Bimonthly Blended Assessment for July 2021
24/07/2021
I, B.Varshitha, roll no.21, student of 3rd semester was given the following formative assessment for bimonthly blended assessment for July, 2021.
This is the link regarding assessment:
http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
Question 1:
What is the reason for giving thiamine in this patient?
my review for the given answer of this question:
I agree that the chronic alcohol consumption causes decreased absorption of the thiamine and leads to deficiency of thiamine. This deficiency causes metabolic imbalance leading to neurological complications. To prevent this thiamine is given to the patient.
Why haven't we done pericardiocentesis in this patient?
my review for the given answer of this question:
Pericardiocentesis is a procedure performed to remove pericardial fluid from pericardial sac which surrounds the myocardium. This procedure is performed in penetrating traumatic injuries causing hemopericardium and cardiac tamponade or in some emergency cases. In this case the patient has no cardiac tamponade and there is less pericardial effusion which is resolving by it's own. Also there are some complications like injury to myocardium, injury to blood vessels. Therefore I agree with the given answer.
What is the probable cause for the normocytic anemia?
my review for the given answer of this question:
What could be the causes for her electrolyte imbalance?
my review for the given answer of this question:
Electrolyte balance is maintained by the kidney by the absorption and secretion of the electrolytes. And by this kidneys contributes to maintain normal pH of the body. Lungs also has a role in pH maintainence during acidosis and alkalosis. Renal dysfunction could be reason for the electrolyte imbalance.
What is the probable cause for kidney injury in this patient?
my review for the given answer of this question:
It is obvious that having more alcohol can effect the kidneys and liver. The patient is a chronic alcoholic. Alcohol alters the structure of the kidneys. The basement membrane of the glomerulus become abnormally thickened and there will be alteration of the cells in kidney tubules. It decreases the ability of the kidney to filter the blood and regulate the body fluids.
Could chronic alcoholism have aggravated the foot ulcer formation ? if yes and why ?
my review for the given answer of this question:
I agree with the answer, as the patient is diabetic healing power will be low. Nutritional and oxygen supply is required for the wound healing. Excessive alcohol consumption may cause nutritional deficiency and alcohol toxicity. Alcohol impair the nutrient absorption by damaging the cells lining the stomach and intestine and inhibiting the transport of some nutrients.
What could be the causes of her sudden exacerbation?
my review for the given answer of this question:
The patient is suffering from chronic obstructive pulmonary disease(COPD), therefore the patient can be more prone for the viral and bacterial infections. I agree with the given explanation to the answer.
Is there any relationship between occurrence of seizure to brain stroke. If yes what is the mechanism behind it?
my review for the given answer of this question:
There is a relationship between occurrence of seizure to brain stroke. In acute ischemic injury, accumulation of intracellular calcium and sodium causing depolarization of the transmembrane potential. This altered membrane properties and increased excitability leads to the lowering of the seizer threshold.
Did the patients history of denovo HTN contribute to his current condition?
my review for the given answer of this question:
I agree to the given explanation that cerebral infract is due to the blockage of the blood vessel by blood clots caused may be due to hypertension.
Question 2
case report
Question 3 and 4
case 1:
https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
In this case a 58 yr old male patient suffering from lower abdominal pain, burning micturation, low back ache, decreased urine output, fever and SOB since 1week.
The patient has the history of using NSAIDs regularly and H/O renal tubular acidosis. The patient is a alcoholic.
RFT and CUE are done to assess the functions of kidney because patient has the complaints of low back ache, decreased urine output and burning micturation.
ECG, 2D Echo and chest x ray are done to check for any pathological causes for SOB
hemogram, FBS, PLBS and HbA1C are done to rule any infection and blood status.
from the above investigations we came to know that there is increased number of neutrophils and decrease in lymphocyte count hence we can conclude that there is acute infection. The patient is anemic.
serum creatinine and blood urea levels are more, this suggest that there is renal dysfunction. Also there is a slight abnormality in LFT may be due to alcohol consumption.
therefore from the above findings the diagnosis can be acute kidney injury secondary to urinary tract infection, associated DM-2 and normocytic and normochromic anemia.
treatment: INJ TAZAR is given to treat bacterial infections, SYP LACTULOSE to treat liver diseases
thiamine is given because the patient is alcoholic.
case:2
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
A 75yr old male patient came with complaints of lower back ache, dribbling of urine and increased involuntary movements of both upper limbs since 10days. Pedal edema, and SOB at rest since 3days.
