General medicine Summative assessment - June 2021

Name -Prasannakalyan
Roll no - 52


Question - 1
Case 1 
Pulmonology:
This is a case of chronic obstructive pulmonary disorder associated with RV failure and bronchitis.she has been experiencing these symptoms for the past 20 years. And is a known case of hy tension & diabetes melitus type II for the past 8 years. She's under medical management for dm & HTN with zorgl & telma 40 respectively. An examination of all systems was done to diagnose rv failure.medication provided are statins, diuretics and steroids. The cause for rv failure seems to be copd which increased load on ventricle causing the failure. The handling of case was adequate but the patient should have come in sooner to avoid complications. Patient must be advised to avoid heavy work and visiting polluted areas as it can aggravate the situation



Case 2 
Neurology: 
Case: 
This is a case of wernicke's encephalopathy secondary to chronic alcohol dependence. The patient was apparently symptomatic 9 days ago, there was sudden onset and he lost his ability to get up off his bed and more around - he was taken to good rmp and was referred to higher Center. He has memory loss since a days and is unable to recognise faces. He is experiencing seizures since 1 year and has had a episodes latest being 4 months ago. Patents experiences tremors and sweating if he does not consume alcohol before sleeping. Patient is concious& coherent but is unable to person thought& reasoning. Treatment of thiamine& pregabalin & lorazepam injection was given. While treatment cab be given the basis of the disease is the alcoholism for which councilling must be given which was not suggested by the attending doctor. Other than this the case was presented well and a clear course of treatment was charted



Case 3 
Nephrology and urology : 
Case:
This is a case of secondary kidney failure due to unmanaged DM. Patient complained of puss in urine& High grade fever for the past 1 week. Patient diagnosed with dm 5 gears ago in regular checkup. Since I gear reduced dripping urine was seen. 3 month ago due to prostomegaly burning mituration was seen. Patient underwent TURP 2 months ago. The patient had investigations done and renal AKI and urosepsis were diagnosed. This is said to be associated with dm & diabetic nephropathy. As treatment diacritics were given & medical management of dm was advised. Along with this i/o was tracked and X-rays of pelvic region was suggested. Hum. Insulin was administered for the d.m. The case was handled efficiently and the root cause was identified. The patient needs to avoid high fluid intake and has to manage his Diabetes better. Regular Hba1C has to be taken to see the prognosis of the disease.



Case 4
Gastroenterology:
The provisional diagnosis given after endoscopy was done and X-ray was taken was ART due to tracheoesophageal fistula or esophageal carditis. She has experienced sudden bouts of tachycardia along with hypoxia for which she was given enoxaparin. Her history at the time of admission was Low grade fever and cough for 2 months and difficulty in swallowing. At the time of admission she did not have tb but developed it over the course of her admission at the hospital. She is a known case of rvd and her husband died of RVD. She has had 2 children and has no habits of smoking or alcohol. HIV rtpcr returned positive and she was started on antivirals for HIV infection. Treatments were histamines given for her hypoxia and enoxaparin for her embolism. Covid19 antibodies were not found in blood but spo2 was at 89 due to sob. The case was handled well but the delay in treatment by the patient caused the worsening of the symptoms.



Case 5 
Infectious diseases and hepatology:
This is a case of liver abscess. The patient was asymptomatic upon which he developed pain in the upper quadrant of the right side along with nausea/vomiting and loose stools. He has no history of dm, his, tb, epilepsy or CVD. The smoking gun for the diagnosis was the patient history of chronic alcoholism for 30 years along with 10 ‘beedis' every day. All vitals were normal but on general examination the patient has Palor suggesting liver involvement. Abdomen is soft and tender but ul quadrant shows less movement during respiration. The treatment given is majorly oral fluids, antibiotics and painkillers. The patient was suggested to undergo pigtail catheterisation but as abbess could not be drained he was placed on medical management and discharged with weekly followup. After 3 weeks of medical management patient felt a lot better and finally the absess was drained and culture was sent to the lab. The culture was determined to be inconclusive. The patient care was excellent and the patient recovered completely.



Case 6
Neurology 
Case :

This is a case of cortical rein thrombosis with hemorogic venous infarction in right posterior temporal lobe. The patient, 17 year old with chief complaint being involuntary movement of upper limbs and lower limbs for the past one day. Has had 5-6 similar incidents in past day. She has GTCS episodes at the frequency of one every 20 mins. Iron deficiency was also seen in hematological investigations. In the hospital lorazepam was given but the seizures continued with decreasing frequency till day 9. Fundoscopy revealed papillaoedema in rt. Eye. Midazolom was given and 3 days of no seizures she was veined off midazdom and finally discharged. The treatment was very good and patient was able to return to normal living soon.



