GENERAL MEDICINE ASSIGNMENT

2019 Batch (3rd semester)

B.Ananya

Roll no.18

I was given the assessment to review and analyse the elogs and clinical cases.

Question 1: peer review

 Link: https://snehithachintala31.blogspot.com/

I chose my friend snehitha,roll no.31 as reference for reviewing a blog.

She took a neurology case and gave reviews to 10 random answers,even I studied the case thoroughly and also 10 random answers which was mentioned in her blog.

Neurology case details was given in following link:

https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html

My analysis of case:

The patient was talking,as well as laughing to himself. He was also unable to lift himself off the bed and move around,and had to be assisted.

All the above things are signs of mental confusion.

He was alcoholic, had stopped drinking .he

developed seizures following cessation of alcohol for 24 hrs, which was associated with restlessness, sweating and tremors.

All the above are signs of alcohol withdrawal delirium.

Albumin is decreased,this may indicate liver or renal problems.

Most probable diagnosis would be 

1.Wernicke's encephalopathy secondary to chronic alcohol dependence.

2.Alcohol withdrawal delirium.

The 10 random answers of the above case reviewed by my friend were correct and had valid points.

Another case was also mentioned by her.

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

She provided all the useful leads to analyse the diagnostic and therapeutic uncertainties around the case.

The efforts made by my friend were really admirable. I really appreciate her work in understanding and making the elog appropriately.

Question 2:

I haven't yet got the chance to do the elog. I will try best to do elog when I get a chance.

Question 3:

I studied few renal failure cases.

Case 1:-AKI Link to the case is below :

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

 After reading the case,my analysis is

- patient is suffering from burning micturition,chills,back pain and decreased output of urine.All these are symptoms of UTI and AKI.

This shows acute kidney injury, secondary to UTI.

Evidence of infection for diagnosing urinary tract infection:

Bacterial culture and sensitivity report shows presence of polymicrobial flora and plenty of pus cells in urine.

Case 2 :-Patient with acute on CKD Link to the case is below :

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

As given patient is diagnosed initially  with diabetes mellitus- 2,gradually develops severe diabetes and is on insulin treatment. Severe diabetes causes damage to filtrating system and blood vessels of kidney. As filtrating system is damaged creatinine and urea levels are altered. Severe diabetes leads to diabetic nephropathy, which causes water 

retention leading to hydroureteronephrosis.

By examination of urine sample as it contains pus cells it is diagnosed with pyuria, caused due to bacterial infection leading to urinary tract infection which leads to urosepsis.This causes burning micturition. Fever is due to infection.

This urosepsis leads to AKI(Acute kidney injury)

Case 3:-Patient with acute on CKD Link to the case is below

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

In this case patient presented to opd with complaint of shortness of breath.He was also having history of chronic renal failure and heart failure.

Provisional diagnosis of this case is Heart failure reduced ejection fraction (hfref) secondary to coronary heart disease; coronary renal failure.

When you have heart disease, your heart may not pump blood in the right way. Your heart may become too full of blood. This causes pressure to build in the main vein connected to your kidneys, which may lead to a blockage and a reduced supply of oxygen rich blood to the kidneys. This can lead to kidney disease.

The shortness of breath in heart failure is caused by the decreased ability of the heart to fill and empty, producing elevated pressures in the blood vessels around the lung

Case 4:-Patient with AKI Link to the case is below :

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

The patient is alcohol addict. Due to increased alcohol intake liver cannot process it which leads to inflammation causing to alcohol hepatitis,

He is diagnosed with acute gastroenteritis.the virus infects the small intestine lining and increase its permeability causing watery diarrhoea.It also leads to low blood flow to kidney causing AKI.

Urine output decreases.

The inflammation of liver slows down the blood flow through it,thus there is increase in pressure in veins which bring blood to liver.

The increased pressure in portal vein causes fluid to accumulate in legs(edema)pitting type and also causes ascites(fluid accumulation in abdomen).

As he is alcohol addict having high blood pressure can have a high risk of coronary artery diseases.

Question 4:

Case 1:

Diagnosis : AKI secondary to UTI, associated with Denovo - DM -2 

Treatment : 

1)IVF : -RL @ UO+ 30ml/hr -NS

2)SALT RESTRICTION < 2.4gm/day

3)INJ TAZAR 4.5gm IV/TID

                                 |

                             2.25gm IV/ TID

4)INJ PANTOP 40mg IV/OD

5)INJ THIAMINE 1AMP IN 100ml NS IV/TID

Case 2:

Diagnosis: Renal AKI secondary to urosepsis with b/L hydroureteronephrosis

Treatment: 

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

Case 3:

Diagnosis: HFrEF secondary to CAD; CRF

Treatment: 

1. TAB. BISOPROLOL 5mg OD

2.TAB. NITROHART 20/37.5mg 1/2 T/D

3.TAB NICARDIA XL 30mg OD

4.TAB. GLICIAZIDE 80mg BD

5.TAB. NODOSIS 500 mg TD

Case 4:

Diagnosis: Alcoholic Hepatitis and aki sec to gastroenteritis

Treatment: 

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  

QUESTION 5

This project has taught me the fundamentals of clinical practise, such as taking a patient's history, presenting a case, and approaching a patient, among other things. Because we are unable to visit offline postings and meet the patients in person due to the pandemic, this form of eblogs has been of tremendous assistance, as we are able to take up a case and convey it in this manner even though we are not physically there in the hospital. I learned about taking a history, analysing a case, presenting a case, and a few diseases. Because it provides us with early clinical exposure, this style of learning will undoubtedly aid us in becoming better clinicians. Due to the lack of patient involvement, I have no such observations as of yet, but I anxiously anticipate them.