Online blended bimonthly assignment toward summative assessment for the month of May 2021
D. THANMAI
ROLL NO: 27
2017 BATCH 31 MAY 2021
I have been given the following cases to solve in an attempt to understand the topic of 'patient clinical data analysis 'to develop my competency in reading and comprehending clinical data including history ,clinical findings, investigation and diagnosis and come up with the treatment plan.
This is the link of questions asked regarding the cases http://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=1
Below are my answers to the medicine assignment based on my comprehension of the cases.
1.PULMONOLOGY
https://
A
1. a) Bacterial or allergens exposure in paddy fields caused → shortness of breath leading to → increase in load on right heart causing →right heart failure which lead to→ pedal edema and →puffiness of face
b) anatomical localization of problem - Bronchi
c) Constant exposure to Allergens or bacteria ,weak immunity
2. a. HEAD END ELEVATION:
3. current acute exacerbation may be due to
ATT drugs causing weakness or upper respiratory tract infection
4. yes, it effected by causing generalized weakness
5. could be due to renal insufficiency ,hypoxia , hypercapnia ,respiratory acidosis etc
2.NEUROLOGY
https://143vibhahegde.
A.
1. a.2 years ago patient is diagnosed with Diabetes type II → he did not follow anti diabetic treatment → year ago severity increased → 4 months ago he developed seizure following sesation of alochol after 24 hrs → 10 days ago he developed general body pains →9 days ago he developed altered sensorium such as irrelevant talking and decreased food intake.
b.Central nervous system
c. ETIOLOGY Prolonged alcohol use leads to the development of tolerance and physical dependence, which may result from compensatory functional changes by downregulation of GABA receptors and increased expression of NMDA receptors with production of more glutamate to maintain central nervous system (CNS) transmitter homeostasis
Abrupt cessation of chronic alcohol consumption unmasks these changes with a glutamate-mediated CNS excitation resulting in autonomic overactivity and neuropsychiatric complications such as delirium and seizures.The latter are usually of generalized tonic–clonic type and are mediated largely in the brainstem by abrogation of the tonic inhibitory effect of the GABAergic delta subunits.
2
a. IVF NS and RL
mechanism:Administer intravenous (IV) fluids for rehydration, as necessary. Most patients with severe alcohol withdrawal are significantly dehydrated, and their fluid requirements range from 4-10 L in the first 24 hours. Because hypoglycemia is common in these patients due to depleted glycogen stores, a 5% dextrose solution (in 0.90% or 0.45% saline) should be used to prevent hypoglycemia.
Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production; insulin inhibits lipolysis and proteolysis and enhances protein synthesis; targets include skeletal muscle, liver, and adipose tissue
4. thiamine is given to patient because it forms thiamine pyrophosphate which is essential for cycles to generate ATP
5. Sudden withdrawal of alcohol cause injury to kidney
6. Sudden withdrawal of alcohol cause injury to kidney thus causing normocytic anemia
7. excessive alcohol intake caused poor wound healing in this patient thus leading to ulcer'
B.
https://kausalyavarma.
1. a.no Slurring of speech, deviation of mouth that got resolved the same day
b. infarct in the inferior cerebellar hemisphere of the brain.
c.In this case, the patient has hypertension for which he has been prescribed medication that he has not taken. Stroke due to an infarct can be caused by blockade or bleeding in the brain due to which blood supply to the brain is decreased, depriving it of essential oxygen and nutrients. This process could’ve caused the infarct formation in the cerebellar region of the brain, thus causing cerebellar ataxia.
1)Tab Veratin
MECHANISM:
Betahistine is one of the few drugs known which is said to improve the microcirculation of the inner ear. It works as a histamine analogue through 2 modes of action
(1) agonist of H1 receptors and
(2) antagonist of H3 receptors.
It has a weak effect on H1 receptors but strong effect on H3 receptors.
