july

   GENERAL MEDICINE ASSIGNMENT 

                         Durga Thadakamalla  131   (3rd sem) 

                        Monthly  online assignment

 

I have been given the following assignment in an attempt to read, comprehend, analyze, reflect upon and discuss captured patient centered data.

QUESTION 1

peer to peer review and assissment

https://130tejomayi.blogspot.com/2021/07/general-medicine-assignment.html

Answers have been presented in brief manner .A very simple style of language and writing has been adopted.

more information   can be added for better understanding of the case. 

QUESTION 3 AND 4 

diagnostic and therapeutic uncertainties around the cases shared. and efficacy of the therapeutic interventions mentioned for each patient. 

AKI :

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

*The presenting illness is well highlighted and presented in a simple language . 

*The history presentation is very comprehensive and presented in a orderly manner.

*The systemic examination is pictorially presented for better understanding of the case .

 PROBLEM;

-Acute kidney injury( AKI)  2° to Urinary tract infection( UTI), associated with Denovo - DM -2

-With ? Right HEART FAILURE,

-With K/C/O - HTN ( Not on Rx)

- AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.

SOLUTION:

SALT RESTRICTION  < 2.4gm/day to decrease load on kidney and water retention in body.

INJ    TAZAR    4.5gm  IV/TID to decrease bacterial infection.

 INJ     PANTOP 40mg  IV/OD to reduce acid related cause.

                             

INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID to solve problem like poor appetite.

SYP    LACTULOSE   15ml    PO/TID [ To maintain stools less than or equal to 2]

Acute on CKD :

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

it was very concise and easy to understand , biochemical reports were clear. placement of diagnostic imaging and treatment history coud have been presented better

PROBLEM:

Acute renal failure (intrinsic)

 Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis

Hyperuricemia 2° to Renal failure 

Uraemia induced tremors( resolved)

Delerium 2° to septic /Uremic encephalopathy (resolving) 

 SOLUTION

• IVF -    NS-0.9%  @100ml/hr

• Inj. Tazar 2.25gm I.V -TID  to reduce bacterial infection.

• Inj. Lasix 40mg I.V -BD  to reduce edema.

•Nebulization Salbutamol -4th hourly  to reduce dyspnoea.

• Inj. Pantop 40mg I.V -OD  to reduce acid related cause.

• Tab. PCM 650mg -TID  pain reliever.

• Foleys catheterization 

•GRBS( general random blood sugar) -12th hourly 

• Inj.25% D with 10units of insulin IV -slow for 1hr to treat hyperkalemia.

CKD :

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

 the information was well presented and each of the patients individual concerns were addressed ,  and pelvic X-rays help in clear understanding and visualization.

 PROBLEM:

- CKD ?  Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).

SOLUTION:

- T. PAN 40mg /PO / OD to reduce gastritis

- oral fluids upto 1.5 - 2 lit / day

- Protein - x ( plant based ) 2 tablespoon   in 1 glass of  milk  

- Donot give IV fluids unless instructed

- T. ZOFER 4mg / PO / SOS used as antiemetic.

- Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved )

- TAB NODOSIS  550 BD alkali used to treat metabolic acidosis.

Patient with coma and renal failure  :

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

Patient's  history of illness has  been presented in terms of event timeline. 

*A very detailed video presentation of  2D Echo of the patient has been attached to the E-log

PROBLEM:

 DKA with AKI ( ? Pre renal) 

SOLUTION:

Inj. NORAD 2amp in 50ml NS used as anti hypotensive

Inj. PIPTAZ 2.25gm used as antibiotic.

Inj. DOPAMINE 2amp in 50ml used to treat heart and kidney failure.

Inj. HAI 1ml in 39ml NS used to treat diabeties.

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

The evaluation of symptomotology of the patient is done nicely. They were arranged in chronological order. Anatomical localization is mentioned.

