Monthly summative assessment july
I have been given the following questions to answer in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment, to assess the quality of treatment given and to suggest improvisations.
Question 1: Competency tested for Peer to peer review and assessment :
Please go through one student's entire answer paper from this link, the one who is closest to your own roll number :
The link i chose:
https://prasannakalyan52.blogspot.com/2021/07/general-medicine-e-log-june-2020.html
1) The first question was their review of other 10 blogspots.
Over all she has summarised all the cases well and their etiology.
She has metioned all the investigations done and also added the advise to be given to the patient before discharge. Her review to all the blogs is complete.
The negative points:
She has not advised the AKI patient with DM correctly during discharge. Instead of advising to take more fluids, she has advised against it. She must study the stages of kidney recovery where the urine production increases in later stages.
2) Her log is adequately presented
3) She has reviewed and recognised the answer of her senior amply. She covered all the facts given.
4) She has recognised the uncertainty of final diagnosis or the relationship between DKA and acute viral hepatitis
Q2) Share the link to your own case report of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case.
https://rollno52.blogspot.com/2021/04/hydrnephrosis-with-uncontrolled-blood.html
Q3) (Testing peer review competency of the examinees) :
Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.
Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):
Please analyze the above linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also 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.
Patients with low back ache and renal failure :
AKI :
https://laharikantoju.
Overview: the case is about a 58 year old male with SOB grade 4 , burning micturition and pain abdomen with fever since 1 week. The person was also obese with a history of HTN for which he is using medication. Based on the reports given it is indicating a infection in the urinary tract although the CUE report doesn't show any indicators of it on the day of presentation.
Appraisal: day to day follow up of reports was done well.
Negative points: The trends of fever are not mentioned. It is obvious that the patient has acquired the UTI in the hospital as the CUE report on presention was normal. The pain in abdomen was not followed properly.
My analysis: The case is a heart failure with Hospital acquired UTI. The diagnosis at the presentation was not adequate.
Acute on CKD :
Overview: This is a case of Acute renal failure (intrinsic) grade1 L4-L5 Spondylodiscitis Multifocal infectious, Spondylodiscitis, Hyperuricemia 2° to Renal failure Uraemia induced tremors( resolved) ,Delerium 2° to septic /Uremic encephalopathy (resolving)
Appraisal: It is adequately presented, the pain was described well and the treatment given was documented well.
Negative points: I could not find anything wrong.
My analysis: it is a case of 75 year old who has got Acute kidney injury on a long case history of CKD. The instigating factor in this case was probably overwork or dehydration.
CKD :
Past E log similar to last case :
Overview: It is a case of 49 old female with complaints of hemorrhoids which resulted in iron deficient anaemia. On blood tests for renal function it was found she had high creatinine level which suggested chronic renal failure.
Appraisal: The follow up of anemia was done well, with the pictures of the dysmorphoc hypochromic cells under microscopy. The treatment for anemia was also followed well. Her menstrual and obstertic history was also taken to rule out any other differential causes for anemia.
Negative points: Failed to reach a cause for CKD. Could not differentiate the cause of CKD from either the incresed blood loss or due to decresed kidney function.
My analysis: Considering the fact that her micturition is regular with no complaints, with the fact that the albumin level in the urine sample was nil, i feel CKD is not the correct diagnosis but the raised serum creatinine has some other reason.
Patient with coma and renal failure :
Overview
Appraisal: The case was documented and followed well with all her complaints being added day to day.
Negative points: The differential causes for diarrhoea and the pain aggravating on fever was not addressed properly. The patient was not recognised as having serious condition whaen presented in the opd. The treatment given was only symptomatic and not rehabilitative.
My analysis: The case has a lot of potholes in the history and the nature of the symptoms present. Considering the fact that the patient uncontrolled blood sugars even after taking fhe prescribed drugs can be seen as the chief aggravating factor for her multi organ failure.
Patients with acute on CKD :
Overview: It is a case of fever with pus in the urine to a 45 year old for 4 days, which on examination showed hydronephrosis secondary to prostate hypertrophy. On futher management the patient deteriorated with generalised weakness and chronic kidney disease.
Appraisal: Well presented
Negative points: His diuretic phase of renal recovery from AKI was not maintained well leading to hyponatremia.
My analysis: The patient could have managed well with sterile procedures for Foley's catheter and management of diuretic phase of AKI recovery. The patient should have been managed well to prevent him slipping to CKD.
Patients with AKI :
Overview
Appraisal: Well documented.
Negative points
My analysis
Q 5) Testing scholarship competency in
logging reflective observations on your concrete experiences of this last month : (10 marks)
This last month i have followed most of the cases with CKD and AKI with input output charting for each case.
I have learned blood pressure monitoring and implementation of dialysis machine in CKD patients.
I have also assisted and done a few procedure such as putting a central line to the IJV and to the femoral vein, doing a pleurel tap and an ascitic tap.
During my posting in the ICU i have monitored all the patients and tried to come up with best management to return the patient to their normal active state.
T
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