MEDICINE MONTHLY ASSIGNMENT
May 31st 2021
Name: Gnana Prasuna Reddy K.
Roll no. 49
8th semester
ANSWERS
1. PULMONOLOGY
https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html
1) Evolution of symptamatology
20yrs ago- 1st attack of shortness of breath
From then, every year in January, episode lasts for a week
12yrs ago- admitted to hospital with severe shortness of breath
Current episode:
Started 30 days back, dyspnoea on exertion, relieved on rest,
But since 2 days, dyspnoea even at rest
Possible explanation: attacks of dyspnoea can be triggered by winter season, vegetative matter, dust, pollen ( provided dyspnoea occurred at the time of working in rice fields)
Possible etiology: vegetative dust (RICE)
On investigation: upon CT, lower airway problem is seen
Other associated symptoms :
1. Pedal edema since 15 days up till ankle level
2. Facial puffiness since 15 days
2) Placebo: has no physiological or pharmacological actions in body, but psychological effect is seen
*Head end elevation:
1. Is used to improve ventillation
2. Indicated in when there is hypoxia, bed ridden patients
*O2 inhalation
1. Used for improving oxygen saturation
2. Used in diseases resulting in lower airway pathology
DRUG THERAPY:
1. Amoxicillin plus clavulinic acid (AUGMENTIN)
2. Azithromycin
3. Frusemide injection
4.Thiamine
4. Hydrocortisone
5. Chest wall physiotherapy
6. Bronchodilator nebulization
7. Blood sugar charting
8. Spo2 monitoring, Blood pressure, Temperature
3) Allergic response to rice dust
Immunocompromised condition due to underlying diabetes and hypertension
Overlying heart problem (ECG)
Acute bacterial infection
Due to all the above, disease progression will be hastened, hence the result
4. Maybe not possible
5. Hypertension leading to use of telmisartan leading to hyponatremia leading to electrolyte imbalance
2. NEUROLOGY
CASE : A
https://143vibhahegde.blogspot.com/2021/05/wernickes-encephalopathy.html
1)
*Episode of seizures 1yr ago
*GTCS 4 months ago after cessation of alcohol (24hrs)
*irrelavent speech and behaviour, assisted movements and inability to rise from bed, short term loss of memory, decreased appetite since 9days
Etiology : chronic alcoholism
Anatomy : Frontal lobe, Hippocampus
2)
LORAZEPAM :
Binds to BZD on postsynaptic GABA-A gated chloride channel neurons within CNS
Inhibits GABA
PREGABALIN :
Decreases synaptic release of neurotransmitters
THIAMINE :
Copes with thiaminedeficiency
3)
Alcohol excess leads to thiamine deficiency leads to accumulation of toxins due to renal disease
5)
The kidneys have an important job as a filter for harmful substance alcohol causes changes in the function of the kidneys and makes them less able to filter the blood .alcohol also affects the ability to regulate fluid and electrolytes in the body. In addition, alcohol can disrupt hormones that disrupt hormones that affect kidney function .people who drink too much are more likely to have high blood pressure. High blood pressure is a common cause of kidney disease
6)
• ALCOHOL causes decreased iron absorption
• it also effects the hematopoietic system thereby reducing hematopoiesis
• therefore, it causes NORMOCYTIC NORMOCHROMIC ANEMIA
7)
YES
REASON :
*DIABETICS have an increased chances of ulcer formation
*as diabetes also delays the healing of ulcer
* chronic alcoholism weakens immune system
CASE:B
https://kausalyavarma.blogspot.com/2021/05/a-52-year-old-male-with-cerebellar.html?m=1
Day 1 :
• The patient had an episode of giddiness at 7:00 a.m. in the morning while he was doing his routine work whitch subsided upon taking rest.
• He also had an episode of vomiting on this day
Day 2 : Asymptomatic
Day 3: Asymptomatic
Day 4 : Asymptomatic
Day 5 : episode of giddiness which was sudden onset after taking alcohol.
Bilateral hearing loss ,aural fullness and tinnitus were present
2 to 3 episodes of vomiting
Postural instability was present
The symptoms aggravated in the next 2 days and were also associated with postural instability
Problem at the level of: Cerebellum
Etiology : Long standing undiagnosed hypertension and alcoholism which led to CVA
Investigation : suggested by CT
2)
The placebo has no physiological and pharmacological actions
1. Vertin
• It is an anti vertigo medicine.
