93 N. Lavanya

Greetings to every one This is lavanya 

3 rd semister student

This is my E log 

Question 1 

Peer review assessment on not only the the student's written case report but also the reading of the cases followed by the question answer session linked above in the video and share your thoughts around each answer by the student along with your qualitative insights into what was good or bad about the answer. 

https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

10/10  long case 

Excellent presentation about rheumatoid arthritis. 

Very detailed presentation about the examinations . 

Detailed presentation about pedigogiic question 

The vitals examination with well described positions is very fascinating 

Well mentioned about refernces 

9/10 short case 1 

Very detailed presentation about CNS examination 

The important points were highlighted in a good way 

Neat presentation .

9/10 short case 2 

Very well presented about cheif complaints 

Good treatment history is given 

The images where very clear and follow up was good 

Question 2

Please analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problem 

https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

Long case 

Problems list and discussion  

Facial puffiness with pedal edemaextending upto the middle of his leg 

Breathlessness, palpitations or chest pain.

 He reported frothing of urine but no haematuria

pain during micturition, no pus or any other abnormal discharge (casts) in urine.

The patient reported that since 2011, he had severe joint pains

Debilitating early morning pains and limitation of movements in his hands, wrists and feet. 

These joint symptoms gradually progressed in severity, now also involving several large joints. 

Past 3 days, he has burning sensation in his eyes with increased tearing but no visual deficits. 

10 year history of chronic bilaterally symmetric polyarthritis

Proteinuria causing anasarca likely due to glomerular pathology. Other systemic causes like heart failure and liver dysfunction can be ruled out due to absence of dyspnea, palpitations, bendopnea or syncope. Liver dysfunction can be ruled out by lack of jaundice, melaena or hematemesis. 

Glomerulonephrits / Nephrotic syndrome 

Features to look for - 

1. Hypertension (secondary hypertension in Glomerulonephritis)
2. Haematuria on Urine Microscopy (particularly dysmorphic RBCs in urine)
3. Quantification of Proteinuria
4. Serum Albumin / Total Proteins
5. Urine specific gravity

Investigations.   

Chest X-ray PA view - Full inspiratory, underexposed film with no malrotation or angulation. Bones - Clavicle, Head of Humerus, Coracoid process and acromion of scapula appear normal.

 The ribs are normal.

 No mediastinal lymph nodes or enlargement. The right heart border shows mildly dilated right atrium. The left heart border shows a prominent aortic knuckle, the pulmonary bay area is normal. 

P waves, QRS complexes and T waves have normal morphology and duration; P-P and R-R intervals are normal. PR and QTc intervals are normal.

Urine microscopy 

Dysmorphic RBCs were those that had altered shape, microcytic or with membrane defects.

Short case 1 

Problems list and Discussion 

Month history of progressive asymmetric involuntary movements of his right index and middle fingers.

He says that these movements often worsened with rest and abated with activity

He has been unable to correct answer sheets because of the involvement of his thumb and maintaining stability of his hand was proving difficult. 

He describes these movements as involuntary, rhythmic to and fro oscillations.

He denies having stiffness in his lower limbs, denies cotton wool sensation of floor, denies burning pain or inability to feel hot or cold stimuli.

 He also denies buckling of knees but, however, he reports that he has been having a great difficulty to walk in the dark since 2 months and says that he feels like he would definitely fall without support. 

Short case 2 

Problems list and discussion 

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 hyper pigmented plaques  over lower limbs ,abdomen , for which he again visited same place and used ayurvedic oils over the leisons.

He also used clobetasol ointment over the leisons.

Question 3 and 4 

https://93nlavanya.blogspot.com/2021/08/93-n.html?m=1

Question 5

It's has been around 3 months we are into this program which is quiet very use full to us  

It's giving us an idea how to dealt with the patient, the exact process which we as doctors sholid follow to come to an exact diagnosis 

We are definetly looking forward for our clinical posting hoping it will be quiet use full 

This sought of online experience is also interesting helping us to gain a lot of knowledge 

 I took up a case of a woman having cvs issues 

It helped me to know the ethiology behind it the investigation to be used and especially the approach towards tha patient 

And also thought we are second semisters with a little bit knowledge, initially was very difficult but know it's good 

Reflection on a personal case experience 

 Recently we are showm a case , of an 12 yr old boy came to the hospital  in mild conscious state and he was unable to walk properly 

    His history revealed that   he was unable to run normally like other children in the school 

              Patient is mal nourished, he was lean 

    And was unconscious  , and he  had an accident in the past for which his both the upper limbs were surgically removed 

                    I myself found this case very interesting and thought to share .