GENERAL MEDICINE - BIMONTHLY BLENDED ASSESSMENT (JULY 2021)
NAME : M.LAXMI SOWMYA
ROLL NO : 71
3RD SEMESTER
QUESTION 1 :
I had gone through my friends assessment where they mentioned about the different cases and provisional diagnosis,laboratory investigations and treatment. Some of them also added pictures related to the disease and mechanism how it occur clearly. They really worked hard and depicted about many cases. They even admired the whole members of general medicine for helping them which is appreciable.
QUESTION 2 :
I have not done any elog of the patient .
QUESTION 3,4 :
PATIENTS WITH LOW BACKACHE AND RENAL FAILURE :
AKI
http://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
she has mentioned clearly about history of present and past illness. She has presented case details with laboratory investigations, provisional diagnosis and treatment.
A 58 year old male patient chief complaints are :
- lower abdominal pain: 1 week
-burning micturation:1week
- low back ache after lifting weights
-dribbling / decrease of urine out put:1week
-fever :1 week
- SOB , rest :1week
INVESTIGATIONS :
Hemogram , CUE , RFT , LFT , ECG , 2D Echo , Chest X-ray , FBS , PLBS ,HbA1C
SEROLOGICAL INVESTIGATIONS:
pH : 7.46
PCo2 : 36.6
PO2 : 81.8
HCO3 : 26.0
St.HCO3 : 26.8
SPO2 : 94.3
USG Abd : B/L Grade -1 RPD
Rigth:10×6cm
left:9.6×5cm
-mild hepatomegaly with Grade-1 fatty liver
Hb-13.6
TLC-13,100
N-91
L-04
E-02
M-03
B-00
PLT(platelet count)-1.26
Clinical Urine Examination:
Pus cells-4 to 6
Epithelial cells-3 to 4
Alb: Trace
Urine: plenty of pus cells
HbA1C : 6.8
RBS : 120mg/dl
Serum creatinine: 5.9 mg/ dl
Blood urea: 128 mg/ dl
Sodium : 133 mEq/L
potassium : 3.6 mEq/L
chloride : 53 mEq/L
Liver Function Test:
TB -1.63
DB -0.48
AST -26
ALT -30
Alkaline Phosphate-245
TP:5.5
Alb-2.9
A/G-1.17
BACTERIAL CULTURE AND SENSITIVITY REPORT:
Nature of specimen: Urine
plenty of pus cells (>10/HPF) seen
culture report: Polymicrobial flora
PROVISIONAL DIAGNOSIS :
ACUTE KIDNEY INJURY SECONDARY TO UTI ASSOCIATED WITH DENOVO-DM-2
TREATMENT :
IVF : -RL @ UO+ 30ml/hr- NS
SALT RESTRICTION < 2.4gm/day
INJ TAZAR 4.5gm IV/TID
INJ PANTOP 40mg IV/OD
INJ THIAMINE 1AMP IN 100ml NS IV/TID
INJ HAI S/C ACC TO SLIDING SCALE
8AM - 2PM - 8PM
SYP LACTULOSE 15ml PO/TID [ To maintain stools less than or equal to 2]
T. ULTRACET PO 1/2 TAB QID
INJ TAZAR consists of ampicillin and cloxacillin which are antimicrobial drugs.Mode of action is it inhibits the bacterial cell wall synthesis and prevents cross linking of peptidoglycan.
ACUTE ON CKD :
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
She has presented the details very clearly and mentioned all the particulars of the case specifically.
A 75yr old male patient , Chief complaints are :
Lower backache since 10days
Dribbling of urine since 10days
Pedal edema since 3days
SOB at rest since 3days
Increased involuntary movements of both upper limbs since 10days .
INVESTIGATIONS :
ECG, RFT, CUE, Hemogram, ABG , Serum electrolytes, Blood urea ,USG Abdomen ,LFT
PROVISIONAL DIAGNOSIS :
Acute renal failure (intrinsic)
Grade 1 L4-L5 Spondylodiscitis ,Multifocal infectious Spondylodiscitis
Hyperuricemia 2° to Renal failure
Uraemia induced tremors( resolved)
Delerium 2° to septic /Uremic Encephalopathy
TREATMENT :
• IVF - NS-0.9% @100ml/hr
• Inj. Tazar 2.25gm I.V -TID
• Inj. Lasix 40mg I.V -BD
•Nebulization Salbutamol -4th hourly
• Inj. Pantop 40mg I.V -OD
• Tab. PCM 650mg -TID
• Foleys catheterization
CKD
https://krupalatha54.blogspot.com/2021/07/a-49-yr-0ld-female-with-generalised.html?m=1
she has presented her elog very nicely. The details about onset of pain is mentioned in chronological order. Provisional diagnosis and treatment is appropriate.
49 years old female chief complaints are:
Since 3 yrs she has history of muscle aches, for which she is using NSAIDs.
She has h/o fever 20 days back
Since 20 days she has generalized weakness.
She also has h/o vomitings since 3 days, with food as content, non - projectile , non bilious.
Urine output - Normal ,No fatigability , pedal oedema , No SOB , facial fluffiness ,
INVESTIGATIONS :
SERUM CREATININE :6.6mg/dl {Normal - 0.6-1.1}
BLOOD UREA : 120mg /dl { Normal : 12-42}
SERUM ELECTROLYTES :
Sodium - 135 mEq/L {Normal - 136-145}
Potassium - 4.6mEq/L {Normal- 3.5-5.1}
Chloride - 105 mEq/L {Normal - 98-107}
Serum electrophoresis:- showed M- band in gamma region.
Bone marrow aspiration:-showed plasma cell dyscaria, probably multiple myeloma ( plasmacytosis 70%).Mild to moderate supression of all cell lineages.
2D echo No significant abnormality.
ECG No significant changes.
USG abdomen Bilateral grade 2 RP
PROVISIONAL DIAGNOSIS :
CKD CHRONIC INTERSTIAL NEPHRITIS SECONDARY TO PLASMA CELL DYSCARIASIS
TREATMENT :
inj.optineuron 1 amp in 500ml NS IV/OD
ivf. NS RL @ uo + 30 ml/hr
inj. erytropoitin 4000 iv s/c weekly twice
tab. pan-d po/od (8 am)
tab. orofer-xt PO/BD
tab. nodosis 500mg PO/BD
protein- x powder 2 tsp in 1 glass of milk PO/TID
tab. zofer 4mg PO/sos
Patient with coma and renal failure :
https://ananyapulikandala106.
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