Bimonthly Formative and summative assessment of 2017 batch (MBBS)

Q1. Review of answers to the questions based on the following case:

Pulmonology

A 55 year old female patient, a resident of Miryalaguda and farmer by occupation came to the hospital on 17/5/21 with the chief complaints of shortness of breath, pedal edema and facial puffiness.

Link to patient details:

https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html

 

A.     Roll no. 5, A. Meghana Reddy

Score: 5/5

Review: The patient suffered from multiple episodes of SOB (shortness of breath) that subsided on medicating. The problem seems to be in the bronchioles and the cause is the probable exposure to allergens while she was working in the fields. She is a known diabetic. The timeline and evolution of the symptoms in the patient has been presented in a simple and efficient manner. The detailed explanation of  mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used was meaningful and easy to comprehend. The explanations given for the patient’s current state of acute exacerbation and electrolyte imbalance seem sensible and convincing. However, the reasoning and explanation for the use of various drugs and diagnostic tests could have been more extensive.

 

B.     Roll no. 15, C. Abhishek

 

Score: 3/5

Review: The timeline describing the onset and progression of symptoms seems to be missing. However, the explanation given for use of each drug and their mechanisms of actions have been adequately described. The reasoning for the questions on electrolyte imbalance of the patient could have been more specific instead of generalized.

C.     Roll no. 26, Santosh

Score: 4/5

Review: The patient’s timeline has been described in detail. The explanations given for the patient’s current state of acute exacerbation and electrolyte imbalance are brief and easy to understand. The mechanism of action, indication and efficacy over placebo of various drugs were well presented.

 

 

D.    Roll no. 48, Shreshta

Score: 3/5

Review: The explanations given for the reasoning questions seem oversimplified and inadequate. The timeline of the patient’s symptomatology was properly represented. There was little or no information regarding the mechanism of action and efficacy over placebo of drugs used.

E.     Roll no. 45, J. Vignatha

Score: 4/5

Review:  The analysis of the available data and presentation of necessary information is satisfactory. The detailed explanations of the mechanism of action of pharmacological or non pharmacological methods used is appreciated.

F.     Roll no. 52, K. Santosh Kumar

Score: 4/5

Review: The case has been well presented. The timeline is adequately informative. Reasoning given for each drug’s mechanism of action are convincing. However, the report is lacking in evidence regarding the diagnostic tests performed on the patient.

G.    Roll no. 67, Ankitha

Score: 3/5

Review: Although the information provided in the report is to the point and organised, there is not enough explanation for each question. Adequate description of mechanism of action, indication and efficacy against placebo of all the drugs are expected.

H.    Roll no. 89, M. Sandhya

Score: 3/5

Review: The anatomical localization of the problem is vague and could have been more specific. The timeline is has been well presented. There is sufficient information regarding the mechanism of action of various drugs but the reasoning questions have been poorly explained.

I.       Roll no. 123, Shareen Begum

Score: 4/5

Review: The explanations provided in the report are appropriate and satisfactory. The detailed description of the attributes of the drugs used is commendable.  Reasoning questions have been correctly answered.

J.      Roll no. 170, Vasitha

Score: 3/5

Review:  There is barely sufficient information regarding the different aspects of the case. The timeline was considerably well presented. However, there is a lack of proper explanation in certain questions.

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Q2. Case studies 

Provisional diagnosis: Anemia with hyperbilirubinemia under evaluation

http://budigammadhumithagm.blogspot.com/2021/06/20-year-old-female-with-anemia-under.html




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Q3. Evaluation of the report on the following case:

A 70 year old female presented to casualty with complaints of Distension of abdomen and shortness of breath Grade-3 since 5days.

Evaluation:

·       The history of present illness was well presented.

·       The images and videos of the diagnostic tests conducted on the patient are clearly visible and make it easier to understand the case,

·       The ECG, 2D Echo, and complete blood picture were clearly represented along with other useful information.

·       The diagnosis of HFrEF which is heart failure with reduced ejection fraction seems logical due to the presence of abdominal distension and shortness of breath which are common features in HF.

·       The course of treatment appears to have been chosen wisely.

·       However, there is lack of extensive explanation in certain areas making it difficult to interpret the significance of the clinical findings for amateurs like us.

·       Not much reasoning or reflection is provided in the report. For instance, it was simply mentioned that the patient passed away but there was little information to explain why it happened.

·       The current case is one of Heart failure due to reduced ejection fraction. That is, the muscles of the left ventricle are not as strong as normal and this leads to reduced or insufficient pumping of blood by the heart.

