September 2021 bimonthly blended assessment

September 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/2021/09/medicine-paper-for-sep-2021-bimonthly.html

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

Please go through the case reports in the links 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.

1.A:) I went through this case reports.

1.Cns-

https://decodemed.blogspot.com/2021/09/this-is-online-e-logbook-to-discuss-our_12.html

-my inputs

-haemogram showed a hb of 10.4 with peripheral smear showing microcytic hypochromic anaemia but anaemia treatment was not mentioned.

- the treatment for pain,weakness ,compressive myelopathy, carcinoma were not mentioned.

-treatment for constipation,stiffness of muscles??

-1st video description?

-remaining collected data is absolutely great in correctness and completeness.

2.haematology-

https://ksairaghu84.blogspot.com/2021/09/24yr-old-female-with-anaemia.html

1.a:)My inputs-

-Since when the patient developed sob was not mentioned.

-Type of fever,whether it was recurrent,intermediate ,whether it was decreased on taking rest or medications was not mentioned.

-Her marriage at very early age at the age of 12 years and giving birth to two children(by c-section-more blood loss?) would have contributed to the development of anaemia in this patient .

-Pallor and icterus even though present,clinical images are not present.

-her hb was very low,about 3.6 mg/dl

-peripheral smear is suggestive of iron deficiency anaemia?

-Iron supplementation was not given??

- cause of anaemia was not ruled out.

-investigations to find type of anaemia were not done.

-remaining collected data is absolutely great.

-since serum potassium was found out to be low,inj.kcl was given .

3.Pulmonology

http://medicalcasetaking.blogspot.com/2021/09/this-is-online-e-log-book-to-discuss.html

-my inputs

- investigations done to rule out type of mass detected on hrct?

-treatment for koch lymphoma?

-collected data is complete and correct

4.

Gastroenterology

https://achalram1512.blogspot.com/2021/09/65-year-old-male.html

My inputs-

-Treatment for pleural effusion and ascites?

-Data collected is complete and is fully correct.

5.Nephrology and cardiology

https://saichennuru.blogspot.com/2021/09/45-year-old-male-patient-with-back-pain.html?m=1

My inputs-

-indications for 5 blood transfusions in the past?

-low hb could be due to?

-cause of anaemia was not ruled out?

-collected data 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. 

2 A:)

1.On this case,

Cns-

https://decodemed.blogspot.com/2021/09/this-is-online-e-logbook-to-discuss-our_12.html

-probkems based on priority-

1.pain and inability to extend right lower limb.

2.inability to walk.

3.weakness of lower limbs .

Diagnostic modality-

-Clinical nervous system examination.

-loss of proprioception upto hip joint.

-mri

- ultrasound guided fnac

Therapeutic modality-

- thyroid surgery may help the patient.

2.On this case-

Haematology-

https://ksairaghu84.blogspot.com/2021/09/24yr-old-female-with-anaemia.html

-problems based on priority-

1.sob

2.fever.

3.cough

4.presence of pallor,icterus,koilonychia

5.low hb of 3.4

6.low potassium

Diagnostic modality-

Haemogram,

Serum electrolytes.

Therapeutic modality-

Tab.dolo for fever.

Inj.kcl for low potassium

3.On this case,

Pulmonology

http://medicalcasetaking.blogspot.com/2021/09/this-is-online-e-log-book-to-discuss.html

-problems on priority-

1.cough 

2.sob

3.pain

Diagnostic modality-

-clinical respiratory examination

-chest xray 

-haemogram

-serum electrolytes.

-hrct

-ecg

-bronchoscopy

Therapeutic modality-

syrup ascoril,antibiotic,pcm,pan,

Nebulization with duolin and budecort,tab.azithral.

4.On this case-

Gastroenterology-

https://achalram1512.blogspot.com/2021/09/65-year-old-male.html

Problems on priority-

-vomitings

-pain abdomen

Diagnostic modality-

-haemogram

-serum lipase and amylase

-lft

-ct scan

-cect abdomen

Therapeutic modality-

IV fluids

Pan,clexane,Tramadol,zofer,amlong.meropenem

5.On this case-

Nephrology and cardiology-

https://saichennuru.blogspot.com/2021/09/45-year-old-male-patient-with-back-pain.html?m=1

Problems on priority-

-1.back pain

2.swelling over legs and abdomen

3.hypertension,diabetes

4.abdominal distension

Diagnostic modality-

Ascitic tap

Rft

Ultrasound abdomen

Haemogram

Seology

Ascitic fluid analysis

Bacterial culture,esr,2d echo,xray

Mri for dorsal spine

Therapeutic modality-

-tab.lasix 40 mg bd

-tab.nicardia 20 mg bd

-tab.orofer xt bd

-tab.nodosis 500 mg bd

-tab.shelcal 500 mg od

-tab.erythropoietin

-inj.iron sucrose.

