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CLINICAL MEDICINE FORMATIVE ASSESSMENT

SOUMYADEEP BISWAS 
ROLL NO. 127

I have been given the following cases to analyse and solve, in an attempt to understand the topic of  'Patient clinical data analysis' to develop my competency in reading and to comprehending clinical data including history, clinical findings, investigations and diagnosis, and then come up with a treatment plan.


This is the link of the question asked regarding the case https://medicinedepartment.blogspot.com/2021/06/medicine-department-paper-for-june-2021.html?m=1


Below are my answers to the medicine assignment based on my comprehension of cases.




ASSIGNMENT

Ans.1 PULMONOLOGY - the patient came with the chief complaint of shortness of breath , pedal edema and puffiness in face. It is a case of COPD and right heat failure. The patient also has bronchiectasis which permanently dilates the bronchi leading to increased mucous formation and difficulty in breathing. Her puffiness in face and pedal edema is due to the increased hydrostatic pressure which shifts the fluid from vessel to the interstitial space.

NEUROLOGY - the patient came with a complaint of irrelevant talking and decreased food intake. He is an alcohol addict and left it leading to some withdrawal symptom. Abrupt withdrawal reduces the inhibitory neurotransmission and increase neurotransmission. Constant consumption of alcohol had down regulated GABA receptor and to maintain homeostasis their is a counter regulation of excitatory neurotransmitter like NMDA.

NEUROLOGY - a patient came with cerebellum ataxia. There was found to be a cerebellar infarct which can be because of the ischaemic stroke.

NEUROLOGY - patient came with palpitations , pedal edema , chest heaviness, radiating pain along left upper limb. Primary ethology being hypokalemia that causes the palpitation , causing QT prolongation and resulting into arrhythmia.

NEUROLOGY - a patient with seizures and altered sensorium and ataxia can be due to damage in brain tissues and alcohol abuse.

NEUROLOGY - patient came with weakness in lower limbs , deviation of mouth, he injured his head during an accident and got a concussion.

NEUROLOGY - patient with cervical myelopathy , with loss of adduction  and extension of ulna. Leading to loss of grip.

CARDIOLOGY- patient came with shortness of breath , chest pain , pedal edema and facial puffiness. This a case of heart failure.

CARDIOLOGY - patient came with shortness of breath , pedal edema , shortness of breath and decreased urine output. There is a diastolic dysfunction , can be having a heart failure.

GASTROLOGY - patient came with pancreatitis , pseudo cyst and lt bronchi pleural fistula. It can be due to the increased alcohol intake .


And. 2 This is the case that I was given for which the slog has been prepared : https://127soumyadeepbiswas.blogspot.com/2021/07/a-case-of-48-yr-old-male-with-fever.html


Ans 3. & Ans.4 A 70 yr old patient came with distended abdomen and shortness of breath of grade 3. She had been taking Thyronorm 100 mg for her hypothyroidism. 

The 2D echo gives us a clear picture of pleural effusion and mi.d pericardial effusion. Her EKG also depicts atrial fibrillation. Later her biochemical report shows hyperthyroidism that can be a possible reason for her atrial fibrillation.

The doctors tried to defibrillate also inj Amiodarone 150 mg and inj Clexane. Amiodarone is a potent arrhythmic agent that is used to treat the atrial fibrillation before it ends up in the ventricles leading to heart failure. Whereas clexane is used as a removal of blood clots , treat angina and heart attacks.


Ans 5. In the midst of the pandemic medical school taking the online approach which is primarily a practical sector. This is the educational set up where doctors interact with the patients and try to gather history and knowledge and try to provide their expertise. But still our medical schools are working and they have brought the clinical rotation for which we had always as a medical student being excited about right in front of our mobile/laptop screens. The general medicine faculty have been doing great and also are helping us to acquire knowledge and helped us learn to use the Internet and motivate us to read research papers and old cases about a topic. This has been a great learning session for all of us , looking forward to attend the clinical postings in the hospital.
















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