 

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Q 4. Analysis of patient problems, solutions and drug efficacies  in case of multisystem cases:

A. CNS

1.     Patient problems: Chief complaint is loss of handgrip and weakness in lower limbs since 10 days following a fall. 1 month back, following which he developed productive cough, low grade fever for which he underwent sputum studies and tested positive for AFB bacilli and treatment was started.

2.     Solutions and treatments:

·       Inj. Optineuron 1Amp in 100ml NS  IV/OD

·       Inj. Thiamine 200mg in 100ml NS IV/TID

·       ATT - according to body weight 2 tab PO/OD

·       Bp/ PR/ Spo2/ Temp charting

 

3.     Efficacy of drugs used: Optineuron is a reliable drug in treating such patients.

 

 

B. Abdominal

1.     Patient problems: Chief complaints of pedal edema, fever and decreased urine output since 10 days. Know case of DM2. She was diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions).

2.     Solutions and treatments: Treatment was different on different days. On June 16th, 2021, the following medications were administered:

  • Inj LASIX 40 mg IV/TID          1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 4 respules    [ 1 - 1 - 1 - 1 ]

 

3.     Efficacy of drugs used: Studies suggests that furosemide is unlikely to be able to improve renal function or mortality directly. In patients with acute lung injury without haemodynamic instability, furosemide may be useful in avoiding fluid retention to facilitate mechanical ventilation.

Ref: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2044.2009.06228.x

 

 

C. Renal

1.     Patient problems: Chief complaint being altered sensorium. History of fever 10 days ago which lasted for 3 days. Pedal edema and SOB grade 4 even at rest. Patient is a known case of chronic kidney disease and hypertension. The provisional diagnosis was CKD (Hypertensive nephropathy) with uraemic encephalopathy.

2.     Solutions and treatments:

·       IVF-NS(0.0+30ml/hr)

·       INJ.LASIX(40mg/IV/TID)

·       INJ.NaHCO3(100meq in 100ml NS/IV/Stat)

·       T.NODOSIS 550mg/P.O/TID

·       BP/PR/Strict I/O Charting

 

3.     Efficacy of drugs used: Sodium bicarbonate (NaHCO3) has been recognized as a possible therapy to target chronic kidney disease (CKD) progression.

Ref: https://journals.physiology.org/doi/abs/10.1152/ajprenal.00343.2020

 

 

D. CVS

1.     Patient problems: Chief complaint is abdominal distension and grade 3 shortness of breath since 5 days. The patient has history of hypothyroidism for which she had been taking medication. She was diagnosed with HFrEF with atrial fibrillation.

2.     Solutions and treatments:

·       Inj. Amiodarone 150 mgIV stat (2 doses)

·       Inj.Amiodarone infusion

             1mg/min till 6hr f/b 0.5 mg/min for next 18 hours

  •                  Inj.clexane 40mg Sc OD

 

3.     Efficacy of drugs used: : Intravenous amiodarone is a safe and effective therapy for life threatening incessant tachycardias in infants and an effective anti-arrhythmic agent for the treatment of supraventricular and ventricular tachycardias.

Ref: https://doc.rero.ch/record/310619/files/431_2003_Article_1302.pdf

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Q 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

Ans.

With a global pandemic on the rise, there was little to look forward to as a first year MBBS graduate. Clinical postings and interaction with patients being the most exciting part of the course, I had assumed that online classes alone wouldn’t be of much help. Clearly, I was wrong and I’m grateful for that. Thanks to our professors and faculty, who have been very enthusiastic and relentless in their approach to teaching, the entire learning experience has been nothing but exciting and engaging. Participating in the telemedicine postings and working with our seniors to investigate various cases has played a huge roll in this.

Although we were all uncertain about multiple things regarding the process of E logging different cases, with the guidance provided by our faculty as well as interns, we eventually started getting the hang of things. It was exciting to take history of patients for the first time. I learnt various skills and techniques that help doctors have fruitful interactions with patients. I have been told that taking history of a patient is an art in itself and turns out that was true. It definitely is nerve wracking but the satisfaction that comes with doing a good job at history taking is commendable.

Apart from interacting with the patients, there have been many more interesting aspects to the online approach to clinical examination and patient care. We got to partake in the case discussions of several interesting cases ranging from mild anaemia to MISC. Reading the blog posts of our seniors’ e Logs and understanding their take on their cases has helped us achieve a deeper understanding of the subjects which are otherwise quite hard to comprehend.

Viewing the cases presented by the post graduates and interns has taught us the techniques of interpreting medical reports and associating them with provisional diagnoses as well as contemplating the future course of action and treatment.

Overall, it has been an enriching learning experience and I hope to continue to be a part of the online case discussions and telemedicine postings even after offline classes are resumed.

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