CLINICAL E LOG GENRAL MED .

BIMONTHLY BLENDED ASSESSMENT - August 2021

- Aug 24, 2021

BIMONTHLY BLENDED ASSESSMENT - August  2021

—104. JESHMITHA PERUMALLA 

https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

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

Please go through the long and short cases in the first link 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.

Please provide your peer review assessment on not only the the student's written case report but also the reading of the cases followed by the question answer session linked above in the video and share your thoughts around each answer by the student along with your qualitative insights into what was good or bad about the answer. 

Answer 1: critical appraisal and qualitative insights about the provider link above —  

Long case 

It is a case of 

A 44 year old, who presented with a 3 day history of anasarca and decreased urine output 

The history of patient was taken in a detailed manner this helps in understanding the probable symptoms and eases out the diagnosis of the case 

All the investigations and laboratory findings are updated in an order and the treatment provided was lucid .

Initially due to Localisation of Acute Problem Acute Glomerulopathy (Glomerulonephritis / Nephrotic syndrome) 

Later, on Localisation of Chronic Problem the diagnosis was changed to  Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral Polyarthritis

It would be clear if this diagnostic uncertainty is not present. 

Short case 1 

A middle aged man presenting with a 6 months history of gradually progressive, asymmetric rest tremor 

The history of patient was taken in a detailed manner this helps in understanding the probable symptoms and eases out the diagnosis of the case 

All the investigations and laboratory findings are updated in an order and the treatment provided was lucid . 

Diagnosis Idiopathic Parkinson's Disease Stage 1 with denovo HTN. Multiple System Atrophy - Parkinsonian Type (MSA-P)

Short case 2:

A 19 yr old male with c/o Itchy Ring leisons over arms and purple strech marks overall abdomen 

Initially the case was diagnosed as  endogenous CUSHINGS SYNDROME.

FINAL DIAGNOSIS : 

IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

TINEA CORPORIS

DENOVO HTN . 

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. 

Answer 2 : the patients data  and the detailed info is provided in the previous answer 

*Long case — there are diagnostic uncertainty in diagnosis of the case initially and there are no therapeutic uncertainties 

*short case 1— no diagnostic and therapeutic uncertainties 

*short case 2 — no diagnostic and therapeutic uncertainties 

Q3) Testing competency in "Evidence based medicine": 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 3 : 

sensitivity and specificity of the diagnostic interventions 

Long case —1) PREDNISOLONE

https://pubmed.ncbi.nlm.nih.gov/1254891/

2)FEBUXOSTAT  https://pubmed.ncbi.nlm.nih.gov/30601228/

Short case 1 

1) Tab. Syndopa Plus 125 mg QID —  https://pubmed.ncbi.nlm.nih.gov/5117312/

2) Tab. Telma 40 mg OD

https://pubmed.ncbi.nlm.nih.gov/22906558/

Short case 2 

1)Ointment AMLORFINE — https://pubmed.ncbi.nlm.nih.gov/32183613/

2)FUSIDIC ACID CREAM.— https://pubmed.ncbi.nlm.nih.gov/32979860/

3)PROLONGATUM INJECTION

https://pubmed.ncbi.nlm.nih.gov/31614334/

4)Tab hizone

https://pubmed.ncbi.nlm.nih.gov/32030666/

5)Tab Shelcal 500 OD and Tab Vit D 3 Od.

https://pubmed.ncbi.nlm.nih.gov/29415929/

6) Tab ULTRACET /PO/SOS.

https://pubmed.ncbi.nlm.nih.gov/21463069/

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. 

Answer 4 : I apologize for not taking any case this month 

Q 5) Testing scholarship competency in  

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

Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 

A sample answer to this last assignment around sharing your experience log of the month can be seen in one student's  answer to Q10 in the  May 2021 assignment in the link below:

https://drsaranyaroshni.blogspot.com/2021/05/assignment-patient-centred-learning.html?m=1

And another student answer to Q5 in the June and July 2021 assignment in the links below :

https://rishitha35.blogspot.com/2021/06/general-medicine-assignment.html?m=1

https://rishitha35.blogspot.com/2021/07/gm-assignment-july.html?m=1

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 : 

The Pandemic may be for the first time compelled medical students to stay back at home for months together during their course of MBBS.

During the second wave of COVID ,which is still on at present , I got stuck up at home while being in the Final year of my MBBS course

A part of it I would like to bring light upon in this writing today.

Due to this pandemic ,as we know there are thousands of people infected with the deadly virus but not having the privilege of being checked upon by a doctor ,or of being alloted a bed and an oxygen cylinder in the vicinity

All these have now become more than known stuffs but 

The other side of the sad story is that there are scores of other patients who do aren't  suffering from COVID but this lockdown, and the scare of hospitals and clinics being infected , have prevented these people from getting even bare minimum of consultations for their varied other pathologies, be it a chronic or an acute one.

In such a scenario , telemedicine comes handy to such patients ,

I have been communicating with quite a few such individuals about whom I shall be discussing.