2)Inj Zofer
MECHANISM:
Zofer Tablet works by inhibiting the action of a chemical substance named serotonin, which is responsible for inducing nausea and vomiting. Ondansetron binds to a receptor known as 5-HT₃, thus inhibits the binding of serotonin to it and prevents vomiting and nausea.
3)Tab Ecosprin
MECHANISM:
Ecosprin is an antiplatelet medicine. It works by inhibiting the action of an enzyme, which makes platelets aggregate together to form a blood clot.
4)Tab Atorvostatin
MECHANISM:
Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.
5)Tab Clopidogrel
MECHANISM:
The active metabolite of clopidogrel selectively inhibits the binding of adenosine diphosphate (ADP) to its platelet P2Y12 receptor and the subsequent ADP- mediated activation of the glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation. This action is irreversible.
6)Inj Thiamine
MECHANISM:
Thiamine combines with adenosine triphosphate (ATP) in the liver, kidneys, and leukocytes to produce thiamine diphosphate. Thiamine diphosphate acts as a coenzyme in carbohydrate metabolism, in transketolation reactions, and in the utilization of hexose in the hexose-monophosphate shunt.
1. a. patient was normal 8 months back then developed b/l pedal edema which gradually progressed.
2. Diuretics
3.Earliest change :decreased T-wave amplitude, ST depression, Twave - and inversion or flat;prolonged PR interval;presence of Uwaves
https://rishikoundinya.
D.
1. If you've had a stroke, you have an increased risk for having a seizure. 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.
2.Abnormal increased activity in fronto-parietal association cortex and related subcortical structures is associated with loss of consciousness in generalized seizures. Abnormal decreased activity in these same networks may cause loss of consciousness in complex partial seizures.
1.→Addicted to alcohol for the past 3 years. According to the attendant he used to drink "a few bottles per day". Drinks both bottled liquor and toddy.
F.
1. since patient doesn't have diabetes or hypertension RTA could possibly be the cause for his present condition
2.
→sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
→Sudden confusion, trouble speaking, or difficulty understanding speech.
- →Sudden trouble seeing in one or both eyes.
- →Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
3.
4.in this case alcohol does not play a major role in cva as he drinks alcohol ocassionally.
5. No, his lipid profile is in normal range
G.
1. There is loss of power of adduction and extension of the ulnar two or three fingers and an inability to grip and release rapidly with these fingers. These changes have been termed "myelopathy hand" and appear to be due to pyramidal tract involvement.
2.Wartenberg's sign is a neurological sign consisting of involuntary abduction of the fifth (little) finger, caused by unopposed action of the extensor digiti minimi. . This finding of weak finger adduction in cervical myelopathy is also called the "finger escape sign".
3.Hoffman's sign or reflex is a test used to examine the reflexes of the upper extremities. This test is a quick, equipment-free way to test for the possible existence of spinal cord compression from a lesion on the spinal cord or another underlying nerve condition.
H.
1. According to MRI cortical vein thrombosis might be the cause of her seizures.
2.
- Pregnancy and the first few weeks after delivery
- Problems with blood clotting; for example, antiphospholipid syndrome, protein C and S deficiency, antithrombin III deficiency, lupus anticoagulant, or factor V Leiden mutation
- Cancer
- Collagen vascular diseases like lupus, Wegener’s granulomatosis, and Behcet syndrome
- Obesity
- Low blood pressure in the brain (intracranial hypotension)
- Inflammatory bowel disease like Crohn’s disease or ulcerative colitis
3.there was a sezuire free period due to administration of antiepileptic drugs as the effect of drugs weans off the sezures appear again followed by administration of phenobarbitone leading to spontaneous resolution of the sezuires.
4.heparin as CLEXANE was given to relive clot in suspission of CVST
3.CARDIOLOGY
https://muskaangoyal.blogspot.
A.
1.
3. risks for developing heart failure could be pericardial effusion could lead to cardiac tamponade causing heart failure ,known case of AV block
4. hypotension is due to pericardial effusion
https://muskaangoyal.blogspot.
