GENERAL MEDICINE- FORMATIVE ASSESSMENT
GENERAL MEDICINE AUGUST 2021 BIMONTLY BLENDED ASSESSMENT
I, B. VAISHNAVI, student of 3rd semester holding roll number 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
QUESTION-1
CRITICAL APPRAISAL ON THE LONG CASE:
Presented the case details well. All the history taking part is also done well. Mentioned all the details in chronological order. Every minute detail is covered. They also mentioned regarding the immunization history. Then they started with the analysis of the history, talking regarding the localization of acute problem followed by the localization of the chronic problem. Then followed by clinical examination- The vitals are mentioned in supine as well as in sitting position. Then head to toe general examination is shown. Systemic examination regarding the skeletal system is depicted with appropriate pictures along with the X-rays. By all the appropriate investigations, they came up with a provisional diagnosis. Also shown few differential diagnosis and came up with an appropriate diagnosis.
QUALITATIVE INSIGHTS:
1.Abdominal fat pad biopsy vs Renal biopsy?
In the answer, firstly the data collected was mentioned regarding biopsy of different organs, by comparing different organ biopsy sensitivity, they came to a conclusion that the biopsy of organ involved has highest Sensitivity.
2. Single DMARD vs Combination therapy?
In the answer, the cochrane review was taken and the clinical efficacy of methotrexate monotherapy vs combination therapy was looked at. There was a pictographic representation collected regarding the data.
3. When to initiate dialysis? how long can we wait?
In the answer , they mentioned regarding the Ex tempore interpretation of the AKIKI-2 trail
4. Can Rheumatoid Arthritis and Gout co-exist together?
In the answer, according to the survey they mentioned in percentage year wise ; The prevalence of gout in RA on Jan 1, 2008 was 1.9% based on the National Health and Nutrition Examination survey
5. Efficacy of Febuxostat vs Allopurinol for Gout?
In the answer, an abstract was mentioned in detail explaining the aim, methods and the results.
CRITICAL APPRAISAL ON THE SHORT CASE-1
The case was well presented. Present illness history is somewhat elaborated. They also mentioned regarding the present history, past history, medical/surgical history, personal history, family history, social and educational history, immunization history in the chronological order. The data regarding the general examination was taken well. They also mentioned in detail regarding the nervous systemic examination. Elaborative CNS examination is done and they mentioned regarding all the motor and sensory system functions, reflexes. Also mentioned regarding the cerebellum, meningeal signs, autonomic system.
CRITICAL APPRAISAL ON THE SHORT CASE-2
The case was presented well. History of present illness ,past history all are explained well in chronological order, allergic history was also mentioned. General examination was also mentioned followed by skin examination. All the information regarding the systemic examination was well presented. Later followed by provisional diagnosis, investigations. As it is a case of cushing syndrome, pictures related to striae was also posted. Treatment plan was also posted appropriately.
QUESTION-2
My Analysis On The Long Case:
The patient reported facial puffiness with pedal edema, bilaterally symmetric, pitting type, frothing of urine, gradually decreasing urine output, severe joint pains involving small joints in his hands and wrist, associated with local edema, painful limitation of movements, debilitating early morning pains also reported, he had burning sensation in the eye, developed subcutaneous swellings in the proximal joints of the fingers.
Appropriate investigations were done , urinary microscopic examination was also done, they came up with a differential diagnosis such as Rheumatoid arthritis, Rheumatoid arthritis with co existent Gout, psoriatic arthritis, enteropathic arthritis, etc. Then they came up with the final diagnosis as Acute Glomerulonephritis, 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.
My analysis on the short case-1:
The patient noticed progressive asymmetric involuntary movements of his right index and middle finger. These movements worsened on rest. These movements were described as involuntary to and fro movements, he feels stiffness in his wrist, walking became difficult with small, short steps and a forward stoop, he reports that he hasn't had morning erections and there was a loss of sexual desire.
Appropriate general and systemic examinations were done and mainly concentrating on the CNS, grade 2 diastolic dysfunction was seen in the 2D Echo. By going through the above problems, they rightly diagnosed it as Idiopathic Parkinsonism stage 1 with denovo HTN, Multiple system atrophy- parkinsonian type ( MSA-P).
My analysis on the short case -2
The patient came with complaints of itchy ring lesions over arms, abdomen, thigh and groin. Purple stretch marks all over the abdomen, lower back, upper limbs, abdominal distension and facial puffiness, pedal edema is seen, low back ache, feeling low, weight gain and decreased libido, loss of libido and erectile dysfunction.
Appropriate General and systemic examinations were done and following it skin examination was also done . Appropriate investigations were done which paved way to the final diagnosis that is Iatrogenic cushing syndrome secondary to topical clobestasol application all over body for approximately one year. Tinea corporis, denovo HTN.
QUESTION-3
REVIEW ON LONG CASE-
The patient symptoms are mentioned appropriately, he mentioned the chief complaints in the language of the patient and following the present illness was narrated as what the patient said. All the history details were mentioned appropriately , investigations were also mentioned. They came up with the final diagnosis followed by the treatment plan.
As it is the renal case and involvement of joints appropriate treatment plan is must, that will help the patient to overcome the symptoms. As there is hyponatremia , free water restriction is mentioned, hemodialysis is also suggested in case of worsening of renal dysfunction.
REVIEW ON SHORT CASE-1:
The patient disease history was elaborated in detail, he mentioned the chief complaints in the language of the patient and following the present illness was narrated in the case according to the details shared by the patient.
According to the investigations and general and systemic examination they came with a correct diagnosis as Parkinsonism. As it is a case of parkinsonism, the appropriate treatment plan is suggested with appropriate dosage.
REVIEW ON SHORT CASE-2:
The patient had history of itching ring lesions and purple striae over the abdomen , abdominal distension is seen, according to this problem list and investigations done, in this case the drug history played a vital role. They came to a correct diagnosis that is iatrogenic cushing syndrome secondary to topical clobetasol application all over body for approximately one year.
As it is a case of cushing syndrome, appropriate treatment plan is suggested to make the patient symptoms subside. Cortisol levels are checked regularly. Regular checkups are must in this case.
QUESTION-4
CASE REPORT:
QUESTION-5
Reflective logging of our own experiences is a vital tool towards competency development in medical education and research. We were able to interact with the patient or their attenders inorder to know their disease condition.
Telecommunication also provided a great opportunity to communicate with the patient and to communicate with you guys through my E- log.
Making an E- logs is helping us a lot in sharing the patient symptoms, history followed by general and systemic examination, then investigations and coming to a final diagnosis. We need to share such information because we may get differential diagnosis, we need to discuss and come to a final accurate diagnosis to provide appropriate treatment plan.
This bimonthly blended assessment is helpful as we are able to critically comment and give reviews to peer E logs and learning the better way of making an E log. This kind of telecommunication makes our understanding even better.
We entered into a new method platform that is competency based medical education of analysing and understanding, this helps us to improvise ourselves, made us better and competent doctor....
Comments
Post a Comment