Ward notes 3rd February 2021 and pending information

 

ICU 

44 M Severe shortness of breath and ascites with features of pulmonary hypertension and history of smoking and alcohol consumption. Died. Autopsy not done. 

55 M with locked in syndrome due to pontine infarct noticed after low grade fever, headache and sudden loss of power and speech. 

Pending E log link with post admission graphical timeline 

55 M CCF with HFrEF due to CAD, Diabetes, HTN, Trunkal obesity, Psoriasis, past splenectomy, PTCA 

https://sridevimaddipati.blogspot.com/2021/01/55-year-old-male-with-chronic-heart.html?m=1

No afterload reducing agents given as ACEI had increased his creatinine and patient went LAMA today to Hyderabad to blow his savings as before because his edema and shortness of breath couldn't be relieved on time.

72 M with recent left supeaorbital swelling, diabetic foot and massive right pleural effusion with mediastinal shift and renal failure dialyzed. 

Pending E log link with post admission graphical timeline 

30M with abdominal pain after alcohol and severe shortness of breath with clinical findings of severe pulmonary hypertension and a history of surgery (sternotomy scar) for congenital heart disease 

Pending E log link with post admission graphical timeline 

63M with shortness of breath CCF and CAD 

Ward updates at 8 pm

PGY3-   ARAVIND REDDY

INTERN -  JEEHARIKA

Male ward - 14 patients

1)68/M with ischaemic CVA with infarct in left mca territory(lentiform parietal)

Pending E log link with post admission graphical timeline 

2) 60/M with heart failure with HFPEF (56%)secondary to CAD

https://navyamallempalli.blogspot.com/2021/02/a-60yrs-old-male-with-sob.html

3)49/M with alcohol liver disease with AKI ; sepsis HBSAG positive

Pending E log link with post admission graphical timeline 

4 )50/M GCTS secondary to epileptic foci with old infarct with DIABETIC KETOACIDOSIS(resolved)

Pending E log link with post admission graphical timeline 

5) 63/M with Parkinson's disease

Pending E log link with post admission graphical timeline 

6 )46/M with alcohol dependence with tobacco dependence with dysthymia 

https://manivarma7.blogspot.com/2021/02/46-year-old-male-who-is-daily-wage.html?m=1

7) 27/M with anasarca, ascites and hypoalbuminemia due to malabsorption 

https://navyamallempalli.blogspot.com/2021/01/26-year-old-man-from-north-east-india.html?m=1

8)58/M with CKD ?diabetic nephropathy,anaemia secondary to CKD

Pending E log link with post admission graphical timeline 

9)60/M HFREF secondary to CAD

10) 73/M with right facio brachial monoparesis ( acute infarct in left frontal lobe)

11) 36/M with alcohol dependence syndrome ? Alcohol withdrawal syndrome

12 ) 27/M with low back ache and B/L axonal neuropathy of upper limbs 

https://mohithak.blogspot.com/2021/01/27year-old-male-with-ankylosing.html?m=1

13)71/M CKD left hydroureteronephrosis with prostatomegaly( obstructive uropathy)

14) 42/M with c/o pain abdomen k/c/o pancreatitis (today's admission)

Pending E log link with post admission graphical timeline 

Female ward - 3 Patients.

1) 73/F with HFPEF with AF secondary to CAD

Pending E log link with post admission graphical timeline 

2) 47/F with HFPEF secondary to anaemia 

http://abdulraheem7168.blogspot.com/2021/02/47-year-old-female-presented-with-acute.html

3) 22/F with hypertensive urgency (resolved ) with iron deficiency anaemia

https://yaminimandava4114.blogspot.com/2021/01/22-year-old-female-with-complaints-of.html

4) 26 F with nephrotic syndrome 

https://asrithareddy10.blogspot.com/2021/01/this-is-online-e-log-book-to-discuss.html

Discharged 

Current ward cases

ICU 4 patients 

50 M with Shortness of breath 

55 M with Anasarca and dyspnoea along with DM 2 HTN psoriasis since years 

case 3: 55 yr old man with severe PAH with moderate AS And AR with AKI on CKD

Case 4: Acute GE with left lower lobe pneumonia with k/c/of congenital heart disease

