BIMONTHLY BLENDED ASSESSMENT - JUNE 2021
—104. JESHMITHA PERUMALLA
The following is a link to the assignment which I have been given for a monthly progress evaluation scheme.
Link to the assignment:
QUESTION 1:
Please go through one particular answer of ten students in this link:
and share your peer review of each answer with your quantitative marking input as well as qualitative insights into what was good or bad about the answer.
ANSWER 1: I will be reviewing the pulmonology case
Qualitative : 9/10
Quantitative : the case is discussed in an order and in a detailed manner. The etiology diagram &flow chart for evolution of symptomatology are helpful to understand clearly
Qualitative: 8/10
Quantitative: No continuity of symptomatology is seen. Mechanism of action,indication & Non-stop pharmacological interventions used for patient is done clearly with the flow chart it helps to analyze the case
LINK 3 :
https://yrahul190.blogspot.com/2021/05/medicine-blended-assignment-may.html?m=1
Qualitative: 8/10
Quantitative: Evolution of symptomatology in terms of event timeline is in a correct order
Anatomical localisation of problem is accurate
The Primary etiology of patient problem is not seen
The treatment is used for patient is in elobrate & informative way. I found it really easier to understand & comprehend, causes for the COPD patient electrolyte imbalance is well balanced
LINK 4 :
https://shareenabegum124.blogspot.com/
http://shareenabegum124.blogspot.com/2021/05/medicine-blended-assingment.html
Qualitative: 9/10
Quantitative : All the sub-questions have been answered in a detailed and comprehensive manner. Diagrams and flowcharts have been used to make it easier to comprehend. The concepts are explained clearly.
LINK 5 :
https://amishajaiswal03eloggm.blogspot.com/
https://amishajaiswal03eloggm.blogspot.com/2021/05/medicine-blended-assignment.html
Qualitative: 8/10
Quantitative: All the sub-questions have been answered in a detailed and comprehensive manner. Diagrams and flowcharts have been used to make it easier to comprehend. The concepts are explained clearly.
QUESTION 2:
Share the link to your own case report 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
http://jeshmitha104.blogspot.com/2021/07/a-40-year-old-male-patient-e-log_1.html
QUESTION 3:
Please go through the cases 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.
ANSWER 3:
MULTISYSTEM —
Critical appraisal : the overall case sheet is presented in correct order and in limited & relevant data is provided that seems easy to go through the case
All the lab investigations conducted were identified & shared
Diagnostic & therapeutic uncertainties : No discussions on diagnostic and therapeutic uncertainties
CNS:
Critical appraisal: medical history is adequate, pictures are uploaded in a correct manner, the detailed treatment gives an idea to tally with the discharge date of patient to know what should accurately given to the patient.
Diagnostic & therapeutic uncertainties : No diagnostic uncertainty was present.
RENAL:
Critical appraisal :No leads, links or discussions were given. All the required data has been included in the chronological order. All investigations (and their dates) were logged in.
Diagnostic & therapeutic uncertainties No diagnostic uncertainty was present
CVS:
Critical appraisal The case sheet has captured all the relevant data in the right order. Correct terminology was used. The reports of all the lab investigations conducted were deidentified and shared
Diagnostic & therapeutic uncertainties
Links/leads/discussion regarding the diagnostic hallmark of the provisional diagnosis and therapeutic uncertainties were not mentioned.
ABDOMINAL:
Critical appraisal The relevant medical history of the patient has been shared in a comprehensive and systematic manner
Diagnostic & therapeutic uncertainties
No diagnostic uncertainty was present
QUESTION 4: Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also 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.
ANSWER 4:
MULTISYSTEM:
Problem list:
- Gradual loss of weight
- Polyuria, nocturia, polydypsia
- Low backache
- Vomiting
- Loose stools
- High grade, intermittent, fever
- Yellow discolouration of eyes and urine
- Nausea & Loss of appetite
- Burning micturition
- DKA
Day 1 - IV fluids, Insulin, Vit K - Insulin is an accepted therapeutic drug for treatment of DKA.
Day 3 - Syp Lactulose was given for constipation
Day 4 - Inj. Lorazepam was given as absence seizures were suspected.
Day 5 - Cerebral malaria was suspected and Inj. FALCIGO, Inj. LEVIPIN, and Inj. DOXYCYCLINE was given.
Cerebral malaria (nih.gov) - The provisional diagnosis is consistent with the symptoms and their progression. A peripheral blood smear can be done to confirm the diagnosis (Presence of Plasmodium falciparum in the smear will confirm it)
Other diagnosis that can be supported by the symptoms are:
Treatment:
- FALCIGO - is an anti-malarial drug.
- LEVIPIL - is an anti-epileptic.
- DOXYCYCLINE - is an anti-malarial
The therapeutic interventions were specific and highly effective for the assumed diagnosis.
CNS:
Problem list:
1. Weakness of both lower limbs
2. Loss of hand grip
3. Bowel and bladder incontinence
4. Generalised weakness and myalgia
The diagnosis was Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level. This diagnosis was supported by an MRI of the brain with cervical spine. The specificity and sensitivity of MRI in diagnosing such an acute case of spondylitis was found to be very high, as compared to a CT scan.
Infectious Spondylodiscitis: Diagnosis and Treatment (nih.gov)
Treatment given:
RENAL:
Problem list:
- Lower back and neck pain
- Altered sensorium
- Shortness of breath (grade 4)
- Loss of appetite
- Lethargy
- Anasarca
Uraemic encephalopathy is a diagnosis of exclusion. Differential diagnosis include:
Reference: Uremic Encephalopathy - StatPearls - NCBI Bookshelf (nih.gov)
Treatment: Inj. LASIX was given to manage Anasarca. The other treatments were not specific to the symptoms.
CVS:
Problem list:
- Abdominal distension
- Shortness of breath
- Hypothyroidism
This was diagnosed as HFrEF with Atrial Fibrillation based on the ECG. ECG has very low specificity in diagnosing ECG. Left-ventricular ejection fraction is the diagnostic hallmark. Heart failure with reduced ejection fraction: A review of clinical status and meta-analyses of diagnosis by 3D echocardiography and natriuretic peptides-guided heart failure therapy (oatext.com)
Treatment:
Amiodarone is highly effective in treating arrythmia Clinical efficacy of amiodarone as an antiarrhythmic agent - PubMed (nih.gov)
Clexane is an anticoagulant. Since patients with AF have a higher risk of thromboembolism and stroke, anticoagulants are used to reduce the risk. Clexane is an effective and safe drug.
ABDOMINAL:
Problem list:
- High grade fever
- Bilateral pitting type pedal edema
- Decreased urine output
- Burning micturition
The diagnosis is consistent with the symptoms. The treatment given is appropriate.
QUESTION 5:
Please reflect on and share your telemedical learning experiences from the hospital as well as community patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.
ANSWER 5:
Telemedical learning, though limited in its level of exposure and involvement, was an interesting experience. It proved to be a tough task to interact with the patients and/or their attenders regarding the case. It took efforts to Elog the case, understand it relate it to the patient and raise questions about it instead of just doing it mechanically. I realised just how important it is to look at and interact with the patients and their attenders in order to develop a good doctor-patient relationship and empathize with them. I also understood the importance of effective and efficient communication when it comes to the patient, and how far it can affect our perception of their problems. I believe this experience would help me gain a better perspective in the future.
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