BIMONTHLY INTERNAL ASSESSMENT

 BIMONTHLY INTERNAL ASSESSMENT - NOVEMBER

November 17, 2020

 CASE : 1

1) "55 year old male patient came with the complaints of Chest pain since 3 days Abdominal distension since 3 days Abdominal pain since 3 days and decreased urine output since 3days and not passed stools since 3days.

https://sreejaboga.blogspot.com/2020/11/is-online-e-log-book-to-discuss-our.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

Pain abdomen:

 1.pancreatitis secondary to ? chronic alcoholism

2.perforated peptic ulcer

3.Inferior wall MI ( epigastric pain)

Oliguria:

Acute kidney injury

Acute tubular necrosis 

SOB ( lungs or heart):

 AKI leading to fluid overload and heart failure.

Pancreatitis leading to pleural effusion / ?ARDS

Sequents of events:

1.congenital bow leg deformity

Alcohol & smoking since 30 years

Abdominal pain & distention , SOB , chest pain , decreased urine output since 3 days

OUTCOMES:

Urine output increased , pedal edema and SOB decreased on day 2

Altered sensorium on Day-3

Dialysis done on day 4

Bilious vomiting on day-5

Dialysis done on day-6

Abdominal pain & vomitings subsided on Day-8

) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Pharma cological:

1.FLUID REPLACEMENT 

2.TRAMADOL 

3.ZOFER 

4.PANTOP 

5.LASIX : For fluid overload

6.NEBULIZATION : For wheezing

Non pharmacological:

1.NBM

2.OXYGENATION

Case 2

2. A 55 year old male, shepherd by occupation, presented to the OPD with the chief complaints of fever (on and off), loss of appetite, headache, body pains, generalized weakness since 2 months, cough since 2 weeks and vomitings and pain abdomen since 2 days. 

https://aakansharaj.blogspot.com/2020/11/55-year-old-male-with-anemia.html?m=1

a) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

ANATOMICAL LOCATIONS WITH ETIOLOGY:

1.Bone marrow and bones

Etiology: Multiple myeloma

2kIDNEYS

Etiology: AKI due to multiple myeloma

3.LUNGS 

Etiology: Tuberculosis 

TIMELINE OF EVENTS:

Alcohol & smoking (35 years) 

Stopped alcohol (4 years)

Fever , generalised weakness & anemia - 2 units blood transfusion (1.5 years)

Stopped smoking (4 months)

Low grade fever , generalized weakness , headache , neck pain , loss of appetite , weight loss (2 months) 

Cough & SOB (2 weeks) 

Vomiting & pain abdomen (2 days)

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Pharmacological:

1.ANTIBIOTICS : For underlying infection 

2.ATT : For TB

3.SEVELAMER : For hyperphosphatemia

4.FEBUXOSTAT : For hyperuricemia

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CASE : 3

3) 51 Year old man with complaints of B/L pitting pedal edema from 5 to 6months,abdominal distension from 2 to 3 days,SOB from 3days.

nithishaavula.blogspot.com/2020/11/51-yr-old-male-with-hfref.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

ANATOMICAL LOCATIONS WITH ETIOLOGY:

HEART (HFrEF - pedal edema , abdominal distention and SOB) :

Etiology: Microvascular dysfunction DM and HTN

Yo

SEQUENCE OF EVENTS:

Tobacco chewing (40 years)

Alcohol (10 years)

DM (7 years) 

HTN (5 years) 

1st Episode GTCS (3 years) & AF with HFpEF

2nd Episode GTCS (2 years)

HFrEF & Anasarca (1 year) - (subsided with medication)

Increased pedal edema , abdominal distention , SOB and decreased urine output (3 days)

Outcome:

Symptomatically releived and discharged

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

Pharmacological:

1.LASIX 

2.METAPROLOL : For Hypertension

3.ENALAPRIL 

4.PHENYTOIN : For seizures

5.H.ACTRAPID INSULIN : For DM

6.PREGABALIN : For neuropathy

Non pharmacological:

Salt restriction

Fluid restriction

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CASE : 4

4) 31 yr old man with B/L pedal edema with scrotal and penile swelling since 2 months

https://nairaditya97.blogspot.com/2020/11/31-yr-old-male-with-bl-pedal-edema-with.html?m=1

A) Where are the different anatomical locations of the patient's problems and what are the different etiologic possibilities for them? Please chart out the sequence of events timeline between the manifestations of each of these problems and current outcomes. 

ANATOMICAL LOCATIONS WITH ETIOLOGY:

HEART FAILURE (pedal edema , penile & scrotal swelling and SOB) :

Etiology: Alcohol causing wet beriberi

SENSORY POLYNEUROPATHY:

Etiology: Alcohol

Events:

Alcohol & khaini (3 years) 

Pins and needles (1 year) 

Palpitations (8 months) 

PND (3 months) 

Pedal edema and SOB (2 months)

Current outcome:

Completly relieved of his symptoms as the wet beriberi resolved.

B) What are the pharmacological and non pharmacological interventions used in the management of this patient and what are the efficacy of each one of them? 

PHARMACOLOGIC :

1.LASIX 

2.THIAMINE 

3.TELMISARTAN : For afterload reduction 

Non pharmacological:

1.$alt restriction

2. Fluid restriction