General Medicine Bimonthly blended assessment August

 Note : The following answers are solely my own interpretations and opinions on the recorded cases from my own observations. Please feel free to comment below, all constructive criticism and feedback is welcome. 

QUESTION 1: Reviewing peer cases

1) Long case

  • The presentation of history and the symptoms and the line of treatment was done good. 
  • Orderly fashion of presenting the diseases and the related scientific studies have also been well written
  • Pedagogic questions provide more insight into the issue
1. Glomerulonephritis
This is the acute problem. Symptom wise treatment is given in the patient, for example in this disease, the relation to heart failure and liver dysfunction are ruled out first, is presented well.

2. Polyarthritis

This is the chronic problem, and inflammation is a characteristic with features like fever, weight loss and bilateral pain for a long time. 

This case is also presented with 4 possible scenarios with their likely probabilities, making us to think about it too. Reactive systemic amyloidosis (previously called secondary amyloidosis) is most probable, so abdominal fat biopsy has to be done and observe after staining with Congo red and check for Apple green birefringence, under polarizing microscope.

2) Short case - 1

Patient diagnosed with Idiopathic parkinsonism with stage 1 denovo HTN, history is taken very well including personal history and all the clinical examination findings are documented well.

Syndopa is a combination of Levodopa and Carbidopa as the former causes nausea which is prevented by the latter drug. Also carbidopa is additive to levodopa.

Telma's used for the denovo HTN.

3) Short case - 2

Patient with iatrogenic Cushing's syndrome (probably due to overuse of cortisol medication) , Tinea corporis (ringworm) and denovo HTN.

History taken well and case represented well

  • Like in earlier case, Telma used for treating the denovo HTN
  • ACTH stimulation test to reduce cortisol production from the adrenals is done.
  • Hizone is for the ringworm, inflammation and itching
  • Excess cortisol is also known to block calcium absorption on bone and stunts bone cell growth. So Shelcal and Bit.D3 supplements are given.

QUESTION 5 : Reflective observations on this month's clinical experience 

I haven't had the chance to interact with any patients yet in the clinics, but I'm hoping for it soon to happen. The COVID-19 pandemic had a truly rough impact in every aspect of our lives. Not just emotionally and mentally for some, but also economically, health wise and education wise too. The work load has also increased a lot for our health care workers and I wish for everyone to stay strong in such times and show true professionalism and responsibility as medical officials and citizens of this country to the society. We must not only concentrate on serving our patients but also ourselves at times, as it's also important to have good overall health to be able to perform well in our everyday lives. Thanks to respected HOD sir, all the PGs and interns we are still able to know about what cases are being admitted in the hospital wards and how they are being handled even in such situations. I would truly find it better if we could start visiting the wards again.



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