July 2021 Bimonthly Blended Assessment

MONTHLY BLENDED ASSIGNMENT (July) 

Welcome to my e-log!

I am Varshitha Kalidindi, a 2nd year MBBS student. Here is an assignment which was given to me for the month of July. 

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

I will be answering it question wise below:-

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


Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :
and share your peer review of each answer with your qualitative insights into what was good or bad about the answer. 

Answer:-
The link to the blog of my peer's assignment is given below:-

The question paper given for the assignment is as follows:-


The answer given by my peer to the first question is as follows:-
 PULMNOLOGY:

  

Comment:
Very attractive representation looks organised and actual effort is seen elaborate explanation and to the point, important points are well highlighted ....

NEUROLOGY:
  
Review 2:

Case 2:
  
Comment:
The entire document is very well-formatted, the organization of the data makes it very easy to look..
Correlation of different aspects is observed..

CARDIOLOGY

Review 3:
 
Case 3:

  
Comment:
I agree with the answer given by the peer he explained it in very good way...Each drug was mentioned and explained in detail about the mechanism of action,in an understandable way.

PULMNOLOGY

Review 4:

Case 4:

Comment:
Each drug was mentioned and explained in detail about the mechanism of action,in an understandable way.

GASTROENTEROLOGY
 
Review 5:
 
Case 5:
 
Comment:
Answering has been done in a point wise manner, with nice detailing & information.
Written in a simple & easy to under

stand manner with to the point information. .

PULMNOLOGY


Review 6:

Case 6:

Comment:
The symptomatology has been explained in a chronological order of occurrence.
The primary etiology of the patient has been mentioned with the necessary finding along with the pictorial representation.

NEUROLOGY:
 
Review 7:

Case 7:

Comment:
Presentation is very neat & easy to follow. 
Point wise answering is clear & precise 
more diagrams would have made it more comprehensive....

NEUROLOGY:

Review 8:

Case 8:

Comment:
The explanation was good, but the certain points could have been highlighted...

NEPHROLOGY AND UROLOGY:

Review 9:

Case 9:

Comment:
Presentation is very neat & easy to follow. 
Point wise answering is clear & precise 
more diagrams would have made it more comprehensive....

CARDIOLOGY
 
Review 10:

Case 10:


Comment :
Each drug was mentioned and explained in detail about the mechanism of action in an understandable way.

My review: I think this student's answer was very concise and simple. The reviews could've been much more elaborate because these reviews don't really prove how much the student really read and comprehended the cases. The reviews seem generic and not really specific to each answer. A briefing of the case in the student's own words and a more detailed review of the cases in question could've really improved this answer.


Question 2 has not been answered by this student because he hasn't dealt with a case yet.

The answer given by this student for question 3 is as follows:-

Renal:

All the required data has been included in the chronological order.
If the history was mentioned in a point wise manner it would have been more comprehensive.
All the investigations done were mentioned along with the deidentified reports.
No discussions on diagnostic and therapeutic uncertainties were given.
The general examination and the systematic examinations done were mentioned accordingly.
The treatment plan was well described with the dates on which drugs were administered.

My review: This review was well explained and the student has very nicely listed all the positives and negatives. I would say that this is a pretty unambiguous answer.

The answer to question 4 of this assignment has been written as follows:-

Problem list at the time of arrival :

1. Complaints of Altered Sensorium 
2. Shortness of breath at rest
3. Lethargy
4. Anasarca
5. Complaints of lower back pain and neck pain
6. Loss of appetite

Problems found while systematic examinations:

1. Presence of oedema
2. Dyspnea is present
3. Hypoactive and delayed response to commands

Treatment : 

Inj. LASIX was given to manage Anasarca.

My review: This is a very concise answer given by this student and more details could've been mentioned about the answer like investigations which were done, why they were done and the outcomes. The investigations are very essential for giving an accurate diagnosis, so it really should've been mentioned in this answer.

