SECOND INTERNAL EXAMINATION SEPT 2023

 




















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OSCE and key learning points (prefinal examination)

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  Following the case discussion of a 60 year old female who presented with active uncontrolled abnormal movements of the limbs, some questions which were discussed as part of the Objective Structured Clinical Examination are: 1. What triggers Status epilepticus in a patient with pre-existing epilepsy?   There are many etiologies for status epilepticus including both obvious causes like non-compliance with the prescribed anti-epileptic medication (To be noted: the medication prescribed in the past for this patient was chronically underdosed) and other causes like: Cerebrovascular accidents Central nervous system infections Drug withdrawal syndromes (alcohol, benzodiazepines) Metabolic derangements (hypoglycemia) Hypoxia Head trauma Hypertensive emergencies Autoimmune disorders In this patient it was noted that at the time of admission, patient had hyperglycemia (GRBS: 222mg/dL) which later normalized without the need for medical intervention.   The next question then...
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A 60 year old female came with uncontrolled abnormal movements lasting more than 30 minutes

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This is an elog prepared with the de-identified health data collected after taking the informed consent of the patient and her attender reflecting an attempt at patient-centered approach to learning clinical medicine.  The patient was brought is a 60 year old woman hailing from Nalgonda. She lives with her elder daughter's family and spends most of her time at home, managing the housework. She was brought to the OPD by her daughter 3 days ago in an unconscious state , with uncontrolled abnormal movement of limbs lasting for more than 30 minutes . HOPI The patient was apparently asymptomatic 23 years ago when, due to a head injury she sustained during a fall a few years before, she began experiencing these episodes of "fits" or (uncontrolled abnormal movements of the limbs and loss of consciousness) with a frequency of 0-2 times/year . Patient has been on anticonvulsive medication since the past 23 years. A typical episode begins with headache and dizziness, up-rolli...
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