Answer all questions
Max Marks: 100
Submit by:
Date: 7/9/2020 9:00 AM
Below is an online formal question paper to be answered online using all available resources at your online disposal over a period of two days and E logged in a manner demonstrated by past examinees in the link below and the link to your E logged answers shared in the same platform where you obtained the current link that you are viewing.
Please go through the patient data in the links below:
1)Patient data collected and logged by intern Dr Alekya.
45 yr old lady who is a housewife and had DM 2 since 5yrs and HTN since 1yr. She was apparently normal 6months back,used to develop pedal edema on and off aggravates on walking and relieves on taking rest for which she was taken to nalgonda hospital and the doctor had advised her to decrease the fluid intake and gave some medications.It was associated with shortness of breath grade 3.
5days back she had developed pedal edema which got progressed and developed abdominal distension,facial puffiness associated with decreased urine output,sob even at rest and chest pain on right side, non radiating with intermittent palpitations.
More here: https://alekyatummala.blogspot.com/2020/09/45-yr-female-with-anasarca.html?m=1
1) What is your complete anatomic and etiologic diagnosis from the data available in the patient's online record linked above? (ignore the provisional diagnosis on admission mentioned in the case report)
2) What are the reasons for her:
Azotemia
Anemia
Hypoalbuminemia
Acidosis
3) What was the rationale for her treatment plan detailed day wise in the record?
Particularly mention rationale and efficacy for some of the drugs administered such as oral and iv bicarbonate? When is iv or oral bicarbonate indicated and why is it contraindicated in certain situations?
4) What was the indication for dialysing her and what was the crucial factor that led to the decision to dialyze her on the third day of admission?
5) What are the other factors other than diabetes and hypertension that led to her current condition?
6) What are the expected outcomes in this patient? Compare the outcomes of similar patients globally and share your summary with reference links.
7) How and when would you evaluate her further for cardio renal HFpEF and what are the mechanisms of HFpEF in diabetic renal failure patients?
8) What are the efficacies over placebo for the available therapeutic options being provided to her for her anemia?
What is the utility of tools like the CKD-AQ that assess the frequency, severity, and impact on daily activities of symptoms of anemia of CKD? Is Telegu among the 68 languages in which it is translated?
10) What is the contribution of protein energy malnutrition to her severe hypoalbuminemia? What is the utility of tools such as SGA subjective global assessment in the evaluation of malnutrition in CRF patients?
2) A similar patient data as above with diabetes and renal failure with metabolic acidosis and hypoalbuminemia logged by intern Dr Bhavya here https://bhavyayammanuru.blogspot.com/2020/09/aki-secondary-to-uti.html?m=1
Please comment on the differences in the diagnosis, therapy and outcomes in both these two patients.
Would you agree with the provisional diagnosis shared for this 58 M in the online case report linked above?
What are the findings in the ultrasound of both kidneys? How do you explain those findings? Would it explain the etiology for his renal failure?
Please feel free to review the literature online before answering the above questions but take care not to plagiarise any of that literature while answering these questions. One can quote only one to two lines maximum from the reference literature and the references and links should be shared along with the quotes or paraphrased information derived from the referenced literature.
Please check out some active learning discussion around answering this case based question format as well as avoiding plagiarism here https://medicinedepartment.blogspot.com/2020/05/frequently-asked-questions-around-case.html?m=1
Please check out these links to few answers in the past in E log books from our other students around different set of questions:
https://medcases.blogspot.com/2020/05/heart-failure-2.html?m=1
https://virtualmedicalcases.blogspot.com/2020/06/the-dark-side-of-depression.html?m=1
https://caseopinionsbyrollno156.blogspot.com/2020/05/trio-of-paraparesis-cases.html?m=1
For a past online question paper in a patient centered clinical problem solving version please check the link below:
https://medicinedepartment.blogspot.com/2020/01/patient-centered-questions-for.html?m=1
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