August 2021 bimonthly blended assessment

August 21,2021

August 2021 bimonthly blended assessment

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

MONTHLY SUMMATIVE ASSESSMENT

I have been given the following questions to answer in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment, to assess the quality of treatment given and to suggest improvisations. 

The below is the link to get question paper.

http://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html

Q1) (Testing peer review competency in the active reader of this assignment) :

Please go through the long and short cases in the first link shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.

A1) On long case,

-Captured data is complete in terms of completeness,correctness,and in proper management.

-use of graphic time chart?

Short case-1

-Captured data is complete in terms of completeness,correctness,and in proper management.

-use of graphic time chart helps in active reading of the reader.

-i learnt prosody means pattern of sounds and rythms in poetry and speech.

Short case-2

-moderate depression is not mentioned in the diagnosis and treatment for depression?

-graphic time chart

-remaining data collected is complete and correct

Q2: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):

Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems.

A2)Long case

Problems based on priority-

-1.generalized oedema

2.frothing of urine.

3.decreasing urine output.

4.joint pains,local oedema,painful limitation of movements,morning stiffness.

5.burning sensation in his eyes.

6.subcutaneous swellings in proximal joints.

Diagnostic modality-

-Head to toe examination

-Musculoskeletal examination

-X-rays,ecg,blood investigations

-RA factor

-Urine microscopy

-abdominal fat pad analysis for amyloidosis.

-needle aspiration of synovial fluid for crystal induced arthritis.

Therapeutic modality-

-Water restriction

-tab.prednisolone p/o 20 mg od

-tab.febuxostat p/o 80 mg od

-haemodialysis.

Short case - 1

Problems based on priority-

-involontary movements of right index and middle fingers.

-difficulty in correcting answer sheets.

-stiffness in right wrist.

-Small short steps,forward stoop gait.

-difficulty in walking upstairs.

-not having morning erections and loss of sexual desire .

-erratic bowel habits.

-difficulty to walk in dark.

Diagnostic modality-

-nervous system examination.

-ecg,2D echo.

-provisionally diagnosed with 

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

Therapeutic modality-

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD

Short case-2

Problems based on priority-

-itchy ring lesions

-purple stretch marks.

-abdominal distension,facial puffiness,pedal oedema,low back ache,feeling low,weight gain and loss of libido.

Diagnostic modality-

-Routine investigations

-8 am cortisol levels

-acth stimulation test.

Diagnosed as,

IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

TINEA CORPORIS

DENOVO HTN ,

Therapeutic modality-

-for tenia corporis-oint.almorfine,fusidic acid cream,saline compresses over lesions.

-for lvh- telma

-for hpa axis suppression-tab.hizone 15 mg per day.

-for low back ache-tab.shelcal and tab.ultracet.

-for feeling low-psychiatric counselling.

-for excoriation of striae and erythematous plauqes when he takes food he is allergic to,he is advised tab.itraconoxole 100 mg bd,lulifin cream,tab.levocetrizine 5 mg od.

Q3) Testing competency in "Evidence based medicine": Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 

A3)

Long case

Review of literature-

The clinical data and biopsy results of 194 SA patients who were treated in Peking Union Medical College Hospital from January 2009 to June 2015 were retrospectively analyzed. Results The highest sensitivity was achieved by biopsy of affected organs,with renal biopsy 97.4%,heart biopsy 95.0% and liver biopsy 87.5%. Among non-invasive biopsy methods,tongue biopsy was found to be 75% sensitive,followed by gingiva biopsy at 57%,abdominal fat pad aspiration at 57%,rectum biopsy at 16%,and bone marrow examination at 8%. Combination of tongue and abdominal fat pad biopsy yielded a detection rate of 93.1%. Conclusions Biopsy of the involved organ has the highest sensitivity. However,combination of multiple non-invasive biopsy methods may has sensitivity comparable to organ biopsy and is safer and more convenient. [7]

Short case -1

Review of literature-

Speech therapy designed to stimulate increased vocal fold adduction with instructions to “increase loudness”, the so called Lee Silverman Voice Treatment (LSVT), using various verbal cues to regulate speech volume, and percutaneous collagen augmentation of the vocal folds (Hill et al 2003) have been used successfully to treat the hypophonic, hypokinetic dysarthria associated with PD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2536542/

Short case-2

Review of literature-

 The presence of low morning serum adrenocorticotropic hormone (ACTH) levels then distinguishes primary adrenal hypercortisolism from Cushing disease and the ectopic ACTH syndrome.

https://pubmed.ncbi.nlm.nih.gov/17961030/

Q4) Testing competency in patient data capture and representation through ethical case reporting/case presentation with informed consent :

Share the link to your own case report this month of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. 

A4)

http://mynewblogbhavya.blogspot.com/2021/08/a-15-year-old-boy-with-complaints-of.html

Q 5) Testing scholarship competency in  

logging reflective observations on your concrete experiences of this last month : (10 marks) 

A5)-In the month of August,15 days went for psychiatric posting where I have seen some cases and observed how the seniors took the history and prescribed the medications.

-The next 15 days were of medicine posting where I got to know about a patient with ascites with montoux test positive ,but ascitic fluid analysis true nat was negative for tb.

-i learnt that for fissure in ano , sitz bath,syrup.cremaffin plus ,ointment anobliss to be given.

-i correlated various topics that were read in books to actual practice as to how seniors are giving treatment to the particular conditions.

-Thanks to everyone who have helped me in increasing my knowledge.

-thanks for patient reading.