general medicine online summative assignment (August)
Name : T.Gowthami
Roll no: 132
BELOW IS THE LINK TO THE QUESTIONS ASKED TO US :
Question 1
Critical appraisal of the captured data and peer review
REVIEW OF LONG CASE
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
Chronic intermittent use of analgesics . Has been using Etoricoxib 60 mg and Febuxostat 80 mg intermittently for the past 8 months. No relevant surgical history. No history of allergy or atopy.
Evolution of symptomatology is well described in the illness.Proper past ,personal ,family ,surgical, medical and immunization histories are provided. Differential diagnosis for the conditions he's been in are given . Classification criteria for rheumatoid arthritis is provided which gives us idea in which category patient is in based on points.The possible scenarios that can be are described in brief. Diagnostic approach is mentioned.After final diagnosis , further plan of treatment is given clearly.
Provisional Diagnosis - Acute Glomerulopathy (Glomerulonephritis / Nephrotic syndrome)
REVIEW OF SHORT CASE 1
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
Present illness is described very well with each and every detail explained properly.All the histories and examinations done are mentioned.Problem presentation with treatment are provided.Source for resting tremor is also given at the last.
REVIEW OF SHORT CASE 2
19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year,Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year,Abdominal distension and facial puffiness since 6 months.
Present illness with evolution of symptomology is perfectly described,Other histories with examinations done are given,Pictures provided clearly indicate it as a case of cushings syndrome, They also explained ruling out endogenous cushings syndrome and giving a final diagnosis of iatrogenic.
Question 2
Problem list for each patient and the diagnostic and therapeutic uncertainty around solving those problems as follows:-
LONG CASE:
Problem list:-
✓Facial puffiness with pedal edema
✓Generalized edema
✓Bilaterally symmetric, pitting type pedal edema
✓Breathlessness, palpitations or chest pain
✓ severe joint pains
✓Decreasing urine output
✓ Frothing of urine
✓Weight loss and loss of appetite
✓Subcutaneous swellings in proximal joints of his fingers
✓Proteinuria causing anasarca
DIAGNOSIS:-
✓Acute Glomerulopathy (Glomerulonephritis/Nephrotic syndrome)
✓Bilaterally Symmetric Chronic ✓Progressive Inflammatory Peripheral Polyarthritis
✓Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.
✓Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis
✓Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis
✓Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis
TREATMENT:-
✓ Free water restriction for Hyponatremia
✓ Tab. PREDNISOLONE P/O 20 mg OD
✓Tab FEBUXOSTAT P/O 80 mg OD
✓Haemodialysis for worsening renal dysfunction.
SHORT CASE (1)
Problem list:
✓Stiffness in his wrist (right >left), now ascended to his elbows
✓Progressive asymmetric involuntary movements of his right index and middle fingers.
✓Overshooting his hand while picking objects
✓Since 2 months his bowel habits have been incredibly erratic, in that he sometimes immediate urge to defecate and sometimes goes 2-3 days with constipation
✓Hasn't been having morning erections since 2 months and loss of sexual desire
Diagnosis:-
✓Idiopathic parkinson's disease stage - 1 with denovo HTN
✓Multiple system atrophy - parkinsonian type (MSA - P)
Treatment:
✓Tab. Syndopa Plus 125 mg QID
✓Tab. Syndopa 125 mg CR OD
✓Tab. Telma 40 mg OD
SHORT CASE (2)
Problem list :
✓Purple stretch marks all over abdomen,lower back ,upper limbs ,thighs since 1 year.
✓Abdominal distension and facial puffiness since 6 months.
✓Pedal edema since 3 months.
✓Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .
✓Loss of libido and erectile dysfunction since 2 months .
✓Multiple hyperpigmented plaques over lower limbs and abdomen
✓Easy fatigue, weakness and lower backache
✓GYNECOMASTIA PRESENT
✓Buffalo hump present
✓Sparse scalp hair
✓Difficulty in getting up from chair
Diagnosis:-
✓IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
✓TINEA CORPORIS
✓DENOVO HTN
Treatment plan:-
✓Ointment AMLORFINE
✓FUSIDIC ACID CREAM.
✓SALINE COMPRESS OVER LEISONS
✓Tab.Telma 20 mg od - due to low cortisol level
✓TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.
✓0.4 ML OF ACTOM PROLONGATUM ✓INJECTION (ACTH) INTRA MUSCULAR @ 7am
✓Tab Shelcal 500 OD and Tab Vit D 3 Od.
✓Tab ULTRACET /PO/SOS.
✓Tab Itraconazole 100 mg bd. And lulifin cream and tab levocitrixine 5mg od.
QUESTION 3
Review of literature around sensitivity and specificity of the diagnostic interventions mentioned and efficacy of the therapeutic interventions mentioned for each patient.
Comments
Post a Comment