Hello all. I am a resident in Medicine and my daily schedule for the week is detailed here: https://docs.google.com/docum
This E log book is a mandatory requirement to assess our daily attendance in terms of our mental presence and our daily learning achievements in the medicine department where every PG Resident here shall by 8:00 PM (unless it's an admission day) provide a brief log of what they have done cognitively as well as hands on for that day from 9:00 AM to 6:00 PM.
I have been told that the daily log can be done here under the following headings
1) Case based learning
a) Inpatient
b) Outpatient
c) ICU
2) Thesis
a) That day's thesis case data
b) Questions around cases or even study design etc
3) Theory knowledge acquisition for end term summative assessment:
Paper I: Basic Medical Sciences
Paper II: Medicine and allied specialties including pediatrics, dermatology &
psychiatry
Paper III: Tropical Medicine and Infectious Diseases
Paper IV: Recent Advances in Medicine
4) Procedures done with video evidence (with patient deidentied)
The E log book or web log book is a formative assessment tool aka internal assessment in India and in India the internal assessment as well as performance in the final exams depends on the HOD's regular formative assessment of the candidate's daily performance that builds up over the three years and this internal assessment is never expressed in the form of any number but in the form of a very very vital role the HOD plays in the candidate's learning journey and it's completion at the end of three years.
For those not logging their daily learning activities here, the impression conveyed would be that they are not having any daily learning activity worth sharing.
So here goes my log of daily activities starting from:Monday:
Went early for the morning rounds and found that my junior intern had still not arrived and that really made me mad as it meant that now I would have to collect all the patient reports by myself. 😡My senior PG admitted this young boy with a chronic gluteal abscess yesterday who had developed both lower limb weakness since five days.Case report:
23M with complaints of weakness of bilateral lower limbs since 5 days along
with tingling and numbness
h/o vomitings 5days back
3-4 episodes non projectile non bilious food particles in content.
when he got up for urination,suddenly he had a fall and got up with the help of father.
gluteal abscess since 5months (operated 5 months back)
scrotal abscess since 20 days(incision and drainage 10 days back)
PAST HISTORY
no similar complaints in past
auto driver
not past history of HTN/DM/ASTHMA
General examination:
Gluteal region as in the image below:
Pallor absent
Icterus absent
No cyanosis clubbing
lymphademopathy, Edema
Afebrile
Bp 120/80 mm hg
Pr 80 bpm
spo2 98%
Cvs s1 s2 hear no murmurs
Rs bilateral air entry + normal vesicular breath sounds heard
P/a soft, non tender
Cns
conscious
speech-normal
cranial nerves intact.
MOTOR SYSTEM
Right. Left
Bulk: normal. Normal
Tone: ul. normal. Normal
LL. hypotonia hypotonia
Power rt. lt
ul. 5/5. 5/5
LL. 2/5. 0/5
Reflexes.
Superficial reflexes
Right. Left
Corneal. P P
Conjunctival P. P
Abdominal. P. P
Plantar Extensor Extensor
Deep tendon reflexes
Right. Left
Biceps. 2+ 1+
Triceps. 2+ 1+
Supinator. 3+ 2+
Knee 3+ 2+
Ankle. 3+ 2+
jaw jerk. 1+. 1+
ankle clonus present. absent
Primitive reflex -absent
Involuntary movements - absent
SENSORY SYSTEM - normal
CEREBELLUM
titubation - absent
Nystagmus- absent
Intensional tremors - absent
Pendular knee jerk - absent
Coordination test -normal
MENINGIAL SIGNS
Neck stiffness - negative
Kernigns sign - negative
Brudzinkis sign - negative
INVESTIGATIONS
HBS AG: negative
ANTIHCV ANTIBODIES: nonreactive
HIV : non reactive
HEMOGRAM :
HB 15.5gm/dl
Platelets 2.23 lakhs/cumm
TLC 9600cells/cumm
Lymphocytes 15%
LFT
TO.BIL. 0.82mg/dl
DI.BIL. 0.21gm/dl
SGOT. 80IU/LIT
SGPT. 10IU/LIT
ALK.PH. 192IU/LIT
TO.PRO. 7.5gm/dl
ALB. 4gm/dl
A/G RATIO. 1.19
RFT
UREA. 16mg/dl
CREATININE. 0.6mg/dl
URIC ACID 3.7mg/dl
CALCIUM. 9.4mg/dl
PHOS. 4.6mg/dl
SODIUM. 136meq/lit
K+. 3.9meq/lit
CL-. 102 meq/lit
ESR 45 mm/1st hr
RBS 99 mg/dl
Cranial mri images:
Cranial mri images:
TREATMENT :
INJ.ZOFER 4mg IV.SOS
INJ.PANTOP 40mg IV OD
BP ,PULSE MONITORING
INJ.AUGMENTIN 1.2g IV BD
OINT.MEGAHEAL FOR LOCAL APPLICATION
SITZ BATH WITH BETADINE TID
FREQUENT CHANGE OF POSITION
I saw the above treatment penned by my senior in upper case and wondered out aloud as to why every patient who gets admitted is prescribed mandatory pantoprazole and this one had vomiting 5 days back!! This comment was frowned upon needless to say.
In the afternoon my senior presented this patient and we had an extensive discussion as to the etiology that you can see in the recorded video here
Procedure:My senior PG medicine asked me to take this patient with severe anemia (web logged by our medical student here:https://classworkdecjan.blogspot.com/2016/12/60f-with-coma-e-coli-sepsis-and-upper.html?m=1) to the pathology department for a bone marrow aspiration and biopsy. Here is a video of that biopsy procedure: https://youtu.be/MeozrO1Nkyk
Theory preparation:
In the afternoon session the same day we also had a few topic discussions that I reviewed again for my theory preparation. Check out the videos here https://m.youtube.com/watch?v=yhXqgGpfIEo&list=PLvOgc9_ v4PCKsIrVK4laA3_rUJOMPAYKJ One such topic (check out the specific video here:https://www.youtube.com/watch?v=YzVI1XZ3nAI&feature=youtu.be)
was about pheochromocytoma where I learned about why in preoperative management of pheochromocytomas, alpha blockers are given prior to beta blockers."At low concentrations, adrenaline acts on beta2 receptors causing vasodilatation.At higher concentration it acts on alpha 1 receptors causing vasoconstriction.If beta blockers are given first, they act upon beta2 receptors, thus blocking them and an unapposed alpha adrenergic activity can be seen which results in HYPERTENSIVE CRISIS and cardiovascular collapse sir.To prevent this non selective alpha blockers are given first to reduce the hypertension.Non selective alpha blockers cause reflex tachycardia. In order to further reduce the blood pressure and to reduce the risk of tachyarrhythmias, beta blockers are added further."
Also, Labetalol(alpha plus beta blocker) has a 1:7 alpha-beta blocking activity and when it is given to a patient with pheochromocytoma, due to more beta blocking action it results in hypertensive crisis again.
So labetalol is also not given.
Thesis project:
At the end of the day one of my batchmates from another unit mentioned that one patient has arrived at the causalty who looks like my thesis case and I am currently working on a thesis on "Etiology ,Management and outcome in patients with hyponatremia" and I have been separately logging all my thesis cases here http://allabouthyponatremia.blogspot.com/?m=1
Here is the detailed MCI guideline based rationale for our daily roster
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