INTERN ONLINE ASSESSMENT- GENERAL MEDICINE

 DURING UNIT DAYS 

CASE 1 

https://08arshewarpavankumar.blogspot.com/2022/09/20-yr-female-with-bl-pedal-edema.html


Presentation for this case https://youtu.be/GFASTNR78Ng

My orientation around the case 

1)What is possible cause of her pedal edema ..?? 

Renal impairment or low output states (cardiac failure ) or acute tubular atrophy 


2)What are the differential diagnosis of the patient ??

Nephrotic syndrome more probably poststreptococcal glomerulonephritis , minimal change disease , LUPUS NEPHRITIS , VASCULITIS, infective endocarditis, libman sach endocarditis , igA nephropathy 

3)What is cause of cough and SOB ?? 

-Due to glomerular injury renal filtration is compromised and there is accumulation of fluid in third space leading to ascitis pleural effusion and pericardial effusion 

-Due to pleural and pericardial effusion there is a SOB 

4) what is determining  factor to prove the fluid is exudative or transudative .?

-SAAG >1.1 indicates high saag transudative fluid which it occurs due portal hypertension

-SAAG<1.1 indicates low saag exudative fluid which may occur due to renal impairment

5) what are the organs involved in SLE .??

-kidney LUPUS NEPHRITIS

 https://www.ncbi.nlm.nih.gov/books/NBK499817/

-CNS INVOLVEMENT https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:c8695186-4ab7-3ae7-bdaf-b9dea67b34a0


CVS Percardial effusion 

RS Pleural effusion 

SKIN Hyperpigmented rash 

6) what is the reason behind her anemia ..??

Impaired erythropoietin response and presence of antibodies against erythropoietin may contribute to the pathogenesis of this type of anaemia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1798007/#:~:text=Haematological%20abnormalities%20are%20common%20in,of%20this%20type%20of%20anaemia


7) What is the reason for her hypertonia and tremor..??

 UMN lesion 

8) WHAT ARE THE CHANCES OF RECURRENCE OF SLE ..?? What are the factors responsible for recurrence of SLE ..?? what are the chances of development of multiorgan involvement in SLE..??

 WORKS DONE UNDER THIS CASE ARE 

assisted in pleural tap 

Assisted in USG guided ascitic tap 


CASE 2 

https://08arshewarpavankumar.blogspot.com/2022/08/19-year-old-female-with-fever-since.html

1)What is the reason behind her fever .??

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866120/


2)What are the tests determine the specificty and sensitivity..??

ANCA sensitivity

DS DNA Specific 

3)Why there is RECURRENCE of disease occur in this patients ..??

4) why the case 1 patient with SLE is given Prednisone but not this patient .??

5) what are the possible outcomes of this patient .??


WORKUP UNDER THIS CASE ARE .??

Inserted IV cannula , took blood samples 


CASE 3 

https://08arshewarpavankumar.blogspot.com/2022/08/icu-bed-no-5-55-yr-old-female-with.html


1)What are the causes of hypoglycemia..??


Medications. Taking someone else's oral diabetes medication accidentally is a possible cause of hypoglycemia. ...

Excessive alcohol drinking. ...

Some critical illnesses. ...

Long-term starvation. ...

Insulin overproduction. ...

Hormone deficiencies.


2) what are the drugs responsible for hypoglycemia

https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:895e9bce-9e66-3de5-b777-c073f5241d0a 

3) what is diff b/w Type 1 and type 2 ..??

In Type 1 DM there is auto antibodies against beta cells which leads to  absence of insulin 

In type 2 DM there peripheral resistance of glucose Is seen then glucose cannot be absorbed so there will  be hyperglycemia 

4) in which type of diabetes patients landup in DKA AND what is the mechanism of action 

Type 1 patients landup with DKA 

MOA - insulin anabolic harmone absence of this harmone leads to lipolysis which leads to formation of formation ketone bodies (acetone , acetoactate , beta hydroxybutyraldehyde ) 

https://www.ncbi.nlm.nih.gov/books/NBK560723/ 


WORKUP UNDER THIS CASE

taken ABG samples and done CPR for this patient


CASE 4

 https://08arshewarpavankumar.blogspot.com/2022/08/is-e-log-book-to-discuss-our-patients.html 

1)What is the cause of SOB .?? 

Abdominal distension pushes the diaphragm upwards and leads to SOB 

2)What is reason for abdominal distension..??

Abdominal distension occur due liver disease which leads to portal htn which in leads to abdominal distension

WORKUP FOR THIS PATIENT

Done CPR and taken ABG samples 



During ward days 

Taken IV samples ,seen camp cases , assisted in intubation

During icu days 

Central line https://youtu.be/tQChFAX41c8

Vitals and grbs monitoring for icu and amc patients 

Assisted in intubation cpr in patients 

During nephro days 

Assisted in central line 

Foleys and ryle tube 

Vitals monitoring and grbs for dialysis patients 















Comments

Post a Comment

Popular posts from this blog

20 yr girl with b/l pedal edema

Image
 This is an E log book to discuss our patient's de-identified health data shared after taking his guardian's signed informed consent. Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable comments in comment box are most welcomed  I have been given this case to solve in an attempt to understand the topic of  "Patient clinical data analysis"  to develop my competency i reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan A pavan kumar  1701006011 Presentation  https://youtu.be/GFASTNR78Ng 20 year female came to casualty with chief complaints of  -Hyperpigmented macules since 15 days -b/l pedal edema si...
Read more

19 year old female with fever since 1week

Image
 This is an E log book to discuss our patient's de-identified health data shared after taking his guardian's signed informed consent. Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable comments in comment box are most welcomed  I have been given this case to solve in an attempt to understand the topic of  "Patient clinical data analysis"  to develop my competency i reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan Previous admission http://anushaboda189.blogspot.com/2022/02/this-is-online-e-log-book-to-discuss.html 1701006011 A pavan kumar  19 yr old female came with the chief complaints of  1) fever...
Read more

Online blended Bimonthly assignment towards Summative Assessment for month of May 2021

PULMONOLOGY🫁 1Q) what is the evolution of the symptomatology in this patient interms of an event timeline and where is the anatomical localisation for the problem and what is the primary etiology of the patient  problem ? 1Ans)Evolution of symptomatology 1st episode of sob - 20 yr back 2nd episode of sob - 12 yr back From then she has been having yearly episodes for the past 12 yrs  Diagnosed with diabetis - 8yrs back Anemia and  took iron injections  - 5yr ago Generalised weakness  - 1 month back  Diagnosed with hypertension  - 20 days back Pedal edema - 15 days back Facial puffiness- 15 yrs back Anatomical location of problem - lungs Primary etiology of patient- usage  of chulha since 20 yrs might be due to chronic usage  2Q)what r the mechanism of action indication and efficacy over placebo of each of the phramacological and nonphramacological interventions  used for this patient? 2Ans)~Head end elevation :# MOA; .improves oxygenatio...
Read more