AUGUST BIMONTHLY ASSESSMENT
This is online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputsThis e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome
QUESTION 1
LONG CASE:
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
The information was very detailed which helped us to come to a more accurate diagnosis.
the features to look for have been mentioned based on the inofrmation collected from the patient
the history was very detailed
the questions have been well answered
localisation of the acute ad chronic problem and their respective provisional diagnosis was well described
the urine microscopy was well analysed and made easier to understand
the diagnostic approach was elaborated and clearly explained
all the factors have been taken into consideration before coming to a conclusive diagnosis.
SHORT CASE 1:
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
History was well taken
systemic examination was detailed
resting tremors helped them diagnose parkinsonism
diagnostic approach could have been more elaborate
SHORT CASE 2:
19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .
-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .
-Abdominal distension and facial puffiness since 6 months.
- Pedal edema since 3 months.
- Low back ache since 3 months .
- Feeling low , not feeling to talk to anyone.
- Weight gain and decreased libido since 3months.
- Loss of libido and erectile dysfunction since 2 months .
The history was well taken
general and systemic examination is detailed
the patient was followed up with dermatologist and psychiatry department
even when the patient was diagnosed with covid they asked him to continue the medications
the patient had a follow up every week and was well treated
the viva was answered well by the student
QUESTION 2
LONG CASE
A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.
Pain in his finger joints and wrist while brushing,
Pain while holding mug when taking bath and
Pain in toes and ankles on both sides when walking
The patient could have had gout or arthritis this was the main diagnostic uncertainty in the case. but the patient was found to have rheumatoid arthritis alongside gout developed later.
the problems were localised for a more acute diagnosis
SHORT CASE 1
A 49 year old English and Telugu language lecturer presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.
The patient had resting tremors which led us to idiopathic parkinsonism stage 1.
the disease was gradually progressive for 6 months.
SHORT CASE 2
19 year old male resident of Nalgonda and currently studying intermediate ,came to opd with complaints of :
-Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .
-Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .
-Abdominal distension and facial puffiness since 6 months.
- Pedal edema since 3 months.
- Low back ache since 3 months .
- Feeling low , not feeling to talk to anyone.
- Weight gain and decreased libido since 3months.
- Loss of libido and erectile dysfunction since 2 months .
the patient had skin ulcers and lesions alongside purple striae and abdominal distension, this caused an uncertainity whether it was cushings or a dermatological cause like tenia corporis. the patient was also diagnosed with mild depression and was referred to psychiatry department. the treatment was well done even through COVID and the patient was seen to get better.
QUESTION 3
LONG CASE:
Features of inflammation such as severe pain associated with edema of the joints and limitation of range of active movements
Early morning stiffness, lasting for more than 30 mins (for 1 hour in this patient)
Pain and edema of joints improving with activity and worsening with rest
Features of uncontrolled systemic inflammation such as fever, involuntary loss of weight associated with loss of appetite.
Swellings at joints and deformation of normal joint posture
anascara and frothy urine with low urine output is a sign of renal pathology
SHORT CASE 1:
a 6 month progressive case with resting tremors
SHORT CASE 2:
Purple striae with lesions and ulcers.
QUESTION 4
This is a link to an ongoing case I have been assigned to -
