Bimonthly assessment- Gen Medicine

Bimonthly Assessment






Name : Anusri Ankam
Roll no: 10

This is an online e-log platform to review about the cases done by our seniors

This is the link regarding the assessment 

https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

Question 1 :

Long case

 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).

He has been diagnosed to have Acute Glomerulonephritis

Localisation of Acute and chronic problem with different provisional diagnosis is done well leading to specify the condition and make the progression of treatment easy.

Features leading to diagnose Acute Glomerulonephritis has been mentioned well like

1.Hypertension(secondary in Glomerulonephritis)

2. Serum albumin/total proteins etc..

Question and answers were quite helpful to know the difference b/w abdominal fat pad biopsy and renal biopsy and came to know about the usefulness of combined therapy of methotrexate used in Glomerulonephritis. 

Short case:

A middle aged man presenting with a 6 months history of gradually progressive, asymmetric rest tremor with autonomic features is provisionally diagnosed with 


1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.
2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

     Systemic and motor examination leading to provisional diagnosis of parkinsons disease is done well in the form of tables.

Iam personally interested to approach patient with this disorder since I was having a well explained lecture during my physiology class in 1st mbbs

  Cogwheel type of rigidity in the wrist and reduced arm swing Gait leading to the diagnosis of parkinsons disease is well explained .

Question 2:

ACUTE GLOMERULONEPHRITIS (long case)

Problems:
1. Anasarca(generalized swelling in the whole body)
2. Oliguria (decreased urine output)
3. Decreased serum albumin leading to decreased oncotic pressure resulting in generalized anasarca
4. Features of hypertension 
The above mentioned features leads us to diagnosis of Acute Glomerulonephritis.
 
Treatment:
1.Free water restriction for hyponatremia
2. Haemodialysis performed to cure oliguria and to prevent the worsening of kidney function. 

PARKINSONS DISEASE (Short case)

Problems:
Involuntary movements - Resting tremors of Right upper limb , 3-4Hz, high amplitude.
Postural hypotension _autonomic feature
Hypersonia of the right wrist Cogwheel rigidity

Treatment:

1. Tab. Syndopa Plus 125 mg QID
2. Tab. Syndopa 125 mg CR OD
3. Tab. Telma 40 mg OD

Question 3
Long case:

The presence of frothy urine and edema strongly supports a glomerular pathology due to significant loss of protein and also decreased urine output. Lead to diagnosis of Acute Glomerulonephritis. 

Short case:
Involuntary movements - Resting tremors of Right upper limb , 3-4Hz, high amplitude.

Gait - Reduced arm swing.
Lead to diagnosis of parkinsons disease


Question  4: 


Question 5:
This  pandemic had a major impact on education being unable to attend offline postings eblogs has been of great help. It's been 6 weeks of GM postings .During first day of my posting I was unable to understand the complications of particular disease and its treatment, but day by day I am getting better at grasping the concepts.The case sheets being given to us makes us more enthusiastic and helps us in furthering our knowledge. 

Sharing knowledge with our peers and interacting with them regarding cases has been of a lot help.

Assigning intern to a batch of five students is a lot helpful for knowing the basics of history taking and correcting our mistakes. 

 I would like to thank GM department for creating such a platform to progress our clinical knowledge

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