Thursday, November 18, 2021

Medicine paper for Nov 2021 bimonthly blended assessment

18/11/2021 9:00 PM


Answer all questions:                                                      

Max Marks: 100 (5 questions in total and 20 marks for each  answer) 

Submit by:   25/09/2021               

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. Also share the detailed online links to every quote or reference cited in your answer. 



Questions plan and context:

All questions are around student driven patient centered case reports prepared by our students from our real but deidentified patients. These cases have also been discussed in theory lectures as well as practical training sessions which are available here : https://medicinedepartment.blogspot.com/2021/10/updated-october-2021-weekly-log-and.html?m=0

Please review one E logged case report link around our current cases (uploaded anywhere between a few days of this post) by one of our 2016, 2017, 2018 and 2019 students in their links available from the LOR link below :





Q1) (Testing peer review competency in the active reader of this assignment) :

Please go through the current case reports in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.


Q2: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data):

Please analyze the linked case report current patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. 

Q3) Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 

Q4) Testing leadership competency in patient data capture and representation through ethical case reporting/case presentation with informed consent from body language of the presenter :

Share the link to your own case report this month of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. 

Please attach a link to your latest YouTube video of your case presentation to assess your current leadership competency expressed in non verbal cues. Check out other shared YouTube videos of prior student's presentations here : https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR


Q 5) Testing scholarship competency in  
logging reflective observations on your concrete experiences of this last month : (10 marks) 

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 one student's  answer to Q10 in the  May 2021 assignment in the link below:


And another student answer to Q5 in the June and July 2021 assignment in the links below :




Please reflect on and share  your learning experiences from the  hospital as well as community  patients over the last month particularly while you were E logging their case report.

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Wednesday, November 17, 2021

BDS 2018 II - INTERNAL ASSESSMENT EXAMINATION question paper

DEPARTMENT OF GENERAL MEDICINE

II - INTERNAL ASSESSMENT EXAMINATION

Date: 15.11.2021

Time: 10 am to 1 pm

Note: Answer all questions                                        Max Marks: 70


  1. Anatomical and etiologic localization for hemiparesis and further management        1x9=9





  1. Etiology pathogenesis clinical features management complications of acute pancreatitis.      1x9=9

Real patient context :



Write Short Notes on                                      8x4=32


1) Dengue Fever clinical features and complications.



2) Cushing syndrome.


3) Mandibular advancement device.


4) Cardiogenic pulmonary edema.


5) Rheumatoid arthritis.


6) Leptospirosis.


7) Heart failure.



8) Ascites.



Write Briefly on                                         10x2=20

  1. Pyrexia of unknown origin.



12) Drug induced liver injury.



13) Evaluation of low back ache.



14) Renal artery stenosis.


15) Acute kidney injury.


16) Oral hypoglycemic agent.


17) Micro vascular and macro vascular complications of diabetes.



18) Lights criteria.


19) Metabolic acidosis


20) Iron deficiency anemia.


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Tuesday, November 16, 2021

Selected answers to the 2017 internal assessment exam theory paper questions

The MBBS 2017 batch Oct 2021 internal assessment question paper prepared from patient data driven group learning with shared date and time links from the group is available at the link below:

https://medicinedepartment.blogspot.com/2021/10/mbbs-2017-batch-oct-2021-internal.html?m=1


Few selected handwritten   answers (by the students while at the examination hall under time pressure and no access to information resources) to the questions are linked below from their log book links collectively available for the entire 2017 batch here : https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1




                   

Time: 10 am to 1 pm

Note: Answer all questions        SET - A                  Max Marks: 60   



10 Marks questions:

1 Define bone density, how is it measured? What are the causes, clinical features,diagnosis and management of osteoporosis? (1+2+2+2+3)




Answers:


1) Roll number 7


2) Roll number 18





 2 What is myxedema coma? Describe its clinical features , diagnosis and treatment of myxedema coma (2+2+2+4)



Answers :

Roll number : 50


Roll number : 63




4 marks questions:

3 What is the diagnostic approach of young onset hypertension and it’s treatment.


Roll number 77


Roll number 86


4 How do you clinically localize the anatomical level of lesion in spinal cord diseases.


Roll number 92:



