87 Shwetha Mummadi
GENERAL MEDICINE BIMONTHLY ASSESSMENT
-August 2021
Roll no.: 87
3rd sem
QUESTION-1:
Please go through the long and short cases in the first link shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.
https://2018-
LONG CASE:
A case of acute glomerulonephritis , due to sec. amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis .
Completeness :
The E-log was complete in all factors . It included chief complaints , present history , past history , medical/surgical history , personal history , family history , social & educational history , immunization history .
This elog had everything one could have asked for ; for a better understanding of the case and to treat in a better way .
Review on the case :
The case was beautifully presented in detail , which is almost closely knit with his details , which seemed like a story to me , like a step-to-step detailed explanation .
Evolution of symptomatology was described in a detail manner .
There was also a detailed explanation of the patient's acute and chronic problem .
General examination was done in a much detailed way ; in different positions with clear documentation .
Clinical images of the patient and investigations were added with deidentification .
Systemic examination with detailed inspection , palpation , range of movements was explained .
Diagnostic approach and treatment was also well explained .
Correctness :
All the data provided in the E-log is correct .
SHORT CASE-1:
Idiopathic Parkinson's disease stage 1 with denovo HTN & multiple system atrophy - parkinsonian type ( MSA-P )
Completeness :
The elog was complete . it included chief complaints , history of presenting illness , history of past illness , medical / surgical history , personal history , family history , social & education history , immunization history.
Review on the case:
The case was beautifully presented in detail , which is almost closely knit with his details , which seemed like a story to me , like a step-to-step detailed explanation .
Evolution of symptomatology was described in a detail manner
CNS examination was described extremely well with all detailed documentation of reflexes etc.
Clinical images of the patient and investigations were added with deidentification .
Correctness :
All the data pirovided in the E-log is correct .
SHORT CASE-2:
Iatrogenic cushings syndrome secondary to topical clobetasol application all over the body for approx. 1 yr.
Completeness :
this elog was little incomplete acc. to me as it didn't include his past history , family history , treatment history , personal history.
Review on the case:
Evolution of current symptomatology was described beautifully .
De-identified clinical images in the presentation , showed us the condition of the pt. clearly .
His follow up details were also neatly documented .
Correctness :
All the data provided in the E-log is correct .
QUESTION-2:
Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems.
https://2018-
LONG CASE:
• PROBLEM LIST:
Generalized edema
-facial puffiness with pedal edema
-bilaterally symmetric, pitting type pedal edema
-breathlessness, palpitations or chest pain
-frothing of urine
-decreasing urine output
-severe joint pains
-weight loss and loss of appetite
-subcutaneous swellings in proximal joints of his fingers
-proteinuria causing anasarca
DIAGNOSIS :
-Acute Glomerulopathy (Glomerulonephritis/Nephrotic syndrome)
-Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral Polyarthritis
-Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
-Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis
-Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
-Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis
TREATMENT PLAN :
1.Free water restriction for Hyponatremia
2. Tab. PREDNISOLONE P/O 20 mg OD
3.Tab FEBUXOSTAT P/O 80 mg OD
4.Haemodialysis for worsening renal dysfunction.
SHORT CASE-1:
PROBLEM LIST :
-progressive asymmetric involuntary movements of his right index and middle fingers.
- Stiffness in his wrist (right >left), now ascended to his elbows
-involuntary movements started appearing in his left hand too
-Walking became difficult with small short steps and forward stoop
-Difficulty in taking up stairs
-swaying of his trunk while walking
-overshooting his hand while picking objects
-Hasn't been having morning erections since 2 months and loss of sexual desire
-since 2 months his bowel habits have been incredibly erratic, in that he sometimes immediate urge to defecate and sometimes goes 2-3 days with constipation
-has been speaking in monotonous drab since 2 months
DIAGNOSIS:
-idiopathic parkinson's disease stage - 1 with denovo HTN
-Multiple system atrophy - parkinsonian type (MSA - P)
SHORT CASE-2:
PROBLEM LIST:
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .
-Purple stretch marks all over abdomen,lower back ,upper limbs ,thighs since 1 year.
-Abdominal distension and facial puffiness since 6 months.
- Pedal edema since 3 months.
- Low back ache since 3 months .
- Feeling low , not feeling to talk to anyone.
- Weight gain and decreased libido since 3months.
- Loss of libido and erectile dysfunction since 2 months .
- Multiple hyperpigmented plaques over lower limbs and abdomen
-Easy fatigue, weakness and lower backache
-Moon face present, thick skin
-poor healing over leg ulcers
-Acne present over face
-Acanthosis nigrans noted over neck
-GYNECOMASTIA PRESENT
-Buffalo hump present
-Sparse scalp hair
-Difficulty in getting up from chair
DIAGNOSIS :
-IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
-TINEA CORPORIS
-DENOVO HTN .
TREATMENT PLAN :
-Ointment AMLORFINE
-FUSIDIC ACID CREAM.
-SALINE COMPRESS OVER LEISONS
-Tab.Telma 20 mg od - due to low cortisol level
- TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.
-0.4 ML OF ACTOM PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR @ 7am
-Tab Shelcal 500 OD and Tab Vit D 3 Od.
-Tab ULTRACET /PO/SOS.
-Tab Itraconazole 100 mg bd. And lulifin cream and tab levocitrixine 5mg od.
QUESTION-3:
QUESTION-4:
Share the link to your own case report this month of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case.
LINK OF CASE:
https://shwethamummadi87.blogspot.com/2021/08/general-medicine-elog.html?m=1
QUESTION-5:
While going through all the blogs that are prepared by my seniors I learnt a lot and it will be useful for me in future for sure.
Elog Idea is much helpful for us , as it is encouraging us to learn more subject.
We are learning how to approach a patient,about History taking and also how to present the case.
Overall It is a great experience,gave scope for interacting and we are learning a lot from this postings.
Thank you.
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