Monthly summative assessment

 

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 : 


After going through one particular answer of ten students in this link
Here are my qualitative insights into what was good or bad about the answer. 

3)What could be the cause of her acute exacerbation

May be due to  INFECTION( infection  causes inflammation in lungs leading to narrowing of airways , blockage may occurs due to swelling and mucus production.

In my opinion I feel that it might be an allergic reaction than an infection as the symptoms are present at the same time of the year , every year. And the acute exacerbation could have been due allergic reaction, hypersensitivity reaction due to weather conditions in January.


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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. 

Ans)https://rollno52.blogspot.com/2021/07/40-year-old-with-pain-abdomen-and.html



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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.
         And
Q4)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. 

MULTISYSTEM:


Overview:
Appraisal:
Negative points:
My analysis:

CNS :



Overview: it is a case of tuberculosis infection spreading from lungs to spine secondarily affecting the nerve roots.
The history and etiology of the infection were taken adequately. .

Appraisal:The fact that the patients relative was also infected with TB solidifies the diagnosis.
The open minded approach to the cause of the paralysis is commendable.

Negative points: The abscess in the spine was not felt during general examination. It could have replaced CT scanning. 
The history for cold abscess was not taken completely.

My analysis: The fact that the spine will be secondarily affected in TB infection is duly observed. Other methods to come to the diagnosis like-
  The micturition and defecation reflex were affected localised the problem to the sacral segments.

Renal :


Captured by one student from 2017 batch in the link below :

Overview: the case was taken correctly including all systems . The treatment was given to infection, hypertension and chronic proteinuria causing kidney failure.
Appraisal: regular monitoring of the creatinine were done .
 The kidneys were prevented from irreversible failure.
Dialysis to remove the toxins causing encephalopathy was done.
The tratment for infection was done.
Negative points: the addictions of the patient was not known. It could give important pointers to the diagnosis of the case and its root cause.
Why was the patient not compliant to take medicine when he had already signs of kidney failure and hypertention- must need a psychiatric advice
The liver failure was not explained which had lead to cirrhosis.
The liver function tests to detect any problem in the liver were not done.

My analysis:
I think that the case history and tests were missing the LFT reports . The ascites were caused due to proteinuria secondary to chronic kidney failure due to uncontrolled hypertension. 



CVS :


Overview: the case is presented adequately. The necessary tests were done without overtesting the patients economic conditions to come to the diagnosis.
Appraisal: the diagnosis and tests were adequate. The problem in the heart was localised with 2D echo. The wall abnormality and the chamber affected were seen. 
Negative points: the cause for abdominal distention was not mentioned
 the cause for atrial fibrillation in a hypothyroidism patient was not solved.
My analysis: the symptoms as of such point to a problem in the pumping function of heart, which lead to SOB and distention. (As the venous return was not adequately pumped forward) . 
The diagnosis must also should have taken the age of the patient into consideration as she is of 70yrs of age were any interventions are not successful and the problem lies in the degeneration of tissue due to old age.


Captured by one student from 2019 batch in the link below :

Abdominal : 


Overview: the case is presented adequately, the right tests were done. The patient's data was collected since the past 5 years which was enough to get to the correct diagnosis.
Positive points: 
Negative points :
    examination-were the kidneys palpated correctly? If yes           why was there no tenderness when it was diagnosed as         urosepsis. 
    Diagnosis: there are no pus cells or markers of inflammation in the due report.
  The fact that the patient was a diabetic was not taken into consideration in suggesting the acute kidney injury secondary to infection.

Questions: can a person in sepsis have a bp of 170/90 as shown in this case.
      Can the patient in urosepsis which could have been secondary to infection (DM as a factor for it) have no signs of infection in the cue report?

My analysis :
   I come to the diagnosis of urinary tract infection with diabetes mellitus as a cause leading to acute kidney injury.
As shes having high pulse rate and generalised lymphadenopathy it could be due to generalised infection with the primary focus from the kidneys.

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Q5)Testing scholarship competency in  
logging reflective observations on your concrete experiences of this last month : (10 marks) 

Reflective logging  of one's own experiences is a vital tool toward competency development in medical education and research. 
Here are the pictures of the log notes I've done during the postings for better understanding the patient symptoms and to reach a correct diagnosis.






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