GENERAL MEDICINE ELOG 2 BY SRI CHAKRA

Online bimonthly assignment

M. Sri Chakra 

3rd semester

Roll no. 72

i have been given the assignment to check our ability to connect with and capture patient centered data (as already demonstrated by many of the 2019, 2017, 2016 batch students) and also the ability to connect with and engage in shared learning with their peers through peer review feedback. 

Below is the link to the questions given to us:-

http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1

QUESTION-1

i went through nitin luckshetty's assignment and briefly reviewed all his answers.

 

Q1. he has chosen 10 cases of different branches and even i have gone through all the cases that he picked and i felt his insights for each cases was very precisely and accurately written and was presented in a very relevant manner.

 

Q2. He has not been assigned to any case yet. 

  

Q3 AND Q4

•    he has taken a case of a 45 year old male with acute kidney injury on chronic kidney disease that is hypertensive nephropathy with uraemic encephalopathy.

• he has explained about his present and past and drug history in a very detailed and precised manner.

• he has also attached the investigation reports and the treatment protocol followed.

 

Q5.he has shared his positive views on clinical online classes and his experience of taking history from the patient for the first time and how properly a patient is reviewed before coming to a conclusion about the problem the patient is suffering.

QUESTION -2

i have not assigned any case yet.

QUESTION -3 

Case 1: 

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1 

A  58 year old with complaints of burning micturition , Lower abdominal pain and backache after lifting weights , decreased urine output and fever SOB. The provisional diagnosis for the case according to the investigations done is AKI SECONDARY TO UTI . associated with other conditions such as DM 2 and hypertension.

INSIGHTS-The serological investigations , are done properly and are in sequence accordingly. Investigations ordered are also mentioned. The history of patient is also in a sequential manner and point wise making it look clear .

 

Case 2 : 

http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

A 75 yr old man with complaints of dribbling of urine , lower backache , pedal oedema , increased involuntary movements of upper limbs ,SOB . Treatment is given in order date by date which makes it easier to look for . And the history of patient is described well . Treatment history could've been mentioned. Investigations done are proper and the provisional diagnosis also is being explained well by them .

Case 3 : 

https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

A 49 yr old female with complaints of mass per anum with bleeding . History of presenting illness mentioning would've made it easy to go through the case. Personal history is well explained. Menstrual , obstetric and birth history are also being mentioned. Investigations done are properly.

Case 4 : 

https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

The case report In brief starts with 'a 35 yr old female ' which is not mentioned here .with complaints of fever , diarrhoea, back pain , chest and abdominal pain . Headings could've been mentioned properly such as systemic examination past history presenting illness.Investigations done are put up day to day accordingly. With mention of prognosis and pictures if necessary . Discharge summary is described well . 

Case 5 : 

https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1

A 52 yr old man with complaints of the abdominal distension. History of patient , investigations done , provisional diagnosis and treatment are described properly . Along with discharge summary. Which made the log look complete . Because it also includes final diagnosis of patient's problem.

Case 6 : 

https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

A 52 year old male With complaints of fever and pus in urine. History of patient is discussed well With highlights. Investigations ordered and done are proper explained along with pictures and reference .Discharge summary could've made the log complete. Treatment is given but it would be good to save it date wise .

Case 7 : 

https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

A 48 year old with complaints of shortness of breath . History and investigations Are given which explains the provisional diagnosis. Treatment is mentioned and reference links are provided which makes it easy to understand.

Case 8 : 

https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1

A 60 yr old female with complaints of decreased urine output , pedal oedema , vomitings and loose stools . History of patient and investigations done are put up along with pictures . Discharge summary is described well.

Case 9 : 

https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

A 43 yr old man with complaints of loose stools, pedal oedema, abdominal distension. History is well explained. Investigations done are in order accordingly. systemic effects are being monitored almost daily , which are updated clearly . Expected date of discharge and summary could've made it complete.

