5 A vignesh

 

GENERAL MEDICINE

 ASSIGNMENT

MONTHLY ONLINE ASSIGNMENT

Question 1:-

LONG CASE

This is a case of Acute Glomerulopathy (Glomerulonephritis / Nephrotic syndrome)

REVIEW

●I appreciate the diagnostic approach given in the blog, it paid attention to all the possibilities, ruled out one by one and arrived to a final diagnosis.

●The localization of acute problem and chronic problem were also explained which I found very helpful

●The examination details are explained very well

●Evolution of symtomatology was described in detail manner. 

●There was also a detailed explanation of the patient's acute and chronic problem. 

There are 5 pedagogic questions were explained in the case which was given pinpoint explaination related to the case

SHORT CASE 2:-

This is a case of

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

REVIEW

●Problem representation was also well described.

●The case was beautifully presented in detail ,which is almost knit with his details,like step to step detailed explanation. 

●Evolution of symptomatology was described in detail manner. 

●CNS examination was described extremely well with all detailed documentation of reflexes etc. 

●Clinical images of the patient and investigations were added with deidentification. 

SHORT CASE 2

This is a case of latrogenic Cushings syndrome secondary to tropical clobetasol application all over the body for approx 1 yr. 

REVIEW :

●Evolution of current symptomatology was described beautifully. 

●deidentified clinical images in the presentation, showed us the condition of the patient clearly. 

●His follow up details were also neatly documented. 

QUESTION 2:-

CASE 1:  First case: A case of acute glomerulonephritis, due to sec. Amyloidosis due to chronic poorly treated seronegative erosive rheumatoid arthritis. 

PROBLEM LIST : 

● Generalized edema 

( facial puffiness, pedal edema) 

●bilateral symmetric, Pitting type pedal edema. 

●breathlessness, palpitations or chest pain. 

●Frothing of urine, decreased urine output. 

●Severe joint pains. 

●Burning sensation in his eyes with increased tearing. 

● Involuntary weight loss &loss of appetite. 

●subcutaneous swelling in proximal joints of his fingers.

●protinuria causing anasarca. 

DIAGNOSIS : 

●Acute glomerulopathy (Glomerulonephritis / nephritis 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 20mg OD 

●Tab FEBUXOSTAT P/O 80 mg OD

●Haemodialysis for worsening renal dysfunction. 

CASE 2- Second case: idiopathic Parkinson's disease stage 1with denovo HTN &multiple system atrophy - parkinsonian type ( MSA-P) 

PROBLEM LIST :

●Progressive asymmetrical involuntary movement of his right index and middle fingers. 

●stiffness in wrist &elbows 

●Walking difficult with small, short steps with forward sloop &also taking stair up .

●No morning erections & also loss of sexual desire. 

●Speaking in monotonous deab.

●High BP -190/110 mm Hg 

●Tone of right wrist - Hypertonia ( cog wheel rigidity). 

●ECG - Sinus tachycardia. 

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. 

CASE -3 Third case : latrogenic Cushings syndrome secondary to tropical clobestasol application all over the body for approx 1 yr. 

PROBLEM LIST:

● 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.

●Pedal edema since 3 months.

●Low back ache since 3 months .

●Feeling low , not feeling to talk to anyone.

●Weight gain and decreased libido since 3months.

●Loss of libido and erectile dysfunction since 2 months .

 ●Multiple hyperpigmented plaques over lower limbs and abdomen .

●Easy fatigue, weakness and lower backache.

●Moon face present, thick skin 

●poor healing over leg ulcers 

●Acne present over face 

● Acanthosis nigrans noted over neck .

●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 : 

●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:-

Testing competency in "Evidence based medicine": Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 

LONG CASE  :-

INVESTIGATIONS 

 

●X-rays can help detect bone damage (erosions) that occurs as a result of long-standing rheumatoid arthritis. They can also detect a narrowing of the joints space, which occurs when cartilage degrades and the bones.

●ESR

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sedimentation rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body

●TREATMENT

Tab. PREDNISOLONE  Low doses of prednisone are safe and effective in the management of RA. Yet, some clinicians continue to manage their RA patients with glucocorticoid doses that are too high or avoid them altogether. Glucocorticoids in low doses have proven to be very effective in suppressing the inflammation associated with RA.

●Tab FEBUXOSTAT

Febuxostat (Uloric) is a medication that lowers the levels of uric acid in the body. It is used for the chronic management of gout. It blocks the active site on xanthine oxidase, preventing the conversion of hypoxanthine and xanthine to uric acid.

SHORT CASE-1

●INVESTIGATIONS 

●Micrographia, or small handwriting, is a common sign of Parkinson's disease. Over 65 percent of patients exhibit micrographia. Patients often notice the difference in their handwriting themselves and a neurologist can confirm the diagnosis by the size of the handwriting in a writing test.

●TREATMENT

●Syndopa Plus Tablet is a combination of two medicines: Levodopa and Carbidopa. This medication is used to treat the symptoms of Parkinson's disease like tremors (shaking), stiffness and slowness of movement. 

SHORT CASE-2

INVESTIGATIONS 

●The 24-hour urinary cortisol test measures the amount of cortisol being produced within the urine over the course of an entire day. Levels higher than 50-100 micrograms per day in an adult suggest the presence of Cushing's syndrome.

QUESTION 4:-

https://05akulavignesh.blogspot.com/2021/07/5-vignesh_12.html

QUESTION 5:-

This platform of doing e-logs and reviewing assignments has been very useful in learning and knowing many case studies. It helped to understand patients pain and need. Solving each case was very interesting this way.