GENERAL MEDICINE ASSIGNMENT-2021
NAME : Luckshetty Nitin Kumar
ROLL NO : 70
Below is the link to the questions given to us:-
http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1
we have been given 5 questions to assess the ability to connect with and capture patient-centered data and the ability to connect with and engage in shared learning with their peers through peer review feedback.
QUESTION-1
Q1)
He has chosen 10 cases of different branches and even i have gone through all the cases that he picked and i felt his insights for each cases was very precisely and accurately written and was presented in a very relevant manner.
Q2)
He has not been assigned a case.
Q3&4)
• he has taken an heart failure with reduced ejection fraction with atrial fibrillations case of 70 years old female.
• he has explained about his present and past and drug history in a very detailed and precised manner.
• he has also attached the investigation reports and the treatment protocol followed.
Q5)
He gave a genuine review and his honest feeling.
QUESTION-2
still didn't get a chance to do a E log.Once its completed shall be updated here
QUESTION-3
CASE NO :1
AKI
CASE LINK:
INSIGHTS:
Histories personal present and past have been taken in chronological order.Diagnosis and treatment must have been explained a little more. How was the lower back pain ruled out is also not explained.
CASE NO :2
ACUTE ON CKD
CASE LINK:
INSIGHTS:
The evolution of symptomatology could've been in order . Treatment is given in order date by date which makes it easier to look for . And the history of patient is described well . Treatment history could've been mentioned. Investigations done are proper and the provisional diagnosis also is being explained well by them .
CASE NO :3
CKD
CASE LINK:
INSIGHTS:
The case was comprehensive and concise and we'll be excreted. All the necessary information was provided and even the investigation with reports and histology slides of the plasma cells was also uploaded.Discharge date and summary mentioning must also be considered important.
CASE NO :4
COMA AND RENAL FAILURE
CASE LINK:
INSIGHTS:
Day to day treatment details are mentioned clearly . Pictures are also included , detailed reports have been provided . But history and treatment have been repeated . Log was very impressive . diagnosis should have been more clear.
CASE NO :5
COMA AND RENAL FAILURE
CASE LINK:
INSIGHTS:
The case is well explained with pictorial depictions, and the vedioes of 2 d echoes were also provided. A detailed treatment plan is given. Details of discharge summary and treatment faculty have been provided . Pictures , videos were included . Advice at discharge is also mentioned .But drug history has not been mentioned.
CASE NO :6
ACUTE ON CKD
CASE LINK:
INSIGHTS:
The log was exceptionally done .it is clear and precise. Comparisons between before and after treatment were done and the diagnosis was made clear.
CASE NO :7
ACUTE ON CKD
CASE LINK:
INSIGHTS:
Well presented blog . It was clear and comprehensive . Important details have been highlighted . Necessary links have also been provided .
CASE NO :8
ACUTE ON CKD
CASE LINK:
INSIGHTS:
The case was not so clear as there were many assumptions in the condition and the patient was symptomatically treated.Discharge summary is not mentioned .
CASE NO :9
AKI
CASE LINK:
INSIGHTS:
The case is done precisely with chronological history and day-wise observations and treatment. the case is clear and pictorially assisted well. Present, past, family history have been mentioned. Pictures of general examination have also been provided.
CASE NO :10
AKI
CASE LINK:
INSIGHTS:
Log was Impressive. The information was clear. It is well assisted with pictures. Treatment and diagnosis are well mentioned. All the required investigation reports and details are provided.
CASE NO :11
AKI
CASE LINK:
INSIGHTS:
Log was clear and precise .Day to day treatment have been mentioned. All the necessary details are mentioned. The case summary has also been provided wich helps in easy understanding. The log was clear and precise. the case summary has been provided which helps in easier understanding.
QUESTION-4
1)
Diagnosis
Acute kidney injury( AKI) 2° to UTI,
Treatment
1)IVF : -RL @ UO+ 30ml/hr
2)SALT RESTRICTION < 2.4gm/day
3)INJ TAZAR 2.25gm IV/ TID
4)INJ PAN TOP 40mg IV/OD
5)INJ THIAMINE 1AMP IN 100ml NS IV/TID
6)TAB. PCM 500mg PO/ SOS
7)INJ HAI S/C ACC TO SLIDING SCALE
8)INFORM GRBS
9)GRBS - 6th Hourly
10) BP/PR/TEMP - 4th Hourly
11) I/O - CHARTING (STRICT)
12)T. ULTRACET PO 1/2 TAB QID
2)
Diagnosis-
Acute renal failure (intrinsic)
Grade 1 L4-L5 Spondylodiscitis, Multifocal infectious Spondylodiscitisl
Treatment
IVF - NS-0.9% @100ml/hr
• Inj. Tazar 2.25gm I.V -TID
• Inj. Lasik 40mg I.V -BD
•Nebulization Salbutamol -4th hourly
• Inj. Pantop 40mg I.V -OD
• Tab. PCM 650mg -TID
• Foleys catheterization
• Temperature ,Bp, PR Charting hourly
• Strict IO Charting
•GRBS -12th hourly
• Inj.25% D with 10units of insulin IV -slow for 1hr
3)
Diagnosis
CKD? Chronic interstitial nephritis is secondary to plasma cell dyscrasias, (multiple myeloma - 70% plasmacytosis).