Case 10 : 

https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

A 60 yr old female with complaints of fever , pedal oedema , decreased urine output. Histories , investigations and examinations done are properly given . Comparison of urea, creatinine, serum electrolytes are done which makes it easier for quick review .Treatment is mentioned in date wise manner and is basically conveyed in a helpful way.

Case 11 : 

http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

A 31 yr old male with complaints of pain in abdomen , vomitings , SOB .Subheadings mentioning must have been proper otherwise good explanation. Investigations done are proper which explains DIAGNOSIS . Summary is given in short which gives us a quick review.

 

QUESTION -4

Case 1 : 

A 58 year old male patient came to casualty with chief complaints of:

- lower abdominal pain: 1 week

 -burning micturation:1week

- low back ache after lifting weights

-dribbling / decrease of urine out put:1week

-fever :1 week

-SOB , rest :1week

Diagnosis : 

Acute kidney injury( AKI) 2° to UTI, associated with Denovo - DM -2

-With ? Right HEART FAILURE,

-With K/C/O - HTN ( Not on Rx)

 

- AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.

Treatment : 

1)IVF : -RL @ UO+ 30ml/hr       -NS

2)SALT RESTRICTION < 2.4gm/day

3)INJ TAZAR 2.25gm IV/ TID

4)INJ PANTOP 40mg IV/OD

5)INJ THIAMINE 1AMP IN 100ml NS IV/TID

6)INJ HAI S/C ACC TO SLIDING SCALE      8AM - 2PM - 8PM

7)SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]

8) GRBS - 6th Hourly

9) BP/PR/TEMP - 4th Hourly

10) I/O - CHARTING

Consequently , Foley's is removed and ultracet tablet , input of 2 liters only and output monitoring is done .

Case 2 : 

      A 75yr old male patient ,labourer by occupation ,came to casuality with Cheif complaints of 

-Lower backache since 10days

- dribbling of urine since 10days

- Pedal edema since 3days 

- SOB at rest since 3days 

- Increased involuntary movements of both upper limbs since 10days . 

Diagnosis : 

Acute renal failure (intrinsic)

 Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis

Hyperuricemia 2° to Renal failure 

Uraemia induced tremors( resolved)

Delerium 2° to septic /Uremic encephalopathy (resolving)

Treatment : 

IVF -    NS-0.9%  @100ml/hr

• Inj. Tazar 2.25gm I.V -TID 

• Inj. Lasik 40mg I.V -BD 

•Nebulization Salbutamol -4th hourly 

• Inj. Pantop 40mg I.V -OD 

• Tab. PCM 650mg -TID 

• Foleys catheterization 

• Temperature ,Bp, PR Charting  hourly 

• Strict IO Charting

•GRBS -12th hourly 

• Inj.25% D with 10units of insulin IV -slow for 1hr 

 Nebulization is reduced consequently and daily monitoring of vitals is being done . And oral fluids restricted to 2 to 3 liters per day .

 

 

Case 3 : 

A 49 yr old female noticed mass peranum with bleeding , diagnosed as haemorrhoids , got Operated. History of muscle aches , uses NSAIDs .Fever got treated at local hospital 

Since 20 days she has generalized weakness.

- She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.

Diagnosis : 

CKD ? Chronic interstitial nephritis secondary to plasma cell dyscariasis, (multiple myeloma - 70% plasmacytosis).

Treatment : 

- T. PAN 40mg /PO / OD

- oral fluids upto 1.5 - 2 lit / day

- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk  

- Donot give IV fluids unless instructed

- T. ZOFER 4mg / PO / SOS

- Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved )

- TAB NODOSIS 550 BD

No fresh complaints are registered , 

Daily monitoring of vitals and systematic examination is done. 

 

Case 4 : 

A 35 yr old female was admitted to the hospital with Chief complaints of

-Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge).

-Back pain( 5 days ago) with abdominal pain and chest pain.

Diagnosis : 

DKA with AKI ( ? Pre renal) 

- Pyelonephritis. 

