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.
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.
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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