Bimonthly Blended Assignment for June 2021
Link to Question Paper:
Question 1: Competency tested for Peer to peer review and assessment :
Please go through one particular answer of ten students in this link:
https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1
and share your peer review of each answer with your quantitative marking input as well as qualitative insights into what was good or bad about the answer.
Answer Q1)
After going through one particular answer 10 students in this link, my review on their answers is as follows:
1) PULMONOLOGY
PATIENT DETAILS :
https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html
REVIEWS FOR THE LINK :
http://haqansariblogformonthlyassiggnment.blogspot.com/2021/06/questions-1-what-is-evolution-of.html
1. Reason for patient's SOB is explained properly i.e., due to pollen and dust from paddy fields. - -Anatomically it is localized to lower air ways[from CT Finding] and etiology lies in the fact that patient had been chronically exposed to lung irritants
2. even in my view placebo cannot relive any of patients discomfort and I agree with chest physiotherapy ,head end elevation , BiPaP-augmented lung expansion. MEDICATION; azithromycin ,lasix ,nebulization with budecort
reasons for her exacerbation are true because she is continuously exposed to allergens[paddy and pollen] , also due to viruses like rhinovirus , influenza , pnemococcus
3. NO, Anti tubercular drug treatment did not affect her symptoms
4. yes, drug induced hyponatremia i.e., telmisartan could have caused electrolyte imbalance
2) NEUROLOGY
PATIENT DETAILS :
https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html
REVIEWS FOR THE LINK :
https://mdparvezahmedansari.blogspot.com/2021/06/medicine-blended-assignment.html
1. Etiology is stated accurately i.e., alcohol withdrawal and symptomatology stands the same [seizures, tremors, restlessness]
2 Thiamine, lorazepam, Kcl are standard medication in my view
3 Alcohol withdrawal symptoms will fit the best
4. It is right decision to give thiamine since it is majorly involved in ATP and NADH production
dehydration is the only probable cause for dehydration in my view
5. The mentioned reason is appropriate i.e., alcohol decreases iron absorption and bleeding ulcer is cause for normocytic anaemia
6. yes aggrevated ulcer is due to both combined effect of diabetes and peripheral neuropathy
3) CARDIOLOGY
PATIENT DETAILS :
https://muskaangoyal.blogspot.com/2021/05/a-78year-old-male-with-shortness-of.html.
REVIEW FOR THE LINK :
https://meesumabbas82.blogspot.com/2021/05/case-opinions-may-2021.html
1. differences between heart failure with preserved ejection fraction and with reduced ejection fraction are explained in detail. causes for Heart failure with reduced ejection fraction are also mentioned
2. decision for not performing an unnecessary procedure [pericardiocentesis] was wiser
3. list of risk factors for heart failure given stand true here
4. several causes for hypotension are mentioned
4) GASTROENTEROLOGY(& PULMONOLOGY)
PATIENT DETAILS :
nakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html
REVIEW FOR THE LINK :
https://sofiajabeen1912.blogspot.com/2021/05/pulmonogy-1.html
1. Time line of symptomatology is illustrated briefly in a photograph
2. Efficacy and mechanisms of drugs is explained in brief
5) NEPHROLOGY
PATIENT DETAILS :
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html
REVIEW FOR THE LINK :
https://abhignyareddy71.blogspot.com/2021/05/online-blended-bimonthly-assignment.html
1. Cause for SOB is correct (i.e., due to usage of diuretics)
2. The cause for drowsiness is effectively illustrated in a photograph
3. Plenty of pus cells in his urine passage appeared as fleshy mass like passage ,there could be parenchyamal damage is the proper explanation
4. Information about complications of TURP are very helpful
6) INFECTIOUS DISEASE (HI VIRUS, MYCOBACTERIA,GASTROENTEROLOGY, PULMONOLOGY)
PATIENT DETAILS :
https://vyshnavikonakalla.blogspot.com/2021/05/a-40-year-old-lady-with-dysphagia-fever.html
REVIEW FOR THE LINK :
https://srinithya27.blogspot.com/2021/05/genral-medicine-e-blogs.html
1. The clinical symptoms choosed will exactly diagnose trachea esophageal fistula
2. Prevention methods adviced are best suited
7) INFECTIOUS DISEASE AND HEPATOLOGY
PATIENT DETAILS :
https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html
REVIEW FOR THE LINK :
https://muskaangoyal.blogspot.com/2021/05/bimonthly-clinical-case-assignment-1.html