Q3) 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)1.On this case,

Cns-

https://decodemed.blogspot.com/2021/09/this-is-online-e-logbook-to-discuss-our_12.html

-review of literature-

The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6482421/

With the increasing incidence of thyroid cancer, there has been a similar increase in development and utilization of multidisciplinary tools to assist in clinical management, such as the growth of genetic panels, incorporation of tumor biology into screening, improved diagnostic imaging, and the standardized TIRADS classification system. New controversies have emerged in surgical practice, such as the role of prophylactic neck dissection in well-differentiated thyroid cancers. While surgery remains the center of treatment for most patients with thyroid cancer, an increasing knowledge base and experience in the multidisciplinary management of thyroid cancer will be required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011473/

2.On this case,

Haematology-

https://ksairaghu84.blogspot.com/2021/09/24yr-old-female-with-anaemia.html

Review of literature-

The complete blood count with red cell indices offers clues to diagnosis. Many anemias have characteristic red cell morphology. The reticulocyte count serves as a useful screen for hemolysis or blood loss. Testing for specific causes of the anemia is performed. Occasionally, examination of the bone marrow is required for diagnosis. Molecular testing is increasingly being use to aid the diagnostic process

https://pubmed.ncbi.nlm.nih.gov/28189170/

3.On this case,

Pulmonology-

http://medicalcasetaking.blogspot.com/2021/09/this-is-online-e-log-book-to-discuss.html

Review of literature-

Bronchoscopy is helpful in the diagnosis and management of various airway and lung diseases. With further advances in technology, a bronchoscopy will not only continue its current role in clinical practice but will expand its scope as a minimally invasive advanced diagnostic and therapeutic tool.

https://www.ncbi.nlm.nih.gov/books/NBK448152/

Fifty patients having cough associated with various respiratory disorders like bronchitis and upper or lower respiratory tract infections were randomly divided into 2 equal groups and were treated with one of the two cough formulas viz, Ascoril cough formula and other cough formula in double-blind manner over a period of 15 days. The evaluation of improvement was carried out by a rating scale using three clinical parameters--cough, sputum and breathlessness. The physicians were asked to rate the effectiveness of the therapy and patients were asked to rate the acceptability of therapy using pre-defined operational criteria. It was observed that the improvement and symptom relief was almost immediate, quicker and better in the group receiving Ascoril as compared to other group.

https://pubmed.ncbi.nlm.nih.gov/11016157/

4.On this case,

Gastroenterology-

https://achalram1512.blogspot.com/2021/09/65-year-old-male.html

Review of literature-

CECT can show morphologic characteristic findings that allow for establishing the diagnosis of acute pancreatitis and determining the extent of disease severity. The best time for performing CECT in acute pancreatitis not well established and if performed immediately after the onset of symptoms, the full extent of pancreatic damage and its severity can be easily underestimated[10,11]. Conversely, a CECT obtained more than 5 d after onset of symptoms that reveals a normal aspect of the pancreas or only mild inflammatory changes (fat stranding) surrounding the pancreas virtually excludes a severe form of acute pancreatitis[12].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133524/

5.On this case,

Nephrology and cardiology-

https://saichennuru.blogspot.com/2021/09/45-year-old-male-patient-with-back-pain.html?m=1

Amylase-rich ascitic fluid commonly occurs in cases of pancreatic duct damage or obstruction due to pancreatitis or pancreatic trauma.44 Elevation of amylase levels above the serum reference range in ascitic fluid was found in up to 90% of patients with acute pancreatitis and pancreatic pseudocyst

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521252/

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 after deidentifying and obtaining proper signed informed consent as per the format here : http://medicinedepartment.blogspot.com/2020/05/informed-patient-consent-and.html?m=1

A4)https://mynewblogbhavya.blogspot.com/2021/09/a-57-year-old-female-with-fever-and.html?m=1

Q 5) Testing scholarship competency in  

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

A5)My learning points-

1.In patients with chronic kidney disease, development of thrombocytopenia can pose additional problems because an increased risk of arterial and venous thrombosis associated with the kidney disease has to be balanced with the increased risk of bleeding from the low platelet count. 

In addition, patients with chronic renal impairment have asso- ciated platelet dysfunction, which enhances the bleeding risk.

Erythropoietin, the primary regulator of red cell production, has been shown to improve platelet production and function in experimental studies.

2.as an intern , I got a chance to keep ryles tube,two times it came from mouth in an unconscious patient,then I got to know the direction by which we have to keep it in nose,then I got it correctly.

3.i learned to keep Foley's catheter in female and male.

4.i learnt doing rat and rtpcr.

5.seeing first patient death in icu duty-

In patient with alcoholic delerium with hepatic encephalopathy as,rr is high about 50,patient was intubated and attenders explained about prognosis,but systole fallen and cpr initiated,but inspite of our efforts, patient expired.

6.seeing second death in icu duty.

Patient is a known case of CKD,she went into coma after dialysis,nor ad was started ,but bp beeing normal and map above 75,nor ad was tapered ,but then after tapering bp was not recordable inspite of increasing nor ad and patient went into refractoy hypotension and cardiac arrest,cpr was initiated inspite which patient expired.

These are my experiences this month.

Thank you for patient reading and for all those who have helped me in increasing my knowledge.