Roll number 107:


5 Causes,diagnosis and treatment of atrial fibrillation.

(Shared on 25th sep, 8:22pm)

Roll number 3:


Roll number 117



6 Describe about megaloblastic anemia.
(Shared on 22nd sep, 2:23pm)

Roll number 118:


Roll number 121:



7 What are the causes, pathogenesis and differential diagnosis of ascites.

One more Elog shared on 31st aug ,3:39pm)

Roll number 122:


Roll number 127:


8 Approach to acute pancreatitis.
(Shared on 22nd sep,1:28pm)


Roll number 128:


Roll number 132:



2 marks questions:

9 Mention the differences in findings between UMN and LMN lesion.
(Discussed on 20th sep 10-11 am class)



10) Indications of hemodialysis.




11) Role of sucralfate in treatment of erosive gastritis?



(Shared on4th sep, 7:48am)



12) Mention the renal manifestations of snake bite?



13) causes of portal hypertension
(Shared on 23rd sep ,12:35pm and discussed during postings)


14 clinical features of Downs syndrome




15) post streptococcal glomerulonephritis complications.
(Shared on 23rd sep, 7:45pm)



16 Causes of cervical myleopathy.
( discussed on 20th sep 10-11am class)



Special Mention for creative communication :

Roll number 74

Interesting introduction in the student's E log  to his answers and we quote from it below :

"Answers below were influenced from the exam paper to the time confinement along with other psychological aspects such as performance anxiety, distress , Anger and a few other things :)"



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Sunday, November 7, 2021

November 2021 weekly log and outcomes of regular patient centered learning sessions

This is a regular academic session impact assessment log for the post graduate residency training program comprising currently of residents of 2019 and 2020 batch. 


The training program comprises of a regular hands on learning of clinical decision making during the bedside rounds from 10 AM to 1:00 PM as well as 2-4 sessions officially divided daily into:

Theory on Monday, 

Seminar on Tuesday, 

Journal club on Wednesday, 

Tutorial on Thursday 

Group discussion on Friday 

Log Book audit on Saturday 

These are blended learning sessions with both online and offline components and while the offline learning timings are as mentioned above, the online component of the learning continues 24x7.

The overall impact of each learning session is assessed under two main headings as impact on the student and impact on patient. 

The detailed headings are :


Impact : 

On learning ecosystem :

Cognitive competency levels touched in different levels of Blooms taxonomy BT (more here : https://sites.pitt.edu/~super1/lecture/lec54091/002.htm):

Approach to disease localization (BT level 1 -3)

Resolving initial diagnostic uncertainty (BT level 1-4)

Therapeutic decision making toward evaluating patient requirements and outcome (BT level 1-5)

Developing and testing innovative diagnostic and therapeutic solutions ( BT level 1-6)

On patient care outcomes :

Was empathic trust built with patient and relatives?

Were the patient requirements identified adequately and a proper problem list made toward assessment? 

Was standard of care provided with provision for care continuity ?


1st November 
Monday 

Theory 

Cerebral venous thrombosis 
Polycystic ovarian syndrome 


Presentation video: 

Presenter Dr Chandana  
Dr Sai Govind 

Attendees Other PGs and UGs 

Impact : 

On learning ecosystem :

Cognitive competency levels touched (BT level 1-4) :

Approach to CNS localization 
Resolving initial diagnostic uncertainty 
Therapeutic decision making 

On patient care outcomes (achieved with BT level 1-4) :

Empathic trust built with patient and relatives 

Standard of care provided with provision for care continuity  

Window of opportunity (needs BT level 1-6): Needs better innovative solutions for her current problems. 

2nd November 2021

Tuesday 

clinical seminar 2-4 PM 

Presenter Dr Zain
Dr Pavan 
Vibha 

Coronary artery disease, heart failure and unstable angina, sudden death 


Presentation video 

Attended by Other PGs and UGs 

Impact : 

On learning ecosystem :

Cognitive competency levels touched :

Approach to cardiac failure in terms of understanding symptomatology, clinical and investigational findings 
(BT level 1-4)

On patient care outcomes (through BT level 1-4) :

Standard of care provided but condition worsened and mortality was the patient outcome 

Window to future: better innovative solutions in terms of diagnostic monitoring and prediction tools as well as better therapeutic effectiveness of newer interventions. 



