Thogaru gowthamiRoll no:132
General medicine assignment (3rd sem)
I have been given the following cases to solve in an attempt to understand the topic of 'patients clinical data analysis' to develop my competency in reading and data including history, investigations and diagnosis.
QUESTION 1
A 40 year old male with complaints of irrelevant talking.
1) NEUROLOGY
What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
Ans:The evolution of the symptomatology is well described in this case.The patient was asymptomatic 9 days ago.The changes are he started talking to himself, laughing to himself and these were sudden in onset.And he had short term memory loss since 9 days .The primary etiology is due to alcohol intake . In this case the etiology and symptoms of the patient were set out.
2) NEUROLOGY
What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
Ans:The drugs supplemented for patient are Thiamine, Lorazepam,Pregablin,potchlor liquid.Non pharmacological are lactulose .Each and every function of the drugs are well set out.Mainly the function of drugs and their action towards receptors are briefly explained.
A 52 year old male with cerebellar Ataxia
3)1A
What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
Ans:The history of the patient was well explained- 7 days ago he gave a history of giddiness,4 days ago he consumed alcohol and developed giddiness that was sudden onset . Associated vomiting 2-3 episodes per day .There is a presence of an infarct cerebellar hemisphere of the brain.This is usually a result of damage to the cerebellum.In this case ,the patient has hypertension.The data which i have seen in this link was very well.Etiology is described in understanding way.
4)2A
What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
Ans:The drugs which were taken are Vertin 8 mg - betahistine which is an anti vergo medication, Zofer 4 mg it is an anti emetic,Ecospirin 75 mg this is aspirin ,Atorvostatin 40 mg ,Clopidogrel 75 mg ,MVT . Thiamine to prevent wernicke encephalopathy.For the following patient the drugs which were given are correct.The patients history of alcoholism make him more susceptible to ischaemic type of stroke.
5)3A
Did the patients history of denovo HTN contribute to his current condition.
Ans: Hypertension can be major risk factor for causing cerebellar infarct,The following answer express that the history of denovo hypertension contribute to his current condition.
QUESTION 2
http://132gowthami.blogspot.com/2021/07/gm-case.html
QUESTION 3 AND 4
I choose the below case which is distension of abdomen.
70 year old female presented to casuality with complaints of Distension of abdomen and shortness of breath Grade-3 since 5days
History of present illness:The patient was apparently asymptomatic 5 days ago then presented with Abdominal distension since 5 days Onset - gradual and progressiveDistension is generalizedSOB - Grade 3 ; since 5days incidious in onset gradual in progeressionsNo History of palpitations ,pedal edema,oliguria,fever,cough,fatigue.
History of past illness ;Hypothyroidism since 5 yearsNo history of hypertension,diabetes asthma tuberculosis.
Treatment history:she was on Thyronorm100mg OD for hypothyroidism .
Family history ; insignificant
Personal history ;
Appetite ; normal
Diet ; mixed
Bowel and bladder ; regular
Sleep; adequate
Addictions ; no
General examination ;Patient is conscious coherent cooperative well oriented to time place person.she is well built,moderately nourished,and examined under informed consent.
Diagnosis:HFrEF with Atrial fibrillation 2 to ?IHDT
Treatment plan;
✓ Inj. Amiodarone 150 mgIV stat (2 doses)
✓Inj.Amiodarone infusion
1mg/min till 6hr f/b 0.5 mg/min for next 18 hours
✓ Inj.clexane 40mg Sc OD.
Herbiochemical report showing severe hyperthyroidism possibly relating to her refractory Atrial fibrillation And attempted for Defebrillation.
The patient was asymptomatic intially and suffered with hypothyroidism and the treatment plan is so accurate but unfortunately she had passed away.
QUESTION 5
This has been wonderful opportunity to attend this online clinical postings.The general medicine department has put in their maximum efforts in making us learn and understand how to capture patients centered data and many basic things about subject and also history taking.Young people are particularly vulnerable to the disruptions the pandemic has caused,and many are now at risk of being left behind in education and also health.
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