Treatment : 

Inj. NORAD 2amp in 50ml NS

Inj. PIPTAZ 2.25gm.

Inj. DOPAMINE 2amp in 50ml

Inj. HAI 1ml in 39ml NS

 Inj. CLEXANE 40gm. 

Iv infusion NS RL @100ml/hr.

Inj. NORADRENALINE(2 amp+46ml NS) 

Inj. LEVOFLOX

Inj. VANCOMYCIN

Inj. MEROPENEM

Inj. FOSFOMYCIN

Inj. LASIX was given. 

 

Case 5 : 

A 52-year-old man presented to the OPD with Cheif Complaints of abdominal distension from the past 7 days.

-2 yrs back he complained of tingling in upperlimbs upto palms lowerlimbs upto knees .

Presented to casualty recently with abdominal distension.

diagnosed with 

Alcoholic Liver Disease,

AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,

Hepatic encephalopathy grade 2

 

 he complains of Constipation and has not passed stools since 5 days.

He also complains of altered Sleep patterns from the past 5 Days 

He had hiccups.

He also Complains of pedal edema grade 2.

Diagnosis : 

INFECTIVE ENDOCARDITIS

WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR

WITH AKI

WITH ?UREMIC ENCEPHALOPATHY ? SEPTIC ENCEPHALOPATHY

WITH ULCER OVER SOLE OF RIGHT LEG

WITH HYPOALBUMINEMIA ? ALCOHOLIC LIVER DISEASE

WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES

 

Treatment : 

1. Inj. Monocef 1gm IV/BD

2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr

3. Procto clysis enema

4. Inj. Pan 40 mg Iv/OD

5. Inj. Thiamine 200mg in 100ml NS /BD

6. Inj. HAI 6U S/C TID

Same treatment followed except Inj. Monocef.

Inj. Augmentin 1.2 gm IV/TID

Tab. Ecospirn 150mg PO/HS/SOS

Tab. Clopidogrel 75mg PO/HS/SOS

Tab. Atorvas 20mg PO/HS/OD added

 

 he had sudden cardiac arrest. CPR was initiated, intubation was done, but couldn't be revived.

 

Case 6 : 

A 52 yr old male with complaints of fever and pus in urine on his 4th admission to the hospital. He had prostatomegaly and underwent TURP before.

 

Diagnosis: 

Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore

 

Treatment : 

Injection PANTOP 40mg IV/OD

Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID

Injection LASIX 40mg IV/BD

Injection optineuron 1AMP in 100ml NS slow IV/OD

Injection NEDMOL 100ml IV/SOS

Tab PCM 650mg TID

Insulin Human actrapid - 16 IU/TID

 

Case 7 : 

 A 48-Year-old male presented to the OPD with chief complaints of Shortness of Breath grade -II from the past 1 week, which converted into grade -III-IV from the past 4 days .

Diagnosis :

HFrEF secondary to CAD; CRF

Treatment: 

1. TAB. BISOPROLOL 5mg OD

2.TAB. NITROHART 20/37.5mg 1/2 T/D

3.TAB NICARDIA XL 30mg OD

4.TAB. GLICIAZIDE 80mg BD

5.TAB. NODOSIS 500 mg TD

6.Cap. BIO-D3 OD

7.Cap. GEMSOLINE OD

8.TAB. ECOSPRIN-AV 150/20mg OD

9.TAB.LASIX 40mg BD

10. SYP. LACTULOSE 15ml

 

Case 8: 

A 60 yr old patient came to the opd with chief complaints of..

- Pedal edema since 3 days.

-Decreased urine output since 3 days.

-H/o vomitings and loose stools 5 days ago lasted 3 days and subsided.

 

Patient was apparently asymptomatic 15 yrs back.. then she developed

Shortness of breath;-

  since 15 years..  

10-15 episodes per year and she was taking medication during the episodes ..