3rd November 2021

Wednesday 

Journal club 2-4 PM 

Obstructive sleep apnoea non CPAP therapeutic options :

Presenter Dr Chandana 


Attended by Other PGs and UGs 

Impact : 

On learning ecosystem (achieved BT level 1-4)
:

Enhanced knowledge of clinical diagnosis and available therapeutic interventions for obstructive sleep apnoea 

On patient care outcomes (through BT 1-4) :

Empathic trust built with patient and relatives 

Standard of care provided with provision for care continuity  

4th November 2021

Thursday 

Tutorial 2-4 PM 

Deepavali 

5th November 2021

Friday 

Group discussion 2-4 PM 

Periodic fever, seizures and glomerular injury 


Review of literature :



Attended by Other PGs and UGs 

Impact : 

On learning ecosystem ( achieved BT level 1-4) :

Enhanced knowledge of clinical diagnosis and available therapeutic interventions for "periodic fever" 

On patient care outcomes (using BT level 1-4) :

Offered the above learning points to the patient and his relatives and made them aware that their rare disease has been described before (initially globally in 1987) and available solutions identified although in terms of therapeutic outcomes not much was achieved except reducing overinvestigations and overtreatment of an hitherto unknown PUO.

6th November 2021

Saturday 

Log Book evaluation :

All UG and PG log books are available here : https://medicinedepartment.blogspot.com/2021/07/?m=0

Dr Ajit PGY1 : 

Logbook accessible here : https://ajithkumar9600.blogspot.com/?m=1

Impact : 

On learning ecosystem :

Cognitive competency levels touched in different levels of Blooms taxonomy BT (more here : https://sites.pitt.edu/~super1/lecture/lec54091/002.htm):

Approach to disease localization (BT level 1 -3)

Resolving initial diagnostic uncertainty (BT level 1-4)

Therapeutic decision making toward evaluating patient requirements and outcome (BT level 1-5)

Developing and testing innovative diagnostic and therapeutic solutions ( BT level 1-6)

On patient care outcomes :

Was empathic trust built with patient and relatives?

Were the patient requirements identified adequately and a proper problem list made toward assessment? 

Was standard of care provided with provision for care continuity ?

Short summary of competencies  attained till now :

BT level 1-4 

Specific comments :

Selective in workflow situations and chooses to limit his talents to procedures.  Needs to improve on his fast reading, comprehension and writing skills to create better impact on the UGs and co PGs 


Dr Zain :





Impact : 

On learning ecosystem :

Cognitive competency levels touched in different levels of Blooms taxonomy BT (more here : https://sites.pitt.edu/~super1/lecture/lec54091/002.htm):

Approach to disease localization (BT level 1 -3)

Resolving initial diagnostic uncertainty (BT level 1-4)

Therapeutic decision making toward evaluating patient requirements and outcome (BT level 1-5)

Developing and testing innovative diagnostic and therapeutic solutions ( BT level 1-6)

On patient care outcomes :

Was empathic trust built with patient and relatives?

Were the patient requirements identified adequately and a proper problem list made toward assessment? 

Was standard of care provided with provision for care continuity ?

Short summary of competencies  attained till now :

BT level 1-4 

Specific comments :

Able to establish good rapport with patients and obtain follow up although chooses to limit it to few occasions.
Needs to improve on his fast reading, comprehension and writing skills to create better impact on the UGs and co PGs 

8th November 
Monday 

Theory : 

Rheumatoid arthritis 


Weils disease 


Cardiac tamponade 


Chronic Peritonitis 


Presentation video: 





Presenters

Dr Zain

Ramya Tulsi Tejasree

Sharanya 

Prashant 

Attendees Other PGs and UGs 

Impact : 

On learning ecosystem :

Cognitive competency levels touched :
Approach to clinical localization of disease pathology

On patient care outcomes :

Empathic trust built with patient and relatives 

Standard of care provided with provision for care continuity  

One patient of hypotension with Weils disease died while the other with hypotension due to cardiac tamponade survived after pericardiocentesis. 

