24 July 2021

 QUESTION 1

Case link:- https://mahendrakancharla444.blogspot.com/

 I went through kancherla  Mahendra's  assignment ,and briefly reviewed all her answers. 

>Q1. He have mentioned 6 different branches . He had presented the insights for each case in very comphrensive and accurately. I have gone through each case  review  which were very reasoning to the given case. There were no photographs related to  the case. It would be easy to understandable with the pictures 

>Q2. He has not been assigned a case 

<Q3&Q4 .He has taken a Renal case of 45yrold male with acute kidney damage on chronic kidney disease with the uraemic encephalopathy. he had made a detail and neat appraisal.he mentioned the present illness  and past history of the patient clearly. Also the provisonal diagnosis is presented.

<Q5. He has shared his personal feeling about the current scenario of the online classes. Truly speaking that it is new and quiet difficult task for us. this makes us to habituate to the online classes for the coming years .It is even new to the faculty and the students but still trying to make this successful and worthy.

QUESTION 2

I have still didn't get a opportunity to do a E log. It will updated here once its completed.

QUESTION 3

Case 1 link :- https://laharikantoju.blogspot.com/

Case Scenario

A 58 year old male patient came to casualty with lower abdomen pain, burning micturation, low back ache, dribbling urine and fever and diagnosed as AKI(acute kidney injury) 2 to UTI associated with DM-2 

Insights -

The case scenario, complaints with detailed reasons, histories of present and past illness is also mentioned clearly. All clinical investigations with photographs are presented. Every detail about  the case is presented in sequential order. The case was regularly updated.

Case 2 link :- https://srinaini25.blogspot.com/

Case Scenario

A 75 year old male patient, labourer by occupation chief complaints of lower backache, dribbiling of urine, pedal edema and increase in involuntary movements of upper limbs.

Insights-

In the case the illness of the patient is presented with corresponding duration. Systemic examination is clearly mentioned which was impressive. In the case the investigations are depicted properly. Each  and every report was regularly updated.

Case 3 link:- https://krupalatha54.blogspot.com/ 

 Case Scenario 

A 49 year old female came to OPD with cheif complaints of vomtings and anasarca since 3 days and stools with yellow discolouration. The past history of her presents the haemorrhoids which is operated.The provisonal diagnosis is CKD 2 to plasma cell dyscariasis.

Insights-

The case is briefed nicely. Treatment, past illness history is very well depicted. All the clinical investigations were presented with the pictures. Also the menstrual and obstretic history was mentioned and  presenting histological investigation was intresting and impressive. The case was updated time to time.

Case 4 link:- https://ananyapulikandala106.blogspot.com/

Case Scenario 

A 35 year old female patient was admitted to the hospital. The cheif complaints were fever and diarrhea, back pain and pain in abdomen and chest. history of the patient was a diabetic over 3 years and there was a infection in the little finger and the infected area was removed. diagnosed as DKA with AKI 

Insights-

The case scenario was presented in a detail manner. treatment and history of past and present illness was concise. Each and every clinical investigations was mentioned clearly day to day. 

Case 5 link:- https://pallavi191.blogspot.com/

Case Scenario 

A 52 year old man presented to the OPD with chief complaints of abdominal distension from the past 7 days. tingling in upper limbs and lower limbs. he was presented to casualty with abdominal distension. provisonal diagnosis as alcoholic liver disease, AKI secondary to UTI on CKD , hepatic encephalopathy grade 2.

Insights-

The case was presented in detail and clear. History of present and past illness and treatment was precise and accurate. all the examinations was attached with pictures and were up to date.

Case 6 link:- https://kavyasamudrala.blogspot.com/

Case Scenario 

A 52 year old male patient presented to hospital with the cheif complaints of fever and pus in the urine. A year back he gradually developed drippling of urine. Diagnosed as renal AKI secondary to urosepsis .

Insights-

The history of present and past illness was clearly mentioned by describing each point. presentation of the blog was good. A detailed summary of treatment and discharge if mentioned would be more better.

Case 7 link:- https://rishikakolotimedlog.blogspot.com/

Case Scenario

48 year old male with chief complaints of shortness of breath grade-2 which converted into grade 3-4 provisional diagnosis - HFrEF secondary to CAD, CRF 

Insights-

The history of presenting illness and past illness was accurately and concisely mentioned. reports were also updated on regular basis. all the events in the case was in chronological order.

Case 8 link:- https:-//keerthireddy42.blogspot.com/

Case Scenario 

A 43 year old male, resident came to casualty with chief complaints of loose stools, pedal edema, and abdominal distension.

Insights-

The whole case scenario is precise and shortly presented. The elog was adequate and compact. The history of illness was described precisely. The general examinations images were also attached. 

Case 9 link:- https://casescape.blogspot.com/

Case Scenario

A 60 year old female presented to the OPD with chief compalints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

Insights-

The history of presenting illness was accurately written with onsets and reports were also updated on a regular basis. And also the day to day treatment was updated. Overall everything was presented in a chronological order.

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 output 

-fever

Diagnosis : 

Acute kidney injury( AKI) 2° to UTI

- 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 : 

)IVF : -RL @ UO+ 30ml/hr

            -NS

2)SALT RESTRICTION < 2.4gm/day

3)INJ TAZAR 4.5gm IV/TID

                               |

                             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

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"

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 as

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 and 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 cc 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.

QUESTION 5:

 We were excited as well as quite nervous that we are going to experience the hospital atmosphere for the 1st time, But because of the pandemic our academics and clinical postings were affected. Although the online classes were quite turbulent in the starting because of our Professors, slowly everything started falling into place.to have a good understanding in case taking and making elog of patients data, it is necessary to have a practice of history taking, which is very complicated for us in the pandemic. And even the clinics are going on perfectly because of the efforts of our Professors in helping us understand the cases thoroughly. And finally, I would like to convey my special thanks to the department of general medicine for encouraging us day by day to improve our knowledge. this type of learning would be definitely make it more effective offline postings.