AMC 0 

Ward patients

1. 60/M with heart failure discussed in the afternoon 

2. 49/M Hbsag +ve case with AKI and alcoholic liver disease 

3. 71/M with CKD with prostatomegaly

4. 60/M with HFREF with CAD

5. 35/M with headache giddiness ?hypochondrasis

6. 63/M with Parkinson’s disease 

7. 27/M with celiac disease

8. 68/M with ischaemic cva with left mca territory infarct with HTN and DM -2

9. 78/M with HFREF with PAH 

10. 27/M with ankylosing spondylitis 

11. 50/M with seizures secondary to old infarcts

12. 58/M with CKD with HFPEF

13. 16/M with HBSAG +ve with acute cholangitis and acute cholecystitis 

14. 36/M with alcohol withdrawal seizures with alcohol dependence syndrome 

15. 75/M with seizures with rt lmn facial palsy with rt monoparesis 

16. 47/F with HFPEF secondary to ?viral/anaemia

17. 73/F with HFPEF with AF secondary to CAD

18. 22/F with DKA with Hypertensive urgency with Iron deficiency anaemia

Medicine department time table

  

DEPARTMENT OF GENERAL MEDICINE

UG, PG & INTERNS HANDS-ON PRACTICAL LEARNING PROGRAM

 

S. No	Day	Ward work up of inpatients by UGs, PGs guided by faculty 8:00 AM to 11:00 AM	Case Presentations UG Presentation PG Discussion 11am to 1 pm	Case Presentations Intern / PG Presentation PG Discussion 2 pm to 4 pm	Theory topic based on the case presentation And Ward cases review 2 pm to 3 pm	Ward case based project presentations 3 pm to 4 pm	Ward work by PGs under 1ston call faculty guidance 4:00 PM to 8:00 AM
1	Monday	Unit I-VII	Unit - V	Unit - V	Unit - II	Unit - V	Unit I
2	Tuesday	Unit I-VII	Unit – VI-VII	Unit – VI-VII	Unit - III	Unit –VI-VII	Unit II
3	Wednesday	Unit I-VII	Unit - I	Unit - I	Unit - IV	Unit - I	Unit III
4	Thursday	Unit I-VII	Unit - II	Unit - II	Unit - V	Unit - II	Unit IV
5	Friday	Unit I-VII	Unit - III	Unit - III	Unit – VI-VII	Unit - III	Unit V
6	Saturday	Unit I-VII	Unit - IV	Unit - IV	Unit - I	Unit - IV	Unit VI-VII

 

 

Medicine paper for January 2021 bimonthly blended assessment

Answer all questions                                                      

Max Marks: 100 (10 marks for each first seven questions and 30 marks for the last question) 

Submit by:                                

Date: 16/01/2021 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 days and E logged in a manner demonstrated by past examinees in the link here https://medicinedepartment.blogspot.com/2020/11/blended-bimonthly-assessment-oct-nov.html?m=0

And here is a sample answer paper from the last exam here: https://ashiness3.blogspot.com/2020/11/bimonthly-assessment-for-month-of.html?m=1 please note that every logged answer paper should contain the link to this "assignment/question paper" page and the patient context for each answer as well as avoid plagiarism as illustrated in the sample answer paper. 

A sample answer to the last question around sharing your experiences can be seen here: https://onedrive.live.com/view.aspx?resid=4EF578BAE67BA469!4180&ithint=file%2cdocx&authkey=!AOy7BpRTn42DBMo

Questions:

 

1) Please go through the patient data in the links below and answer the following questions:

26 year old woman with complaints of altered sensorium somce 1 day,headache since 8 days,fever and vomitings since 4 days

More here: https://harikachindam7.blogspot.com/2020/12/26-year-old-female-with-complaints-of.html

Case presentation  links: 

https://youtu.be/fz9Jssoc-mA

https://youtu.be/d4lLX04oL8s

https://youtu.be/CSCxw2zp7Oc

a). What is the problem representation of this patient and what is the anatomical localization for her current problem based on the clinical findings?

b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? Please chart out the sequence of events timeline between the manifestations of each of her problems and current outcomes. 

c) What is the efficacy of each of the drugs listed in her prior treatment plan that she was following since last two years before she stopped it two weeks back? 

