June Assignment GM

         35 Rishitha (3rd sem)

MONTHLY ONLINE ASSIGNMENT


I have been given the following assignment in an attempt to read, comprehend, analyze, reflect upon and discuss captured patient centered data.


This is the link of the questions asked regarding the cases:




Question 1

1. PULMONOLOGY CASE



>Evolution of symptomatolgy was explained in flow chart. 
>Proper explanation of acute exacerbation is given.


2. NEUROLOGY CASE -2A




>This case is well presented. The use or flow charts made it easier to get in the information. 
>The pharmacological action, the administration of thiamine is well explained..


3. NEUROLOGY CASE- 2B



>The pharmacological and non pharmacological intervention is well explained.
> But the data was too lengthy. Must have use flow charts. 


4. CARDIOLOGY CASE- 2A


 
>Direct and straight answers made it easy to understand.


5. GASTROENTEROLOGY CASE



>The information provided is at par. 
>But the segregation and presentation must have been a more presentable, would have made it more easy to grasp. 



6. CARDIOLOGY CASE -2B



>Use of pictures and flow charts and detailed information was appreciative. 


7. NEPHROLOGY CASE (UROLOGY)



>Quantitative assessment can be rated 8/10. 


8. INFECTIOUS DISEASES (MUCORMYCOSIS, OPHTHAMALOGY, ENT, NEUROLOGY)

Case details: http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html


>Must have tried using pictures.
> Theory part is explained well. 


9. GASTROENTEROLOGY CASE



>answering has been done in a point wise manner, with nice detailing & information.
>reference links to answer information are appreciated


10. NEUROLOGY CASE -2C



>presentation is very neat & easy to follow.
>point wise answering is clear & precise 
>more diagrams would have made it more comprehensive.








Question 2 

Share the link to your own case report of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. 






Question 3

I have chosen the following case to provide my critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties 


1. Hypertensive Nephropathy has been used to describe the clinical syndrome characterised by long-term essential hypertension. HN is the leading cause of ESRD in Africans in the second leading cause of ESRD worldwide

  -Two physiological mechanisms have been proposed for the development of hypertensive nephropathy:
i) Glomerular ischaemia- chronic hypertension results in narrowing of pre-glomerulus arteries and arterioles with the consequent reduction in glomerular Blood flow
ii) Glomerular hypertension and glomerular hyper filtration

   -Initial hypertension —> glomerular endothelial damage and sclerosis,
subsequently in an attempt to compensate for the loss of renal function the remaining nephrons undergo vasodilation of the preglomerular arterioles and —>increase in renal bloodflow and glomerular filtration. 
  -The result is glomerular hypertension, glomerular hyperfiltration and progressive glomerulus sclerosis 

Most of the patients with hypertension, the condition present for many years as in this case it was present for the past five years because of the periods of accelerated or poorly controlled BP. Hence the patient also witnessed mental status changes which are also the symptoms of Uremia. This caused Uremic Encephalopathy 




2. Uremic Encephalopathy- It’s an organic brain disorder which occurs due to the buildup of toxins which are normally cleared by kidneys.

 -It develops in patients with renal failure usually when creatinine clearance levels fall and remain below 15 mL/min. 

 -Uremia is final stage of progressive renal insufficiency and result in multiorgan failure. 

 -Results from accumulating metabolites of proteins in amino acids and concomitant failure of renal catabolic, metabolic and endocrinologic processes. 

 -Uremic encephalopathy  is one of many manifestations of Renal failure

 - Accumulation of diamethylarginine leads to Vasoconstruction inducing hypertension




Question 4)

 DIAGNOSTIC AND THERAPEUTIC INTERVENTION

Diagnostic steps:


1. ECG - report must be taken to check any left ventricular hypertrophy 

2. CBC - Detect leucocytosis which may suggest an infectious cause and determine whether anemia is present

3. Urine analysis- MicroAlbuminuria

4. Ultrasound- To check the kidney size whether it’s symmetric or normal or moderately reduced.

5. Order a toxicology screen. 



Prognosis:

-Benign Nephrosclerosis:This condition will rarely result in renal failure. As some 

renal damage has occurred, patients may be considered to have diminished renal 

reserve. 

-Malignant nephrosclerosis:This condition will only occur in the context of severe hypertension with diastolic blood pressure in excess of 130mm Hg. Patients will usually have a pre-existing renal disease which has progressed to induce malignant hypertension. At the onset of escalating blood pressure, protein and blood may appear in the urine.

-Haemodialysis Is recommended for patients Who progress to ESKD.






Question 5)

Testing scholarship competency in  logging reflective observations on your concrete experiences of this last month : 

Since lockdown got us at our homes, i had to spend my majority of first year and now second year too at my home. Being stuck here and not able to have hospital visits really discomforts me. 

Being there no patient interaction, i have no such observations or experiences as of now, but am looking forward to these eagerly.

All i can say now is about how covid has affected all of us and that’s the only thing i got to observe and experience lately.
On celebrating as to how we tackled first wave of COVID, the second wave was way too devastating. The economic and social disruption caused by the pandemic is disturbing. 

Presently the impacts of COVID-19 in daily life are extensive and have far reaching consequences. Healthcare category got to face a lot consequences too.

    • • Challenges in the diagnosis, quarantine and treatment of suspected or confirmed cases
    • • High burden of the functioning of the existing medical system
    • • Patients with other disease and health problems are getting neglected
    • • Overload on doctors and other healthcare professionals, who are at a very high risk
    • • Overloading of medical shops
    • • Requirement for high protection
    • • Disruption of medical supply chain. 


















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