1. Adverse effects of consuming locally made alcohol are explained
2. Etiopathogenesis of liver abscess in a chronic alcoholic patient is illustrated
3 .Probability of Liver abscess in its lobes is demonstrated
8) INFECTIOUS DISEASE (MUCORMYCOSIS, OPHTHALMOLOGY, OTORHINOLARYNGOLOGY, NEUROLOGY)
PATIENT DETAILS :
http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html
REVIEW FOR THE LINK :
https://143vibhahegde.blogspot.com/2021/05/medicine-blended-assignment-may.html
1. Symptomatology are described briefly event wise according to the following dates
2. Mechanism and Efficacy is properly illustrated in photograph sequentially
3. Explained the reason for sudden raise in mucormycosis in India
9) INFECTIOUS DISEASE (COVID-19)
PATIENT DETAILS
https://nikhilasampathkumar.blogspot.com/2021/05/covid-pneumonia-in-pre-existing-case-of.html
REVIEW FOR THE LINK :
https://meesumabbas82.blogspot.com/2021/05/case-opinions-may-2021.html
1. Explained about Importance of ILD in prognosis of COVID Patients
2. Provided reference link to study about effects of using steroids in COVID patients (https://www.health.harvard.edu/blog/does-lupus-or-arthritis-affect-your-prognosis-if-you-get-covid-19-2020110921230#:~:text=There%20was%20some%20good%20news,prognosis%20for%20the%20arthritis%20patients.)
3. Role of auto immune response in COVID Patients (https://www.healio.com/news/rheumatology/20210329/covid19-more-severe-than-influenza-in-patients-with-autoimmune-disease)
10) MEDICAL EDUCATION
This experience of blogging medicine cases and giving out case opinions and answers to all other patient related questions has been very illuminating and definitely an innovative approach to learning during this pandemic in my opinion.
Question 2-4:
Patient centered data
captured by students from 2016 batch in the link below:
MULTISYSTEM:
https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1
CNS :
https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1
Renal :
https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1
Captured by one student from 2017 batch in the link below :
CVS :
https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1
Captured by one student from 2019 batch in the link below :
Abdominal :
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
Question 2: Share the link to your own case report 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 Q2)
http://rishik37.blogspot.com/2021/07/gm-elog-case-5.html
Question 3: (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.
Answer Q3)
1.Multisystem disease
https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1
■COMPLETENESS OF THE FOLLOWING CASE PRESENTATION
•The case has completeness in all factors
The case begins with the chief complaint the history of presenting complaints ina a chronological order personal history is written well
the vitals have been explained
•Icterus -present is shown with image
•All Investigations done are suggesting the provisional diagnosis and any changes occuring in the patient on every day basis and uncertainties around the diagnosis have been given .
The changes in the treatment based on the patient's status
•Mention the patient when he was infected with
COVID and were there any kind of complications.
■CORRECTNESS - All the data listed here is correct as I observe
ABILITY TO PROVIDE USEFUL LEADS ON THE PARTICULAR CASE
•This may be post covid effect on liver causing FULMINANT LIVER FAILURE and HEPATIC ENCEPHALOPATHY. FLH is ~30 to 50 % cause is viral infections.
https://www.sciencedirect.com/topics/medicine-and-dentistry/fulminant-hepatic-failure
https://www.google.com/search?q=ACUTE+FULMINANT+LIVER+FAILURE,+HEPATIC+ENCEPHALOPAThy&client=ms-android-samsung-gj-rev1&hl=en-GB&prmd=ivn&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiu84vsm8fxAhUBWX0KHTYECw8Q_AUoAXoECAIQAQ&cshid=1625
2.CNS case Presentation
https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1
■COMPLETENESS -
•The history of the patient,symptoms and signs have been listed well. The clinical images were provide with the laboratory investigations.
•The patient's treatment and daily update of his status mentioned.
•The tests for cervical myelopathy when the provisional diagnosis of the patient was cervical myelopathy, would have been a good way of understanding the symptoms
■CORRECTNESS OF THE DATA
•The data that has been presented is correct
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684836/3.