For example: 

Why was she given bisphosphonates? 

What is the efficacy of using primary bisphosphonate prophylaxis for patients started on corticosteroids?

- 

What is the efficacy of using primary PPI prophylaxis during initiation of any  corticosteroids to prevent Gi ulcers? 

d) Please share any  reports around similar patients with SLE and TB meningitis?

Any reports of normal  csf leukocyte count and normal csf protein in meningitis? 

What could be the probable cause for a normal csf leukocyte count in a patient with chronic meningitis? 

e) What is the sensitivity and specificity of ANA in the diagnosis of SLE? 

2) Please go through the two thesis presentations below and answer the questions below by also discussing them with the presenters:

https://youtu.be/sw8o8y5Yw_I

What was the research question in the above thesis presentation? 

What was the researcher's hypothesis? 

What is the current available evidence for magnesium deficiency leading to poorer outcomes in patients with diabetes? 

https://youtu.be/jXVS5J1-RNE

What was the research question in the above thesis presentation? 

What was the researcher's hypothesis?

What is the current available evidence for the utility of monitoring salt excretion in the hypertensive population? 

3) Please critically appraise the full text article linked below:

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2003.01233.x

What is the efficacy of aspirin in stroke in your assessment of the evidence provided in the article. Please go through the RCT CASP checklist here https://casp-uk.net/casp-tools-checklists/ and answer the questions mentioned in the checklist in relation to your article. 

4) Please mention your individual learning experiences from this month.

5) a) What are the possible reasons for the 36 year old man's hypertension and CAD described in the link below since three years? 

https://vamsikrishna1996.blogspot.com/2021/01/36-year-male-presented-to-casualty-at.html?m=1

b) Please describe the ECG changes and correlate them with the patient's current diagnosis. 

c) Share an RCT that provides evidence for the efficacy of primary PTCA in acute myocardial infarction over medical management. Describe the efficacy in a PICO format. 

Medicine question paper for December 2020 bimonthly blended summative assessment

Below is an online formal question paper to be answered online using all available resources at your online disposal over a period of days and E logged in a manner demonstrated by past examinees in the link here https://medicinedepartment.blogspot.com/2020/11/blended-bimonthly-assessment-oct-nov.html?m=0

 Answer all questions                                                      

Max Marks: 100 (10 marks for each first seven questions and 30 marks for the last question) 

Submit by:                                

Date: 16/12/2020 9:00 AM 

Here is a sample answer paper from the last exam here: https://ashiness3.blogspot.com/2020/11/bimonthly-assessment-for-month-of.html?m=1 please note that every logged answer paper should contain the link to this page and the patient context for each answer as well as avoid plagiarism as illustrated in the sample answer paper. 

A sample answer to the last question number 8 around sharing your experiences can be seen here: https://onedrive.live.com/view.aspx?resid=4EF578BAE67BA469!4180&ithint=file%2cdocx&authkey=!AOy7BpRTn42DBMo

Questions:

Please go through the patient data in the links below and answer the following questions:

1) A 55 year old man with Recurrent Focal Seizures

Detailed patient case report here: http://ushaindurthi.blogspot.com/2020/11/55-year-old-male-with-complaints-of.html

1. What is the problem representation of this patient and what could be the anatomical site of lesion ?

2. Why are subcortical internal capsular infarcts more common that cortical infarcts?

3. What is the pathogenesis involved in cerebral infarct related seizures?

4. What is your take on the ecg? And do you agree with the treating team on starting the patient on Enoxaparin?

5. Which AED would you prefer?

If so why?

Please provide studies on  efficacies of each of the treatment given to this patient.

Question 2) 55 year old man with Recurrent hypoglycemia

Patient details in the intern logged online case report here: http://manojkumar1008.blogspot.com/2020/12/shortness-of-breath-with-high-sugars.html

Questions:

1. What is the problem representation for this patient? 

2. What is the cause for his recurrent hypoglycemia? And how would you evaluate? 

3. What is the cause for his Dyspnea? What is the reason for his albumin loss?

4. What is the pathogenesis involved in hypoglycemia ?

5. Do you agree with the treating team on starting the patient on antibiotics? And why? Mention the efficacies for the treatment given.

