Soumyadeep Biswas
Roll no. 127
BELOW IS THE LINK TO THE QUESTIONS ASKED TO US:-
http://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html
QUESTION 1:-
Below is the link of the student for which I am giving my peer review.
https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1
LONG CASE :-
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
REVIEW:-
*The Case is well presented and patient data has be deidentified and privacy is marked.
*Case history is taken beautifully precisely taken including social ,educational and surgical history which is way too essential to understand the socio economic back ground of the patient and helpful in accurate diagnosis.
FINAL DIAGNOSIS : -
*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.
*All investigations were directly related to the presented symptoms like ESR was
120mm/hour which clearly provides the lead for inflammatory process occurring due to osteoarthritis .
*Serum creatinine and urea levels were elevated signifying the AKD .
TREATMENT :-
*Free water restriction for Hyponatremia.
*Tab. PREDNISOLONE P/O 20 mg OD -Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders.
*Tab. FEBUXOSTAT P/O 80 mg OD Febuxostat, sold under the brand names Uloric and Adenuric among others, is a medication used long-term to treat gout due to high uric acid levels.
*Hemodialysis for worsening renal dysfunction.
#All the drugs are mentioned appropriately in accordance to the presenting symptoms.
#Mechanism of action of drug is not mentioned.
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.
*They were not troublesome initially but for the past 2 months he has been unable to correct answer sheets. He has symptoms which include stiffness, involuntary movements, with no morning erections from last two months, also denies cotton wool sensation of floor, denies burning pain or inability to feel hot or cold stimuli
*The patient presents with cog wheel type of rigidity in the wrist with hypotonia in major group of muscles. Patient presents with resting tremors which are characteristic feature of Parkinson's disease. Also the patient is hypertensive.
TREATMENT :-
*Tab. Syndopa Plus 125 mg QID first line drug in parkinsons.
*Tab. Syndopa 125 mg CR OD.
*Tab. Telma 40 mg OD used for the hypertension.
SHORT CASE-2 :-
A 19 year old male resident of Nalgonda and currently studying intermediate , came to OPD with complaints of :-
*Itchy Ring lesions 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 .
purple striation over the anterior abdominal wall along with buffalo hump , thin skin are suggestive of increasing corticosteroid levels that leads to Cushing syndrome.
The patient also complaints of itchy ring lesions which are suggestive of Tinea corporis fungal infection.
TREATMENT :-
*Ointment Amorolfine ,is a morpholine antifungal drug that inhibits Δ-sterol reductase and cholestenol Δ-isomerase, which depletes ergosterol.
* Tab Shelcal 500 OD and Tab Vit-D 3 Od, Shelcal for treatment low calcium levels.
*Tab ULTRACET /PO/SOS for inflammation.
QUESTION 2:-
Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):-
LONG CASE :-
PROBLEMS:-
*Generalized edema :- it was due to glomerulonephritis.
*Joint pains:- it was due to rheumatoid arthritis.
INVESTIGATIONS:-
*X ray of peripheral joints to conclude the severity of arthritis usually by observing the osteolytic lesions.
*X ray of chest to rule out any pleural effusion due to excess fluid retention.
*ECG to to rule out any cardiac abnormalities.
*CUE for checking the severity of glomerulonephritis by quantifying the amount of albumin and glucose present in urine.
*CBC for grading the extent of blood infection and prognosis of inflammation caused due to arthritis.
*ESR usually gets elevated in active inflammation in body.
*KFT for grading the severity of kidney damage due to glomerulonephritis.
TREATMENT:-
*Free water restriction for Hyponatremia.
*Tab. PREDNISOLONE P/O 20 mg OD -Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders.
*Tab. FEBUXOSTAT P/O 80 mg OD Febuxostat, sold under the brand names Uloric and Adenuric among others, is a medication used long-term to treat gout due to high uric acid levels.
*Hemodialysis for worsening renal dysfunction.