The patient has H/O jaundice which is relived.
RFT and CUE are done to assess the functions of kidney because patient has the complaints of low back ache and dribbling of urine.
hemogram is done to detect whether there is any infection or not.
ECG, 2D Echo are done to check for any pathological causes for SOB.
MRI spine conformed the spondylodiscitis.
from the above investigations we came to know that there is increased number of neutrophils and decrease in lymphocyte count hence we can conclude that there is infection. And the culture report has confirmed the growth of staphylococcus aureus in blood.
serum creatinine and blood urea levels are more, this suggest that there is renal dysfunction. And there is increased levels of uric acid in blood i.e hyperuricemia.
therefore from the above findings the diagnosis can be acute renal failure, multifocal infectious spondylodiscitis and hyperuricemia secondary to renal failure.
case 3:
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
A 49 yr old female suffering from vomitings since 3days. The patient has history of haemorrhoids, H/O muscle aches since 3yrs for which she is using NSAIDs.
serum creatinine and blood urea levels are more, this suggest that there is renal dysfunction.
serum electrophoresis showed M-band in gamma region.
bone marrow aspiration showed plasma cell dyscaria, probably multiple myeloma. Mild to moderate supression of all cell lineages.
therefore from the above findings the diagnosis can be chronic interstitial nephritis secondary to plasma cell dyscariasis.
case:4
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
A patient was admitted to the hospital with complaints of fever and diarrhea since 5days and back pain with abdominal pain and chest pain. Before visiting the OPD, she complained of severe breathlessness and pain in chest. Her random blood glucose levels was 580mg/dl.
RFT and CUE are done to assess the functions of kidney.
LFT to assess the function of the liver.
serum creatinine and blood urea levels are more, this suggest that there is renal dysfunction.
total bilirubin, direct bilirubin, SGOT, alkaline phosphate, total protein and albumin levels are abnormal in LFT.
Culture report confirmed the growth of skin commensals.
therefore from the above findings the diagnosis can be diabetes ketoacidosis with acute kidney injury.
case 5
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
A 52 yrs old male patient present to the hospital with fever since 4days and pus in urine. 1yr back he gradually developed drippling of urine and burning micturation since 3months.He had prostomegaly and advised TURP.
RFT and CUE are done to assess the functions of kidney.
from the above investigations we came to know that there is increased TLC and decrease in lymphocyte count hence we can conclude that there is acute infection. The patient is anemic.
serum creatinine and blood urea levels are more, this suggest that there is renal dysfunction.
hemogram, FBS, PLBS and HbA1C are done to rule any infection and to know blood glucose status.
therefore from the above findings the diagnosis can be acute kidney injury secondary to urosepsis with bilateral hydroureteronephrosis with known history of diabetes mellitus type 2 since 5yrs with diabetic nepropathy with anemia secondary to chronic kidney disease.
case 6
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
A 43 yr old male came to the hospital wit complaints of loose stools, abdominal distension and pedal edema since 20days.He is alcoholic.
In edema there will mainly 3 causes i.e due to cardiac failure, liver diseases and renal diseases. And investigations are done to known the functions of the cardiac, liver and kidneys.
urine and blood examination is done to know whether there is any dysfunction of kidney and urine examination is done for the assessment of filtration function of kidney.
RFT,CBP and CUE are done to assess the functions of kidney.
ECG is done exclude the heart diseases causing edema.
LFT to assess the function of the liver.
serum creatinine and blood urea levels are more, this suggest that there is renal dysfunction.
total bilirubin, direct bilirubin, SGOT, alkaline phosphate, total protein and albumin levels are abnormal in LFT.
therefore from the above findings the diagnosis can be alcoholic hepatitis, acute kidney injury secondary to the gastroenteritis.
Question 5
In my opinion this type of clinical exposure is mandatory for every one of the student. This type of learning making us to apply our knowledge that we learnt from text books and classes.
We are learning how to interact with patients and squence of steps required for the proper diagnosis of the disease. It helping us to improve our knowledge day by day. By this gaining some confidence.
Integration with subject is easy and we can easily memorize the concepts.
Daily we are able to face many cases and trying to observe and analyse the case, in this process we are learning many new things .
I want to thank and appreciate all who are trying to help us in this pandemic situation.
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