Treatment
T. PAN 40mg /PO / OD
- oral fluids up to 1.5 - 2 lit / day
- Protein - x ( plant-based ) 2 tablespoons in 1 glass of milk
- Donot give IV fluids unless instructed
- T. ZOFER 4mg / PO / SOS
- Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved )
- TAB NODOSIS 550 BD
4)
Diagnosis-
DKA with AKI ( ? Pre renal)
Treatment
Inj. NORAD 2amp in 50ml NS
Inj. PIPTAZ 2.25gm.
Inj. DOPAMINE 2amp in 50ml
Inj. HAI 1ml in 39ml NS
Inj. CLEXANE 40gm.
Iv infusion NS RL @100ml/hr.
Inj. LEVOFLOX
Inj. VANCOMYCIN
5)
Diagnosis-
INFECTIVE ENDOCARDITIS
WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR WITH AKI
WITH?UREMIC ENCEPHALOPATHY? SEPTIC ENCEPHALOPATHY
WITH ULCER OVER SOLE OF RIGHT LEG
WITH HYPOALBUMINEMIA? ALCOHOLIC LIVER DISEASE
WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES
Treatment
1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Proctor lysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
Inj. Augmentin 1.2 gm IV/TID
Tab. Ecospirn 150mg PO/HS/SOS
Tab. Clopidogrel 75mg PO/HS/SOS
Tab. Atorvas 20mg PO/HS/OD added
6)
Diagnosis
Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bedsore
Treatment
Injection PAN TOP 40mg IV/OD
Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
Injection LASIX 40mg IV/BD
Injection optineurin 1AMP in 100ml NS slow IV/OD
Injection NEDMOL 100ml IV/SOS
Tab PCM 650mg TID
Insulin Human actrapid - 16 IU/TID
7)
Diagnosis
HFrEF secondary to CAD; CRF
Treatment
1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GASOLINE OD
8.TAB. ecosprin-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml
8)
Diagnosis
Interstitial lung disease,
? Right heart failure.
Acute kidney disease.
Treatment:-
1. IV fluids
2. Tab. Pan 40 mg PO OD
3. Inj. Lasix 80 mg IV BD
4. Thiamin 200 mg in 100 ml NS IV BD
5.Tab. Levocet 5 mg Po BD
6.Liquid paraffin for LIA
7.Grabs 6 the July
8.I/o charting, temp. Charting
9)
Diagnosis
ALCOHOLIC HEPATITIS,
AKI SECONDARY TO ACUTE GASTROENTERITIS
Treatment
- INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
- INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
- INJ LASIX 40 mg
- TAB. ALDACTONE 50 mg PO / BD
- INJ PAN TOP 40 mg IV/ OD
- ABDOMINAL GIRTH MEASUREMENT DAILY
- BP /PR/TEMP/ RR -4 hourly
- I/O CHARTING
10)
Diagnosis -
- Acute kidney injury secondary to urosepsis
Treatment
- Inj LASIX 40 mg IV/TID 1 -1 - 1
- IVF - NS @ UO + 50 ml/hr
- Inj MAGNEXFORTE 1.5 gm/IV/BD
- Tab NODOSIS - 500 mg PO/OD
- Tab OROFEA - XT PO/OD
- Inj HAI s/c
- Neb plain Asthalin 2 respules QID
- Strict I/O charting
- Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
11)
Diagnosis -
Acute pancreatitis with AKI
with ?B/L pleural effusion and moderate ascites.
Currently in ? Alcohol withdrawal.
with ?B/L pleural effusion and moderate ascites.
Currently in ? Alcohol withdrawal.
Treatment
Iv fluids : NS 40 ml /hr.
IV lasix 40 mg BD .
Tab Nodosis .
IV PIPTAZ 4.5 Gms. BD
Iv 25%Dextrose. 100 ml BD
Tab . Nicardia 10 mg TID.
QUESTION-5
To have a good understanding in case taking and making e-log of patient's data , it is necessary to have a practice of history taking ,which for us is complicated because of this pandemic . Though it's tough time , our general medicine department is putting efforts in making us understand every case possible. And my experience towards this type of learning online was really good and made it more interesting. This type of learning would definitely make it more effective offline. And I hope it will be easier when we attend offline postings .
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