Bimonthly assessment July 2021

• The question paper link for this month's(July 2021) bimonthly assessment.

http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1

 Question 1: Competency tested for Peer to peer review and assessment :

• https://vasavipakker.blogspot.com/

Review: The whole assessment was kept brief and simple.The factual information from the investigations where put forth and  understanding of the cases was given. Although the facts that were stated, could've been more insightful if their  own aproach towards the cases had been, the possible outcomes, the pathophysiology behind it and also use of appropriate visual representation could've been more helpful.

Q2) Share the link to your own case report 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. 

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

Q 3

CKD 

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

This is a case of Multiple myeloma(uncommon type).

The patient had a history of muscle aches, generalised muscle weakness, nausea and vomiting, she had lost her appetite. 

General exam and lab investigations revealed 

Anemia(low Hb levels and pallor)

Anemia is due to impaired iron utilisation as seen in the lab investigations(high ferritin levels and low serum iron levels).The impaired utilisation could be due to cytokine induced upregulation of hepcidin.

Right wrist joint pain And Xray of chest:

Showing the involvement of osteoclasts activity(osteoporosis)in the bones due to malignancy of bone marrow cells(bone marrow aspiration analysis). The diagnosis was done and treated accordingly in a short span of time. 

Patients with coma and renal failure:

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

The patient had come with complaints of fever and backache with diarrhoea. On arrival at the hospital,  she had succumbed to a cardiac arrest for which CPR was administered.lab findings like complete blood picture,LFTs and RFTs where ordered which showed increased levels of urea and creatinine and later,  she was put on dialysis.Later USG was done which revealed an enlarged kidney and gradually her haemoglobin levels had come down as a consequence of  kidney injury . Due to her persistent  vegetative state and no improvement in her coma scale an MRI was ordered which confirmed that there's Septic shock due to hypoxemia. Also the bed sores were due to a hospital acquired infection which cannot be healed by the patient herself because she's a known diabetic,hence the degeneration and necrosis of tissue at the site(this was confirmed because a simlar infection had occured in her little finger in the past, and as treatment the infection site was removed). Hence, timely care and repeated change of dressing was done to relieve her of the pain. But there is poor prognosis and hence she was discharged.

Patients with acute on CKD:

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

The patient had undergone TURP transurethral resection of prostate in the past due to prostamegaly. But his RFTs where still in a critical state. The Complete blood picture and ABG analysis were ordered which showed a common profile(to that of a normal individual). X ray of the abdomen was done which revealed urinary bladder thickening and hydroureteronephrosis.Hydroureteronephrosis is defined as a dilatation of the renal pelvis, calyces and ureter caused by the obstruction to free flow of urine from the kidney, leading to progressive atrophy of the renal cortex.Also the patient's urine contained pus cells which was indicative of sepsis in the urinary tract.Hence all of the parameters used for coming to a conclusive diagnosis seem to be valid.

Patient with AKI:

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

This is a direct case of alcoholic hepatitis with gastroenteritis.The history pertaining to this case is accurate and the lab investigations ordered have also provided a ground proof diagnosis of the said condition.

Hemogram,CUE,CBP,RFT,LFT,ECG,CXR PA VIEW,USG ABDOMEN,,PT/ INR,APTT,BT/CT These were the lab investigations ordered.The whole  report was jotted down well. 

Q 4

Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021

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

The investigations that can further be ordered to confirm the case of multiple myeloma are -LDH concentration(high), BUN(high).Diagnosis could also be confirmed by immunoelectephoresis which would show increased levels of monoclonal antibodies.

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

The investigations that were ordered were apt for the case.The MRI scan was revealing which helped in further treatment of the patient.Additional investigations that can further be ordered could be an angiogram to check for any infarct in the heart tissue(to know as to why she had a cardiac arrest on arrival at the hospital).

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

All the investigations lead to the diagnosis of the case and better treatment of the patient. Hence, no diagnostic uncertainties were found. 

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

The history of the patient was helpful in diagnosis of the case. The treatment plan was well worth and the patient has been recovered. No diagnostic uncertainties were found.

Q 5) Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 

The pandemic has been too hard on us, making learning online ; which was a daunting task at first. We had dreamt of attending our clinical postings offline and experience something which we haven't before. But i'd be lying if i had said that the online postings weren't helpful. It was quite a challenge for us to connect with patients on phone,but with  the guidance of our HOD sir, pgs and interns of the general medicine department it was seemlessly taken care of.  The clinical postings in the morning and discussions of the cases in the afternoon has helped me to get a better perspective of the said case. The process of making an elog has helped me to connect with patients and also the interns had briefed me up about the case very well, which I'm sure will help me to remember and  retain things for a longer time. Also the laboratory investigations that need to be ordered where understandable by me. Although i was able to interpret things well online, but i'd prefer to be at the hospital in person to enjoy this kind of hospital exposure.!

Thankyou.