B.
1. hypertension→ left ventricular hypertrophy ,uncontrolled hyperglycemia ,obesity
2. Anemia due to chronic illness
3. (GRBS - 290% ) non healing ulcers due to un controlled diabetes
4. initially patient was diagnosed with type 2 Diabetes , he was prescribed with oral hyperglycemic drugs ,the he was prescribed with insulin later it progressed to stage 4 where he faced vascular complications such as retinopathy the micro vascular complications such as non healing ulcers.
https://preityarlagadda.
C.
1. a. 10 years ago patient has undergone surgery for inguinal herina → 3 yyears ago he has a history of NSAID abuse andon and off facial puffines → facial puffiness prolonged for next 2 years →1 year ago he developed grade II SOB and HTN →2 days ago he has decreased urine out put + SOB grade II which progressed to grade IV
b. Anatomical localization : Blood vessels
c.The physical stress of hypertension on the arterial wall also results in the aggravation and acceleration of atherosclerosis, particularly of the coronary and cerebral vessels. Moreover, hypertension appears to increase the susceptibility of the small and large arteries to atherosclerosis.
2. PHARMACOLOGICAL INTERVENTIONS
3. this patient have cardio renal syndrome type IV
PATHOGENESIS OF CARDIO RENAL SYNDROME IS DEPECITED IN THE BELOW FIGURE
4. Hypertension
5. APTT and INR are ordered on a regular basis when a person is taking the anticoagulant drug warfarin to make sure that the drug is producing the desired effect.
D
1.TIMELINE OF EVENTS-
2.PHARMACOLOGICAL INTERVENTIONS
- Met XL
- Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis
3 INDICATIONS:
4. Provider-related factors
Inappropriate PCI recommendation without coronary artery bypass grafting (CABG) facility availability.
PCI and diagnostic catheterisation performed during the same session (ad hoc PCI).
Lack of shared decision making.
Medico-legal concerns related to risks from failed medical intervention.
Poorly regulated, privatisation and fee-for-service in healthcare.
Fear of missing the ‘widow-maker’.
Patient related factors
Patient preference for minimally invasive PCI over CABG.
Lack of health literacy among patients.
Fear, anxiety, misperceptions and misbeliefs among patients about PCI benefits over optimal medical therapy and lifestyle modification.
https://kattekolasathwik.
F
1.Because of the fluid loss occurred to the patientthere is decreased preload- so, SOB occurred due to decreased CO
4.GASTEROENTEROLOGY & PULMONOLOGY
https://63konakanchihyndavi.
A
1.Evolution of symptomatology
Antomical location of etiology is pancreas(ductal obstruction, acinar cell injury, defective intracellular transport)
The pathophysiology of acute pancreatitis is characterized by a loss of intracellular and extracellular compartmentation, by an obstruction of pancreatic secretory transport and by an activation of pancreatic enzymes Attributed to alcohol
2.PHARMACOLOGICAL INTERVENTIONS
a. ING. MEROPENAM
mechanism:Meropenem is bactericidal except against Listeria monocytogenes, where it is bacteriostatic. It inhibits bacterial cell wall synthesis like other β-lactam antibiotics. In contrast to other beta-lactams, it is highly resistant to degradation by β-lactamases or cephalosporinases.
b. ING. METROGYL
mechanism:Metronidazole diffuses into the organism, inhibits protein synthesis by interacting with DNA and causing a loss of helical DNA structure and strand breakage. Therefore, it causes cell death in susceptible organisms.
c. ING. AMIKACIN
mechanism:he primary mechanism of action of amikacin is the same as that for all aminoglycosides. It binds to bacterial 30S ribosomal subunits and interferes with mRNA binding and tRNA acceptor sites, interfering with bacterial growth.
d. TPN ( Total Parenteral Nutrition )
mechanism: the early administration of enteral nutrition must be the standard therapeutic approach in patients with severe acute pancreatitis it decreases the risk of infection; TPN is only required in a few patients.
e. IV NS / RL
mechanism:Patients with acute pancreatitis lose a large amount of fluids to third spacing into the retroperitoneum and intra-abdominal areas. Accordingly, they require prompt intravenous (IV) hydration within the first 24 hours. Especially in the early phase of the illness, aggressive fluid resuscitation is critically important.
f. ING. OCTREOTIDE
mechanism:
Like somatostatin, octreotide also decreases the release of growth stimulating hormones, decreases blood flow to the digestive organs, and inhibits the release of digestive hormones such as serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide.
