40 YEAR OLD FEMALE WITH PERIORBITAL PUFFINESS

 Medicine Blended Assignment :

October 24, 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

Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

This is the link regarding assessment :

https://medicinedepartment.blogspot.com/2021/10/oct-2021-formative-bimonthly-blended.html?m=1

Question 1 : 

Link:

https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

A detailed history was taken and the history is very well presented. History analysis was good. A detailed presentation was done. The clinical images are kept which helped us to understand much better.  The interpretation of results is also done. The work is appreciative. 

Link:

https://87tharunkumar.blogspot.com/2021/10/38-yr-old-male-presented-with-lower.html

 

A thorough history taking was done.Multiple  Investigation report images are kept and are clear .The information provided was precise. It was good overall and easy to understand. 

Link:

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

A thorough history taking is done.Multiple images are kept which helps in better understanding and also interesting. 

Presentation was neat and elaborate. 

Question 2 , 3:

DIAGNOSTIC AND THERAPEUTIC INTERVENTION -

GASTROENTEROLOGY -

https://63konakanchihyndavi.blogspot.com/2021/10/a-case-discussion-on-chronic-liver.html

Diagnosis : 

Chronic liver failure and kidney disease.

Investigations :

- RFT , LFT 

- HEMOGRAM , CUE 

- ECG , USG 

- Abdomen , BGT , ABG 

- VIRAL SEROLOGY , CHEST X RAY, 2D echo.

Treatment :  

- Fluid restriction : < 1t / day

- Salt restriction : < 2gm / day

- Tab . Lasix - 40 mg , BD

- Tab . Metalazone 5mg , BD 

- Tab . Thiamine 100 mg , OD

- Syrup . Lactulose 15 ml , BD

- Tab . Rifagut 550 mg , BD

- Protein powder with 100 ml milk , 2 times daily 

- Abdominal girth & weight measurement daily

- Tab . Udiliv 300 mg , BD

- 2-3 egg whites / day

CNS -

http://keelasreevalli.blogspot.com/2021/09/a-52-yr-old-female-homemaker-by.html

Diagnosis :

Altered sensorium under evaluation secondary to hyponatremia( euvolemia)?SIADH 

Sepsis secondary to ?cellulitis ? Typhoid

with complete right bundle branch block.

Investigations :

- CBP , CUE 

- LFT , RFT 

- Serum osmolarity , Serum Electrolytes 

- ECG , Urinary electrolytes 

- MRI brain , Chest X Ray

Treatment :

- Propped up position 

- IVF 3% Nacl @10 ml/hr 

- Ryles catheterization 

- Foley's catheterization 

- Inj.Piptaz 4.5 gm /IV/BD

- RT feeds : 100ml water 2nd HRLY 

                        50 ml milk 4rth HRLY 

HAEMATOLOGY -

https://mahithguduri63.blogspot.com/2021/09/pancytopenia-under-evaluation.html?m=1

Diagnosis :

Pancytopenia under evaluation

Investigations :

- Haemogram, LFT 

- Blood grouping and Rh typing 

- Serum Electrolytes ,Blood Urea 

- T3,T4,TSH, Bone marrow biopsy, ECG 

Treatment :

- Inj METHYLCOBALAMINE 1000mg IV OD

- Inj IRON SUCROSE 1 amp in 100ml NS IV

- Vitals monitoring

CARDIOLOGY , PULMONOLOGY -

https://vamsikrishna1996.blogspot.com/2020/12/supraja-medicine-elog-nephrology-case.html?m=1

Diagnosis :

CKD ON MHD WITH HTN WITH B/L TRANSUDATIVE PLUERAL EFFUSION SECONDARY TO HD

Investigations :

- Prothrombin time , LFT

- ABG, CBP, ECG

- Chest X RAY , 2D Echo

- Haemogram, Lipid profile

Treatment :

- Salt and water restriction

- Inj.augmentin 625mg od

- Tab nicardia10mg tid

- Tab.pantop 40mg od

- Tab.lasix 40mg bd

- Tab.orofer xt od

- Tab shelcal.hs od

- Tab nodosis 550mg od

- Tab zofer 4mg tid

- Nebulisation with budecort and salbutomol 8th hrly

- Bp/pr/temp/spo2 and I/O charting monitoring

NEPHROLOGY -

https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html?m=1

Investigations :

- Hemogram

- RFT, CUE 

Question 4:  

This month I didn't take up the case yet.

    

Question 5:

Our clinical postings started this month . I was very excited to have true clinical exposure facing patients in person , as till that day it was only the textbook presentation of a patient that we had seen . On the first day  A case was presented to us in the lecture hall and a focus on the clinical images was done . We were told the importance of  observing signs that we could figure just by looking at the patient . especially if the patient can not describe their problem to you . Next we went to the wards where we saw patients with infections , some hemodialysis patients . We were shown how to elicit shifing dullness and we were also shown cardboard rigidity of abdomen . Next week I took history of one patient assigned to me where the patients came to opd with shortness of breath. I was a very excited to take history of the patient . It was the first time that we had done this in person , it took a while to become comfortable with communicating with a patient . Later that same class another case presentation was done , where we revisited the anatomy of the motor tracks in CNS , to pinpoint where a lesion is present

 

Thank you