• Composition: betahistine
• Indications:. Endolymphatic hydrops
• It is an H1 receptor agonist and H3 receptor antagonist
2.Zofer
• It is an anti-emetic
• It is a serotonin antagonist
3. Clopidogrel
It is an antiplatelet medication which is used in conditions such as impending stroke and in heart attack with aspirin
4. Atorvastatin
It is a HMG-coA reductase inhibitor which is used to lower blood cholesterol
5. Aspirin
It is a NSAID which works by inhibiting cyclooxygenase.
It is used in people with heart diseases and in management of heart attack
Most dangerous and rare side effect is Reyes syndrome
6. Multivitamin tablets
These are used to prevent vitamin deficits and also help to replenish the stores of fat soluble vitamins
3) Considering the history and fact that hypertension is a risk factor for CVA wcan assume that he might be a chronic hypertensive which was undiagnosed.
Smoking and alcohol history would add weight to this presumption as they are thought to be the risk factors for hypertension.
Alcohol is a risk factor for stroke.
4) Yes
CASE : C
http://bejugamomnivasguptha.blogspot.com/2021/05/a-45-years-old-female-patient-with.html
1) Patient has palpitations,pedal edema ,chest pain and heaviness , dragging type of pain in left upper limb, all suggestive of a heart problem
Previous history of hypokalemic paralysis suggestive of recurrent hypokalemic episodes
This might lead to compensation by kidney leading to reabsorption of potassium along with water which might have lead to pedal edema
Further the hypokalemia causes physiological heart defects and ECG changes which could Be the cause for palpitations and left upper limbs paralysis.
2)
RISK FACTORS FOR HYPOKALEMIA
ABNORMAL LOSSES
• Medications: enema,diuretics,laxatives,steroids
• renal causes: mineralocorticoid excess,osmotic diuresis,renal tubular acidosis,hypomagnesemia
TRANS-CELLULAR SHIFTS
• alkalosis
• thyrotoxicosis
• delirium tremens
• head injury
• hypokalemic periodic paralysis
Inadequate intake
3)
ECG changes in a case of hypokalemia are
• Earliest change in ECG: Decreased T- wave amplitude
• ST depression and T wave inversions
• Prolonged PR interval.
• U wave
• Pseudo prolonged QT interval which actually is QU interval.
In severe cases of hypokalemia ventricular fibrillation and rarely AV block are seen.
CASE:D
https://rishikoundinya.blogspot.com/2021/05/55years-old-patient-with-seizures.html
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.
https://www.healthline.com/health/stroke/seizure-after-stroke
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 conscious-ness in complex partial seizures. Thus, abnormally increased or decreased activity in the same networks can cause loss of consciousness. Information flow during normal conscious processing may require a dynamic balance between these two extremes of excitation and inhibition.
CASE E
https://nikhilasampathkumar.blogspot.com/2021/05/a-48-year-old-male-with-seizures-and.html?m=1
1)
CAUSE : ALCOHOLISM
Mechanism:
Damage from alcohol is a common cause of cerebellar ataxia. In patients with alcohol related ataxia, the symptoms affect gait (walking) and lower limbs more than arms and speech. It can also cause associat
increased in chronic alcoholics.
CASE F
http://shivanireddymedicalcasediscussion.blogspot.com/2021/05/a-30-yr-old-male-patient-with-weakness.html
1) No
2)
• Sudden numbness or weakness in arm or leg especially one side of body
• Sudden onset of dizziness , difficulty in walking
• Sudden confusion , trouble speaking or understanding speech
• Sudden headache with no known cause
3)
Combination of thrombolytic and neuroprotective therapy is given
4)As the patient is a chronic alcoholic, it is possible that alcohol migh have not played role in his attack
5.Yes, high TGA And high cholesterol are risk factors for stroke
CASE:G
https://amishajaiswal03eloggm.blogspot.com/2021/05/a-50-year-old-patient-with-cervical.html
1)
In many of the cervical spinal cord disorders,the ulnar 2-3 fingers lose their ability to grasp ,and rapidly release objects and also there is an impairment of adduction and extension in these fingers. it is called as myelopathy hand.