3.Renal case Presentation
https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1
■COMPLETENESS -
•The e - log feels to be incomplete, as there is no update on the patient after 22 June 2021 and no discharge summary
■CORRECTNESS OF THE DATA
•The data that has been presented is correct
■ABILITY TO PROVIDE USEFUL LEADS
•Useful leads around the therapeutic uncertainties have not been provided.
examples of such leads would include - a clinical comparison of the patient's data with the case presentation on AKI on CKD
4.CVS
https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1
■COMPLETENESS -
•The e-log is complete, the history of the patient is mentioned well, each clinical investigation has been supported with videos and accurate data, the updates on the patient have been regular.
■CORRECTNESS-
•the data presented is correct
■ABILITY TO PROVIDE USEFUL LEADS
•to understand and compare the atrial fibrillation due to hyperthyroidism check for another similar cases associated.
•Traditionally, this classification of HF (ie, HFrEF and HFpEF) has been based on EF values as estimated with imaging modalities such as echocardiography, radionuclide ventriculography, contrast angiography, and cardiac magnetic resonance imaging.
5.Abdominal Case Presentation
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
■COMPLETENESS
•The case feels to be a little incomplete as
there have been no updates after 23 June, also discharge summary is not provided.
•The rest of the case has been provided well with each investigation being dated and the changes in the treatment options.
■CORRECTNESS -
•The data is presented correctly
ABILITY TO PROVIDE USEFUL LEADS -
•Leads around this case-not provided a case presentation similar to this one would have been great to compare the clinical findings and the diagnosis.
Question 4: 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.
Answer 4)
1.Multi system case presentationhttps://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1
•Chief complaint : Lower back pain . fever , yellowish discolouration of the eyes, 2 episodes of vomiting , three episodes of loose stool and blood in urine .
•Problem list :
-Temperature - Afebrile
-Icterus present
-Creatinine levels in the urine - 0.6 mg/dl <normal
-Sodium level 132 mEq/L < the normal range.
-ABG results PCO2- 17.4 mmHg <normal range and PO2 - 119mmHG >normalrange , ph - 7.26 that is acidic
-Hemogram - MCV, and MCHC of the patient are < the normal range while the MCHC is> the normal range. The patient also presents with increased RBC count
-Prothrombin time is increased -24 seconds
-Ketone bodies are present in the urine that indicates ketoacidosis
-Glycated hemoglobin is 6.6%which is higher than the normal range
-The urine is slightly acidic, contains excessive albumin, and an increased level of sugar
-C-Reactive proteins are elevated
-APTT test has a higher value than the normal range
-COVID -19 antibodies are positive
-Total bilirubin, Direct Bilirubin, Liver enzymes are all elevated
-Total serum proteins are low
-Altered sensorium
•Discussion of the diagnostic and therapeutic uncertainty :
▪︎ CT SCAN was done when the patient was suspected for an absence seizure, after the presentation of no responsiveness to verbal communication
.▪︎ COVID-positive antibodies were found
This case was one such case that explained the hepatic encephalopathy - the patient with increased liver enzymes and had an altered sensorium this caused a neurological deficit in the patient Which was treated on time
Review of literature around the topic -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111098/
2.CNS case Presentationhttps://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1
•Chief complaint: Sudden fall followed by weakness of both the lower limbs, loss of hand grip 10 days ago, bowel and bowel incontinence.
•Problem list:
-Patient a Known case of tuberculosis infection, and have loss of consciousness , generalised weakness, and myalgia
-Increased tone of the lower limbs bilaterally right and left
-Reduced reflexes bilaterally in supinator muscles of the lower limb
-Serum electrolytes evaluation found out that the sodium and chloride level in the given patient is s134 milliequivalents per liter and 96 milliequivalents per liter which is slightly lower than the normal range.
-The lymphocytes are 14 percent indicating a decrease than the normal range is 20-40 percent
-The MRI of the brain with cervical spine shows that there is significant erosion of the inferior endplate of c5 and superior endplate of c6
-An epidural abscess is seen at the level of c5-c6 that is causing the spinal cord compression and posterior displacement of the cord.
