Bimonthly blended assessment Aug -2021

  This is the link of the questions that are  given for this month  : https://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html?m=1

This is the link for long and short case : https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

 Question :01 

Long case : 

This is the case of : ➡️Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

➡️Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

➡️Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

➡️Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

Treatment given to the patient is : 

 Free water restriction for Hyponatremia

Tab. PREDNISOLONE P/O 20 mg OD

 Tab FEBUXOSTAT P/O 80 mg OD

 Haemodialysis for worsening renal dysfunction

As this is the long case each and every point is taken into consideration and every thing is discussed in detail .

Every heading is mentioned and photos of the patient suitable for diagnosis is attached in elog to make it easy to understand the Diagnosis 

Questions : 

1.Abdominal fat pad biopsy vs Renal biopsy ?

Answer given to this question has perfect research history and appropriate answer with detail information as been given .Good to know this information . Conclusion   given at last is   However,combination of multiple non-invasive biopsy methods may has sensitivity comparable to organ biopsy and is safer and more convenient. [7]

2.Single DMARD vs Combination therapy ?

A Cochrane review, published in The BMJ [8] looked at the clinical efficacy of Methotrexate monotherapy vs Combination therapy (MTX + Non-biological or MTX + Biologicals).

This is also published information and reference is given . Here the survey is also mentioned .

3 .when to do dial

4 :Can Rheumatoid Arthritis and Gout co-exist together ?

 Survey  says that : Typical intracellular monosodium urate crystals were present in 9 of 22 patients with acute gout; all had developed gout after the RA incidence date. This is also data based and is very useful .

5 .Efficacy of Febuxostat vs Allopurinol for Gout ?

This answer is very simply explained with the test involving the aim ,method and results of the test . The final answer given is the UL efficacy of febuxostat  is non inferior to that if allopurinol group .

2.Short case :

This is the case with diagnosis of 1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

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

Treatment given to the patient : 

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD. 

Here the case is discussed in the proper  format and every thing is discussed in detail .Atlast it is the nice case with all the information .

Short case 3 .

 This is the case of : IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.T

INEA CORPORIS

DENOVO HTN . 

Treatment : Here the daywise  treatment  is discussed and every thing is in detail .

Question :2 

Long case : Here  the problems the patient has : 

    Features of inflammation such as severe pain associated with edema of the joints and limitation of range of active movements

     Early morning stiffness, lasting for more than 30 mins (for 1 hour in this patient)

    Pain and edema of joints improving with activity and worsening with rest

    Features of uncontrolled systemic inflammation such as fever, involuntary loss of weight associated with loss of appetite.

    Swellings at joints and deformation of normal joint posture 

With all this problems the patient is diagnosed with 

➡️Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

➡️Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

➡️Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

➡️Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

Therapeutic solution: 

Free water restriction for Hyponatremia

Tab. PREDNISOLONE P/O 20 mg OD

Tab FEBUXOSTAT P/O 80 mg OD

 Haemodialysis for worsening renal dysfunction

Short case 2 

Problems faced by the patient : 

*progressive asymmetric involuntary movements of his right index and middle fingers.

*He says that these movements often worsened with rest and abated with activity

*involvement of his thumb and maintaining stability of his hand was proving difficult.

*His  handwriting has become ugly with very small letters. On interviewing further, the patient reports that he feels stiffness in his wrists (Right>Left), which has now ascended to his elbows. He says the stiffness is present throughout the range of motion.

  *walking has become difficult with small, short steps and a forward stoop, and he feels that although he weighs 60 kgs. he feels like it weighs 100 kgs. 

Diagnosis : Stage 1 is the mildest form of Parkinson’s. At this stage, there may be symptoms, but they’re not severe enough to interfere with daily tasks and overall lifestyle. In fact, the symptoms are so minimal at this stage that they’re often missed. But family and friends may notice changes in your posture, walk, or facial expressions.

A distinct symptom of stage 1 Parkinson’s is that tremors and other difficulties in movement are generally exclusive to one side of the body. Prescribed medications can work effectively to minimize and reduce symptoms at this stage.

Therapeutic solution : Treatment

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD

4 . 4th hourly BP/PR/Temp monitoring

Short case 3  

Patient compliants the following problems 

Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .

Abdominal distension and facial puffiness since 6 months.

slowly developed erythematous round leisons which are annular shaped and itchy all over abdomen , upper limb ,groin and inner thigh region 

Here he is diagnosed with IATROGENIC CUSHINGS SYNDROME . 

TINEA CORPORIS .DENOVO HTN .

Therapeutic solution : Tab Shelcal 500 OD and Tab Vit D 3 Od.Tab ULTRACET /PO/SOS.

 Question :3

Long case : 

Here every thing is explained systemically with the official language and simple grammer .

Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

➡️Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

➡️Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

➡️Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis.

Short case :1

I think is the peculiar case that I have read about Parkinsonism .it is also very well explained and very systemically presented with all the headings .prognosis of this case : 

Stage 1 is the mildest form of Parkinson’s. At this stage, there may be symptoms, but they’re not severe enough to interfere with daily tasks and overall lifestyle. In fact, the symptoms are so minimal at this stage that they’re often missed. But family and friends may notice changes in your posture, walk, or facial expressions.

A distinct symptom of stage 1 Parkinson’s is that tremors and other difficulties in movement are generally exclusive to one side of the body. Prescribed medications can work effectively to minimize and reduce symptoms at this stage

Short case :3 

Diagnosis : cushing syndrome 

As we are very familiar with Cushing syndrome and by reading this case history it is very well recollected and even better understood about it .

 Question :4This is the case that I have done my elog under the guidance of one of the intern mam .

 https://aksharakruthi.blogspot.com/2021/08/case-discussion.html

Question :5 

 We are not attending  General medicine posting  from aug 2 due to covid situation . . Thank you for Gm department as they are trying to teach   about case presentation and   knowledge regarding general medicine .This is even a better idea to do elog because we are atleast gaining some knowledge by this elogs about case presentation and today we came to know about long case presentation .

Thank you sir .