Case 7 
Pulmonology :
 Case :
Review : 

This is a case of covid-19. During the pandemic the patient tested positive for Covid and was admitted. Further investigations revealed impaired CBP and impaired respiratory exam. Steroids were given along with supplemental o2 and antipyretic. Vitamins were also prescribed. The patient was discharged upon feeling better. As medical intervention was done before worsening of symptoms patient recovered well but if timely treatment was not given the situation of the patient could hove been a lot worse. 



Case 8 
Cardiology: 
Case :
Review: 
This is case of atrial fibrillation and bilateral thrombosis. Patient presented with sob and decreased urine output since one day. Sob went from grade 2 to 4 and decreased urine since 4 days. Upon ccf at presentation and cardiorenal syndrome 4 with denovo dm2. Patient was in the hospital for 8 days and bp was sustained by Inj. Dobutamine. Irregular ECG was treated with digoxin & heparin. Day 5 rise in serum creatinine & urea and nephrologist referred. Day 8 upon fall of creatinine & urea patient was discharged and a dose of statins and diuretics. The patient was treated well and was discharged upon request by the patient.



Case 9 
Cardiology :
Review :
https://akash688.blogspot.com/2021/05/online-blended-bimonthly-assessmentmay.html 

This is a case of acute coronary syndrome in patient with dm and past history of tb. She presented with sob and sweating. The patient was advised for PCI. The patient was discharged but PCI was never done. The reason given was vaccines were not available due to the pandemic. There was a lot of negligence in this case and even though the patient is fine she has to be regularly monitored to make sure she does not relapse. PCI means per cutaneous coronary investigation also known as coronary angiogram is used to find any defects in the heart or the vessels of the heart.



Case 10 
Neurology

                              Case :
Review:
This is a case of cervical my elopathy. The patient was admitted with complaints of weakness in limbs for the past day with sudden onset after a session of heavy alcohol binge. Patient has ht for 5 years but no dm, epilepsy or Tb.radiological instigations shows c3 to c6 compression of the spine. The patient was referred to a neurosurgeon for emergency surgery. Treatment was given for alcoholism and withdrawal symptoms. Due to C3 to C6 compression quadrapaligia was seen and if not treated as an emergency can lead to several more problems like apnea in the future. The patient was managed well and patient was normal after surgery. 



Question 2




Question 3 & 4


Question 3 
Acute viral hepatitis associated with DKA is the above given case. The primary sign for the diagnosis was the presence of ictiris and the sudden loss of appetite. Patient had history of polyuria,nocturia,polydypsia since 2 months. 10 days ago, patient attended a function outside and after 2 days he developed low backache and 2 episodes of vomitings and 3 episodes of loose stools for one day which subsided on its own. This caused the patient to appear at the opd where subsequent investigations were done.  Burning mituration was also seen. Assessment showed internal paranchimal bleed and a palatable bladder. Patient tested positve for covid antibodies on the 5th day of admittion.  On day 16 patient tested negetive to covid and had manageble LFT and was discharged. Patient was advice on egg White diet twice a day and asked to come back for review after one week



Question 4 
The ultimate cause for acute viral hepatitis remains idiopathic. The cause was suspected to be viral due to the food from the function but the symptoms were existing before and were only aggravated post food intake. Therefore we can postulate that the cause of the hepatitis while being idiopathic was aggravated by the food poisoning. The liver function tests and the urine samples helped in the diagnosis to be narrowed down to the liver and  the covid diagnosis worsened the case causing the prolonged prognosis of this patient. The causes for the distended bladder remain unknown. 



Question 5

The ongoing pandamic has seen a apradime shift with our first postings for general medicine being made possible via an online portal. This has given us a unique perspective into what the future of medicine might hold for doctors as the growing population might entail the use of such technologies for the doctor to be able to treat as many patients as efficiently as possible. I would like to thank Dr Rakesh Biswas our General Medicine HOD for taking both the time and effort to ensure that we as students are well equipped with practical knowledge that will help us to become better doctors in the future. The cases over the past one month were both varied and helped us apply the knowledge we learnt our first 2 semisters.  I'd also like to thank my seniors, the current inter batch and the general medicine Post graduate students who were with us all along the way to hell transition us from a pre clinical to a clinical setting. This form of interactive learning and treating patients is here to stay and its our responsibility as future doctors to adapt to the new environment and make sure we are well prepared for all future challenges that we will face 























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