2)
• It is also called as Wartenberg sign
• It is an involuntary abduction of little finger due to unopposed action of Exrensor digit minim
3)
Hoffmanns reflex
When The investigator flicks the fingernail of middle finger down , there is an involuntary Flexion of thumb or index finger
This is called as positive Hoffman's reflex
It is seen in UMN lesions and corticospinal tract lesions.
CASE H
https://neerajareddysingur.blogspot.com/2021/05/general-medicine-case-discussion.html?m=1
1) Thrombosis and infarction
2)
1. BETA THALASSEMIA
2. HEMOLYTIC ANEMIA
3. HEAD TRAUMA
4. IRON DEFICIENCY
5. CANCER
6. INTRACRANIAL HYPOTENSION
3) The postictal state is the altered state of consciousness after an epileptic seizure. It usually lasts between 5 and 30 minutes, but sometimes longer in the case of larger or more severe seizures, and is characterised by drowsiness, confusion, nausea, hypertension, headache or migraine, and other disorienting symptoms.
4) Anticoagulants
3. CARDIOLOGY
CASE A
https://muskaangoyal.blogspot.com/2021/05/a-78year-old-male-with-shortness-of.html
1) Preserved ejection fraction - cardiac output is not affected
Reduced ejection fraction - cardiac output decreases
2)
As the condition is resolving, there is not need for pericardiocentesis
3)
• hypertension
• CAD
• DM
• MEDICATIONS
4) Venous return is low, leading to low cardiac output
CASE B
https://muskaangoyal.blogspot.com/2021/05/a-73-year-old-male-patient-with-pedal.html
1)
1. hypertension
2. alcoholic cardiomyopathy
3. CKD
2)
*KIDNEYS aare the source of erythropoietin
*when the kidney is effected erythropoietin is decreased which decreases RBC COUNT thereby leading to anemia
3) Diabetes mellitus
4)
* stage 1: defined as DCBD (dysglycemia-based chronic disease )insulin resistance;
* stage 2: defined as DCBD prediabetes;
* stage 3: defined as DCBD type 2 diabetes; and
* stage 4: defined as DCBD vascular complications, including retinopathy, nephropathy or neuropathy, and/or type 2 diabetes-related microvascular events.
All these stages have been noted in this case
CASE C
https://preityarlagadda.blogspot.com/2021/05/biatrial-thrombus-in-52yr-old-male.html
1)
EVOLUTION OF SYMPTOMATOLOGY
*HISTORY OF FACIAL PUFFNESS ON AND OFF 2YR
*HISTORY OF SOB SINCE 2 DAYS GRADE 2 to 4
SITE : HEART
CONDITION: FIBRILLATION
3)
Type 1 cardiorenal syndrome occurs when there is acute decompensation of cardiac function leading to a decrease in glomerular filtration. Researchers have previously proposed a decline in cardiac output with decreased renal perfusion as the leading underlying cause for worsening kidney function in cardiorenal syndrome types 1 and 2. However, recent studies have postulated that increased central venous pressures are a more critical factor.[1] When patients develop fluid overload due to worsening cardiac function, venous pressures increase and are transmitted back to the efferent arterioles; this results in a net decrease in the glomerular filtration pressure and renal injury. Other factors involved in the pathogenesis of types 1 and 2 cardiorenal syndromes include elevated intraabdominal pressures, activation of the renin-angiotensin-aldosterone system (RAAS), activation of the sympathetic nervous syndrome and increased inflammatory damage to the kidney related to heart failure.[6][7] Targeting this cycle is the mainstay of therapy for type 1 cardiorenal syndrome. Types 3 and 4 cardiorenal syndromes more likely result from volume overload from renal dysfunction, abnormal cardiac function in the setting of metabolic disturbances (such as acidemia), and neurohormonal changes that accompany renal disease.[8] Patients can develop type 5 cardiorenal syndrome in the setting of sepsis, systemic lupus erythematosus (SLE), diabetes mellitus, decompensated cirrhosis, or amyloidosis; all of these disorders can lead to disease in both the heart and kidney.
