MEDICINE DEPARTMENT PAPER FOR JULY 2021 BIMONTHLY BLENDED ASSESSMENT

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Question-l 
Peer review 

Link: https://50himavathsa.blogspot.com/2021/07/general-medicine-assignment.html
Himaratsa-50

Case reviews-He has analysed all the cases after reading both the case report and the assessment and has come to varied conclusions on the cases, their prognosis, their treatments and the post discharge care received by the patient. He has gone into great detail about the causes and the solutions for the majority of the cases but has fallen short of criticism and has not provided valuable input and feed back that will help the doctors writing these cases improve their methodology. He has gone into detail of the cases after they have come to the op but has missed the root causes like alcoholism which could have caused the cases in the First place. Overall himaratsa has done very well and I have leant a lot from his assessment.

Case presentation E-Log - no case log given

Case analysis - He has analysed a case of aki- acute kidney injury a 45 year old man.
Link - https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

He initially goes into a review of the case presentation. He then analyses the diagnosis of AKI and goes into the rational as to why it is aki. He comes to the conclusion that the AKI is because of CKD caused by hypertension and the patient has uremic encephalopathy. He then goes into the treatment given. He has gone through great effort to understand the complicated case given as many contributing factors are seen in the provisional diagnosis given. The author of the cases has not gone into detail about future management therefore that has also been missed in the case analysis. Overall an excellent effort has been made by both the case author and himavatsa to summerise the case given.

Overall my fellow peer has done a very good job doing the assessment considering that we had no prior experience and I am confident that both him and I can do a lot better over the course of our medical education.

QUESTION 2 

http://sriyagarikapati.blogspot.com/2021/06/a-case-of-acute-pancreatitis.html

http://sriyagarikapati.blogspot.com/2021/06/50year-male-with-uremic-encephalopathy.html

http://sriyagarikapati.blogspot.com/2021/07/year-old-male-came-to-casuality-with.html

Question 3 


1)AKI

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

The provisional diagnosis made was AKI secondary to UTI associated with DM2 and hypertension .All the investigations were given in a proper sequence and history of patient was in sequential maanner .



2) CKD 

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

The blog was made very clear with diagnosis and symptoms along with secondary manifestations . Details about entire treatment were provided



3) CKD

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

 Case is well presented patients obstetric , menstrual and previous birth histories were well explained .



4) patient with renal failure 

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

This blog was so impressive with pictures and proper treatment details along with previous history and family history 



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

In this blog details of all the treatment and treating faculty were included and insights were also provided with all the lab reports and pictures .



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

All the details were included in a precise way . but discharge summary was not included and all the other investigations were in order .



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

This log has entire provisional diagnosis and treatment procedure was included .blog has links of reference .



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

This blog was made so perfect by including discharge summary and all the investigations but treatment procedure would have made it complete.



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

This blog consists of pictures of general examinaation and all the other histories like family , previous history etc.



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

Log is so impressive with all the details and diagnosis was very well mentioned. 



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

This blog gives a quick review about the entire case and its details and it's subheadings were also good.

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 : Hyperuricemia 2° to Renal failure 
Treatment:
• IVF - NS-0.9% @100ml/hr
• Inj. Tazar 2.25gm I.V -TID 
• Inj. Lasik 40mg I.V -BD 

✱Case 3
Diagnosis: Chronic interstitial nephritis secondary to plasma cell dyscariasis
Treatment:   
- T. PAN 40mg /PO / OD
- oral fluids upto 1.5 - 2 lit / day
- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk  

✱Case 4 
Diagnosis: DKA with AKI 
Treatment:
Inj. NORAD 2amp in 50ml NS
Inj. PIPTAZ 2.25gm.
Inj. DOPAMINE 2amp in 50ml
Inj. HAI 1ml in 39ml NS

✱Case 5
Diagnosis:INFECTIVE ENDOCARDITIS
Treatment:
1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD

✱Case 6 
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 7
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 8
Diagnosis: Acute on CKD 
Treatment: 
1. Tab. Augmentin 625 mg ×7 days
2. Tab. Wysolone 40 mg ×10 days.
    30 mg × 10 days 
    20 mg ×10 days
    10 mg ×10 days.
3. Tab . Lasix 20 mg × 1 month.

✱Case 9
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  
     

✱Case 10
Diagnosis: Acute Kidney Injury secondary to Urosepsis
Treatment:
 Inj LASIX 40mg (8am- 2pm -8pm)
IVF - NS @ UO + 50 ml/hr

✱Case 11
Diagnosis: pancreatitis in a chronic alcoholic 
Treatment:
IV lasix 40 mg BD .
Tab Nodosis .
IV PIPTAZ 4.5 Gms. BD 
Iv 25%Dextrose. 100 ml BD 
Iv fluids : NS 40 ml /hr.

QUESTION 5
Testing scholarship competency in logging reflective observations on your concrete experiences of this last month write an essay for 10 marks on the above topic:

We have started our internship program on 2nd June, due to the covid pandemic we have been struck in our homes for the last 1 year , and completed our final year in online, because of which we lost the valuable 1 year of practical classes in which we could learnt something. With all these fears of not seeing patients for one year and suddenly coming in touch with patients was quite exciting and with all new hopes we started our internship and posted in the general medicine department in which we are having a lot of exposure to different kinds of patients, we have had experiences of seeing patients suffering and all the efforts done by PG's and us to save them arose a quite doctor in me. I have experienced both the feelings of being successful in saving the patient which filled me with immense happiness and failure which filled me with grief. The most important thing then I realised was the world was grey and not black and white. I understood the feeling of being a doctor. Our HOD sir in every day rounds explained about each and every case and asked me to film it and asked to know about every patient, in the process of I got the valuable information from sir and which ignited a sense of learning in me. It helped me understand about a lot of topics which I couldn't understand by reading books, and the interactive sessions in the afternoon also helped me a lot to learn how to present cases and understood how discussion helps in solving the cases. I will also learn to ask questions in which I am lacking and try to be a good and active member of medical team. I thank general medicine department for the opportunity.

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