FORMATIVE ASSESSMENT
GENERAL MEDICINE BIMONTLY BLENDED ASSESSMENT - JULY 2021
I, B.VAISHNAVI, student of 3rd semester holding roll no. 22 was given the following formative assessment to facilitate connections between different systems or disciplines of knowledge or learning in healthcare which is purely reflecting the theme" scholarship of integration in medical education and research"
You can go through the below link for assessment questions
http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
QUESTION -1
Here's my review to the following cases. Go through it!
http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1
Here is the link of my friend's assessment. Go through it!
https://varshitha039.blogspot.com/2021/07/formative-assessment.html
CASE-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?
I agree to the answer given, it is appropriate to the question posed. She mentioned every thing regarding the etiology and also some other causes which might be the reason for the patient problem. She emphasized the answer by adding her own ideology. She appropriately mentioned the problem and it's cause, making the readers comfortable.
CASE-2
what is the reason for giving thiamine in this patient?
What are the changes seen in ECG in case of hypokalemia and associated symptoms?
I agree with the answer. Such basics everyone of us must know. By going through this we got to know the changes seen in ECG in case of hypokalemia and associated symptoms. She even compared the normal ECG and the abnormal one in the case enhancing our understanding capacity.
CASE-4
Does his lipid profile has any role for his attack?
I agree to this answer. It is appropriate to the question, as we need to no every thing in detail regarding the patient, any minute detail is not left. No other references are needed, going through this answer gives us the correct and appropriate answer.
CASE-8
How does the pre-existing ILD determine the prognosis of this patient?
I agree to the answer. It stated very well the necessity to know regarding the pre-existing ILD which lead to the prognosis of the patient. Each and everything regarding the patient problems are discussed in detail in order to get this appropriate answer.
CASE-9
Could chronic alcoholism have aggravated the foot ulcer formation? If yes, how and why?
I agree to the answer. It is very well emphasized in the answer that chronic alcoholism have aggravated the foot ulcer formation. The answer shows that even she agreed with the statement and given the necessary reasons to prove it right.
CASE-10
QUESTION -2
CASE REPORT
https://bommakantivaishnavi.blogspot.com/2021/07/general-medicine-case-discussion.html
QUESTION -3
CASE-1
Below is the link shared on patient centered data around the theme of renal failure patients with AKI
https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
Critical appraisal of the captured data:
-The details of the patient are arranged accordingly, the drug history is also taken. The general and systemic examination were shown and each and every system is examined appropriately. An elaborate description was given on the patient's investigations. The condition of the patient everyday is reported in the E log. Bacterial culture was done and reports were depicted. Proper investigations along with X-rays were also shared.
All the details are not arranged chronologically. I found a bit problem in going through the complaints of the patients. Apart from these negatives, everything about this E log is appropriate.
CASE-2
Below is the link shared on patient centered data around the theme of renal failure patient acute on CKD
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
Critical appraisal of the captured data:
The complaints of the patient were arranged in chronological order, helping the readers to analyze the case well. Detailed explanation of the patient complaints was given in history of present illness. The general examination and systemic examination were appropriate. Appropriate investigations are done and the reports are shown. These details brought us to an appropriate diagnosis of the case. The treatment plan was updated everyday.
The E log made is appropriate, but it would be even better if the case reporter had explained the treatment plan with patient's problems. This would help us in better understanding of the treatment plan.
CASE-3
Below is the link shared on patient centered data around the theme of renal failure patient on CKD
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
Critical appraisal of the captured data:
All the minute details regarding the patient's complaints were described. As the patient is a female, her menstrual and obstetric history was also given importance. Elaborate description of the investigations was given. ECG findings were also shown. Graphical representation of the serum protein electrophoresis was also added to the E log. Bone marrow aspiration reports were attached and histological findings are also shown. The appropriate treatment plan was also given.
The E log made is complete and provided all the useful leads to analyze the diagnostic and therapeutic uncertainties of the case
CASE-4
Below is the link shared on patient centered data around the theme of renal failure patient on CKD
http://casereports.bmj.com/content/2009/bcr.03.2009.1726
Critical appraisal of the captured data:
The patient complains are well elicited. The investigations shows the CT scan of the lumbosacral spine, Cranial CT scan, the bone marrow histology. There is a detailed description on the given investigations and the references they took in order to make this blog was also given at the end. There pictographic representation of the above investigations, helped us in easy understanding.
