no clinical pics of the symptoms like pedal edema.
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.
https://pubmed.ncbi.nlm.nih.gov/19362767/
Link supporting the data
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.
The telemedical learning from the hospital has been a new experience and we learnt quite lot of things through reflective observation during lockdown. it's a bit challenging as we have just entered internship ,We have learnt elogging of the cases in a very short span of time and made juniors do so. I could answer the questions from juniors easily as I have been part of many discussion in ICU and wards . By doing this assignment I could view many cases and many case scenarios through which I learned many things
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