Answer 5 answered by this student is given below:-
If we just take a look at what we have achieved with the help of telemedical communication the answers are never ending. Like all the case history can be shared throughout the world, and we can also recieve suggessions from the experts who have always been working in that field for a long time. The task of making an elog might look as an easy one but it's not. Making an elog consumes a lot of time and effort, we have to collect the patient history by talking to their attendent or patient themselves which was a tough task. It is the first time ever that we started an interaction with the patient which was enough to increase our anxiety but the task was incomplete. Talking to the patient directly would have given us much more valuable information and we could understand their pain and suffering by looking at them. We've missed all these interactions due to the pandemic but there is nothing else we could think of to use the time available to the fullest. This experience we gained by writing elogs and writing the assignment gave us an opportunity to learn something new, basics of what a doctor should do when he has encountered a patient. History taking which includes present history, past history, family history, treatment history and so on along with their biodata. Each step gives us a clue of some sort, helps us the process of diagnosis. We believe this experience would help us gain a better perspective in the future. 

My review: The answer is acceptable for the question and sums up the month's experiments in a concise way. Some sentences are a little generic but overall the answer really does talk about the experience during that month, so it is a good answer.


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. 


Answer:-
I really didn't interact with a patient or work on a case yet, though I would really love to. I just haven't been able to get a case to work on and would really love the opportunity to work on a case. I really hope that I get that opportunity soon.
    So instead, I will give the link to a blog that I have made based on another case that my seniors have worked on, which was also discussed in the group:-
 https://144varshithakalidindi.blogspot.com/2021/07/a-case-of-75-year-old-male.html

I will now try to briefly discuss this case.
The patient is a 75 year old male and came to the hospital with the following:-
1. Left-sided weakness and deviation of the mouth to the right side, which shows that the left side of the face is paralysed.
2.The patient wasn't able to contain his urine as well and arrived at the hospital with a foley's catheter to drain the urine from the bladder.
3. Deglutition was difficult for the patient as well and he could only drink when given water with a bottle cap. Ryle's tube was inserted to feed the patient. He also has not stools since the previous day.
    The provisional diagnosis given for this case after some investigations is, the patient has left hemiparesis 2⁰ due to an acute infarct in the region of the middle cerebral artery.
     The treatment for this patient includes pain relievers, blood thinners (to prevent clots), nutritional supplements, antacids, lipid-lowering agents, hepatic artery infusion 3 times a day. The drugs' names are mentioned in the link.
     The patient is also being fed through the Ryle's tube with water and milk with sugar. His vitals are also being frequently monitored.

Q3) (Testing peer review competency of the examinees) :

Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyse the diagnostic and therapeutic uncertainties around the cases shared.


Answer:-

This case is very complete and all the details of the patient with the complaints, the investigations, the diagnosis and the treatment have been very well described. The details are mentioned accurately. This e-log could've actually been improved by colour coding the abnormal values in the investigations. The treatment was logged on a day by day basis, which is clear. The diagnosis of the case was also evident through the investigations and the therapeutic advice was thus easier to give with certainty.


This e-log is complete with all the details of the patient, complaints, examinations and investigations along with the provisional diagnosis and the treatment. The treatment is especially detailed and impressive. The values of various parameters have been shown with actual pictures of the files, which shows accuracy. It would've been more clear if the abnormal values were also mentioned separately. The information provided is adequate for determining the diagnosis and the treatment accordingly.


The information is complete with mention of the complaints of the patient, examinations, investigations and the provisional diagnosis and treatment given. All the values of the investigations have been mentioned accurately. The abnormalities in the patient's investigational values have also been separately mentioned, which makes the e-log even more understandable and easier to examine and reach a diagnosis. 
The treatment has been logged very nicely.


This e-log mentions all the examinations, investigations, provisional diagnosis and treatment. The information was logged in a day by day manner which is very clear and impressive. There is also an explanatory discharge summary which is very useful. The investigational values have been shown with actual file pictures which confirms accuracy. Adding videos to the e-log was also a really nice idea. Also, the treatment has been logged in a very detailed and day by day manner. These help reach a proper diagnosis and treatment accordingly and helps remove uncertainties.


