67 K. Sai Likhitha

 BIMONTHLY BLENDED ASSESSMENT- JULY 2021

Name- K. Sai Likhitha

Roll no-67

Batch- 2019 3rd semester

Link to the assessment/ question paper- 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.

Review to the answers given by roll no 65- https://suchithakola65.blogspot.com/2021/07/suchitha-kola-65-bimonthly-assessment.html?m=1

1. Response to the first question was given very well with proper quantitative marking and qualitative assessment to each case. The answers i.e reviews to the cases were given in point wise manner which was impressive. Links to all the cases ( pulmonology, cardiology and neurology) reviewed were provided.  Although the presentation was good, the bad part is only cases from cardiology, pulmonology and neurology were taken and reviewed. It would have been appreciated if also the cases from nephrology, gastroenterology and other branches were included. Overall the presentation was good. The question has been understood properly and answers were precise and to the point.
2. For the second question the elog has been done well. The case was about a 40 year old male patient with chief complaints of focal seizures, involuntary micturition and altered sensorium. The history has been taken properly without revealing the patient's identity and also of the institution's. General examination and systematic examination were mentioned briefly. For some investigations, values were typed in and for the others direct reports were attached which would have been better if avoided. Overall the elog is not very impressive it was okay. The bad part is it has not been updated.. the proper final diagnosis was not mentioned and also the systematic examination part was very brief. It would have been much easier to understand if eloborated and described well.
3. The third question is to give critical appraisal of the captured data in terms of completeness, correctness and analyse the diagnostic and therapeutic uncertainties around the case. The review was given very well well discussing the pro's and con's but the diagnostic and therapeutic uncertainties around the case were not mentioned.
4. The fourth question was not properly answered.  Although the problems were listed well, the diagnostic and therapeutic uncertainties around the case were missed instead the treatment given was listed. Discussing about the diagnostic and therapeutic uncertainties related to the case will help in understanding the case better. The response has been given only for one case. Overall the response was brief and not very much impressive.
5. The fifth question is to share their experience of the last month. The concrete experience was shared regarding the telemedical learning in brief. It would have been appreciated if the positives and negatives were listed separately and discussed.

Question 3 & 4- Testing peer review and scholarship competency.

I have combined the third and fourth questions in an attempt to understand the case better and to discuss and review the whole case at one place.

Case 1- AKI

Link- https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

My critical appraisal : 

• The data was not well covered.
• The history and examination were not presented well.
• Coming to the investigations part some values were typed in without directly attaching the photographs of reports which is appreciated but for some, photographs were attached that too the identifiers were not properly removed.
• All the investigations were attached date wise.
• Overall the data in the case is not very well covered and completed.

List of problems:

• Burning micturition.
• Low backache after weightlifting.
• Decreased urine output.
• Lower abdominal pain.
• SOB at rest.
• Fever.
• Hypertension. 
• Renal tubular acidosis.

Diagnostic and therapeutic uncertainties:

The provisional diagnosis was acute kidney injury secondary to urinary tract infection. The investigations showed high blood urea levels and low serum albumin levels which suggests kidney failure. AKI leads to build up of waste products in the body as kidneys doesn't perform their function properly which leads to altered fluid balance in the body which further lead to his symptoms. The AKI may be misdiagnosed with other renal diseases.

Case 2 - Acute on CKD

Link- http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

My critical appraisal:

• The case was presented very well. Its was very clear and easy to comprehend.
• The detailing of the case was very impressive.
• It would have been better if the investigations were typed in rather than attaching photographs.
• The case history was presented very well and the general and systematic examination was also done well.
• The treatment given was mentioned very clearly and detailedly.

List of problems: 

• SOB at rest.
• Lower backache on weightlifting.
• Dribbling of urine.
• Pedal edema.
• Involuntary movements of upper limbs.

Diagnostic and therapeutic uncertainties:

The initial provisional diagnosis was acute renal failure, spondylodiscitis, hyperuricemia secondary to renal failure, multifocal infectious spondylodiscitis, uremic encephalopathy. The final diagnosis is acute on chronic kidney disease. MRI of lumbosacral spine showed multifocal infectious spondylodiscitis. Further the case has been shifted to orthopaedic department to treat spondylodiscitis.

Case 3 - CKD

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

My critical appraisal:

• The history and was take well, particularly the personal history was very detailed.
• All the investigations and photographs were attached properly without revealing patients identity.
• The treatment given was very detailedly mentioned date wise.
• The follow up of the case was very impressive. The reports from outside hospital were also attached.
• The elog is being updated regularly.
• Overall the case was very well covered and it was very easy to understand and comprehend.