SHORT CASE-1 :-
PROBLEMS:-
1. Patient complained of involuntary movements with resting tremors and denied sensation in the lower limb along with muscle stiffness.
2. Decreased tension in major groups of muscle suggesting hypotonia.
3. Difficulty in speaking.
#All this points to the diagnosis of Parkinson's Disease.
*Superficial reflexes absent on the left side.
*Deep tendon reflexes are reduced showing hypotonia.
*Micrographia is present i.e, suggestive of Parkinson's disease.
*ECG suggestive of Sinus Tachycardia with pseudo infarct pattern in leads-I and aVL with dagger q waves in the same leads.
*No late intrinsicoid deflection of R wave with modified Cornell criteria showing LVH.
*2D Echo shows Gade-2 Diastolic dysfunction.
TREATMENT:-
*Tab. Syndopa Plus 125 mg QID increasing the dopamine levels in the brain.
*Tab. Syndopa 125 mg CR OD.
*Tab. Telma 40 mg OD used as an antihypertensive drug.
SHORT CASE-2 :-
PROBLEMS:-
1. Itchy lesions .
2. Purple striation over the anterior abdominal wall.
3. Weight gain along with edema.
4. lower back ache.
5. loss of libido.
INVESTIGATIONS:-
*ECG done to rule out any cardiac abnormalities (NORMAL).
*In view of low back ache X-ray LS spine was done which was normal.
TREATMENT:-
1.Ointment Amorolfine ,is a morpholine antifungal drug that inhibits Δ-sterol reductase and cholestenol Δ-isomerase, which depletes ergosterol.
2.Tab Shelcal 500 OD and Tab Vit-D3 Od, Shelcal for treatment low calcium levels.
3.Tab ULTRACET /PO/SOS for inflammation.
QUESTION 3:-
Testing competency in "Evidence based medicine": 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.
LONG CASE :-
INVESTIGATIONS:-
X-ray :-
X-rays can help detect bone damage (erosions) that occurs as a result of long-standing rheumatoid arthritis. They can also detect a narrowing of the joints space, which occurs when cartilage degrades and the bones in the joint get closer together. Magnetic resonance imaging (MRI).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837821/
ESR :-
People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body.
TREATMENT:-
*Tab. PREDNISOLONE Low doses of prednisone are safe and effective in the management of RA. Yet, some clinicians continue to manage their RA patients with glucocorticoid doses that are too high or avoid them altogether. Glucocorticoids in low doses have proven to be very effective in suppressing the inflammation associated with RA.
*Tab FEBUXOSTAT
Febuxostat (Uloric) is a medication that lowers the levels of uric acid in the body. It is used for the chronic management of gouts. It blocks the active site on xanthine oxidase, preventing the conversion of hypoxanthine and xanthine to uric acid.
SHORT CASE-1 :-
INVESTIGATIONS:-
*Micrographia, or small handwriting, is a common sign of Parkinson's disease. Over 65 percent of patients exhibit micrographia. Patients often notice the difference in their handwriting themselves and a neurologist can confirm the diagnosis by the size of the handwriting in a writing test.
https://parkinsonsdisease.net/symptoms/micrographia-handwriting
TREATMENT:-
*Syndopa Plus Tablet is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors (shaking), stiffness and slowness of movement.
https://medlineplus.gov/druginfo/meds/a601068.html
SHORT CASE-2 :-
INVESTIGATIONS:-
*The 24-hour urinary cortisol test measures the amount of cortisol being produced within the urine over the course of an entire day. Levels higher than 50-100 micrograms per day in an adult suggest the presence of Cushing's syndrome.
https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cushings-Disease
TREATMENT:-
*Shelcal as calcium supplement as there's increase in bone resorption.
QUESTION 4:-
Below is the link of my case report of a patient that I have gone with personal investigations, and I mentioned every detail based on the information given by the patient and gone up with all the investigations that should be needed.
QUESTION 5:-
Testing scholarship competency in logging reflective observations on your concrete experiences of this last month.
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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