3)

A. 41 year old man with Polyarthralgia

Case details here: https://mahathireddybandari.blogspot.com/2020/11/41m-with-chest-pain-and-joint-pains.html?m=1

1. How would you evaluate further this patient with Polyarthralgia?

2. What is the pathogenesis involved in RA?

3. What are the treatment regimens for a patient with RA and their efficacies?

B. 

75 year old woman with post operative hepatitis following blood transfusion

Case details here: https://bandaru17jyothsna.blogspot.com/2020/11/this-is-online-e-log-book-to-discuss.html

1.What are your differentials for this patient and how would you evaluate?

2. What would be your treatment approach? Do you agree with the treatment provided by the treating team and why? What are their efficacies?

4) 60 year woman with Uncontrolled sugars

http://manojkumar1008.blogspot.com/2020/12/60-yr-old-female-with-uncontrolled.html

1. What is the problem representation of this patient?

2. What are the factors contributing to her uncontrolled blood sugars?

3. What are the chest xray findings?

4. What do you think is the cause for her hypoalbuminaemia? How would you approach it?

5. Comment on the treatment given along with each of their efficacies with supportive evidence.

5) 56 year old man with Decompensated liver disease

Case report here:  https://appalaaishwaryareddy.blogspot.com/2020/11/56year-old-male-with-decompensated.html

1. What is the anatomical and pathological localization of the problem?

2. How do you approach and evaluate this patient with Hepatitis B?

3. What is the pathogenesis of the illness due to Hepatitis B?

4. Is it necessary to have a separate haemodialysis set up for hepatits B patients and why?

5. What are the efficacies of each treatment given to this patient? Describe the efficacies with supportive RCT evidence. 

6) 58 year old man with Dementia

Case report details: http://jabeenahmed300.blogspot.com/2020/12/this-is-online-e-log-book-to-discuss.html

1. What is the problem representation of this patient?

2. How would you evaluate further this  patient with Dementia?

3. Do you think his dementia could be explained by chronic infarcts?

4. What is the likely pathogenesis of this patient's dementia?

5. Are you aware of pharmacological and non pharmacological interventions to treat such a patient and what are their known efficacies based on RCT evidence?

7) 22 year old man with seizures

Case report here http://geethagugloth.blogspot.com/2020/12/a-22-year-old-with-seizures.html

1. What is the problem representation of this patient ? What is the anatomic and pathologic localization in view of the clinical and radiological findings? 

2. What the your differentials to his ring enhancing lesions?

3. What is "immune reconstitution inflammatory syndrome IRIS and how was this patient's treatment modified to avoid the possibility of his developing it?

 8) Please mention your individual learning experiences from this month.

CBBLE 2 and an introduction to its information granularity

 

Just to share an example from our regular workflow, "information granularity" in the medical curriculum may be also guaged by online assessment links where if you click on this link here below: https://medicinedepartment.blogspot.com/2020/11/blended-bimonthly-assessment-oct-nov.html?m=0, you may find links to both formative and summative assessment of each individual student, intern and PGs of different years. 

Once you open those links you will find links to the log books of each student that can show the details of each patient they have cared and learned from as a part of a formative assessment of their verbal competency and you will also find links to their offline presentations in the form of online videos as a reflection of their subjective non verbal competency that can be guaged from their body language. 

In our medical education workflow, information granularity appears to begin with the student's online learning portfolio reflecting students learning outcomes and continues (unendingly as learning is a never ending stream) with the patient's healthcare outcomes as the primary beneficiary of Medical education is the patient? 

And then once we dig deeper into the patient's report there are different layers of information granularity about the patient beginning in the macroworld captured by our senses and standard current radio imaging as well those in the microworld of the patient's cells captured through the microscope and the molecular world captured in biochemical tests. 

More here in the link below on the origins of CBBLE2 and I quote:

"Slowly the realization dawned that individual case based experiences were different from the average data being  represented in Clinical trials where each of these individuals was just a number.