This is a very complete e-log with the patient complaints, examinations, investigations, diagnosis and treatment. The discharge summary was also elaborate and well-explained. There were very descriptive photos and videos for understanding the 2D echos, which was very helpful. Pictures of the official reports from the investigations show accuracy as well. The treatment and the advice given to the patient were described clearly and separately as well.


This case mentions the patient's complaints, examinations, investigations, diagnosis and treatment. However, giving a discharge summary could've really helped improve this e-log. It still has a good amount of information and associated pictures for the investigations, which made the log a concise yet informative one. It has accurate information and the diagnosis and treatment have been analysed well with the help of  the clear information.


This is a very complete e-log with the patient's complaints, examinations, investigations, diagnosis and treatment. There is no discharge summary but the important points to be taken into consideration from the patient histories and investigations have been well highlighted for clear understanding. Posting pictures of the original investigatory records shows accuracy as well. The best part about this e-log is that it has many reference links and this makes the case all the more comprehensive and informative. It is a very nice e-log.


The case is complete with patient's complaints, examinations, investigations, diagnosis and treatment. There is no discharge summary, which could've improved the log. All the pictures of the lab records and the scans show accuracy. The clarity of the information helps reach a proper diagnosis and treatment.


The e-log is complete with patient's complaints, examinations, investigations, diagnosis and treatment. The information has been given in an accurate manner. Also, the logging of the treatment and patient progress was described in a day by day manner and is very informative. These help approach a good diagnosis and advise treatment accordingly.


This e-log is also complete with patient's complaints, examinations, investigations, diagnosis and treatment. The information has been given in an accurate manner with pictures of the investigational records. The logging of the treatment was also very descriptive and neat. The info and the way it was presented really helps reach a proper diagnosis and thus treatment.


The e-log was complete with patient's complaints, examinations, investigations, diagnosis and treatment. The pictures of the official records and the patient pictures were very helpful and clear. The summary was also very concise and easy to understand. The treatment was mentioned clearly as well. This logging helped reach a proper diagnosis and thus treatment.


Q4: 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):

Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 

Answer:-


A 58 year old male came to the casualty with complaints of lower abdominal pain, burning micturition, low back ache, decreased urine output, fever and shortness of breath.
   Upon examination of abdomen, tenderness was seen present. Burning micturition was confirmed by the abundance of pus cells in the urine. On blood examination leukocytosis was seen. After all the examinations and investigations, it was diagnosed as acute kidney injury and urinary tract infection. 
   Treatment included intravenous administration of ringer lactate and normal saline to replace fluids and electrolytes, tazar for the UTI, antacids, laxatives, thiamine administration.


A 75 year old male came to the casualty with complaints of lower backache, dribbling of urine, pedal edema, shortness of breath, involuntary movements of both upper limbs. He has a history of jaundice.
   After all the examinations and investigations, the patient was diagnosed with Acute renal failure (intrinsic), Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis, Hyperuricemia 2° to Renal failure, Uraemia induced tremors, Delirium secondary to septic /Uremic encephalopathy.
   The treatment given to this patient includes IV infusion of normal saline, tazar for the infection, lasix (diuretic), airway muscle relaxants for breathing, antacids, painkillers, insulin injections.


A 49 year old female had noticed mass per anum and bleeding and got operated for it after it was diagnosed as haemorrhoids. She has a history of muscle aches for which she is using NSAIDs. She also has generalised weakness and vomitings. 
    Serum electrophoresis showed an M band in the gamma region and bone marrow aspiration showed plasma cell dyscaria, both suggestive of multiple myeloma. Haemogram shows decreased haemoglobin. Patient was thus diagnosed with Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).
   The treatment includes antacids, oral fluids, protein and milk, antiemetics, iron supplementation.