List of problems:

• Myalgia, generalized weakness.
• Fever.
• Hemorrhoids.
• Vomitings.
• Plasma cell dyscarias.
• Dimorphic anaemia.

Diagnostic and therapeutic uncertainties:

The final diagnosis was not yet mentioned as the case is still ongoing. The provisional diagnosis was CKD and  multiple myeloma. The serum electrophoresis showed M band in gamma region. Bone marrow aspiration showed plasma cell dyscaria, mild to moderate suppression of all cell lineages.

Depending on these investigations multiple myeloma was suspected with 70% plasmacytosis. 

Case 4 - coma and renal failure.

Link- https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

My critical appraisal:

• The case was very well covered and completed in all aspects.
• The history has been taken very well covering everything.
• All the identifiers were removed properly.
• The systematic examination was done well.
• It would have been better if the investigations were typed rather than putting photographs.
• Overall the case was presented well.

List of problems: 

• Type 2 DM.
• Abdominal distension.
• Alcoholic liver disease.
• Hepatic encephalopathy.
• Tingling sensation in the limbs.
• AKI secondary to UTI on CKD.
• Pedal edema.
• Constipation.

Diagnostic and therapeutic uncertainties:

Provisional diagnosis was infective endocarditis or hepatic encephalopathy. The patient had a non healing injury which raised suspicion of DM and confirmed. Finally he was diagnosed with infective endocarditis with AKI with acute multiple infracts in bilateral cerebral and cerebellar hemispheres. MRI showed small multiple infracts in brain. Despite the efforts and treatment, the patient died of sudden cardiac arrest and could not be revived.

Case 5 - Acute on CKD

Link- https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

My critical appraisal:

• The elog has been covered and completed well.
• The photographs were attached for investigations which could have been avoided.
• Highlighting of the important points is appreciated.
• At the end of the elog reference links were provided and discussion has been done which was impressive.
• The overall presentation was very nice.

List of problems:

• SOB 
• Deranged RFT.
• Chronic renal failure.
• Orthopnea and bendopnea.
• Diabetes mellitus.
• Hypertension.
• Edema.
• Irregular bowel movements.
• Dyspnea.

Diagnostic and therapeutic uncertainties:

The provisional diagnosis was HFREF (heart failure with reduced ejection fraction) secondary to CAD (coronary artery disease) and chronic renal failure. The patient was a known case of heart failure. Beta-blockers and renin-angiotensin system inhibitors have yielded promising results in patients with HFrEF associated with advanced kidney disease . 

Case 6 - AKI

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

My critical appraisal:

• The case history is presented very well.
• Photographs of the patient were attached in general examination part without revealing the identity of patient.
• All the investigations were attached properly.
• The treatment given was mentioned date wise clearly which was impressive.
• Overall the data was well covered and completed.

List of problems:

• Pedal edema.
• Abdominal distension.
• Loose stools.
• Fatty liver with mild hepatomegaly.
• Mild ascites.

Diagnostic and therapeutic uncertainties: 

The provisional diagnosis was alcoholic hepatitis, AKI secondary to acute gastroenteritis, HFrEF secondary to CAD, alcoholic and tobacco dependence syndrome. The abdominal girth of the patient is being measured daily to see whether there is any accumulation of fluid. The diagnostic uncertainties around the case were properly solved and the final diagnosis was alcoholic hepatitis and AKI secondary to gastroenteritis.

Question 5 - Experience of last month.

The telemedical learning experience has been great. Elogging of the cases and integrating them with the subjects we have already studied (1st MBBS) and with the current subjects has improvised our knowledge and elevated our skills. Although we are learning a quite lot of things through these online classes, but the effectiveness is not as great as offline teaching. Elogging of the case reports has been a great concrete experience. Hoping this pandemic situation will come to an end soon so that we can attend our clinical postings and interact with patients directly unlike the virtual discussions going on now.

67 K. Sai Likhitha

BIMONTHLY  BLENDED ASSESSMENT - JUNE 2021

Name- K. Sai Likhitha

Roll no- 67

Batch - 2019 3rd semester

Link to the assessment/ question paper- https://medicinedepartment.blogspot.com/2021/06/medicine-department-paper-for-june-2021.html?m=1

Question 1 - Competency tested for Peer to peer review and assessment.