2002: Contrary to what trial data projected, every individual was unique and had unique life trajectories and it was found that medical students were best suited to unearthing these trajectories as documented here: https://www.eubios.info/EJ124/ej124j.htm

Some of these medical students who were now academic faculty, revisited this idea in the last CBBLE paper here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/

2007: It was gradually becoming clearer that current evidence based medicine needed a more meaningful methodology to answer individual patient requirements here: https://pubmed.ncbi.nlm.nih.gov/17683292/

2008: And soon the first conceptual model for current CBBLE was shared here: http://www.ncbi.nlm.nih.gov/pubmed/19018905

It was called "user driven healthcare" UDHC and described a prevalent phenomenon evolving with the internet and the only difference with the later CBBLE appears to be that the term "blended learning" got added to the same process suggesting that the CBBLE had a strong component of offline connection and locality that was blended to requirements of online users. 

The CBBLE idea as a subset of the UDHC phenomenon was to build a Case based reasoning database that could offer any individual patient data a platform for obtaining comparisons between other individual patients who had similar data patterns and then see if near matches of individual trajectories would offer similar outcome trajectories in those group of patients and this was inspired by a seminal paper on case based reasoning linked here: https://pubmed.ncbi.nlm.nih.gov/15533257/

The pursuit of clinical problem solving using online user driven learning was a polymathic pluralistic activity and we derived a lot of lessons from other fields as illustrated in chapters of the UDHC book here 

https://www.igi-global.com/chapter/user-driven-learning-environment-botany/49258

2009: The model could be scaled to the last mile primary care and act as an efficient bridge between primary and tertiary, individual home, community collaborative center and academic institutions as proposed here:   https://pubmed.ncbi.nlm.nih.gov/19811603/

2010-2020--

Many such cases started getting logged by last mile workers in various parts of India particularly West Bengal and they were processed by a CBBLE that fed case based problems to a global forum for conversational learning as shared here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117104/

The forum was made by global medical and engineering  students and there is more about them in the above article as well as in the UDHC book and journal issues here https://www.igi-global.com/journal/international-journal-user-driven-healthcare/41022 as well as their own web pages."

More here: https://medicinedepartment.blogspot.com/2020/07/medical-cognition-research-and-cbble.html?m=1

Blended bimonthly assessment Oct-Nov 2020 results

 Following are the links to the submitted assignments by the students (interns, PGs year 1 and year 2) for the the assignment posted for 7/10/2020 here: https://medicinedepartment.blogspot.com/2020/09/medicine-paper-for-october-2020-first.html?m=1  and the assignment posted for 16/11/2020 here:https://medicinedepartment.blogspot.com/2020/11/blended-learning-bimonthly-assignment.html?m=1 

and in the links below one can find that the summative has been also accompanied by a numerical formative assessment of their online learning portfolios using both verbal and non verbal cues. 

Interns from 2015 MBBS batch posted in the department of Medicine from 

23.09.2020 to 22.11.2020. 

https://docs.google.com/document/u/2/d/1_BNuQlhQ2BXzoKnO_ZL1LUbGAIihInwL3duJ0S_7Xz0/mobilebasic

PGY1s from the 2020 MD General Medicine batch 

https://docs.google.com/document/d/1O4sJDILfqQ0RoGX7f0vR1op7y5JWfLekao9_LsJFtK4/edit?usp=drivesdk&ouid=100497219830377837116

PGY2s from the 2019 MD General Medicine batch :

https://docs.google.com/document/d/1nrUSM2n1wxbtPJIgwYNUIr1GDMc0aWhXK0ikjn4EmHw/edit?usp=drivesdk&ouid=100497219830377837116

The formative assessment has been divided into non-verbal which assesses their competency in procedural domains including empathic communication and body language and verbal which assesses their ability to communicate their work through their day to day E logs.

Most students have done reasonably in the formative assessment in both verbal and non verbal communication domains although a lot remains to be improved on. 

Most students haven't done well at all in the summative assessment as they are still trying to get a hang of how to express themselves in an online open access world where their answers are meant to create a societal impact rather than impress just one examiner who may end up giving good numerical scores in appreciation of their ability to answer from rote memorized facts as per tradition. It's possible that in the current phase of evolution we may find that many have not only plagiarised blatantly from articles on the internet (inspite of express instructions on how not to resort to that) but also copy pasted from each other's log books.