A 35 year old female came to casualty with complaints of fever, diarrhoea (with blood discharge)and vomiting, back pain with chest pain and abdominal pain. The patient is diabetic and takes oral hypoglycaemic agents. She was facing severe breathlessness before coming to the opd. The patient was in a state of altered sensorium on arrival. 
   CPR was administered when the patient became unresponsive (gasping). After all the examinations, the patient given a provisional diagnosis of diabetic ketoacidosis with AKI. The USG was suggestive of pyelonephritis. The patient also developed bed sores at the hospital.
  Treatment included antibiotics for the bed sores, Norad to treat hypotension so as to improve blood flow to heal the sepsis, HAI for diabetes and anticoagulants.

A 52 year old man presented to the OPD with complaints of abdominal distension. He was diagnosed with type 2 Diabetes Mellitus in the past and started taking medication for it. He also had complaints of tingling in the upper limbs and lower limbs. At present, his complaints include abdominal distension, constipation, altered sleep patterns, hiccups, pedal edema.
   Icterus was noticed on general examination. After all examinations and investigations, the patient was diagnosed with infective endocarditis with AV vegetations with AKI, maybe uremic and/or septic encephalopathy, ulcer over sole of right leg, Hypoalbuminemia ( maybe alcoholic liver disease),multiple acute cerebral and cerebellar infarcts.
   Treatment includes antibiotics, enema, antacids, HAI for diabetes, thiamine administration, blood thinners.


A 52 year old male patient presented to the hospital with complaints of fever and pus in urine. He was diagnosed with Diabetes Mellitus in the past and took medication for it. In the past he had also experienced dribbling of urine, hesitation and reduced flow of urine. It was not associated with any pain. More recently after that, he had experienced burning micturition and a urologist told him he had prostatomegaly, for which he was advised to undergo turp. Before operation the patient had high sugar levels. He also had fever with chills and rigor and icterus, treated with antibiotics.
   His 1st admission at the hospital, the patient presented with generalised weakness and decreased appetite for which he received treatment.
   His 2nd admission at the hospital, the patient presented with drowsiness and had fluctuating BP. He was found to have hyponatremia and was treated for it. He had high creatinine levels as well for which he was treated.
   His 3rd admission at the hospital, the patient presented with shortness of breath on exertion, fever with chills and rigor, burning micturition. He had high creatinine levels. Fleshy mass like and foamy passage in urine was seen as well.
   His 4th admission, which is the present one, the patient complains of fever and pus in urine.
After all the examinations and investigations, the patient was diagnosed with Renal AKI secondary to urosepsis with bilateral hydroureteronephrosis, diabetes type 2 with diabetic nephropathy, anaemia secondary to CKD with grade 1 bed sore.
   Treatment includes antacids, antibiotics, diuretics, painkillers, multivitamin supplementation, antipyretic, HAI for diabetes.


A 48 year old male presented to the OPD with complaints of shortness of breath. He was diagnosed in the past with chronic renal failure. A few months after that, he had chest pain and he was told at the hospital that he had heart failure, but he was normal after the angiogram. More recently, the patient was symptomatically treated for shortness of breath. At present he has complaint of shortness of breath. Orthopnea and bendopnea were present as well.
    He has history of diabetes and hypertension. He is taking calcium supplementation.
On general examination, edema was seen in feet. Dyspnea was seen in respiratory examination. FBS and PLBS were found to be elevated. ESR is elevated and haemoglobin is decreased.
   After all examinations and investigations, the patient was diagnosed with HFrEF (Heart failure with reduced ejection fraction) secondary to CAD; CRF.
    Treatment includes antihypertensives, vasodilators, hypoglycaemic agents, antacids, vitamin D supplementation, diuretics, laxatives, painkillers.


A 60 year old female patient came to the OPD with pedal edema, decreased urine output, vomitings and loose stools. She also has shortness of breath. In the recent past, she was diagnosed with pneumonitis with suspected right heart failure and interstitial lung disease. She was treated. Presently, she has pitting type of pedal edema which has progressed to anasarca.
  Investigations showed elevated blood urea and creatinine levels. Patient was sent for dialysis with suspected uremic encephalopathy. 2-D echo showed right heart failure. HRCT chest shows pulmonary oedema after 4 dialysis sessions with static creatinine levels and hypoxia didn't improve.
  The patient developed hypercapnia on 3rd day of admission possibly due to hypertension secondary to obesity. Patient was then started on intermittent BiPAP. The pco2 level started fluctuating and finally the patient with discharged and advised for home oxygen support.


