40 YEAR OLD FEMALE WITH PERIORBITAL PUFFINESS

 Medicine Blended Assignment :

August 25, 2021

General medicine bimonthly blended assignment :

Hi, I'm K.Lahari , a medical student (3rd sem).

I have been given the following cases to solve in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and coem up with a treatment plan

This is the link regarding assessment:

https://medicinedepartment.blogspot.com/2021/08/medicine-paper-for-aug-2021-bimonthly.html?m=1

Question 1 : peer review 

link : 

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

Long case it is about Acute Glomerulopathy

 (Glomerulonephritis / Nephrotic syndrome)

It was very concise and easy to understand and the information was well presented. The pictures of examining and reports are quite useful to understand in a better way and are well placed. Investigations were done and treatment was given accordingly, it is really awesome work and I can understand hardwork behind this work .Periodic updates on lab investigations is appreciated.

Short case is about 1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

A thorough history taking has been done and the case is well explained using all the pictures of investigations and reports.Details on investigations ordered are precise and clear. Input of information is organised.

Question 2

Long case

Problems:

Facial puffiness , bilaterally symmetric, pitting type pedal edema, extending upto the middle of his legs. Breathlessness, palpitations or chest pain. He reported frothing of urine but no haematuria. Gradually decreasing urine output over the past 3 days. The patient also denied any history of yellowish discoloration of skin or sclera.

Provisional Diagnosis - Acute Glomerulopathy (Glomerulonephritis / Nephrotic syndrome)

Features of inflammation such as severe pain associated with edema of the joints and limitation of range of active movements

Early morning stiffness, lasting for more than 30 mins (for 1 hour in this patient)

Pain and edema of joints improving with activity and worsening with rest

Features of uncontrolled systemic inflammation such as fever, involuntary loss of weight associated with loss of appetite.

Swellings at joints and deformation of normal joint posture 

Provisional Diagnosis - Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral Polyarthritis

Treatment:

Free water restriction for Hyponatremia

Tab. PREDNISOLONE P/O 20 mg OD

Tab FEBUXOSTAT P/O 80 mg OD

Haemodialysis for worsening renal dysfunction

Short case:

Problems:
Movements often worsened with rest and abated with activity. They were not troublesome initially but for the past 2 months he has been unable to correct answer sheets because of the involvement of his thumb and maintaining stability of his hand was proving difficult. He describes these movements as involuntary, rhythmic to and fro oscillations.

 Stiffness in his wrists (Right>Left), which has now ascended to his elbows. He says the stiffness is present throughout the range of motion. 

At this point, he also says that his walking has become difficult with small, short steps and a forward stoop, and he feels that although he weighs 60 kgs. he feels like it weighs 100 kgs. 

Difficulty in taking stairs up, in that he feels he sometimes might lose balance.  

speech lacks that 'edge' which he previously had. On asking further, the brother says that he has been speaking in a monotonous drab since 2 months. 

Problem Representation -

A middle aged man presenting with a 6 months history of gradually progressive, asymmetric rest tremor with autonomic features is provisionally diagnosed with 

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

Treatment:

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD

Question 3:

Conclusions Biopsy of the involved organ has the highest sensitivity. However,combination of multiple non-invasive biopsy methods may has sensitivity comparable to organ biopsy and is safer and more convenient.

The presence of frothy urine and edema strongly supports a glomerular pathology due to significant loss of protein and also decreased urine output. 

Right upper limb , 3-4Hz, high amplitude.

Gait - Reduced arm swing.

asymmetric rest tremor with autonomic features is provisionally diagnosed with Idiopathic Parkinson's Disease Stage 1 

Question 4 :

I haven't got any chance to make a case report or presentation this month. Looking forward to it.

Question 5 :

Making a blog on a case is very interesting and my pleasure to do and I am very glad that the hod sir and the pg ,intern  mams and sirs for guiding us. This kind of learning is very good opportunity for us.

We are working in small groups, and it is helping to communicate with each others and to gather useful information .Knowing and writing about a case , helping improving ability to induce a deeper level of learning by inducing more critical thinking skills.

By Peer review , getting the feedback on our blog writing, will improve to do much better

blog generally take the format of:

CHIEF COMPLAINTS:

HISTORY OF PRESENTING ILLNESS:

TREATMENT HISTORY:

PERSONAL HISTORY:

FAMILY HISTORY:

PHYSICAL EXAMINATION:

VITALS:

SYSTEMIC EXAMINATION

INVESTIGATIONS

And all..

And by writing the information under those above headings , makes us to knows about history taking , examinations and investigations to be done.

Thank you

K.Lahari

Roll no: 61