 2 months back....

 pneumonitis with Type 1                   Respiratory Failite,

 ? Interstial lung disease, 

? Right heart failure .

Treatment

1. Tab. Augmentin 625 mg ×7 days

2. Tab. Wysolone 40 mg ×10 days.

    30 mg × 10 days 

    20 mg ×10 days

    10 mg ×10 days.

3. Tab . Lasix 20 mg × 1 month.

4. Pantop 

5. Montek FX -- 1 month.

6.Oxygen inhalation.

 

Present complaints are: 

Pedal edema

since 3 days, which is pitting type.. which gradually progressed to anasarca.

 

Decreased urine output..

since 3 days..

There is no h/o burning micturition.

 

Vomitings

since 5 days , food as content and 2 episodes per day.

 

Loose motions

5 days ago 5 episodes lasted for 1 day.

 

There is no complaints of fever, cold and cough.

 

Treatment : 

1. IV fluids

2. Tab. Pan 40 mg po OD 

3. Inj. Lasix 80 mg IV BD

4. Thiamin 200 mg in 100 ml NS IV BD

5.Tab. Levocet 5 mg Po BD

6.Liquid paraffin for LIA

7.Grbs 6 th hrly

8.I/o charting, temp. Charting

 

Case 9 : 

A 43 yr old male ,resident of nalgonda came to casuality with chief complaints of

-loose stools since 20 days 

-Pedal edema since 20 days

-Abdominal distension since 20 days 

 

 

Diagnosis : 

ALCOHOLIC HEPATITIS ,

AKI SECONDARY TO ACUTE GASTROENTERITIS  

HFrEF SECONDARY TO CAD 

ALCOHOLIC AND TOBACCO DEPENDENCE SYNDROME 

 

Treatment : 

INJ THIAMINE 100 mg in 100 ml NS slow IV / TID

INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD

INJ LASIX 40 mg

TAB. ALDACTONE 50 mg PO / BD

INJ PANTOP 40 mg IV/ OD

ABDOMINAL GIRTH MEASUREMENT DAILY

BP /PR/TEMP/ RR -4 hourly 

I/O CHARTHING

 

 

Case 10 : 

A 60yr old female presented to the OPD with chief complaints of

- pedal edema since 10 days

- decreased urine output since 10 days 

-fever since 10 days.

 

Diagnosis: 

Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)

With anenmia of chronic disease 

 

Treatment: 

 Inj LASIX 40 mg IV/TID 1 -1 - 1

 IVF - NS @ UO + 50 ml/hr

 Inj MAGNEXFORTE 1.5 gm/IV/BD

 Tab NODOSIS - 500 mg PO/OD

 Tab OROFEA - XT PO/OD

 Inj HAI s/c

 Neb plain Asthalin 2 respules QID

 Strict I/O charting

 Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]

GRBS charting is introduced and daily monitoring of vitals is done .

 

Case 11 : 

31 yr male farmer by ocupation,resident of Miryalguda Came with chief complaints of

- pain in abdomen since a week

-Vomiting since a week

-Sob since 2 days.

Diagnosis : 

Acute pancreatitis with AKI 

with B/L pleural effusion and moderate ascitis.

Currently in Alcohol withdrawal.

Treatment : 

Iv fluids : NS 40 ml /hr.

IV lasix 40 mg BD .

Tab Nodosis .

IV PIPTAZ 4.5 Gms. BD 

Iv 25%Dextrose. 100 ml BD 

Tab . Nicardia 10 mg TID.

D A Y W I S E U P D A T E S: 

Day 1and 2 =Urine output 1500ml   Fluid intake 3000ml

 

QUESTION-5

 The General medicine department has done a quite a good work in making us understand the subject. For every clinical case they have guided us how to study and analize the case. I have learned how to capture the patient centred data for diagnosing the diseas. I have got a chance to see the many types of investigations done in order to diagnose a disease. I am grateful for this opportunity to involve in these study.