A 43 year old male patient came to the casualty with complaints of loose stools, pedal edema, abdominal distension. He has a history of TB and took treatment as well.
   After all examinations and investigations, the patient was diagnosed with alcoholic hepatitis, AKI secondary to acute gastroenteritis, HFrEF secondary to CAD, Alcoholic and tobacco dependence syndrome.
  Treatment includes thiamine supplementation, multivitamin supplements, diuretics, antihypertensives, antacids.


A 60 year old female presented to the OPD with complaints of pedal edema, decreased urine output and fever. Reports from other hospitals suggest AKI. Known case of Diabetes Mellitus and is receiving treatment.
  On examination, generalised lymphadenopathy was seen. Pitting type of pedal edema is seen bilaterally. After all examinations and investigations, the patient was diagnosed with AKI secondary to urosepsis with hyperkalaemia, anaemia of chronic disease.
   Treatment includes IV infusion of normal saline, diuretics, antibiotics, antacids, HAI for diabetes.


A 31 year old male patient came with complaints pain in abdomen, vomiting and shortness of breath. He was then treated for these and his creatinine levels rose, after which he was referred to our hospital. On general examination, he was found to have pitting type of pedal edema. Abdominal examination showed distension and tenderness.
   After all examinations and investigations, he was diagnosed with acute pancreatitis with AKI with suspected bilateral pleural effusion and moderate ascitis. He is also currently withdrawing from alcohol.
   The patient was managed conservatively with painkillers and IV fluids. The patient then developed pedal, scrotal and penile edema on the 4th day of admission and was advised for haemodialysis due to features of overload. He underwent haemodialysis, which helped lower creatinine levels after 2 sessions.


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.

Please reflect on and share your telemedical learning experiences from the  hospital as well as community  patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.

Answer:-

This month's experience has included more elaborate and detailed info than that of the last. Being able to connect with patients online has really been an advantage in that it lets us see more patients than we normally would if we were in person, i.e. offline. I do however still believe that the offline learning experience will be much more useful because there will always be hindrances when it comes to connecting with patients online, like connections issues and audio problems. Still, the experience has been very good nonetheless.
     I have also, unfortunately, not yet gotten the chance to E log a case report by actually taking down a history of a patient by myself, communicating with them and capturing all the essential data. That is one experience that I am really looking forward to and would grasp the first opportunity that I get to be able to finally contribute to a case.
     One of the most interesting cases that I have seen this month was of a patient with hemiballismus. It was a case that I have come across in theory and learnt about in physiology, a subject in my first year of medicine. This was the first time I got the opportunity to see a patient who actually had this disorder. I do consider myself lucky to have gotten such an opportunity.
     One of the more recent patients that we have come across is a patient had a sudden onset of left upper and lower limb weakness, with the mouth also deviated to the right side (the healthy side). In the session that day, we could see how the tone was decreased in the patient in the left upper and left lower limbs. This condition made it difficult to swallow food and thus led to hypoglycaemia in this patient. This case has really shown how much a patient can be affected by a single disorder which leads to others.
     There was another patient that we saw on the same day and the patient was basically not eating well due to difficulties with deglutition. The patient also took enzyme tablets on an empty stomach, which were supposed to be taken with food. The patient had visibly lost a lot of muscle and body weight. His pants had become so visibly loose, it was truly shocking. This case has really made me realise that a patient must be made well aware of how the tablets are supposed to be taken and maybe a brief idea about what the tablets do can really prevent the patient from such mishaps. It also shows how such problems can affect a patient so much.
     These online classes have been very helpful and are very easily viewable at the comfort of home, yet I really do look forward to offline sessions where the patients can be observed in more detail hopefully and the experience will be all the more informative and wonderful!


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