Window of opportunity : Need blooms taxonomy level 6 discussion to develop better innovative solutions among the students but it's not happening anytime soon. 

9th November 2021

Tuesday 

clinical seminar 2-4 PM 

Differentiating spondyloarthropathy with peripheral arthritis from Rheumatoid arthritis 

Presenter 

Dr Rashmita

 
Context : 

27F


28F


Presentation video 

Attended by Other PGs and UGs 

Impact : 

On learning ecosystem :

Cognitive competency levels touched :

Approach to polyarthritis  in terms of understanding symptomatology, clinical and investigational findings 

On patient care outcomes :

Standard of care provided but difficult to meet patient requirements 

Window to future: better innovative solutions in terms of  better therapeutic effectiveness 



10th November 2021

Wednesday 

Journal club 2-4 PM 

Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction .
RCT - placebo control trial .


P- Total 4744 patients with HFref .
2373- Dapagliflozin 10mg od .
2371 - placebo

I- Dapagliflozin vs placebo

C- Placebo 

O - The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death.
1) 237 - In dapaglifozin grp had worsening heart failure and 227- Died.
2) 326- placebo had worsening HF
273- DIED .

CONCLUSION : 

Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes.

But pts who were included , dapagliflozon had more patients with NYHA class 2  and placebo had more pts with NYHA class 3,4 HF . Which can explain frequent hospital admissions in them .

Presenter Dr KV 

Context : A patient without diabetes started on dapagliflozin --- Link : http://pawanbhasin.blogspot.com/2021/11/a-72-y-old-male-patient-general.html

Attended by Other PGs and UGs 

Impact : 

On learning ecosystem :

Newer therapeutic trials awareness 

On patient care outcomes :

Was more confident of stopping the intervention after ascertaining it's non clinical significance after critical appraisal of the journal article.


11th November 2021

Friday 

Group discussion 2-4 PM 

Rheumatic fever diagnostic uncertainty and overinvestigations after referral 

Headache and migraine 

Context: Long distance referrals for diagnostic and therapeutic uncertainty 


Attended by Other PGs and UGs 

Impact : 

On learning ecosystem :

History taking and patient education demo in action 

On patient care outcomes :

Patient education and continuation of beneficial care 

12th November 2021

Saturday 

Log Book evaluation :

Interns 2015 residual batch of thirty on trial to finalize their internship completion on the basis of their apparent learning competencies attained at the end of their internship. 

Their logs are accessible here :


13th November 2021

Sunday 
14th November 2021

Sunday 

15th  November 2021

Monday 

Theory 

Potts spine 

Presented by 

Dr Nikita 

Context :

39 M


30 M



Tuesday 

Clinical seminar 

November 16, 2021

Clinical seminar 

Management of seizures 

Presenter 

Dr Raveen 

Dr Kalyan 

Context : http://elogformedicalcase.blogspot.com/2021/11/recurrent-seizures-activity.html


Wednesday 

November 17 2021

Journal club 

In this context:  http://elogformedicalcase.blogspot.com/2021/11/recurrent-seizures-activity.html, the journal club for today required browsing through quite a few articles such as these here 👇

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173734/

And these https://pubmed.ncbi.nlm.nih.gov/33822427/

And a typical journal club RCT article with ridiculous efficacy such as this one 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2762700

Second Article and context :

50 patients presenting to the hospital with peritonitis. 

39 of them had typical infectious peritonitis, and their mean peritoneal fluid amylase level was 11.1 (range, 0 to 90). 

6 patients had pancreatitis and a mean peritoneal fluid amylase level of 550 U/L (range, 100 to 1,140 U/L). 

