80 Soumya Menda
3rd sem
I have given assignment to read,analyze and reflect the cases in detail of clinical data such as history,clinical findings,investigations and diagnosis.
The below link is of questions from the assignment;
Question 1 :peer review
Case 1
Review on the question-
what is the evolution of the symptomology 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?
Review:Here a 40 year old male who is alcoholic presented with Cheif complaints of irrelevant talking and decreased food intake and history of 2 -3 seizures ,short term memory loss.And how alcohol effects various systems of our body in long run and pathophysiological reasoning for the symptoms of were explained in detail.
Case 2:
Review on:Stroke causes increased risk of seizures
A 55year old male patient came to opd with c/o altered sensorium and involuntary movements and recurrent episodes of seizures since 5yrs and recently fell on road while running and on visiting hospital diagnosed brain stroke.
I agree with the reasoning . A stroke causes your brain to become injured. The injury to your brain results in the formation of scar tissue, which affects the electrical activity in your brain. Disrupting the electrical activity can cause you to have a seizure. Coming to what is seizure ,Cells in the brain send electrical signals to one another. The electrical signals pass along your nerves to all parts of the body. A sudden abnormal burst of electrical activity in the brain can lead to the signals to the nerves being disrupted, causing a seizure. This electrical disturbance can happen because of stroke damage in the brain.
A seizure can affect you in many different ways such as changes to vision, smell and taste, loss of consciousness and jerking movements.
Seizures can also be more likely if you had a severe stroke, or a stroke in the cerebral cortex, the large outer layer of the brain where vital functions like movement, thinking, vision and emotion take place.Some people will have repeated seizures, and be diagnosed with epilepsy. The chances of this happening may depend on where the stroke happens in the brain and the size of the stroke.
Case 3:
Question :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?
And reason for her electrolyte imbalance?
Review:55 year old female with shortnes of breath, pedal edema and facial puffiness
Review:Evolution of symptoms
• 1st episode of SOB :- 20 years ago (in month of january)
• Since then she had yearly episodes of SOB for 8 years lasting 1 week occurring around january
• 12 years ago another episode of SOB lasted for 20 days
•Then after yearly episodes for 12 years around january lasting for month SOB was (Grade- 2)
• Diagnosed with Diabetes 8 years ago
• Anemia and took iron injection:- 5 years ago
• Generalized weakness :- 1 month ago
• Diagnosed with Hypertension:- 20 days back
• Pedal edema:- since 15 days
•Facial puffiness:- 15 years back
LOCALISATION OF PROBLEM: Lungs
Primary etiology : could be due to pollen allergy or due to usage of chulha since 20 years
And the electrolyte imbalance also well explained through the diagram as such
May be due to RIGHT HEART FAILURE ( Decreased cardiac output leads directly to reduction renal blood flow , with impairment of renal exceretion of water and ELECTROLYTES.
Case 4:
Question:
What are the reasons for recurrence of hypokalemia in her? Important risk factors for her hypokalemia?
Review:In the case of a 45 year old female patient with palpitations, pedal edema , chest pain, chest haeviness, radiating pain along left upper limb
The reasons for recurrence of Hypokalemia in this patient are given as :
. Diuretics use
. Albumin is completely absent in this patient- indicating severe malnutrition,
inflammation, this can result in Hypokalemia.
- The risk factors for hypokalemia include :
.Malnutrition
.Use of diuretics
.Diarrhoea
.Vomitings
.Excessive alcohol use
.Excessive sweating.
And I agree with the given explanation and the other symptomatology is also well explained.
Case5
A 78 year old male with shortness of breath, chest pain , bilateral pedal edema and facial puffiness
Question :
1.The difference btw heart failure with preserved ejection fraction and with reduced ejection fraction and risk factors for development of heart failure in the patient .
Review :The difference between heart failure with preserved ejection fraction and with reduced ejection fraction is well explained through diagram and the different risk factors for developing of heart failure in the patient were also highlighted.
Case 6
Question: Risk factors for cortical vein thrombosis
Review:In case the 17 year old female patient with Involuntary movements of both upper and lower limbs and she is diagnosed with cortical vein thrombosis which might be the cause of her seizures.
The risk factors are given as
Infections:
Meningitis, otitis,mastoiditis
Prothrombotic states:
Pregnancy, puerperium,antithrombin deficiency proteinc and protein s deficiency,Hormone replacement therapy.
Mechanical:
Head trauma,lumbar puncture
Inflammatory:
SLE,sarcoidosis,Inflammatory bowel disease.
Malignancy.