PROBLEM

INFECTIVE ENDOCARDITIS

WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR

WITH AKI

WITH ?UREMIC ENCEPHALOPATHY ? SEPTIC ENCEPHALOPATHY

WITH ULCER OVER SOLE OF RIGHT LEG

WITH HYPOALBUMINEMIA ? ALCOHOLIC LIVER DISEASE

WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES

SOLUTION:

1. Inj. Monocef 1gm IV/BD To treat UTI.

2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr to treat endocarditis.

3. Procto clysis enema to relieve constipation.

4. Inj. Pan 40 mg Iv/OD to reduce fever

5. Inj. Thiamine 200mg in 100ml NS /BD to reduce vomiting andimprove cardiovascular condition.

Patients with acute on CKD :

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

a thorough history taking has been done and the case is well explained using all the pictures of investigations and reports.

PROBLEM:

Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore

SOLUTION:

Injection PANTOP 40mg IV/OD

Injection PIPTAZ  4.5 stat  and 2.25 gm  IV/ TID

Injection LASIX 40mg IV/BD

Injection optineuron 1AMP in 100ml NS slow IV/OD TO reduce blurred vision.

Injection NEDMOL 100ml IV/SOS mild analgesic.

Tab PCM 650mg TID

Insulin Human actrapid - 16 IU/TID

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

The presenting illness is well highlighted and presented in a simple language . 

*The history presentation is very comprehensive and presented in a orderly manner.

*The systemic examination is pictorially presented for better understanding of the case .

PROBLEM:

 - HFrEF secondary to CAD; CRF   (Heart failiure with reduced ejection fraction )

SOLUTION:

1. TAB. BISOPROLOL 5mg OD treat high blood pressure.

2.TAB. NITROHART 20/37.5mg 1/2 T/D s used in the treatment of heart failure
3.TAB NICARDIA XL 30mg OD reduces the workload of the heart.
4.TAB. GLICIAZIDE 80mg BD to control blood glucose well
5.TAB. NODOSIS 500 mg TD  an  antacid
6.Cap. BIO-D3 OD vitamin D analog,
7.Cap. GEMSOLINE OD used to treat low blood calcium levels .
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

Patients with AKI :

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

 Alcohol withdrawal Timeline along with a relevant diagram has been also added to e log

PROBLEM:

  ALCOHOLIC HEPATITIS ,

AKI SECONDARY TO ACUTE GASTROENTERITIS  

HFrEF SECONDARY TO CAD 

ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME

SOLUTION:

• INJ THIAMINE 100 mg in 100 ml NS slow IV / TID
• INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD
• INJ LASIX 40 mg
• TAB. ALDACTONE 50 mg PO / BD  reduces the swelling
• INJ PANTOP 40 mg IV/ OD
• ABDOMINAL GIRTH MEASUREMENT DAILY
• BP /PR/TEMP/ RR -4 hourly 
• I/O CHARTHING

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

The date and time of patient's entry into the hospital and  time of death has not been mentioned.Case have been presented in brief manner .

PROBLEM:

Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)

With anenmia of chronic disease 

SOLUTION:

• Inj LASIX 40mg
• IVF - NS @ UO + 50 ml/hr

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

Case have been presented in brief manner .The systemic examination is pictorially presented

PROBLEM:

Acute  pancreatitis with AKI 

with ?B/L pleural effusion and moderate ascitis . 

Currently in ?Alcohol withdrawal.

SOLUTION:

 

 Iv fluids : NS 40 ml /hr.

IV lasix  40 mg BD .

Tab Nodosis . used to treat acid indigestion, heartburn, sour stomach, stomach upset, metabolic acidosis, severe diarrhoea.

IV PIPTAZ 4.5 Gms. BD  t is used to urinary tract infections,

Iv 25%Dextrose. 100 ml BD 

Tab . Nicardia 10 mg  TID. used to treat high blood pressure (hypertension)

QUESTION 5

telemedical learning experiences from the  hospital 

Amidst the global pandemic , Practical class have been difficult to hold and these online postings have helped us.Altough i never got a chance to interact directly with a patient the elogs of my seniors and my fellow classmates helped me in understanding patient condition.They are  also useful in practice of history taking .