This blog is an assessment and the questions are in the below link
https://medicinedepartment.blogspot.com/2021/06/medicine-department-paper-for-june-2021.html?m=1
Following are the answers for questions in the link
QUESTION 1 : Competency tested for Peer review and assessment :
go through one particular answer of ten students in this link:
- https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1
and share your peer review of each answer with your quantitative marking input as well as qualitative insights into what was good or bad about the answer.
ANSWER 1:
PULMONOLOGY
1) Case : A 55 year old female With shortness of breath , pedal edema , puffiness of face .
https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html
Review 1:https://rishitharaok.blogspot.com/
Quantitave marking : 7/10 .
Qualitative insights : the cause and localisation of the problem are mentioned clearly .
Mechanisms of pharmacological interventions are explained well for each of it. But their efficacy over placebo effect could've mentioned which would've given a better idea .
The evolution of symptomology in terms of event timeline is not mentioned and it is priliminary for any patient care .
Flowcharts could've been used for better understanding.
Review 2: https://181sagivikas.blogspot.com/
Quantitative marking : 5/10
Qualitative insights :Localisation and cause of problem is mentioned .
Evolution of symptomology is in chronological order of event timeline .
Mechanisms of pharmacological interventions were not properly explained. Causes for electrolyte imbalance is not explained.
Review 3:https://173joshuapaulelogcases.blogspot.com/?m=1
Quantitative marking : 5/10
Qualitative insights : this review on given questions is exactly the same as above . With no explanation of mechanisms of pharmacological interventions and causes for electrolyte imbalance .
Localisation , cause of problems , symptomology in terms of event timeline are proper .
Review4 : https://171mkfarhanelogcases.blogspot.com/
Quantitative marking: 5/10
Qualitative insights : this review is same as above two . Answers are not expressed clearly . Vague .
Review5 :https://02shishirareddy.blogspot.com/
Quantitative marking : 10 /10
Qualitative insights : all the answers are explained to the point with a flowchart of evolution of symptomology .
Mechanisms and indication are upto mark .
Review6 : https://amishajaiswal03eloggm.blogspot.com/
Quantitative marking: 9/10
Qualitative insights: all the answers were explained well except the effect of att Which could've been explained in more detail than by giving it a term 'generalized weakness'.
Review7 : https://caseopinionsbyrollno05.blogspot.com/
Quantitative marking : 9/10
Qualitative insights : the answers are understandable . Easy with flowcharts . Effect of att could've been explained in detail.
Review8: https://daddalavineeshachowdary.blogspot.com/
Quantitative marking: 6/10
Qualitative insights : flowcharts and diagrams could've been used.
Chronological order for evolution of symptomology is not followed and not explained well.
Effect of att and causes for electrolyte imbalance is explained Properly.
Mechanisms of pharmacological interventions and indications and efficacy over placebo are not explained in detail.
Review 9 : https://saichennuru.blogspot.com/
Quantitative marking: 8/10 .
Qualitative insights: anatomic localisation and cause of problem is given .
Mechanism of pharmacological interventions is given .
Indications and efficacy over placebo effect is not mentioned.
Other answers are understandable.
Review 10:https://meesumabbas82.blogspot.com/
Quantitative marking : 10/10
Qualitative insights : all the answers seemed good with pictures and flowcharts.
Evolution of symptomology is in order .
Reference links for pharmacological interventions are given for each of it .
Indications and efficacy are also mentioned clearly.
In the above 10 reviews , non pharmaceutical interventions could have been mentioned too.
ANSWER 2
QUESTION 3: 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.
ANSWER 3:
CASE: A 60 year old female with pedal oedema since 10 days , decreased urine output since 10 days and fever since 10 days .
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
In the above case , The Description is written well but the patient's past history could've showed much more info such as all the medication he's been on in past years which could also lead to or may be one of the reasons for renal failure .
Investigations done were proper.
Dates on which investigations and the treatment done should not be given in e-logs as far as I know . Only the month and year to be mentioned and update to be done from date of admit as day 1 day 2 so on ....
The inj magnexfortene used as antibiotic in this case subsided the urosepsis . Orofen for pallor to treat anaemia and nodosis as alkalinizing agent .
Discharge summary and advice at discharge are not mentioned which seemed the case to be incomplete .
Images of patient showing pedal oedema could've been inserted and urine output should be mentioned as on the given dates as 1st day 2nd day etc.., so on as to Know the prognosis .
QUESTION 4 : discuss the diagnostic and therapeutic uncertainty around solving those problems. Also 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.
CASE: A 70 year old female with distension of abdomen and shortness of breath grade-3 since 5 days .
https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1
ANSWER 4 : with the clinical signs of distension ..the case might be an ascites or organomegaly or bloating due to air with constipation. And the shortness of breath exclusively along with abdominal distension gives us a clear idea of heart failure .
Cardiac biomarkers ,ECG and 2D echo to be done to diagnose .
In the above case the review about diagnosis interventions were given showing atrial fibrillation in ECG and video showing it In 2D echo .
Diagnosis : heart failure with reduced ejection fraction and atrial fibrillation .
Review around the specificity of diagnostic interventions were mentioned accurately .
In most of the cases hyperthyroid patients develop this condition of atrial fibrillation . But here this might have developed due to overtreatment of hypothyroidism leading to very low level of TSH .
https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-7-489
this link shows the cases and explanation for conversion of hypothyroidism to hyperthyroidism which is usually rare and is often considered due to over treatment of hypothyroidism with thyroxine but its underlying cause is still suspicious .these 3 cases covered in above link depict this conversion becoming common and is now not considered that hypothyroidism is a permanent problem and taking thyroxine is for lifelong.
Therapeutics : defibrillation is done to correct it .
Amiodarone is used to treat atrial fibrillation and clexane is usually used for Treating bloodclots and angina etc..,
Specificity on therapeutics could have made it complete.
The patient had passed away unfortunately
Her thyroid profile should have been included in the Diagnostic interventions.
QUESTION 5 : reflect on and share your telemedical learning experiences from the hospital as well as community patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.
ANSWER Over all it has been a good learning experience of how to log the patient data and in detailed presentation of the cases
Hands on experience regarding sample collection
Insertingand removing foleys and ryles
Drawing blood
Connecting IV fluids
About Equipments used in ICU
Drugs at ICU
Had good experience with central line