Dehydration
Nephrotic syndrome
Drugs:
Oral contraceptives,steroids,Inhibitors of angiogenesis
Chemotherapy:Cyclosporine and l asparginase
Hematological:
Myeloproliferative Malignancies
Primary and secondary polycythemia
Intracranial :
Dural fistula,
venous anomalies
Vasculitis:
Behcets disease wegeners granulomatosis.
Case 7:
Question: Pathogenesis of renal involvement due to heart failure (cardio renal syndrome)
Review: The pathophysiology of cardio renal syndrome is explained such that- it can be attributed to two broad categories of "hemodynamic factors" such as low cardiac output which was earlier considered the main reason for renal involvement due to decreased blood flow to the kidney leading to deterioration of renal function.
In light of new research it is now thought that elevation of both intra-abdominal and central venous pressures are the main reasons for impaired renal function.
And also there are about 5 types of cardiorenal syndromes.
CR1: Rapid worsening of cardiac function leading to acute kidney injury (HFpEF, acute heart failure, cardiogenic shock, and right ventricular [RV] failure)
CR2: Worsening renal function due to progression of chronic heart failure
CR3: Abrupt and primary worsening of kidney function leading to acute cardiac dysfunction (heart failure, arrhythmia, ischemia)
CR4: Chronic kidney disease leading to progressive cardiac dysfunction, LV hypertrophy (LVH), and diastolic dysfunction
CR5: Combination of cardiac and renal dysfunction due to acute and chronic systemic conditions.
Case 8:
Question :Dyspnea in pancreatitis
Review:In case of 25 yr old man with severe epigastric pain,episode of vomiting and shortness of breath,
The cause of dyspnea is explained as Pancreatitis causes chemical changes in the body that affect lung functions.This causes oxygen levels in blood to fall to dangerously low levels.
Case 9:
Question:The reason for blebs and non healing ulcer in the legs of diabetic patient.
Review:As the patient is Diabetic these complications are part of micro and macrovascular and can be explained as Diabetic complications i.e., renal insufficiency may delay healing and account for higher amputation rates observed in diabetic patients under dialysis treatment. Wound environment (e.g., presence of neuropathy, ischaemia, and infection) may significantly influence healing by interfering with the physiological healing cascade and adding local release of factors that may worsen the wound. The timely and well-orchestrated release of factors regulating the healing process, observed in acute wounds, is impaired in non-healing wounds that are blocked in a chronic inflammatory phase without progressing to healing. And simply explained as
Diabetic bullae, also known as bullosis diabeticorum, is a spontaneous, distinct, non-inflammatory, blistering condition of the skin predominantly seen in patients with diabetes mellitus.
Circulation of blood at the wound site is critical for wound healing. As a result of narrowed blood vessels, diabetic wound healing is impaired because less oxygen can reach the wound and the tissues do not heal as quickly.
Case 10
Question: Etiopathogenesis of Liver abscess in chronic alcoholic patient.
Review:The etiopathogenesis of the case is well explained using diagramic representation and raised the point that alcohol plays a major role as a predisposing factor for the formation of liver abscesses that is both amoebic as well as pyogenic liver abscess because of the adverse effects of alcohol over the Liver.
Question 2:Patient case history report : I haven't yet get a chance to present a case.
Question 3 :Reflection on given few cases:
1.Multisystem
Review :Case of the18 year old male seemed complicated as diagnosed and the presentation of the case is very clear which helped me to understand better about the
ACUTE FULMINANT HEPATIC FAILURE SECONDARY TO POST INFECTIOUS(VIRAL/ BACTERIAL) TOXIN
WITH HEPATIC ENCEPHALOPATHY
COAGULOPATHY
METABOLIC SEIZURES (? ABSENCE SEIZURES)
DKA RESOLVED
DENOVO TYPE 1 DM
WITH THROMBOCYTOPENIA they really managed the case very carefully.And this case contributed more points in learning .I felt it was great work by doctors in solving the problems of the patient.
2.CNS
https://pallavi191.blogspot.com/2021/06/gm-cases.html?m=1
Review:It is a case of Quadreparesis secondary to infectious spondylitis of C4, C5, C6, C7 and D1 with Epidural abscess at C5 - C6 level.And the case presentation was clear enough to understand and it was great work.
3.CVS
https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1
Review:It is case of a 70 year old female with Abdominal distension and Shortness of breath with history of hypothyroidism and diagnosed as HFrEF with Atrial fibrillation ,it is presented well .
Question 5:
This is really a great opportunity to come across the work of the doctors and fascinating cases ,they definitely increased curiosity to learn and go through new cases and improved application of theory in practical .I'm greatful to HOD sir and all intern pgs in supporting us in learning the clinicals during this covid situation.And through this assignment I came to learn more about elogs and history taking and case presentation which we are learning in theory these days.
Thank you,
Name :Soumya
Roll no:80
Batch:2019.