-Cord edema is present
-Subligamentous spread is seen as suggested from the prevertebral collection extending from c2 to c3
•Discussion of the diagnostic and therapeutic uncertainty :
At first the prognosis was suffering from cervical myelopathy but after the MRI done,it was known that the patient had a rapidly PROGRESSING QUADRIPARESIS
The literature surrounding the diagnosis -
https://pubmed.ncbi.nlm.nih.gov/7606123/
3.Renal disorder case Presentation
https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1
•Chief complaint : Altered sensorium, morning lethargy, fever 10 days ago, Pedal oedema with anasarca and shortness of breath even at rest.
•Problem List :
-History of hypertension
-Pedal edema with anasarca
-Known case of chronic kidney disease
-Altered sensorium
-morning lethargy
-ECG - findings - Sinus Rhythm , Nonspecific T wave abnormality , borderline echo
-Hb - 12 g/dl which is slightly less than the normal range
-Lymphocytes are reduced to 11 % < the normal range
-Urine examination, albumin levels of urine are present which is not normal
-Ultrasound report shows - CMD partially lost in the right kidney, Grade II fatty liver, simple renal cyst,
-Grade II -III Renal parenchymal disorder
•Discussion of the diagnostic and therapeutic uncertainty :Renal Parenchymal Disorder
The investigations taken were :
Complete blood picture
Complete urine examination
ECG
Ultrasound
HbsAg-rapid
Anti HCVAb -rapid
HIV-rapid
4.CVS casehttps://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1
•Chief complaint: Distension of abdomen and shortness of breath since 5days
•Problem List:
-Shortness of breathe
-Abdominal distension
-Hypothyroidism
-Feeble pulse rate
-Hb - 10.3 gm/dl lower than the normal range
-PCV, MCV,MCH lower than normal
-Elevated levels of HbA1c- 6.7 percent
-Random Blood sugar - 85 mg/dl lower than the normal range
-ECG abnormal
-2d- ECHO - Pleural effusion , Mild Pericardial effusion
•Discussion of the diagnostic and therapeutic uncertainty :
HFrEF with Atrial fibrillation 2° ?IHD
compare the atrial fibrillation due to hyperthyroidism check for another similar cases associated.
5.ABDOMINAL CASE
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
•Problem list
-Pedal edema
-Known case of DM type 2
-Acute kidney injury secondary to urosepsis
-Decreased urine output, burning micturition
-High Blood Pressure - 170-110 mmHg
-Pulse rate is high - 111 beats per min
-Ultrasound Examination - Right kidney had grade I Renal parenchymal disease , Left kidney had Grade II Renal parenchymal Disease
-Raised serum creatinine - 3.4 mg/dl
-Raised Blood Urea- 65 mg/dl
-Serum eleclytes - Potassium level raisedd - 5.3 milli equivalents/L
•Discussion of the diagnostic and therapeutic uncertainty :
Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease
Question 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.
A sample answer to this last assignment around sharing your experience log of the month can be seen in one student's answer to Q10 in the May 2021 assignment in the link below:
https://drsaranyaroshni.blogspot.com/2021/05/assignment-patient-centred-learning.html?m=1
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 5)
In the last month , we began our general medicine internship postings. Due to the ongoing pandemic, classes were taken online which was making it slightly challenging for us to follow. Nevertheless, it has been a great change for us to come back to posting in person and to be informed about the day to day happenings of the hospital. They help us apply our subjective knowledge in a clinical setting which helps to form a bridge between both. Although the wards are extremely chaotic, professors and PG’s have been doing their best to pass on their knowledge to us and it is very encouraging for interns to be present in a clinical setting. It helps us understand how much practical knowledge differs from reading books and to experience it all as interns has been a refreshing experience. We greatly appreciate the opportunity given to us and are trying to utilize it thoroughly. I have learnt several practical aspects of being a doctor. I also got to understand the grievances of patients and how important it is to provide a healing atmosphere for their recovery. Our HOD of General Medicine, Dr. Rakesh Biswas has been explaining each and every single case along with the pathophysiology of symptoms and further complications. Discussions on the cases with my peers and juniors helped me understand multiple ways to go about relating the symptoms to different organ systems and in understanding the etiology of the diseases. Interactive learning is taking up a huge role in our academics and it will make me a better part of a medical team. I thank our General medicine department for presenting us this great opportunity.
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