The patient's complains are not chronologically shown with no side headings of the history taken. The investigations part and the history part is mixed, confusing the readers.
CASE-5
Below is the link shared on patient centered data around the theme of patient with coma and renal failure
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
Critical appraisal of the captured data:
The details regarding the patient's complains were well shown. Detailed description is given for better understanding. 2D echo report was also showed along with a video ,enhances our understanding capacity. Day to day laboratory analysis were updated. Fever chart was also graphically represented. MRI scan was also done, reports were also posted. Treatment plan was also updated everyday.
It would be easier for the reader to go through the case , if the sub headings are properly highlighted. Apart from this ,the case scenario was perfectly illustrated.
CASE-6
Below is the link shared on patient centered data around the theme of patient with coma and renal failure
https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
Critical appraisal of the captured data:
The patient centered data was well elicited in the E log. With clear demarcations of history of present illness, past illness, personal and family history are well given by these and along with the proper investigations taken we can come to an appropriate diagnosis. The pedal edema s also shown along with a picture. Videos of 2D echo were also attached, enhancing our understanding.
The chief complains are not properly highlighted in this E log. Apart from that everything is appropriate regarding the case scenario.
CASE-7
Below is the link shared on patient centered data around the theme of renal failure patients acute on CKD
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
Critical appraisal of the captured data:
The patient centered details were captured well. Important aspects related to the case are highlighted. Fever chart is diagrammatically represented. Investigations are updated everyday. Urine bag with plenty of pus cells picture was attached to the E log. Fever chart is graphically represented. An elaborate description on the X-ray was also given.
There are no such negatives found in this E log, it was found to be appropriate.
CASE-8
Below is the link shared on patient centered data around the theme of renal failure patients acute on CKD
https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
Critical appraisal of the captured data:
The complaints of the patient are arranged in chronological order. The important points are perfectly highlighted. Drug history was also mentioned, which plays an important role in understanding the immune condition of the patient. The investigation reports are attached and the problem is described there itself, which helps in coming to a diagnosis. The pre medication and post medication findings are illustrated graphically.
It would be beneficial if the case reporter had explained the treatment plan with the problems of the patient.
CASE-9
Below is the link shared on patient centered data around the theme of renal failure patients acute on CKD.
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
Critical appraisal of the captured data:
The details regarding the history of present illness, past illness were taken. X-rays were also depicted regarding the past illness. Fever chart was graphically represented. The pictures regarding edema are also attached in the E log. HRCT of thorax was also shown, pco2 trend is diagrammatically shown.
The treatment plan was not properly addressed in the E log. Apart from that everything in the E log is appropriate.
CASE-10
Below is the link shared on patient centered data around the theme of renal failure patients with AKI:
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
Critical appraisal of the captured data:
The patient complaints are given point wise, thus the concentration directly goes to the complaints. In general examination of the patient, along with description pictures of the patients were also attached. Day to day condition of the patient is updated. The treatment is given appropriately to the patient's problem.
Drug history of the patient to be mentioned, as it plays a vital role in knowing the patient's immune condition and to treat accordingly.
CASE-11
Below is the link shared on patient centered data around the theme of renal failure patients with AKI
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
Critical appraisal of the captured data:
The patients complaints are elicited well. The patient details such as history of present illness, past history were given. Fever chart is graphically represented. Treatment plan was also updated everyday. The pictures related to physical examination are attached. The investigations are done and related reports are attached.
It would be benefitted if the case reporter described the treatment plan with appropriate patient problem. Apart from that, the case scenario is appropriately described.
CASE-12
Below is the link shared on patient centered data around the theme of renal failure patient with AKI
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
Critical appraisal of the captured data:
The patient complaints are elicited well. Fever chart is graphically represented in this case. The general examination and systemic examination are perfectly elicited in this E log. The patient identities are well masked in this case scenario. Scrotal and penile swelling were observed and attached here. Whole case is summarized at the end of the E log.
It would be convenient for the reader, if the font size is increased. Here the background is more highlighted than the content. Apart from these negatives, everything in this case scenario is appropriate.
QUESTION-4
CASE-1
Below is the link shared on patient centered data around the theme of renal failure patient with AKI:
https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
My analysis and reflection on the above case:
A 58 years old male came with complaints of lower abdominal pain, burning micturition, low back ache after lifting weights, dribbling of urine output, fever, SOB at rest, blurring of vision, black outs, trauma to head, hypertension(not on medication).
