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