PARAPERESIS

 ELOG GENERAL MEDICINE BIMONTHLY ASSIGNMENT AUGUST 2021

August 24, 2021

LUCKSHETTY NITIN KUMAR

Roll no 70

2019(3rd sem)

This blog is an assessment for questions linked below:

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

QUESTION-1

**Critical appraisal of the captured data and peer review 

https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

https://youtu.be/953auU42R0k

LONG CASE:

A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

Evolution of symptomatology is well described in the illness.Proper past ,personal ,family ,surgical, medical and immunization histories are provided. Differential diagnosis for the conditions he's been in are given . Classification criteria for rheumatoid arthritis is provided which gives us idea in which category patient is in based on points.The possible scenarios that can be are described in brief. Diagnostic approach is mentioned.After final diagnosis , further plan of treatment is given clearly.

 SHORT CASE-1:

A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.

Present illness is described very well with each and every detail explained properly.All the histories and examinations done are mentioned.Problem presentation with treatment are provided.Source for resting tremor is also given at the last.

SHORT CASE-2:

19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year,Abdominal distension and facial puffiness since 6 months.

Present illness with evolution of symptomology is perfectly described,Other histories with examinations done are given,Pictures provided clearly indicate it as a case of cushings syndrome, They also explained ruling out endogenous cushings syndrome and giving a final diagnosis of iatrogenic.

QUESTION-2

**Problem list for each patient and the diagnostic and therapeutic uncertainty around solving those problems as follows:-

LONG CASE:

Problem list:-

Generalized edema

Facial puffiness with pedal edema 

Bilaterally symmetric, pitting type pedal edema

Breathlessness, palpitations or chest pain

Frothing of urine 

Decreasing urine output

Severe joint pains

Weight loss and loss of appetite 

Subcutaneous swellings in proximal joints of his fingers 

Proteinuria causing anasarca

Diagnosis:-

Acute Glomerulopathy (Glomerulonephritis/Nephrotic syndrome) 

Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral Polyarthritis

Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis

Treatment:-

Free water restriction for Hyponatremia

Tab. PREDNISOLONE P/O 20 mg OD

Tab FEBUXOSTAT P/O 80 mg OD

Haemodialysis for worsening renal dysfunction.

SHORT CASE-1:

Problem list:-

Progressive asymmetric involuntary movements of his right index and middle fingers.

Stiffness in his wrist (right >left), now ascended to his elbows

Involuntary movements started appearing in his left hand too

Walking became difficult with small short steps and forward stoop 

Difficulty in taking up stairs 

Swaying of his trunk while walking

Overshooting his hand while picking objects 

Hasn't been having morning erections since 2 months and loss of sexual desire

Since 2 months his bowel habits have been incredibly erratic, in that he sometimes immediate urge to defecate and sometimes goes 2-3 days with constipation 

Has been speaking in monotonous drab since 2 months

Diagnosis:-

Idiopathic parkinson's disease stage - 1 with denovo HTN 

Multiple system atrophy - parkinsonian type (MSA - P) 

Treatment:-

Tab. Syndopa Plus 125 mg QID

Tab. Syndopa 125 mg CR OD

Tab. Telma 40 mg OD

SHORT CASE-2:

Problem list:-

Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

Purple stretch marks all over abdomen,lower back ,upper limbs ,thighs since 1 year.

Abdominal distension and facial puffiness since 6 months.

Pedal edema since 3 months.

Low back ache since 3 months .

Feeling low , not feeling to talk to anyone.

Weight gain and decreased libido since 3months.

Loss of libido and erectile dysfunction since 2 months .

Multiple hyperpigmented plaques over lower limbs and abdomen 

Easy fatigue, weakness and lower backache 

Moon face present, thick skin 

Poor healing over leg ulcers 

Acne present over face 

Acanthosis nigrans noted over neck 

GYNECOMASTIA PRESENT 

Buffalo hump present 

Sparse scalp hair 

Difficulty in getting up from chair

Diagnosis:-

IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

TINEA CORPORIS

DENOVO HTN

Treatment plan:-

Ointment AMLORFINE 

FUSIDIC ACID CREAM.

SALINE COMPRESS OVER LEISONS

Tab.Telma 20 mg od - due to low cortisol level

TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.

0.4 ML OF ACTOM PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR @ 7am

Tab Shelcal 500 OD and Tab Vit D 3 Od.

Tab ULTRACET /PO/SOS.

Tab Itraconazole 100 mg bd. And lulifin cream and tab levocitrixine 5mg od.

𝐐UESTION 3

𝐋𝐨𝐧𝐠 𝐜𝐚𝐬𝐞

𝐂𝐚𝐬𝐞 𝐥𝐢𝐧𝐤-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

A 44 year old man presented to OPD with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

The symptomatology of the case was accurately presented . All the positive findings of acute glomerulopathy and chronic problem were clearly discussed along with the favouring features of inflammatory pathology were elaboratively diacussed before coming into the final diagnosis which is acute glomerulonephritis secondary to Amyloidosis, anaemia of chronic disease secondary to poorly treated rheumatoid arthritis.

Short cases-

Case link-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html

A 19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :

-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year ,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year ,Abdominal distension and facial puffiness since 6 months, Pedal edema since 3 months , Low back ache since 3 months .

The case was presented in chronological order , he was diagnosed with Iatrogenic cushings syndrome which means raised cortisol levels due to over use of Clobetasol which is a corticosteroid.

The patient was also referred to dermatologist for the treatment of tinea corporis and also to the opthalmologist .

The patient has also lost his self esteem and was also referred to psychiatry department.

Case link-https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006002-case-presentations.html

35 year old man working as a food caterer presented to our OPD with the chief complains of :-

Dyspnea at rest since 5 days 

Cough with expectoration since 5 days 

Bilateral pedal edema since 4 days 

Abdominal distension since 3 days

The symptomatology was clearly and compactly explained.Upon examining the abdomen through ultrasound grade 1 fatty liver as he was an alcoholic,mild ascites so was advised salt restricted diet and right pleural effusion. On analyzing all the investigation reports and examinations he is diagnosed with Heart failure with reduced ejection fraction and denovo detected type 2 diabetes mellitus.

QUESTION 4 

I have not been assigned case, will update as soon as I get one. 

QUESTION 5

Due to this pandemic we are unable to appear directly and experience the patient but even though we had a very good experience which is not had been possible without the general medicine department. Dr. Rakesh biswas sir, HOD made possible by teaching every single aspect regarding capturing the patient centered data. We have learned how to take the history and data from a patient so as to communicate and diagnose the problem. This paved us a way of learning new things in a different way. Sharing knowledge with our peers and interacting with them regarding the cases has been so much help full to us. We have learning the basic knowledge regarding how to interact with the patient and taking history from them. This has been a wonderful opportunity to interact with the peers. The E logs which has been kept for us are helpful and made me learning so many new things. Once again thank you for this opportunity.