According to the investigations, RBS is slightly elevated, serum electrolytes are below normal, blood urea level is elevated, serum creatinine levels is also elevated, plenty of pus cells are seen in urine, culture report shows polymicrobial flora, serum albumin is below normal, Hb is slightly decreased.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as acute kidney injury. AKI is causing build up of waste products in the blood and makes it hard for the kidneys to keep the right balance of fluid. Appropriate treatment plan is also followed.
CASE-2
Below is the link shared on patient centered data around the theme of renal failure patient acute on CKD:
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
My analysis and reflection on the above case:
A 75 years old male came with complaints of lower backache, dribbling of urine, pedal edema, SOB at rest, increased involuntary movements of both upper limbs, jaundice(relieved on plant based treatment)
According to the investigations, increased blood urea level, elevated levels of serum creatinine levels are noted, decreased hemoglobin content and lymphocytes count. There is increased serum uric acid levels, blood and urine culture did not show any growth, tachycardia is observed.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as acute on chronic kidney disease. Treatment for CKD can only help to relieve the symptoms and stop it getting worse.
CASE-3
Below is the link shared on patient centered data around the theme of renal failure patient with CKD.
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
My analysis and reflection on the above case:
A 49 year old female came with complaints of hemorrhoids(operated), muscle aches(using NSAIDS), fever(treated), generalized weakness, vomiting(content is food, non projectile, non bilious).
According to the investigations, ABG shows decrease in pH, hemoglobin content is decreased slightly, Blood smear showed amisopokilocytosis with microcytes, macrocytes, macro-ovalocytes and few tear drop RBC cells. Increased blood urea levels and serum creatinine levels are observed. Pathological findings of bone marrow aspiration are also shown.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as chronic kidney disease. Appropriate treatment plan was also elicited which helps in treating the symptoms.
CASE-4
Below is the link shared on patient centered data around the theme of renal failure patient with CKD:
http://casereports.bmj.com/content/2009/bcr.03.2009.1726
My analysis and reflection on the above case:
A 47 year old male came with complaints of oliguria and uremic symptoms such as anorexia, nausea and vomiting, severe back ache, sudden altered sensorium with restless twitching of the limbs
According to the investigations, serum creatinine levels are elevated, ABG report revealed metabolic acidosis. Renal biopsy showed moderate tubulo-interstitial nephritis, mild global glomerular sclerosis. The CT scan revealed multiple punched out osteolytic lesions. The bone marrow findings are suggestive of Walden storm's macroglobulinemia.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as chronic kidney disease.
CASE-5
Below is the link shared on patient centered data around the theme of renal failure patient with coma
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
My analysis and reflection on the above case:
A 35 year old female came with complaints of fever and diarrhea, back pain with abdominal pain and chest pain, altered sensorium, once patient suddenly became unresponsive.
According to the investigations, ABG showed severe metabolic acidosis, hypotension is seen. Hemoglobin and lymphocytes content is low. Elevated levels of alkaline phosphatase, bilirubin are seen. Kidney function tests showed increased urea, creatinine, uric acid levels. Blood culture reports showed growth of skin commensals.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as renal failure with coma.
CASE-6
Below is the link shared on patient centered data around the theme of renal failure patient with coma
https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
My analysis and reflection on the above case:
A 52 year old male came with complaints of abdominal distension, non healing injury on the right foot, tingling in the upper limbs up to palms and lower limbs up to the knee, constipation, altered sleep patterns, pedal edema grade 2, icterus.
According to the investigations, the hemoglobin content and lymphocyte count is decreased, increase in total count and neutrophils. There is increased urea, creatinine and uric acid levels. Increased alkaline phosphatase levels.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as alcoholic liver disease, AKI secondary to UTI on CKD, secondary to diabetic nephropathy, hepatic encephalopathy grade 2.
CASE-7
Below is the link shared on patient centered data around the theme of renal failure with acute on CKD
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
My analysis and reflection on the above case:
A 52 year old male came with complaints of fever, pus in urine, dribbling of urine, hesitation and reduced flow of urine, burning micturition, prostomegaly, fever with chills and rigor, yellowish discoloration of eyes(given iv antibiotics).