4)
• Abnormal lipid profile
• Diabetes
• Hypertension
• high unsaturated fats in diet
• obesity
5)
APTT & INR are the basic tests for clinical evaluation
APTT is a measure of intrinsic coagulation pathway and is used to know thrombotic activities
CASE D
https://daddalavineeshachowdary.blogspot.com/2021/05/67-year-old-patient-with-acute-coronary.html?m=1
1)
67 year old hypertensive and diabetic women with a recent history of completely treated pulmonary tuberculosis has developed sudden onset sweating on exertion and grade 4 shortness of breath at night.
At the time of presentation she had a higher level of blood sugars of about 256 milligram per deciliter. On examination bilateral inspiratory crepitations were heard.
Site: coronary artery obstruction.
Possible etiology: chrnic hypertension and diabetes
2)
Placebo has no physiological and pharmacological actions
METOPROLOL
• It is a beta blocker
• It is used to control blood pressure ,and also used in Angina and M
3)
Indications
• Acute STEMI
• Acute non ST elevation acute coronary syndrome
• Angina equivalent
• Stable and unstable angina
• Critical coronary artery stenosis
Absolute contraindications
• Non compliance with the procedure and inability to take the dual antiplatelet therapy
• Multiple percutaneous interventions re stenosis
• High bleeding risk
Relative contraindications
• Intolerance for long term antiplatelet therapy
• Short artery less than 1.5 mm
• Hypercoagulable state
• Absence of cardiac surgery backup
• High grade CKD
• Chronic total occlusion of SVG
• Critical left main artery occlusion with no graft or collateral
• Stenosis less than 50%
4)
People suffer complications including bleeding, blood clots, infection, heart rhythm disturbances and even death from heart attack if PCI is performed in a patient who does not need it
CASE E
https://bhavaniv.blogspot.com/2021/05/case-discussion-on-myocardial-infarction.html?m=1
1) The patient has first developed right sided chest pain over three days ago which was insidious in onset and gradually progressive type. The pain was radiating to back and there wa
Site: inferior wall of heart
Possible etiology : long standing Diabetes
2)
TAB. ASPIRIN 325 mg PO/STAT:
It is an NSAID which is used to releive impending MI
TAB ATORVAS 80mg PO/STAT
It is a statin which is used in patients with high cholesterol levels
TAB CLOPITAB 300mg PO/STAT
It is an anti platelet medication which is used to prevent MI OR FURTHER DAMAGE
INJ HAI 6U/IV STAT
It is regular insulin which is used to control blood levels
VITAL MONITORING.
It is necessary for constant surveillance of patient .Any abnormality in vitals should be treated immediately
3)
It would be Definitely of help As it restores a proper blood flow in the artery
CASE F
https://kattekolasathwik.blogspot.com/2021/05/a-case-of-cardiogenic-shock.html
1)
As i.v fluids are administered in order to increase the ability of heart to pump blood,it might have relieved the hypotension there by relieving the symptoms
3)
As the patient has dribbling of urine with oliguria and a previous history of TURP they might have suspected UTI and empirically ceftriaxone was given.
4) GASTROENTEROLOGY (AND PULMONOLOGY) 10 Marks
A)
https://63konakanchihyndavi.blogspot.com/2021/05/case-discussion-on-pancreatitis-with.html
1)
Evolution of symptomatology and event timeline -
• Pain abdomen and vomiting ; was treated conservatively 5 YRS AGO
• Pain abdomen and vomiting Since 1 week
• Constipation, burning micturition, fever Since 4 days
After admission -
• CT scan - showed pseudocyst
• Chest X ray - showed left pneumothorax and left pleural effusion
Site- Pancreas
Possible etiology - Chronic alcohol intake
2)
Amikacin, metronidazole and meropenam are all.given to control infection.
TPN : total parenteral nutrition
It is given to bed ridden patients.it contains carbohydrates,proteins, fats vitamins and minerals
NS/RL
It is given as fluid replacement inorder to combat dehydration
Tab.Pantop
It is a proton pump inhibitor.it is used in this case for its anti pancreatic secretory
Inj.octreotide
It is a somatostatin analogue
It decreases the secretions of pancreas
It also has anti inflammatory and cytoprotective effects
Inj.Thiamine
It is B1 supplement.
It is given here because; due to long fasting & TPN usage , body may develop B1 deficiency
Wernicke encephalopathy secondary to B1 deficiency may be caused... so a prophylactic B1 supplemention is necessary.
