77 VAISHNAVI MANGA

BIMONTHLY BLENDED ASSESSMENT-August 2021

                    I am Vaishnavi Manga. I have been given this assignment in an attempt to understand the topic of Scholarship of integration in medical education and research to develop my competency and comprehending clinical data including history , clinical findings, investigations and diagnosis
We have been given an assignment to analyze and review three long and short cases.
QUESTION-1
https://2018-21batchpgy3gmpracticals.blogs
pot.com/2021/08/18100006003-case-presentations.html?m=1
   
Long Case:-

The long case is presented based on acute glomerulonephritis.A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.The present illness of the patient was precisely described till date and the symptoms, the difficulties of the patient ,his daily activities and problems faced by him was explained clearly with appropriate reasons. His personal history is taken in detail. The patient presented with anasarca and frothing urine which decreases the urine output in renal pathology. This is aimed as localisation of the acute problem of patient.The chronic disease of the patient is Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral Polyarthritis.The clinical examination is done in all the aspects.The systemic examination is done briefly, which can be noticed that there is puffiness of the face and bilateral pedal edema.The positives for appendicular skeleton was mentioned concisely taking the patient condition into consideration. Other investigations related to kidney dysfunction are posted and the treatment and the function of particular drug are given in a proper manner that made it comprehensive. Overall the presentation was good. 

Short Case-1 :-

The patient is suffering with Parkinson disease. He was not able to use his thumb and right index finger. The clinical examination with sensory system and motor system are done appropriately. The general examination does not show any abnormalities. His higher mental functions related to language, reading and writing are impaired.There is a cog wheel type of rigidity at the wrist which shows the Parkinsonism.The cardiac examinations are done. Overall the presentation is good but it would be more clear if they mentioned things in detail for reaching the diagnosis. 

Short Case-2 :-

A 19year old male with Cushing syndrome. Symptoms for Cushing syndrome include distended abdomen and dark stria over the abdomen and gynaecomastia. This patient presented with all of them which lead to the provisional diagnosis. The hormone level was taken into consideration. All the investigations with appropriate photographs requires was mentioned accordingly before one year and when the patient is presented in op.The dermatologist opinion is taken and treatment is given accordingly and the condition was taken till date.

QUESTION-2:

LONG CASE:-

A 44 year old stonemason from Miriyalguda, presented with a 3 day history of anasarca
frothy urine and gradually decreasing urine output, on a background of a 10 year history of chronic bilaterally symmetric polyarthritis (evidenced by severe pain, edema and limitation of joint movements).

Final diagnosis:

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. 

Differential diagnosis:
Rheumatoid arthritis
Treatment:1.Free water restriction for Hyponatremia
2.Tab. PREDNISOLONE P/O 20 mg OD
3.Tab FEBUXOSTAT P/O 80 mg OD
4.Haemodialysis for worsening renal dysfunction
Short case-1
Problem list:
A 49 year old patient presented with:
1.a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers
2.Can't able to move those fingers
3.The wrist is stiffened.
4.Walking became difficult with short steps
5.Difficulty in staring up with loss of sexual desire 6.Irregular bowel habits are seen
7.Not speaking properly since two months
Treatment:
1. Tab. Syndopa Plus 125 mg QID
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD

Short case-2

Problem list:

A 19 year old male came with complaints of:
1.Itchy Ring lesions over arms ,abdomen ,thigh and groin since 1 and half year. 
2.Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year.
3.Abdominal distension and facial puffiness since 6 months.
4.Pedal edema since 3 months.
5.Low back ache since 3 months .
6.Feeling low, not feeling to talk to anyone.
7.Weight gain and decreased libido since 3months.
8.Loss of libido and erectile dysfunction since 2 months. 
Treatment:
tab telma 20 mg od .
INJECTING 0.4 ML OF ACTOM PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR.
TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.
  
QUESTION-3:

Long case:

To reach the diagnosis of acute glomerulonephritis:
Hypertension (secondary hypertension in Glomerulonephritis)
Haematuria on urine microscopy (particularly dysmorphic RBCs in urine)
Quantification of proteinuria
Serum albumin / Total proteins
Urine specific gravity / calculated urine osmolality to check for isosthenuria (to look for secondary tubular/interstitial damage) 
 Renal biopsy, if diagnosis remains uncertain
 To reach the diagnosis of inflammatory polyarthritis:
Features of inflammation such as severe pain associated with edema of the joints and limitation of range of active movements
 Early morning stiffness, lasting for more than 30 mins (for 1 hour in this patient)
Pain and edema of joints improving with activity and worsening with rest
Features of uncontrolled systemic inflammation such as fever, involuntary loss of weight associated with loss of appetite.
Swellings at joints and deformation of normal joint posture .
1.Febuxostat decreases the amount of uric acid in the body.
2.tab prednisolone 20mg is used to treat arthritis


Short case-1:

Nervous system examination is done to the patient because of language, reading and writing problem which showed an impairment.The wrist shows  cogwheel type of rigidity which is a feature of parkinsons.the examinations of brain are done in order to check whether cerebrum , cerebellum are involved in this.there are no intentional tremors and absence of knee jerk.the coordination tests are done which are normal.the Rhombergs sign is negative.micrographia a test to elicit the bradykinesia component of Parkinson is positive.
1.syndopa plus is a combination of two medicines Levodopa and carbidopa used to treat the symptoms of Parkinson disease such as tremors, stiffness and slowness of movements
2.tablet telma is used to treat high blood pressure and heart failure

Short case-2:

General examination is a must for Cushing's patient.
Pedal edema present - pitting type extending upto knee.
Abdominal distension present.
Moon face present
Pink striae noted over anterior abdominal wall and on low back and on upper arms and thighs.
Thin skin present . 
Poor healing noticed over leg ulcers and easy bruising noted .
Acne present over face .
Acanthosis nigrans noted over neck.
GYNECOMASTIA PRESENT .
Buffalo hump present .
Sparse scalp hair .
All these symptoms lead to the diagnosis of Cushing's syndrome.
  1.amlorfine is an antifungal medication.
2.tab hisone is used for allergies, anaphylaxis, asthma, rheumatoid arthritis

QUESTION-4:

I have not prepared an e-log yet. Will post it soon after it's done.

QUESTION-5:

This assignment is all about the things we learnt in our 1st MBBS theory. All the cases focused commonly on glomerulonephritis, Parkinson's, Cushing's syndrome. The presentations with proper diagnosis, investigations, treatment, appropriate images made it more clear and comprehensive for us to understand our theoretical knowledge precisely. This assignments came handy for us to know about the diseases even without in person postings. These blogs are really helpful for us in gaining knowledge about the patient's conditions.