Octreotide is useful in overdose management of sulfonylurea type hypoglycemic medications, when recurrent or refractory to parenteral dextrose. Mechanism of action is the suppression of insulin secretion.
g. ING. PANTOP
mechanism:The mechanism of action of pantoprazole is to inhibit the final step in gastric acid production. In the gastric parietal cell of the stomach, pantoprazole covalently binds to the H+/K+ ATP pump to inhibit gastric acid and basal acid secretion. The covalent binding prevents acid secretion for up to 24 hours and longer.
h. ING. THIAMINE
mechanism:Vitamin B1 (thiamin) is indispensable for normal function/health of pancreatic cells due to its critical role in oxidative energy metabolism, ATP production, and in maintaining normal cellular redox state.
i. ING. TRAMADOL
mechanism:Tramadol is a centrally acting analgesic with a multimode of action. It acts on serotonergic and noradrenergic nociception, while its metabolite O-desmethyltramadol acts on the µ-opioid receptor. Its analgesic potency is claimed to be about one tenth that of morphine.
5) Nephrology (and Urology)
https://kavyasamudrala.
A.
1. the reason for SOB was- metabolic acidosis .
2. He has intermittent episodes of drowsiness because of increased levels of creatinine in the body...
3. He complains of fleshy mass in urine because of patient feels thick urine coming out of his body...the reason behind is the patient had urosepsis.....the culture and sensitivity showed the E.Coli infection...it is the most common cause of UTI....because these infection many pus cells has formed...and these pus cells increase the cloudyness of the urine ..so the patient feels fleshy mass like urine.
4..INTRA-OPERATIVE COMPLICATIONS 1-Hypotension 2-TURP syndrome 3-Haemorrhage 4-Perforation of bladder/prostatic capsule 5-Hypothermia 6-Bacteremia and sepsis 7-Complications of positioning 8-Erection.
https://drsaranyaroshni.
B.
1.Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, or excessive activity and impulsivity, which are otherwise not appropriate for a person's age
2. the child doesn’t have the excessive urge of urination at night time because ADHD is a physcosomatic disorder
3.
8) Infectious disease (Mucormycosis, Ophthalmology, Otorhinolaryngology, Neurology)
http://manikaraovinay.
A) 1. 3 years back HYPERTENSION → on 18th April 2021[ he took COVID-19 Vaccine → developed high grade fever with chills and rigor → relieved on medication ]→ 3 days later similar symptoms which did not relieved on medication →on 18th April 2021[ generalized weakness, facial puffiness, peri orbital edema and drowsiness ] → 4th May 2021 [facial puffiness , peri orbital edema , weakness of upper and lower limbs ]
2. Itraconazole acts by inhibiting the fungal cytochrome P-450 dependent enzyme lanosterol 14-α-demethylase. When this enzyme is inhibited it blocks the conversion of lanosterol to ergosterol, which disrupts fungal cell membrane synthesis.
Amphotericin B binds with ergosterol, a component of fungal cell membranes, forming pores that cause rapid leakage of monovalent ions (K+, Na+, H+ and Cl−) and subsequent fungal cell death
3. un regulated usage of steroids in COVID-19 effected patients who are also having co morbidities like Diabetes ,show rise in the incidence of Mucormycosis
9) http://medicinedepartment.
10) I personally would love to learn without stress ,without rushing and with in depth info . I felt link there is more to learn .
