GENERAL MEDICINE ASSIGNMENT(AUGUST 2021)
Name- A. Sri Sai Tarun
Roll no - 03
Sem-3rd sem
BELOW IS THE LINK TO THE QUESTIONS ASKED TO US :
QUESTION-1
*Critical appraisal of the captured data and peer review
LONG CASE:
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
Evolution of symptomatology is well described in the illness.Proper past ,personal ,family ,surgical, medical and immunization histories are provided. Differential diagnosis for the conditions he's been in are given . Classification criteria for rheumatoid arthritis is provided which gives us idea in which category patient is in based on points.The possible scenarios that can be are described in brief. Diagnostic approach is mentioned.After final diagnosis , further plan of treatment is given clearly.
SHORT CASE-1:
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
Present illness is described very well with each and every detail explained properly.All the histories and examinations done are mentioned.Problem presentation with treatment are provided.Source for resting tremor is also given at the last.
SHORT CASE-2:
19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of 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.
Present illness with evolution of symptomology is perfectly described,Other histories with examinations done are given,Pictures provided clearly indicate it as a case of cushings syndrome, They also explained ruling out endogenous cushings syndrome and giving a final diagnosis of iatrogenic.
QUESTION-2
*Problem list for each patient and the diagnostic and therapeutic uncertainty around solving those problems as follows:-
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:-
- Free water restriction for Hyponatremia
- Tab. PREDNISOLONE P/O 20 mg OD
- Tab FEBUXOSTAT P/O 80 mg OD
- 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)
Treatment:-
- Tab. Syndopa Plus 125 mg QID
- Tab. Syndopa 125 mg CR OD
- Tab. Telma 40 mg OD
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
**Review of literature around sensitivity and specificity of the diagnostic interventions mentioned and efficacy of the therapeutic interventions mentioned for each patient.
LONG CASE:
Investigations done are:-
- Current Admission - Blood tests
- Blood work from previous presentations to hospital. RA factor was negative
- 24hrs urinary protein: 1500 mg
- 24hrs urinary creatinine: 0.8
- Urine Microscopy - Freshly voided urine sample was centrifuged at high speed (> 2700 RPM) and sediment collected and fixed on glass slide and examined under microscope at 400 (10x * 40x) showed DYSMORPHIC RBCs (black circles) and occasional pus cells (red circles). Dysmorphic RBCs were those that had altered shape, microcytic or with membrane defects.
Efficacy of Treatment given:-
- Tab. PREDNISOLONE P/O 20 mg OD:-It is used to treat conditions such as arthritis, blood problems, immune system disorders, skin and eye conditions, breathing problems, cancer, and severe allergies. It decreases your immune system's response to various diseases to reduce symptoms such as pain, swelling and allergic-type reactions.
- Tab FEBUXOSTAT P/O 80 mg OD:-class of medications called xanthine oxidase inhibitors. It works by decreasing the amount of uric acid that is made in the body. Febuxostat is used to prevent gout attacks but not to treat them once they occur.
- Haemodialysis for worsening renal dysfunction
SHORT CASE-1:
Investigations done are:-
- ECG:-Shows Sinus Tachycardia with pseudo infarct pattern in leads I and aVL with dagger q waves in the same leads,No late intrinsicoid deflection of R wave with modified Cornell criteria showing LVH.
- 2 D Echo :-Grade II diastolic dysfunction
Efficacy of Treatment given:-
- Tab. Syndopa Plus 125 mg QID:- is a combination of two medicines used to treat Parkinson's disease. It is one of the most effective medications to relives symptoms of Parkinson's disease such as tremor, muscle stiffness and difficulty moving.
- Tab. Syndopa 125 mg CR OD:-is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors , stiffness and slowness of movement.
- Tab. Telma 40 mg OD:- is a medicine used to treat high blood pressure and heart failure. Lowering blood pressure helps to prevent future heart attack and stroke.
SHORT CASE-2:
Investigations done are:-
- CBP - HB - 13.4 g/dl
- TLC - 6,800
- PLT - 1.5 lakhs.
- RBS - 139 mg/dl
- CUE - ALBUMIN - +1
- SUGARS - NIL .
- PUS CELLS - 3-4
- RBC - NIL .
- LFT - TB -1.03
- DB-0.21
- ALBUMIN - 3.9
- RFT - UREA - 22
- SERUM CREATININE -0.6
- ELECTROLYTES - NA - 136
- K- 4
- CL-98
- USG ABDOMEN - NORMAL.
- ECG - SINUS TACHYCARDIA
- LVH PRESENT.
Efficacy of Treatment given:-
- Tab.Telma 20 mg od - due to low cortisol level
- TAB HIZONE 15 mg:- is prescribed for Severe allergic reactions,Allergic conditions,Cancer,Skin disorders,Eye disorders.
- Tab Shelcal 500 OD and Tab Vit D 3 Od:-To treat vitamin D and Calcium deficiency.
- Tab ULTRACET /PO/SOS:-is a combination of two medicines that are used for short term relief of pain, inflammation, and swelling in conditions that affect joints and muscles.
- Tab Itraconazole 100 mg bd.:-to treat a variety of fungal infections.
- Tab levocitrixine 5mg od.:-relieve runny nose, sneezing, and redness, itching.
QUESTION-4
QUESTION-5
*Logging reflective observations on my concrete experiences of this last month ..
- To have a good understanding in case taking and making e-log of patient's data , it is necessary to have a practice of history taking ,which for us is complicated because of this pandemic.
- I express my gratitude for their help in making us students understand the cases and doing e-logs.
- It's great to have experience of taking history of patient's admitting in our hospital in 3rd semester itself and understanding what why and how the disease is being caused . These questions are making us curious to learn clinical subjects more efficiently.
- Online classes during this pandemic has made a huge impact on medical students life as this has never happened before and professors are trying their best to explain each and every topic exclusively without us being in front of them which might be really hard for them .
- I hope these online sessions end soon and we are excited to go to offline postings .
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