23/05/2021 3:00 PM
Answer all questions:
Max Marks: 100 (5 questions in total and 20 marks for each answer)
Submit by: 31/05/2021
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 one of the past examinees in the link here:https://
caseopinionsbyrollno156. blogspot.com/2020/10/medicine- blended-assignment-october. html?m=1
And this was in response to one of the past assignments here: medicinedepartment.blogspot.
Feel free to be creative and not necessarily be restricted by the above format. Please be original and refrain from plagiarism. 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.
Questions plan and context:
All questions are around student driven patient centered case reports prepared by our students over last one month and most of the questions are what naturally arose in the minds of these students while trying to help their patients. For the same students taking this exam, marks will be provided for their contribution to the questions.
We are also utilizing this online assessment platform for a participatory action research strategy in "developing student driven patient centered research projects and your online answers will also be analyzed and interpreted with that intent for example the question around covid is linked to our ongoing covid project and the question around heart failure is linked to our heart failure project detailed here: https://
More here on current medicine department projects: medicinedepartment.
The questions below cover the entire spectrum from anatomy, physiology to diagnostic, therapeutic uncertainty to resolve one disease theme and predictably move from symptoms to diagnosis and treatment challenges. For traditional classification purposes we have classified the questions into anatomical areas.
Most questions test the reading comprehension skills of the examinee and some prior familiarity with medical terms and strategies and also more importantly assesses their ability to use online search tools toward better expression of their learning points in the form of answers that are again made available open access for post publication peer review.
In summary the answers to the following questions in this online question paper will assess the examinee's competencies in empathically dealing with:
Clinical problem solving
Medical terminologies familiarity including areas of anatomy, physiology, pathology
Current EBM strategies for managing diagnostic and therapeutic uncertainty
Section 1) Please go through the patient data in the links below and answer the following questions:
1) Pulmonology (10 Marks)
A) Link to patient details:
Questions:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
3) What could be the causes for her current acute exacerbation?
4. Could the ATT have affected her symptoms? If so how?
5.What could be the causes for her electrolyte imbalance?
2) Neurology (10 Marks)
A) Link to patient details:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
3) Why have neurological symptoms appeared this time, that were absent during withdrawal earlier? What could be a possible cause for this?
4) What is the reason for giving thiamine in this patient?
5) What is the probable reason for kidney injury in this patient?
6). What is the probable cause for the normocytic anemia?
7) Could chronic alcoholism have aggravated the foot ulcer formation? If yes, how and why?
B) Link to patient details:
Questions-
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
3) Did the patients history of denovo HTN contribute to his current condition?
4) Does the patients history of alcoholism make him more susceptible to ischaemic or haemorrhagic type of stroke?
C) Link to patient details:
Questions:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are the reasons for recurrence of hypokalemia in her? Important risk factors for her hypokalemia?
3) What are the changes seen in ECG in case of hypokalemia and associated symptoms?
D) Link to patient details:
QUESTIONS:
1. Is there any relationship between occurrence of seizure to brain stroke. If yes what is the mechanism behind it?
2. In the previous episodes of seizures, patient didn't loose his consciousness but in the recent episode he lost his consciousness what might be the reason?
E) Link to patient details:
Questions: 1) What could have been the reason for this patient to develop ataxia in the past 1 year?
2) What was the reason for his IC bleed? Does Alcoholism contribute to bleeding diatheses ?
F) Link to patient details:
Questions
1.Does the patient's history of road traffic accident have any role in his present condition?
2.What are warning signs of CVA?
3.What is the drug rationale in CVA?
4. Does alcohol has any role in his attack?
5.Does his lipid profile has any role for his attack??
G) Link to patient details:
__*Questions*_
1)What is myelopathy hand ?
2)What is finger escape ?
3)What is Hoffman’s reflex?
H) Link to patient details:
Possible questions:
1) What can be the cause of her condition ?
2) What are the risk factors for cortical vein thrombosis?
3)There was seizure free period in between but again sudden episode of GTCS why?resolved spontaneously why?
4) What drug was used in suspicion of cortical venous sinus thrombosis?
3) Cardiology (10 Marks)
A) Link to patient details:
1.What is the difference btw heart failure with preserved ejection fraction and with reduced ejection fraction?
2.Why haven't we done pericardiocenetis in this pateint?
3.What are the risk factors for development of heart failure in the patient?
4.What could be the cause for hypotension in this patient?
B) Link to patient details:
Questions:
1.What are the possible causes for heart failure in this patient?
2.what is the reason for anaemia in this case?
3.What is the reason for blebs and non healing ulcer in the legs of this patient?
4. What sequence of stages of diabetes has been noted in this patient?
C) Link to patient details:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
3) What is the pathogenesis of renal involvement due to heart failure (cardio renal syndrome)? Which type of cardio renal syndrome is this patient?