1. Roll no 67

Neurology case

Case- https://67ankithareddy.blogspot.com/2021/05/medicine-blended-assignment-may-2021.html?m=1

Quantitative marking- 9/10

Qualitative assessment- The case was about a 40 yr old male with complaints of irrelevant talking. He is a chronic alcoholic and the neurological manifestations in this patient are primarily due to thiamine deficiency and increase in levels of toxins in the body due to renal disease.

The elog was well presented and the answers to the questions were given to the point with appropriate pictures.

2. Roll no 26

Pulmonology case

Case- http://santhoshdarimedi.blogspot.com/2021/05/medicine-blended-assignment.html

Quantitative marking- 8/10

Qualitative assessment- The case was about a 55 year old female patient, with the chief complaints of shortness of breath, pedal edema and facial puffiness. 

The information was provided point wise and neatly presented. Diagram / flowchart would have been helpful. Overall it was good and easy to comprehend. 

3. Roll no 93

Cardiology case

Case- https://93deepanandikonda.blogspot.com/2021/05/blended-bimonthly-assignment-toward.html

Quantitative marking-9/10

Qualitative assessment- The case was about a 78 years old male with complaints of sob, chest pain, bilateral pedal edema and facial puffiness.

The elog was presented very well. It ws very neat and clear with appropriate pictures. Highlighting the important points is appreciated. Different topics are clearly marked and separated. Mechanisms are explained very well.

4. Roll no 1

Nephrology and urology case

Case- https://aitharaveena.blogspot.com/2021/05/online-blended-medicine-assignment-may.html

Quantitative marking- 9/10

Qualitative assessment- The case was about a 52 year old male patient with shortness of breath burning micturition and fever.

It was presented very neatly and clearly. Necessary and important points were highlighted. Everything was very well presented.

5. Roll no 95 

Gastroenterology case

Case- https://raveelaravi.blogspot.com/2021/06/medicine-case-discussion.html

Quantitative marking-7/10

Qualitative assessment- The case was about a 25 year old male with epigastric pain.

Some answers to the questions were very brief while some were appropriate and to the point. The sites and links are not mentioned at some places. It would have been good if mechanisms and etc are explained with pictures and flowcharts.

6. Roll no 100

Infectious diseases and hepatology case

Case- https://nehae-logs.blogspot.com/2021/05/bimonthly-assignment-for-may-2021.html

Quantitative marking-9/10

Qualitative assessment- The case was about a liver abscess in a chronic alcoholic patient.

The answers to the questions were given very well with appropriate pictures, flowcharts and also reference links. The flowcharts are appreciated. Overall it was very clear and neatly presented.

7. Roll no 108

Infectious diseases

Case- http://108subramanyamelogcases.blogspot.com/2021/05/online-blended-bimonthly-assignment.html

Quantitative marking- 7/10

Qualitative assessment- The answers were very brief. Adding pictures and flowcharts to the elog would have made it better. Little bit more detailing of the topic would have elevated the presentation. It was easy to comprehend.

8. Roll no 117

Cardiology case

Case- https://lasyasakilam27.blogspot.com/2021/05/medicine-bimonthly-assessment.html

Quantitative marking- 8/10

Qualitative assessment- The case was about a patient with acute myocardial infarction.

The information provided was concise and to the point. The pharmacological interventions and placebo thing was presented well in tabular form. It was easily comprehensible and little detailing is necessary for some topics.

9. Roll no 70

Neurology case

Case- https://70pranaykp.blogspot.com/2021/05/general-medicine-assignment-may-2021.html

Quantitative marking-8/10

Qualitative assessment- Mechanisms were eloborated well.  Point wise manner of answering and highlighting important points would have made it easier to read and understand. Overall it was well.

10. Roll no 4

Neurology case

Case- https://amitsharma1996.blogspot.com/2021/05/medicine-assignment-may-2021.html

Quantitative marking-6/10

Qualitative assessment- Answers were very brief.  Tabulation of some topics would have made it easier to understand. Pictures, diagrams, flowcharts would have been helpful. Highlighting has not being done.

Question 2- 

I haven't got a chance to make a case report yet.

Question 3- Testing peer review competency of the examinees.

Link - https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1

The case was of a 28 year old male with chief complaints of sudden fall followed by weakness of both the lower limbs (paraplegia) and loss of hand grip 10 days back, associated with bowel and bladder incontinence. The final diagnosis of the patient is Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level.

My critical appraisal of the case.

• The data of the patient is captured very well.
• The pictures of the patient were captured properly without revealing the patient identity.