5 patients were found to have other intra-abdominal pathology, and their mean peritoneal fluid amylase level was 816 U/L (range, 142 to 1,746 U/L).

https://www.researchgate.net/publication/21432501_Usefulness_of_peritoneal_fluid_amylase_levels_in_the_differential_diagnosis_of_peritonitis_in_peritoneal_dialysis_patients

Context : 

https://kavyasamudrala.blogspot.com/2021/11/66-year-old-male-with-abdominal.html


November 18, 2021

Thursday :

Tutorial : CNS localization 

Presenter : Dr A Vaishnavi, Dr Zain, Dr Raveen and 

Dr Bhavani 

Context :  https://emanichandana.blogspot.com/2021/11/39-year-old-male-patient-with-altered.html

November 19, 2021

Friday 

Group discussion: 

Context : PUO in a male diabetic with loin pain and lower urinary tract symptoms of urgency and burning 

https://prashanthsharma101.blogspot.com/2021/11/a-case-of-39-year-old-male.html?m=1

Presenters : Dr Vaishnavi, Dr Nikita, Dr Pooja (intern) and Dr (Soujanya 2017)


Impact : 

On learning ecosystem :

Cognitive competency levels touched :

Approach to clinical localization of disease pathology was done reasonably well and differential diagnostic hypothesis formulated in the face of high diagnostic and therapeutic uncertainty 

On patient care outcomes :

Empathic trust built with patient and relatives 

Standard of care provided with provision for care continuity  

Challenges met/not met : 

Fever monitoring and post admission illness timeline was well supervised. 

Imaging and labs for further  clinical localization of the PUO was driven by the discussion 

Multiple therapeutic interventions were made for the differentials in the face of diagnostic uncertainty further driven by ongoing patient suffering and an attempt to gather the "medical cognition" learning points made here : 

November 20, 2021

Saturday 

Log Book assessment: Dr AV, Dr Nikita 

Context : An elderly patient with severe anemia, hypotension, severe metabolic acidosis, encephalopathy and recent fracture femur 

Case report link :

Impact : 

On learning ecosystem :

Cognitive competency levels touched :

Approach to clinical localization of disease pathology was done reasonably well and differential diagnostic hypothesis formulated 

On patient care outcomes :

Empathic trust built with patient and relatives 

Standard of care provided with provision for care continuity  

Challenges met/not met : managing diagnostic  arranging of repeating hemoglobin levels, repeat imaging to assess hematoma, continuing dialysis, reviewing the literature around giving bicarbonate in high anion gap metabolic acidosis and an attempt to gather the "medical cognition" learning points made here : 


Theory on Monday, 22nd - 
Alcoholic DCMP with HFrEF

 
Ataxic gait


Video link


Seminar on Tuesday,  23rd

Topic- Infective endocarditis

Video link



Journal club on Wednesday, 24th

Liu H, Qiao L, He Z. Wernekink commissure syndrome: a rare midbrain syndrome. Neurol Sci. 2012 Dec;33(6):1419-21. doi: 10.1007/s10072-012-0966-4. Epub 2012 Feb 4. PMID: 22307446.

A clinically rare midbrain syndrome- Wernekink syndrome discussed in the context of following patient


Tutorial on Thursday 25th

Importance of direct visualisation of 2D ECHO rather than mere measures values with emphasis on different planar views.
 
Video link


Group discussion on Friday  26th

Detection of Rifampicin resistance by gene probe assay(CBNAAT)

95% of mutations associated with rifampin resistance occur in an 81-bp core region of the bacterial RNA polymerase gene, rpoB. (enzyme involved in synthesis of target site of Rifampicin)

All mutations that occur within this region result in rifampin resistance. 
The assay uses novel nucleic acid hybridization probes called molecular beacons. 

Five different probes are used in the same reaction, each perfectly complementary to a different target sequence within the rpoB gene of rifampin-susceptible bacilli and each labeled with a differently colored fluorophore.
Together, their target sequences encompass the entire core region. 

The generation of all five fluorescent colors during PCR amplification indicates that rifampin-susceptible M. tuberculosis is present. 

The presence of any mutation in the core region prevents the binding of one of the molecular beacons, resulting in the absence of one of the five fluorescent colors



Log Book audit on Saturday 27th


Theory on Monday- 29th-

Panhypopituitarism
 
Video link


Seminar on Tuesday- 30th

SEPTIC SHOCK AND AUTONOMIC DYSFUNCTION


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