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
- 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.
- 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.
- 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.
- 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.
- 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
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
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
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.
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
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.
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