97 P.V. ABHIGNA BIMONTHLY BLENDED ASSESSMENT - JUNE 2021

UNDERSTANDING CASES IN GENERAL MEDICINE 

P.V. Abhigna 

Roll no. 97 

Question 1. 

1. answer by roll no. 1

PULMONOLOGY CASE

quantitative assessment : 9/10 

qualitative assessment : 

• The elog was well presented, with information arranged neatly & concisely.  
• Choice of diagrams & pictures, their placement was good. 
• It was Overall well written and easy to comprehend.

2. answer by roll no.26

CASE D 

quantitative assessment : 7/10 

qualitative assessment : 

• The language of the answer was easy to understand.
• The flow of information was from simple to complex & well thought out. 
• Point wise manner would have worked better than paragraph format . 
• Diagram / flowchart would have been helpful. 

3. answer by roll no. 35

QUESTION 2

quantitative assessment : 8 /10 

qualitative assessment : 

• the information provided was concise, clear and to the point. 
• presentation was very neat. 
• more details could have been provided about each of the drug action. 

4. answer by roll no. 45

CASE 2B 

quantitative assessment : 6/10

qualitative assessment : 

• Evaluation of Symptomatology, Anatomical Localization & Etiology have covered the case details well.
• Appropriate highlighting has been done 
• Pictures / diagrams/ flowcharts would have been helpful. 

5. answer by roll no. 51

CASE 4 

quantitative assessment : 7/10

qualitative assessment : 

• point wise presentation especially of timeline is neat. 
• answering has been to the point & concise. 

6. answer by roll no. 59

CASE A PULMONOLOGY 

quantitative assessment : 9/10 

qualitative assessment :

• Tabular arrangement of information makes it very easy to read & follow
• timeline & detailing has been thorough
• diagrams provided are also very useful. 

7. answer by roll no. 64

NEUROLOGY 

quantitative assessment : 8/10

qualitative assessment : 

• Different sections have been clearly marked & separated 
• Answers are easily comprehendible & to the point 
• timeline of events has been detailed neatly .
• diagrams could have made explainations of mechanisms better. 

8. answer by roll no. 70

NEUROLOGY 

quantitative assessment : 8/10

qualitative assessment : 

• detailing in the answer is thorough.
• diagrams have been used wherever appropriate
• mechanisms have been elaborated well
•  a more point wise manner of answering would have made it easier to read.

9. answer by roll no. 82

GASTROENTEROLOGY

quantitative assessment : 9.5/10

qualitative assessment : 

• answering has been done in a point wise manner, with nice detailing & information.
• reference links to answer information are appreciated
• written in a simple & easy to understand manner with to the point information. 

10. answer by roll no. 88

CARDIOLOGY

quantitative assessment : 8/10

qualitative assessment : 

• presentation is very neat & easy to follow. 
• point wise answering is clear & precise 
• more diagrams would have made it more comprehensive. 

Question 2. 

Link to my elog

Question 3: 

My Critical Appraisal of this Case 

Chief complaint : It is always written in the patients words. Instead of 'Pedal Edema' it would most probably be 'swelling in legs'. 

Furthermore, elaborations could be made on the periodicity & frequency, exacerbating / relieving factors regarding each of the symptoms.  If the patient had been having the symptoms since 10 days, then why are they coming to the OPD today? 

 History Of Present & Past Illness : 

 HOPI has been presented well. It covers the time duration of her symptoms in the past, her past diagnosis & answers the three main questions :

• When was it diagnosed?
• How was it diagnosed?
• How has it been treated. 

More information about her regimen with tab Teneligliptin 20 mg could have been taken & also details about how regular this patient had actually been with her medication. 

Personal History, Family History have appropriately covered aspects related to the patient's background. 

- No history of genetic illnesses can be seen 

- It could have been stated whether marriage was non consanguineous or consanguineous and if so, the degree of consanguinity. 

 - further elaborations on her alcohol consumption 

General Examination, Vitals have all been taken appropriately with the necessary details. 

Systemic Examination is thorough .  

Provisional Diagnosis, Investigations, Treatment have been put as required. 

Overall, this case has been covered well.  With C/C, HOPI, Personal History greatly aiding the cause towards the making of an accurate & timely provisional diagnosis. 

Question 4 :

1. Multisystemic

Problems : 

1. Acute liver failure with ?acute pancreatic failure

2. Hepatic encephalopathy

3.  Indirect hyperbilirubinemia- Criggler najjar syndrome

4. hepatic coagulopathy 

5. denovo diabetes type 1

6. Diabetic ketoacidosis ( on presentation ; resolved)

Therepeutic possibilities: 

Ketoacidosis : 

• INSULIN : for lowering blood glucose levels. 
• IV DEXTROSE : to prevent rapid lowering of blood glucose & prevent hypokalemia
• VITAMIN K  to prevent haemorrhage 

Edema : 

• 3% NaCl IV Solution to draw fluid from EC comapartment into vascular compartment.

2. CNS

Problems: 

1.TB 

2. quadriparesis 

3. Infection spondylitis

Therepeutic possibilities: 

For INFECTION : 

• monocef given works against bacteria and interviews formation by a in the bonds that hold the cell wall together(and hence treats infection)

for VIT B6, B12 SUPPLEMENTATION : 

• optinuerin 

3. Renal

Problems:  

1. Hypertension

2. CKD

3. edema

4. Shortness of Breath

Therepeutic Possibilities: 

for EDEMA: 

• Lasix has been used to drain out excess fluid
• It works by blocking sodium water and chlorine reabsorption and hence diuresis 
• IVF NS also aids in diuresis

for SOB : 

• NaHCO3 given to stabilize the metabolic acidosis, that caused the SOB. 

4. CVS 

Problems : 

1.  Hypothyroidism
2. Shortness of Breath 
3. Atrial Fibrillation 

Therepeutic Possibilities: 

for HYPOTHYROIDISM:

• tab thyroxine

for ATRIAL FIB: amiodarone

5.  Abdominal

problems : 

1. pedal edema

2. fever 

3. acute kidney injury 

4. Urosepsis

Therepeutic possibilities: 

For PEDAL EDEMA:  

• T/t of underlying kidney condition 
• Appropriate diuretic  ( lasix, spirunolactone etc) 

for FEVER : 

• Antipyretic eg. Ultracet

for UROSEPSIS: 

• Antibiotics

Question 5: 

The online classes especially the postings have proven a valuable learning experience. Although I feel it would have been an even better experience offline but under the current circumstances this have been a great resource for getting clinical Exposure. 

The making of E-logs have provided me insights on appropriate history taking & data arrangement. Going through my friends' e-logs & other e-logs has provided exposure to a variety of cases in a short span of time. 

Doing this assignment has given me insights into some great blogs made by my seniors that i have learnt from & hopefully use this knowledge when I make more of my own in the future.