Medicine paper for February 2021 bimonthly blended assessment

 Answer all questions                                                      

Max Marks: 100 (10 marks for each  answer) 

Submit by:                                

Date: 16/02/2021 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/2021/02/blended-bimonthly-assessment-dec-2020.html?m=1

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 current "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:

50 year man, he presented with the complaints of

Frequently walking into objects along with frequent falls since 1.5 years

Drooping of eyelids since 1.5 years

Involuntary movements of hands since 1.5 years 

Talking to self since 1.5 years 

More here: https://archanareddy07.blogspot.com/2021/02/50m-with-parkinsonism.html?m=1

Case presentation  links: 

https://youtu.be/kMrD662wRIQ

a). What is the problem representation of this patient and what is the anatomical localization for his 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 his problems and current outcomes. 

c) What is the efficacy of each of the drugs listed in his current treatment plan 

2) Patient was apparently asymptomatic 2 years back then he developed weakness in the right upper and lower limb, loss of speech.

More here: https://ashfaqtaj098.blogspot.com/2021/02/60-year-old-male-patient-with-hrref.html?m=1

Case presentation  links: 

https://youtu.be/7rnTdy9ktQw

a). What is the problem representation of this patient and what is the anatomical localization for his 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 his problems and current outcomes. 

c) What is the efficacy of each of the drugs listed in his current treatment plan 

3) 52 year old male , shopkeeper by profession  complains of  SOB, cough  ,decrease sleep and appetite since 10 days and developed severe hyponatremia soon after admission. 

More here https://soumya9814.blogspot.com/2021/01/this-is-online-e-log-book-to-discuss.html?m=1

Case presentation video:

https://youtu.be/40OoVEQBgS4

a) What is the problem representation of this patient and what is the anatomical localization for his 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 his problems and current outcomes. 

c) What is the efficacy of each of the drugs listed in his current treatment plan especially for his hyponatremia? What is the efficacy of Vaptans over placebo? Can one give both 3% sodium as well as vaptan to the same patient?  

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

Blended bimonthly assessment Dec 2020-Jan 2021 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 16/12/2020 here 

https://medicinedepartment.blogspot.com/2020/12/medicine-question-paper-for-december.html?m=0 and the assignment posted for 16/01/2020 here 

https://medicinedepartment.blogspot.com/2021/01/?m=0

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  23.11.2020 to 21.01.2021

https://docs.google.com/document/d/1JTUgVrFL1mJXg33K08G6F_dsDI1VW3QMwXGNLtnd-cI/edit?usp=drivesdk

PGY1s from the 2020 MD General Medicine batch 

https://docs.google.com/document/d/1CJRa8ZVjE91xwHl3bZxwn8gm3etFT0G7aOQIbxqYDSQ/edit?usp=drivesdk

PGY2s from the 2019 MD General Medicine batch :

https://docs.google.com/document/d/1sS3uMX2gc6JYrurdya3Wo9qLDtqW88qx3yoOJfAqoSU/edit?usp=drivesdk

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. 

Ward PGY3 duty roster

 DEPARTMENT OF GENERAL MEDICINE

WARD DUTY

PGY3 INCHARGE

STAFF & PG DUTY ROSTER FOR THE MONTH OF FEBRUARY - 2021

Sl. No	Day	Unit	WARD DUTY PGY3 INCHARGE	FLOOR DUTY	FACULTY
					1st Call	2nd Call
1	Monday	I	Dr. Praneeth	Dr. Aditya Dr. Sushmitha Dr. Divya Chaitanya Dr. Vamshi Dr. Sai Charan	Dr. Praveen	Dr. Rakesh Biswas
2	Tuesday	II	Dr. Sathish	Dr. Sufiya Almas Dr. Ushasree Dr. Nikitha Dr. Chandana Dr. Pradeep	Dr. Vijaya Laxmi	Dr. Y.S. Kanni
3	Wednesday	III	Dr. Aravind	Dr. Vamshi Krishna Dr. Aashitha Dr. Raveen	Dr. Hareen	Dr. Y.S. Kanni
4	Thursday	IV	Dr. Laxma Reddy	Dr. Manasa Dr. Ajith Kumar K. Vaishnavi Dr. Durga Krishna	Dr. Vijaya Laxmi	Dr. Rakesh Biswas
5	Friday	V	Dr. Natasha Rao	Dr. Zain Alam Dr. Shashikala Dr. Shailesh	Dr. Praveen	Dr. Y.S. Kanni
6	Saturday	VI- VII	Dr. Sai Radha	Dr. Rashmitha Dr. A. Vaishnavi Dr. Manasa Dr. Vinay	Dr. Hareen	Dr. Rakesh Biswas
7	Sunday	VI	Dr. Sai Radha	Dr. Rashmitha Dr. A. Vaishnavi Dr. Manasa Dr. Vinay	Dr. Hareen	Dr. Rakesh Biswas

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.