87 Shwetha Mummadi

 GENERAL MEDICINE BIMONTHLY ASSESSMENT

-October 2021

Shwetha Mummadi

Roll no.87

Question-1:

Critical Appraisal -

GASTROENTEROLOGY -

https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

- The case discussed is of Chronic liver failure and kidney disease.

- The case is very well explained.

- The main abnormalities of patient are highlighted which are easy to grasp. 

- There is a video link kept which is very clear about ascitic tap.

CNS -

 http://keelasreevalli.blogspot.com/2021/09/a-52-yr-old-female-homemaker-by.html

- This case is well presented.

- The day to day investigations and treatment are mentioned clearly.

- The clinical presentation of patient is clear in the pictures.

HAEMATOLOGY -

https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1

- The above case presentation is nice. 

- The case is of Pancytopenia. 

- The vitals of the patients are well updated day to day.

CARDIOLOGY , PULMONOLOGY -

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

- The case is explained good.

- It would be more effective if the main events are highlighted.

- The 2 D Echo video of the patient is presented so the cardiovascular activity is better understood.

NEPHROLOGY -

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

- The case presentation is nice.

- As the case is currently ongoing the investigations and treatment are to be updated.

Question-2:

Gastroenterology:

https://vamsikrishnarollno16.blogspot.com/2021/10/a-case-of-64yrs-old-male-patient-with.html?m=1

•Diagnosis: Obstructive Jaundice..

▪︎investigations:

-LFT ,RFT,CHEST X RAY and hemogram.

CNS:

https://87tharunkumar.blogspot.com/2021/10/38-yr-old-male-presented-with-lower.html

•Diagnosis: Hypertension, Demyelinating lesion ,with U/L Optic disc edema with Pyrexia.

•Investigations:

-CUE, Hemogram, ultra sound, ECG,MRI.

Hematology:

https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1

•Diagnosis: Pancytopenia under evaluation. 

•investigations:

- Hemogram, ECG,LFT,blood grouping and Rh type ,serum electrolytes (Na, K, Cl)and creatinine. 

-blood urea.

-Bone marrow biopsy. 

-T3,T4,TSH levels.

Pulmonalogy, Cardiology:

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

•Diagnosis:CKD on MHD with HTN with B/L Transudative pleural effusion secondary to HD.

•Investigations:

-Prothrombin time ,ABG, LFT,CUE, ECG, 2D echo. 

-Hemogram, Lipid profile ,Chest X ray. 

Nephrology:

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

•Diagnosis:

•investigations:

-Hemogram.

-RFT, CUE.

Question-3:

DIAGNOSTIC AND THERAPEUTIC INTERVENTION -

GASTROENTEROLOGY -

https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

Diagnosis : 

Chronic liver failure and kidney disease.

Investigations :

- RFT , LFT 

- HEMOGRAM , CUE 

- ECG , USG 

- Abdomen , BGT , ABG 

- VIRAL SEROLOGY , CHEST X RAY, 2D echo.

Treatment :  

- Fluid restriction : < 1t / day

- Salt restriction : < 2gm / day

- Tab . Lasix - 40 mg , BD

- Tab . Metalazone 5mg , BD 

- Tab . Thiamine 100 mg , OD

- Syrup . Lactulose 15 ml , BD

- Tab . Rifagut 550 mg , BD

- Protein powder with 100 ml milk , 2 times daily 

- Abdominal girth & weight measurement daily

- Tab . Udiliv 300 mg , BD

- 2-3 egg whites / day

CNS -

http://keelasreevalli.blogspot.com/2021/09/a-52-yr-old-female-homemaker-by.html

Diagnosis :

Altered sensorium under evaluation secondary to hyponatremia( euvolemia)?SIADH 

Sepsis secondary to ?cellulitis ? Typhoid

with complete right bundle branch block.

Investigations :

- CBP , CUE 

- LFT , RFT 

- Serum osmolarity , Serum Electrolytes 

- ECG , Urinary electrolytes 

- MRI brain , Chest X Ray

Treatment :

- Propped up position 

- IVF 3% Nacl @10 ml/hr 

- Ryles catheterization 

- Foley's catheterization 

- Inj.Piptaz 4.5 gm /IV/BD

- RT feeds : 100ml water 2nd HRLY 

                        50 ml milk 4rth HRLY 

HAEMATOLOGY -

https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1

Diagnosis :

Pancytopenia under evaluation

Investigations :

- Haemogram, LFT 

- Blood grouping and Rh typing 

- Serum Electrolytes ,Blood Urea 

- T3,T4,TSH, Bone marrow biopsy, ECG 

Treatment :

- Inj METHYLCOBALAMINE 1000mg IV OD

- Inj IRON SUCROSE 1 amp in 100ml NS IV

- Vitals monitoring

CARDIOLOGY , PULMONOLOGY -

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

Diagnosis :

CKD ON MHD WITH HTN WITH B/L TRANSUDATIVE PLUERAL EFFUSION SECONDARY TO HD

Investigations :

- Prothrombin time , LFT

- ABG, CBP, ECG

- Chest X RAY , 2D Echo

- Haemogram, Lipid profile

Treatment :

- Salt and water restriction

- Inj.augmentin 625mg od

- Tab nicardia10mg tid

- Tab.pantop 40mg od

- Tab.lasix 40mg bd

- Tab.orofer xt od

- Tab shelcal.hs od

- Tab nodosis 550mg od

- Tab zofer 4mg tid

- Nebulisation with budecort and salbutomol 8th hrly

- Bp/pr/temp/spo2 and I/O charting monitoring

NEPHROLOGY -

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

Investigations :

- Hemogram

- RFT, CUE 

Question-4:

Link to case:

https://shwethamummadi87.blogspot.com/2021/08/general-medicine-elog.html?m=1

QUESTION-5:

Changing to Competency based medical education and offline classes is very helpful  to know about the clinical scenarios . 

In this month we got a chance of history taking and went to the wards.

This is very useful for improving our skills in history taking and examination.