Bimonthly Blended Assessment for June 2021

I have been given the following formative assessment for bimonthly blended assessment for June 2021 .This is the link regarding assessment: .https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1

  Question 1:peer review 

1.case : https://amishajaiswal03eloggm.blogspot.com/

My review on this question : 1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

Review:I agree with the diagnosis because the patient works in paddy fields so he is affected with the allergens in the paddy field .The flow chart answered in this question is appropriate and gives the  complete symptomatology .

2 .case : https://avulanikhil09.blogspot.com/

Question: could chronic alcohlism have aggravated the foot ulcer formation ?if yes and why ?

Review : the answer for this explained is true and due chronic alcoholism ➡️ diminished immune response ➡️leads to ulcers 

3. case:  https://bejugamomnivasguptha.blogspot.com/

Question :  Is there any relationship between occurrence of seizure to brain stroke. (3 m)

Review : it is obviously true that shock may lead to seizures .

Shock ➡️scar formation in brain ➡️it disrupt electrical signal ➡️it leads to seizures .so the explanation in this answer is exactly true 

4.case :https://daddalavineeshachowdary.blogspot.com/

Diagnosis : it is a case of  55 yr old female with viral pneumonia  secondary to covid 19 and Dm 

Review : The case discussion is very good and the treatment is explained in the right order .

5.Case :https://budigesaikiran14.blogspot.com/

Diagnosis : alcohol induced cerebellar ataxia 

Review : Reasons for cerebellar ataxia is very well discussed .

It is due to damage to GABA -A receptor impaired glucose metabolism vit B1 deficiency .the way of answering a question is so attractive and it is easy to understand .

6.case: https://aniganikavya06.blogspot.com/

 Diagnosis :Acute exacerbation of COPD associated with right heart failure and bronchiectasis.

Review :  What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

Answer: 

    1st episode of SOB- 20years back

    2nd episode- 12years back (from then she has been having yearly episodes for the past 12years)

    15years back- Facial puffiness

    8years back- Diagnosed with diabetes

    5years ago- Diagnosed with anemia and took iron injections

    1month back- Generalized weakness

    20days  back- Diagnosed with hypertension

    15days back- Pedal edema

 Anatomical Location of problem-Lungs- Bronchi and bronchioles

  Primary etiology- Usage of chulha since 20years

Answer explained is appreciable .every thing is really so point to point and easily understandable .

Case : 7 https://02shishirareddy.blogspot.com/

 Diagnosis : Alcohol induced dementia 

Review : Causes for electrolyte imbalance: 

                       Respiratory acidosis with metabolic alkalosis(due to renal compensation) in AECOPD patientswith chronic hypercapnia is the usual cause ofhypochloremia in these patient Commoncauses ofderanged serum sodium levels include hyperglycemia, use of thiazides or nonsteroidal anti-inflammatory drugs, congestive cardiac failure, chronic renal failure, and low dietary salt intake.

 Common causes of hypokalemia include diarrhea, laxative abuse, vomiting, certain diuretics, drugs like insulin, β2agonists, and theophylline.20 Thus, COPD patients per

se are predisposed to electrolyte imbalance. In turn electrolyte imbalance can cause respiratory muscle weakness, cardiac arrhythmia, low cardiac output. 

                    Thus the presence of electrolyte imbalance leads to significantly poor outcome among COPD patients.It is very interesting to know about the acidosis and very happy to read and get the knowledge about respiratory acidosis .it is really very helpful .

Case :8 https//savanthreddy.blogspot.com/

Diagnosis : INFECTIOUS DISEASE (Mucormycosis) 

Review : What are the postulated reasons for a sudden apparent rise in the incidence of mucormycosis in India at this point of time?

I think it is because of the use steroids in an uncontrolled manner.

COVID 19 is not the first disease where steroids are used as one of the main stay of treatment (in severe cases) but what has gone wrong in the recent time is even the lay man who got infected with Corona started using steroids right from the day 1 with no monitoring by a specialised physician.And they are not following any specific course of treatment.As many of them are also diabetic patients the are getting succumbed to mucormycosis.And it is not ending with mucormycosis but various other fungii are emerging to cause an epidemic.

