General medicine blended assignment
Name: Venkata Meghana Badam
Many more investigations had been done and diagnosed as infective endocarditis with AV vegetation with moderateAS severe AR with AKI.
All the examinations ,history taking, investigations are very well done
Roll No: 146
Batch: 2019 (3rd Sem)
Question No: 1
The cases which was reviewed by my friend were very well explained.The necessary questions were posed and checked,reviewed and assesed appropriately taking into the consideration of patients history, diagnosis and also the treatment partof the diagnosed disease.The pathophysiology of the patients disease,it's symptoms and clinical features are relevantly show with required pictures and videos.
He has thoroughly examined all the system by taking and choosing different patients with different diseases. He has individually choosen cardiology, nephrology, pulmonary, enterology, urology and also infectious Diseases and studied the cases properly to actually know the cause and how to diagnose them and as well he tried to learn the treatment part also.
The efforts made by my friend were really admirable. I really appreciate his work in understanding and making the elog appropriately.
Question No: 2
I haven't got the chance.
Question No: 3
Patient with coma and renal failure
In the above case the patient is asymptomatic since 2 yrs and had a non healing injury to the right foot which raised a suspicion of diabetes mellitus.
Complaints are tingling in upper limbs upto the palms and in lower limbs upto the knees.history of present illness past history and family history are taken.
Before the consultation he is not known with hypertension, CAD,asthma,tb,epilesy.
No history of surgeries and blood transfusions in the past.
Presently he had icterus and pedal edema
No pallor,cyanosis,clubbing and lymphadynopathy this is he's general examination.
Systemic examination is normal
Investigations are
Many more investigations had been done and diagnosed as infective endocarditis with AV vegetation with moderateAS severe AR with AKI.
Treatment is given and the patient visited the hospital for maintenance hemodialysis.
Acute on CKD:
The patient came to op with cheif complaints of lower backache, dribbling of urine, pedal edema and increased involuntary movements. The lower backache and dribbling of urine suggests that he has some kidney related disorders .He was finally diagnosed having ACUTE RENAL FAILURE (ARF).The examination and the presentation was done very good, elaborated clearly with appropriate test reports and scans. Its very neat that the day to day medication was also clearly mentioned.
Patients with acute on CKD:
As given patient is diagnosed initially with diabetes mellitus- 2,gradually develops severe diabetes and is on insulin treatment. Severe diabetes causes damage to filtrating system and blood vessels of kidney. As filtrating system is damaged creatinine and urea levels are altered. Severe diabetes leads to diabetic nephropathy, which causes water
retention leading to hydroureteronephrosis.
By examination of urine sample as it contains pus cells it is diagnosed with pyuria, caused due to bacterial infection leading to urinary tract infection which leads to urosepsis. This causes burning micturition. Fever is due to infection.
This urosepsis leads to AKI(Acute kidney injury)
The presentation is one of my fellow mate and it was presented very clearly and effectively such that the overview of the patient details can be clearly understood. I really admire her work and it was very good and great presentation.
In this case history is very clear which includes present, past, family, personal, obstetric history and menstrual history.
All the examinations are done with necessary investigations.
Patients with AKI:
This is the case in which the examination pictures are also given clearly .
All the examinations ,history taking, investigations are very well done
The presentation deals about the case of pancreatitis in a chronic alcoholic with Acute Kidney Infection. The patient presented with pain in the abdomen in the epigastric region .All the investigations, images, are clearly mentioned along with the summary which shortly reviews the presentation. Its neat and clean presentation.
A 60 year old female came to op with complaints of pedal odema since 10 days along with decreased urinary output. The presentation shows all the laboratory tests reports coherently .The appreciable thing is detailed description of the patients treatment and her clinical features. The presentation is very accurate and apparently mentioned.
Question No: 4
ACUTE KIDNEY DISEASES:
It is sudden in onset, primarily reversible. Generally, the patients come to OPD with c/o oliguria, lower abdominal pain, decrease in urine output with burning micturition, SOB, fever, vomiting's - bilious, pedal edema in bilateral lower limb pitting type. It can be identified by serum creatinine levels O/e it shows low albumin levels, with normal hemoglobin concentration, not associated with anemia [rarely anemia can be noticed], normal lipid profile. Sometimes AKI are associated with other diseases like hepatomegaly, pancreatitis, CHF. Renal transplantation is not required, the patient should be on dialysis for a short period of time.
CHRONIC KIDNEY DISEASES:
It is sudden in onset, predominantly irreversible. General c/o of patients are muscle aches, fever, generalized weakness, vomiting's - non-bilious, normal or increased urinary output [polyuria], no pedal edema [if associated with pedal edema there is periorbital edema too which indicates severe kidney damage], SOB- absent. O/e size of the kidney is reduced, hemoglobin concentration decreased, anemia is seen, marked changes in lipid profile [decreased HDL, increased LDL, TG]. Renal transplantation is necessary, dialysis- required repeatedly.
ACUTE ON CHRONIC KIDNEY DISEASE:
Sudden fall in GFR is diagnosed as acute kidney disease, nevertheless, some pt has pre-existing kidney injury leading to CKD.
Question No: 5
I have learnt a lot in the last month in general medicine department. I have learnt how to approach a patient and understand their problems. It taught me that not only being sympathetic but being empathetic is most important. It also taught me the importance of doctor patient relationship. It improved my case solving technique. I also understood the importance of listening.
We learned a lot while studying our peers assignments, we are learning a lot through these assignments. As we have only online postings things are hard to understand but these assignments made them easier, I am also able to learn about diagnosis treatment of Various diseases though everything is not clear. I am able to learn patient history taking, general examination and doctor patient relationship, what are all needed to reach a diagnosis. I am able to omit the remaining ones. This assignment helped in various ways during this pandemic.
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