Inj.TRAMADOL
It is an opioid analgesic which is given to relieve pain.
3. Why did he complaint of fleshy mass like passage in his urine?
ANSWER
any clots of TURP left in URETHRA OR pus cells in the urine might have appeared as fleshy mass to him.
4. What are the complications of TURP that he may have had?
ANSWER
• TUR Syndrome
• clot retention
• UTI
• early urge incontinence
CASE C
https://chennabhavana.blogspot.com/2021/05/general-medicine-case-discussion-1.html
1)
The child would be suffering from anxiety disorder which leads to this type of behaviour.
As pointed out in the history sudden stoppage of smartphone exposure must have affected the child psychologically which in turn have led to such a behaviour
2)
As the patient has no urge of urination at night, he might be suffering from
• psychomotor disorder
• undiagnosed anxiety
3)
• antibiotic therapy
• analgesics
• suspicion of OAB - anti cholinergic therapy
7. INFECTIOUS DISEASES AND HEPATOLOGY
Case : A
https://kavyasamudrala.blogspot.com/2021/05/liver-abscess.html
3)
Yes
4)
• A large liver abscesa>5cm in diameter as it woul rupture
• Multiple liver abscess
• Liver abscess in left lobe
• Non responding to medical treatment for >7 days
8) Infectious disease (Mucormycosis, Ophthalmology, Otorhinolaryngology, Neurology) 10 Marks
Case A
http://manikaraovinay.blogspot.com/2021/05/50male-came-in-altered-sensorium.html
SYMPTOMATOLOGY
• 18TH APR: Post vaccination fever with chills and rigors
• 28TH APR: facial puffiness, generalised weakness and periorbital edema
• 4TH MAY: presented to OPD in an altered mental state
Site : RHINO ORBITO CEREBRAL DISEASE
2)
Placebo has no physiological and pharmacological actions.
Drugs given are
The proposed drug was inj.liposomal amphotericin B but due to un availability itraconazole is being given
Itraconazole is an azole group of anti fungal drugs.it is indicated in fungal infections
3)
Steroid overuse and usage of industrial oxygen
Poor hygienic conditions may all contribute to the mucormycosis
9. INFECTIOUS DISEASES- COVID 19
Case 2
https://nehapradeep99.blogspot.com/2021/05/a-50-year-old-female-with-viral.html
1)
Her HbA1C is 7.9 which means that she was having raised sugar from long time,it might have been diagnosed while performing routine diagnostic tests.
2) Diabetes ia a metabolic disease which might significantly influence pathologic processes in body.
3) D-dimers are the indicator of thrombosis.In severe covid, the pathologic events lead to vichows triad and hence monitoring and carefully evaluating the patients for thrombotic events is necessary.
CASE 21 :
https://sudhamshireddy.blogspot.com/2021/05/a-65-year-old-female-with-fever.html
1)
DIABETES is a chronic inflammatory condition which alters our metabolic state and thereby intervening in our body's response to pathogenic organisms.DIABETES SPECIFICALLY TYPE 2, characterised by hyperglycemia and insulin resistance would promote the production of glycosylation end products and pro inflammatory cytokines. In addition to this, it also promotes the production of adhesive molecules which are a key in tissue inflammation.
This may be the basic pathogenesis which not only increases the susceptibility of an individual to infections but also increases the severity.
2)
• Glycemic control : with insulin or oral agents
• limited usage of steroids
• careful monitoring of patient
• oxygenation if needed
3.)
As per the study conducted , there is an increased risk of mortality and morbidity in patients with prior history of stroke
CASE 23
1)
• Preexisting lung disease inform of tuberculosis and bronchial asthma
• diabetes mellitus
• prior attack of pneumonia
• CKD
2)
• COVID &DM are both hypercoaguable states
• this might have initiated the thrombosis in the patient which is marked by rise in D-DIMER levels
3)
* Head end elevation
*Continuous O2 inhalation
*Intermittent BiPaP
* Bronchodilator Nebulization
4)
High levels of glucose in the blood leads to accumulation of extra material in glomeruli. It increases the stress of glomeruli in turn leading to gradual and progressive scarring. Eventually leads to the development of CKD
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