And another reason for rise in mucormycosis cases may be the usage of tap water in oxygen concentrators.As most of the patients are being diagnosed of Covid in late stages in the second wave many of them Are requiring oxygen concentrators for supplemental oxygenation.And due to Lack of the people are using tap water instead of distilled water which serves as reservoir for the growth of mucormycosis.So this may be one of the reason for rise in mucormycosis cases. I feel really happy by reading this new information about the disease that is happening in our india and it is very well explained with the good image and reason behind the this epidemic 

Case 9 : https://gsuhithagnaneswar.blogspot.com/?m=1

Diagnosis : cervical spondylosis Recurrent hypokalemic paralysis 

   Review : What are the reasons for recurrence of hypokalemia in her? Important risk factors for her hypokalemia? ➡️Since the patient complains of oedema the drugs used to relieve it such as diuretics can cause hypokalemia 

The patient also no albumin which is a cause for both oedema and hypokalemia 

The risk factors including 

1.    Alcohol use(excessive

2.    Chronic kidney disease

3.    Diabetic ketoacidosis

4.    Diuretics (water retention reliever

5.    Excessive laxative u

6.    Folic acid deficiency

7.    Primary aldosteronism  

8.    Some antibiotic uses 

It is point to point and easy everything is easily reviseble .happy to read about this new case 

Case 10 :   https://blendedasessmentmadhukumar.blogspot.com/

Diagnosis : inferior wall MI with uncontrolled sugars with k/c/o DM since 8yrs.

Review : What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

➡️Chest pain- since 3days

Giddiness - since morning

Profuse sweating- since morning

Anatomical location of the lesion is inferior wall of the heart.

Etiology: 

Smoking

Diabetes mellitus

Hypertension

This is the good answer and nice explanation without much description .

Question 2 : patient case history report : I haven't yet  get a chance to present a case .

Question 3 .& 4 :

Reflection on given few cases :

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

Review : it is really awesome work and I can understand hardwork behind this work .it is the case of  ACUTE FULMINANT HEPATIC FAILURE SECONDARY TO POST INFECTIOUS(VIRAL/ BACTERIAL)  TOXIN MEDIATED  MISC

WITH HEPATIC ENCEPHALOPATHY

COAGULOPATHY

METABOLIC SEIZURES (? ABSENCE SEIZURES)

DKA RESOLVED

DENOVO TYPE 1 DM

WITH THROMBOCYTOPENIA they really managed the case very carefully .

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

Review : this is a case of. Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level. I really as a UG can be able to handle this huge diagnosis but very happy that atleast I got to u know about this case .It is useful information for me and the case was presented in a easy and more information was given .

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

Review :  The provisional diagnosis is HYPERTENSIVE NEPHROPATHY) WITH URAEMIC ENCEPHALOPATHY.

This is well explained  case and I really like the way they differentiated the subjects accordingly.very lucky to come across this blog 

4.CVS : 

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

Review : this is the case of HFrEF with Atrial fibrillation .but the patient is dead unfortunately . history taking and the way of presenting the case is so neat and very easy . I can easily makeout their hardwork .

5 .Abdominal :

Review : it is the case of Acute kidney injury secondary to urosepsis  is with hyperkalemia ( resolved)

With anenmia of chronic disease .

Urosepsis  is resolved in this case .the team has managed the case very well 🙂

Question 5 : 

This is my pleasure to write this blog and I am very happy for the hod sir and for all the pg mams and sirs out there who are helping us since one mount to get throught this online clinical posting .it is really difficult for us to understand online clinical posting but you people are helping in taking history and presenting a case .Though the wards are so busy but still you are trying to help us to learn something in this pandemic time and making us write this blog . It is very important to correlate the theory with clinical knowledge but  you are making us to understand everything thing and specially the whatsapp group is making us curious to learn something 

Thank u from 2019 batch .

name : Akshara kruthi 

Roll no : 40