NAME : SRINIJA KARNEKANTI
ROLL NO : 63
BATCH : 2019 ( 3rd SEMESTER )
AUGUST 2021 —BIMONTHLY BLENDED
ASSESSMENT
★ QUESTION NO : 1
Competency tested for Peer to peer review and assessment :
* The link consists of three cases { one long case and two short cases }
Long case is about — Polyarthritis leading to Acute Glomerulonephritis
- The history of the case is well taken , all the detail mentioned in a chronological order
- Analysis of the symptoms and signs is appreciable
- Investigations are well dispalyed
Short cases are about - Idiopathic Parkinson's Disease Stage 1 with denovo HTN and the other is about - Iatrogenic Cushings Syndrome
- Both the cases presented well
- Mainly the second case prognosis is well displayed with the help of photographs
★QUESTION NO : 2
Testing scholorship competency of the examinees ; ability to read comprehend , analyze , reflect upon and discuss captured patient centered date . Analyze the above linked long and short cases patient data by first preparing a problem list for each patient in order of perceived priority and then discuss the diagnostic and therapeutic uncertainity around solving those problems
* LONG CASE :
- In this case patient presented to OPD with facial puffiness and pedal oedema
- prior to this patient had history of severe joint joint pains , the joint pains made his daily activities difficult
- The joint pains were initially Asymmetric and gradually became bilaterally symmetrical and involving the small joints of his hands and wrist . The joint pains were associated with significant local edema , and painful limitation of movements
- Debilitating early morning pains and limitation of movements usually last for an hour , He reported that pains and limitation of movements improved with the activity , with gradual reduction in edema of joints
- Joint symptoms gradually progressed in severity , now also involving several large joints
- Recently has burning sensation in his eyes with increased tearing but no visual defects
- He also reported that the is frothy and there is decreasing in urine output
Frothy urine and decrease in urine output suggests problem in RENAL SYSTEM , Anasarca likely due to GLOMERULAR PATHOLOGY , other systemic causes can be ruled out as there is no history of Dyspnea , palpitations , and also there are no signs of yellowish discolourization of skin ruling out LIVER DYSFYNCTION
* SHORT CASE - 1 :
- In this case the patient presented to the OPD with two month history of progressive Asymmetric involuntary movements of his RIGHT INDEX and MIDDLE fingers
- Patient reported that these movements often worsened with REST and ABATED with activity
- He describes these movements as INVOLUNTARY , RHYTHMIC TO and FRO OSCILLATIONS
- Presence of stiffness throughout the range of motion
- NO History of difficulty in reading the news paper , holding the paper , turning pages or folding it back
- Same involuntary movements also appearing in his left hand
- Difficulty in taking stairs up , GAIT - reduced arm swing , presence of COG WHEEL RIGIDITY at the wrist joint , decreased clarity in speech and also plains of having ugly handwriting recently
The diagnosis stated as Idiopathic Parkinson's Disease Stage 1 with denovo HTN Multiple system Atrophy - Parkinsonian Type [ MSA - P ]
* SHORT CASE - 2 :
- The patient presented to the OPD with : Itchy Ring lesions over arms , abdomen , thigh , and groin
- presence of purple stretch marks all over abdomen , lower back , upper limbs , thighs
- presence abdominal distension and facial puffiness
- pedal edema , low back ache , feeling low , notfeeling to talk to anyone , weight gain and decreased libido
- Skin is thin , poor healing noticed over leg ulcers and easy bruidsing noticed , Acne over face , Acanthosis nigrans noted over neck
- GYNECOMASTIA PRESENT , Buffalo Hump present , sparse scalp hair
The presence of purple straie gives an idea of Cushings Syndrome ; there is a dilemma whether it is endogenous or exogenous as the patient shows slow response to the treatment
★QUESTION NO : 3
Testing competency in "Evidence based medicine": Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned.
★ LONG CASE
Acute Glomerulonephritis , likely due to secondary Amyloidosis due to chronic poorly Treated Seronegative Erosive Rheumatoid Arthritis
Dilutional Hyponatremia Secondary to Anasarca due to Glomerulonephritis
Hyperuricemia likely due to decreased uric acid excretion precipitating Gouty Arthritis
Anemia of chronic Disease secondary to poorly Treated Rheumatoid Arthritis
* Glomerulonephritis is inflammation of tiny filters in kidney ; may be Acute or chronic
* Signs and Symptoms include :
Foamy urine due to excess protein (proteinuria)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
These symptoms and signs are observed in the above case indicating Glomerulonephritis
* Rheumatoid arthritis is a chronic inflammatory affecting joints
- It affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
— Signs and symptoms of rheumatoid arthritis may include:
-Swollen joints
-Joint stiffness that is usually worse in the mornings and after inactivity
—Earlya Rheumatoid Arthritis tends
to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.
— As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders.
★ SHORT CASE : 1
1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.
2. Multiple System Atrophy - Parkinsonian Type (MSA-P).
— Parkinson's disease is a progressive nervous system disorder that affects movement.
— Symptoms start gradually
— In the early stages of Parkinson's disease, your face may show little or no expression
— Parkinson's signs and symptoms may include:
- Speech changes
- Tremor : A tremor, or shaking, usually begins in a limb, often your hand or fingers.
- Writing changes : writing may appear small.
- Impaired posture and balance
— Parkinson's disease symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine.
★ SHORT CASE : 2
IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.
TINEA CORPORIS
DENOVO HTN .
— Cushing syndrome results when body has too much of the hormone cortisol over time.
— The signs and symptoms of Cushing syndrome can vary depending on the levels of excess cortisol.
*Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
*Acne
*Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)
*high blood pressure
—Cushing's syndrome can develop from taking oral corticosteroid medications, in high doses over time.
{ EXOGENOUS CHUSHING'S SYNDROME}
— The other condition can be due to body producing either too much cortisol or too much adrenocorticotropic hormone (ACTH), which regulates cortisol production.
{ ENDOGENOUS CUSHING'S SYNDROME }
* In this cases, Cushing syndrome may be related to:
- A pituitary gland tumor
- A primary adrenal gland disease.
★QUESTION NO : 4
Share the link to your own case report this month 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.
I did not get any chance to prepare elog this month.
★ QUESTION NO : 5
Testing scholarship competency in logging reflective observations on your concentrate experiences of this last month
Eventhough I could not get a chance to prepare my own log , I had gone through some logs done by my friends and had great number of points to note and apply. And also the long and short cases of the assessment were interesting .
Thank you.
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