According to the investigations, decrease in hemoglobin content and lymphocytes, PCV is also decreased. Bacterial culture showed positive to staphylococcus aureus. Increased levels of serum creatinine and blood urea, altered serum electrolytes are also observed.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as renal failure with acute on CKD. Appropriate treatment plan was also attached in this E log.
CASE-8
Below is the link shared on patient centered data around the theme of renal failure with acute on CKD
https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
My analysis and reflection on the above case:
A 48 year old male came with complaints of SOB grade 2, chest pain diagnosed to have heart failure, there is orthopnea and bendopnoea present. Edema of feet is observed, dyspnea is present.
According to the investigations, fasting blood sugar and post lunch blood sugar is elevated, erythrocyte sedimentation rate is elevated. Hemoglobin is lower than the normal, increased levels of alkaline phosphatase is observed, slight increase in TG levels is also observed.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as HFrEF secondary to CAD; CRF
CASE-9
Below is the link shared on patient centered data around the theme of renal failure with acute on CKD
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
My analysis and reflection on the above case:
A 60 year old female came with complaints of SOB and anasarca, decreased urine output, vomiting, loose stools, pneumonitis.
According to the investigations, decreased lymphocyte count, decreased MCV and MCH levels, increased RBC count is observed. Increased serum creatinine and blood urea levels. Altered serum electrolytes is also observed. HRCT reports showed peri-bronchial cuffing in both lungs, pulmonary venous congestion is seen, minimal bilateral pleural effusion, mild pericardial effusion is seen.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as renal failure with acute on CKD.
CASE-10
Below is the link shared on patient centered data around the theme of renal failure patient with AKI
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
My analysis and reflection on the above case:
A 43year old male came with complaints of loose stools, pedal edema, abdominal distension, pallor is present, dilated veins are present on the abdomen.
According to the investigations, mild free fluid noted in perihepatic, perisplenic, RIF, LIF. Grade 2 fatty liver with mild hepatomegaly, mild ascites is observed. Raised echogenicity of bilateral kidney correlated with RFT.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as alcoholic hepatitis, AKI secondary to acute gastroenteritis, HFrEF secondary to CAD, alcohol and tobacco dependence syndrome.
CASE-11
Below is the link shared on patient centered data around the theme of renal failure patient with AKI
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
My analysis and reflection on the above case:
A 60 year old female came with complaints of pedal edema which is bilateral and pitting type, decreased urine output, fever, SOB. Acute kidney injury secondary to urosepsis(resolved by dialysis), burning micturition.
According to the investigations, increased serum creatinine and blood urea levels are observed, altered serum electrolytes are observed. Decreased hemoglobin content, total count. Bacterial culture reports showed positive to candida spp.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as acute kidney injury secondary to urosepsis.
CASE-12
Below is the link shared on patient centered data around the theme of renal failure patient on AKI:
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
My analysis and reflection on the above case:
A 31 years old male came with complaints of pain abdomen(epigastric region, non radiating, intermittent type), vomiting(non projectile, bilious contents), SOB, weak back ache.
According to the investigations, increased serum creatinine levels, altered serum electrolytes are observed, decrease in hemoglobin content is seen. Bacterial culture showed no growth of any microorganism. Pancreas head and tail are observed with altered echo texture, moderate ascites is observed.
As a conclusion, by going through the patient problems and some of the investigations it is correctly diagnosed as pancreatitis in a chronic alcoholic with AKI.
QUESTION-5
Reflective logging of our own experiences is a vital tool towards competency development in medical education and research. It is an important platform to address our understandings in the form of this E logs. The best part is, while making an E log we are going through many references and our subject is improving.
Gaining knowledge from one's own experience has an impact in our understanding capacity. It is a very good stage in comprehending our ideas. By making an E log, we are analyzing all the investigations and problems of the patient and leading to a correct diagnosis.
This type of assessment is helpful as we are able to critically comment on our peer E logs and learning the better way of making an E log. By critical appraisal, we tend to learn a lot. This kind of telecommunication makes our understanding even better.
At this level if we were thorough with n number of cases, in future we will be in a position to make miracles in medical world. As we entered into a new method of learning where students need to put on efforts and the teachers need to guide them, this type of E learning helps us a lot.
Reflective logging has good impact on our understanding capacity. It implies that we are using the resources we have in this pandemic in a right way. Hope to see such new methods of learning, where abundant knowledge is being shared.
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