• The history of the patient is covered clearly including history of present illness, past history, family history and the personal history.  
• The general examination and systematic examination of the patient were performed well and presented clearly with appropriate grading of the reflexes.

• All the investigations done are attached in the elog.

• The diagnostic and therapeutic uncertainties around the case were analysed correctly. Intially the provisional diagnosis was cervical myelopathy and pott's spine but later finally it was diagnosed as quadriceps secondary to infectious spondylitis.

• Overall the data in the case is well covered and completed including the diagnostic and therapeutic uncertainties involved with the case.

Question 4- Testing scholarship competency of the examinees.

Case 1- Multisystem

Link- https://nikithaedam48.blogspot.com/2021/06/18-year-old-malefrom-miryalagudawho-is.html?m=1

List of problems:

• Low backache one week ago.
• Fever since 5 days.
• yellowish discolouration of eyes since 3 days. 
• Vomitings.
•  loose stools and blood tinged urine.
• Lose of weight since 6 months.
• Polyuria, nocturia and polydipsia since 2 months.

Diagnostic and therapeutic uncertainties around the case:

The provisional diagnosis was acute viral hepatitis, denovo DM 1, diabetic ketoacidosis as the patient's lft was abnormal. The final diagnosis was acute fulminant hepatic failure secondary to bacterial/ viral infection (as toxins were found) with hepatic encephalopathy, coagulopathy due to disturbance in the hemostasis which occurs due to liver failure. Diabetic ketoacidosis was resolved.

Case 2- CNS

Link- https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1

List of problems:

• weakness of both the lower limbs (paraplegia). 
• Loss of hand grip 10 days back.
•  bowel and bladder incontinence.
• generalized weakness and myalgia 15 days back.
• AFB bacilli.
• TB

Diagnostic and therapeutic uncertainties around the case:y

The provisional diagnosis was cervical myelopathy and pott's spine. The final diagnosis was Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level. Cervical myelopathy is a degenerative condition caused by compression of spinal cord. Pott's spine is a kind of tubercular arthritis of intervertebral joints. MRI brain with cervical spine has showed infectious spondylitis of C4, C5, C6, C7 and epidural abscess at C5-C7.

Case 3 - Renal

Link- https://61tejarshini.blogspot.com/2021/06/general-medicine-case-discussion.html?m=1

List of problems:

• Hypertension.
• Chronic kidney disease.
• Altered Sensorium (Hypo active), lethargy.
• Fever 10 days back.
• Pedal edema with Anasarca.
• Shortness of breath even at rest.

Diagnostic and therapeutic uncertainties around the case:

The patient is a known case of chronic kidney disease. The diagnosis of the patient was acute kidney injury on chronic kidney disease (hypertensive disease nephropathy) with uremic encephalopathy. The clinical manifestations in the patient were due to increased fluid content in the body due to kidney failure. Uremic encephalopathy is due to accumulation of toxins in the brain due to acute or chronic renal failure.

Case 4- CVS

Link- https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

List of problems:

• Distension of abdomen.
• Shortness of breath.
• Hypothyroidism.

Diagnostic and therapeutic uncertainties around the case:

ECG showed atrial fibrillation. 2d echo showed pleural effusion and mild pericardial effusion. The diagnosis of the case was heart failure with reduced ejection fraction (HFrEF) with atrial fibrillation. HFrEF occurs when left side of the heart does not pump blood out to the body.

Case 5 - Abdominal 

Link-https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

List of problems:

• Pedal edema.
• Decreased urine output.
• Fever.
• Type 2 diabetes mellitus.
• Shortness of breath.
• Acute kidney failure.

Diagnostic and therapeutic uncertainties around the case:

The diagnosis of the case was acute kidney injury secondary to urosepsis (infection of urinary tract) with anemia of chronic disease. Hyperkalemia was resolved. The clinical symptoms are due to increased fluid content in the body due to acute kidney injury.

Question 5- Testing scholarship competency in  logging reflective observations:

The telemedical learning from the hospital has been a new experience and we are learning a quite lot of things through reflective observation. Although we cannot make a critical comment as we are never exposed to face to face interaction with patients at hospital and don't know how that'll be but as of now it's a bit challenging as we have just entered our 2nd MBBS. This virtual case discussion is a concrete experience as we are being involved in new things. We have learnt elogging of the cases in a very short span of time with the help of interns and professors. By doing this assignment I could view my seniors elogs and learned a few things from their presentations.