4) What are the risk factors for atherosclerosis in this patient?
5) Why was the patient asked to get those APTT, INR tests for review?
D) Link to patient details:
Questions-
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
3) What are the indications and contraindications for PCI?
4) What happens if a PCI is performed in a patient who does not need it? What are the harms of overtreatment and why is research on overtesting and overtreatment important to current healthcare systems?
E) Link to patient details:
Questions:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What are mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological interventions used for this patient?
3) Did the secondary PTCA do any good to the patient or was it unnecessary?
F) Link to patient details:
1. How did the patient get relieved from his shortness of breath after i.v fluids administration by rural medical practitioner?
2. What is the rationale of using torsemide in this patient?
3. Was the rationale for administration of ceftriaxone? Was it prophylactic or for the treatment of UTI?
4) Gastroenterology (& Pulmonology) 10 Marks
A) Link to patient details:
QUESTIONS:
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What is the efficacy of drugs used along with other non pharmacological treatment modalities and how would you approach this patient as a treating physician?
B) Link to patient details:
1) What is causing the patient's dyspnea? How is it related to pancreatitis?
2) Name possible reasons why the patient has developed a state of hyperglycemia.
3) What is the reason for his elevated LFTs? Is there a specific marker for Alcoholic Fatty Liver disease?
4) What is the line of treatment in this patient?
For the master chart to the "pancreatitis thesis project" please get in touch with Dr Shashikala PGY1 and Dr Divya PGY2 and share their insights into the above project problem they are working on.
C) Link to patient details:
Possible Questions :-
1) what is the most probable diagnosis in this patient?
2) What was the cause of her death?
3) Does her NSAID abuse have something to do with her condition? How?
5) Nephrology (and Urology) 10 Marks
A) Link to patient details:
1. What could be the reason for his SOB ?
2. Why does he have intermittent episodes of drowsiness ?
3. Why did he complaint of fleshy mass like passage in his urine?
4. What are the complications of TURP that he may have had?
B) Link to patient details:
Questions
1.Why is the child excessively hyperactive without much of social etiquettes ?
2. Why doesn't the child have the excessive urge of urination at night time ?
3. How would you want to manage the patient to relieve him of his symptoms?
6) Infectious Disease (HI virus, Mycobacteria, Gastroenterology, Pulmonology) 10 Marks
A) Link to patient details:
Questions:
1.Which clinical history and physical findings are characteristic of tracheo esophageal fistula?
2) What are the chances of this patient developing immune reconstitution inflammatory syndrome? Can we prevent it?
7) Infectious disease and Hepatology:
Link to patient details:
1. Do you think drinking locally made alcohol caused liver abscess in this patient due to predisposing factors
present in it ?
What could be the cause in this patient ?
2. What is the etiopathogenesis of liver abscess in a chronic alcoholic patient ? ( since 30 years - 1 bottle per day)
3. Is liver abscess more common in right lobe ?
4.What are the indications for ultrasound guided aspiration of liver abscess ?
B) Link to patient details:
QUESTIONS:
1) Cause of liver abcess in this patient ?
2) How do you approach this patient ?
3) Why do we treat here ; both amoebic and pyogenic liver abcess?
4) Is there a way to confirmthe definitive diagnosis in this patient?
8) Infectious disease (Mucormycosis, Ophthalmology, Otorhinolaryngology, Neurology) 10 Marks
A) Link to patient details:
Questions :
1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?
2) What is the efficacy of drugs used along with other non pharmacological treatment modalities and how would you approach this patient as a treating physician?
3) What are the postulated reasons for a sudden apparent rise in the incidence of mucormycosis in India at this point of time?
9) Infectious Disease (Covid 19)
As these patients are currently taking up more than 50% of our time we decided to make a separate log link here:
for this question that contains details of many of our covid 19 patients documented over this month and we would like you to:
1) Sort out these detailed patient case report logs into a single web page as a master chart
2) In the master chart classify the patient case report logs into mild, moderate severe and
3) indicate for each patient, the day of covid when their severity changed from moderate to severe or vice versa recognized primarily through increasing or decreasing oxygen requirements
4) Indicate the sequence of specific terminal events for those who died with severe covid (for example, altered sensorium, hypotension etc).
Please check out the thesis log here for the example of a blogged master chart https://vamsikrishna1996.
10) Medical Education: (10 marks)
Experiential learning is a very important method of Medical education and while the E logs of the students in the questions above represent partly their and their patient's experiences, reflective logging of one's own experiences is a vital tool toward competency development in medical education and research. A sample answer to this last assignment around sharing your experience log of the month can be seen in the link below but while this is by a student onsite in hospital and not locked down at home we would be very interested to learn about your telemedical learning experiences from our hospital as well as community patients over the last month even while locked down at home: https://onedrive.live.
