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Showing posts from June, 2021

10.

  It was a wonderful learning experience from all the cases we have seen online. Due the efforts of our general medicine department , it is making a a lot of help to connect to subject as well as patients nd not waste our time

NEPHROLOGY(A)

 1.what could be the cause for his SOB Ans- His sob was is due to Acidosis which was caused by Diuretics 2. Reason for Intermittent Episodes of drowsiness  Ans-Hyponatremia was the cause for his drowsiness  3.why did he complaint of fleshy mass like passage inurine Ans-plenty of pus cells in his urine passage  appeared as  fleshy mass like passage to him 4. What are the complicat ions of TURP that he may have had Ans-         Difficulty micturition         Electrolyte imbalances          Infection

CARDIOLOGY(E)

 A1.   Evolution of symptomatolgy: 8yrs back- diagnosed with DM 3 days back- developed chest pain radiating to back and dragging type since morning - giddiness and profuse sweating. Anatomical localization in this pt. is heart primary etiology is uncontrolled DM nd inferior wall MI A2. TAB. ASPIRIN 325 mg PO/STAT TAB ATORVAS 80mg PO/STAT TAB CLOPIBB 300mg PO/STAT INJ HAI 6U/IV STAT A3. starting PTCA after 12 hours is acceptable but after 3 days is not correct and can lead to complications.

CARDIOLOGY(D)

 A1. Evolution of symptomatology : 12yrs ago- diagnosied with DM. 1yr ago  - has heartburn like symptoms which are relieved without medication 7months ago- diagnosed with TB nd took treatment 6months ago- diagnosed with HTN  1/2 hour back- SOB grade 4 Anatomical localization in this patient is Heart. primary etiology is partial bloakage in coronary artery. A2. INDICATIONS: Acute ST-elevation myocardial infarction (STEMI) Non–ST-elevation acute coronary syndrome (NSTE-ACS) Unstable angina. Stable angina. Anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope) High risk stress test findings.          CONTRAINDICATIONS : Intolerance for oral antiplatelets long-term. Absence of cardiac surgery backup. Hypercoagulable state. High-grade chronic kidney disease. Chronic total occlusion of SVG. An artery with a diameter of <1.5 mm. A3. when PCI is  performed in pt. who does not need it ..it lead to complications. Harms of over treatme...

CARDIOLOGY(C)

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 A1.   Evolution of symptomatology and event timeline -  Past- 10yrs ago - Operation for Hernia Since 2-3 yrs - Facial puffiness 1 yr ago - SOB grade II 1 yr ago - was diagnosed with Hypertension. When the patient came to OPD -  Since 2 days - SOB which progressed from Grade II to Grade IV. Since 2 days - Decreased urine output. Since 1 day - Anuria After admission -  CT scan - Showed dilated pulmonary vessels and thrombi in the atria. 2D Echo - Showed LV dysfunction. Anatomical location - Atria (SA node) A2. Digoxin - It is a cardiac glycoside              MOA - It increases intracellular sodium that will cause an influx of calcium in the heart and cause an                     increase in contractility. It is vagomimetic.               Indications - Heart failure and arrhythmias.           Carvediol - It...

PULMONOLOGY(A)

 A1. Evolution of symptomatology and Event timeline- 20 Years ago - SOB Grade1 for a week , occurred every year for the same duration 18 Years ago- Polyuria and was diagnosed with DM 12 Years ago - SOB Grade 1 for a month 1 Month ago - Weakness was giving IV 30 Days ago - SOB ( latest episode) gradually progressive 20 Days ago - HRCT showed Bronchiectasis 15 Days ago - Pedal edema and facial puffiness 2 Days ago - SOB Grade 4 , drowsiness and  decreased urine output.  Anatomical location of the problem is BRONCHIOLES. Primary etiology is rice dust exposure as patient is a farmer working in paddy fields. A2. Augmentin - Amoxicillin + Clavulanic acid. A3. The pt. was started on antitubercular drugs even though she was tested negative for AFB. ATT includes drugs like ISONIAZIDE , RIFAMPACIN , ETHAMBUTOL , PYRAZINAMIDE AND STREPTOMYCIN . ISONIAZIDE can cause side effect like hypersensitivity reaction. COPD is a also an allergic which might have exacerbated due to use of isoni...

NEUROLOGY(E)

 Questions: 1) What could have been the reason for this patient to develop ataxia in the past 1 year? The patient has minor unattended head injuries in the past 1 yr. According to the CT scan, the patient has cerebral haemorrhage in the frontal lobe causing probably for the occurrence of Frontal love ataxia 2) What was the reason for his IC bleed? Does Alcoholism contribute to bleeding diatheses ? The patient has minor unattended head injuries. During the course of time the minor hemorrhages if present should have been cured on their own. But the patient is a chronic alcoholic. This might have hindered the process of healing or might have stopped the healing rendering it to grow further more into 13 mm sized hemorrhages occupying Frontal Parietal and Temporal lobes

NEUROLOGY(H)

 1) What can be  the cause of her condition ?          According to MRI  cortical vein thrombosis might be the cause of her seizures.              2) What are the risk factors for cortical vein thrombosis? 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 3)There was seizure free period in between but again sudden episode of GTCS why?r...

NEUROLOGY(B)

  1)      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 patients problem? ANS. Timeline of the patient is as follows- 7 days back- Patient gave a history of giddiness that started around 7 in the morning; subsided upon taking rest; associated with one episode of vomiting 4 days back- Patient consumed alcohol; He developed giddiness that was sudden onset, continuous and gradually progressive. It increased on standing and while walking. H/O postural instability- falls while walking Associated with bilateral hearing loss, aural fullness, presence of tinnitus Associated vomiting- 2-3 episodes per day, non projectile, non bilious without food particles Present day of admission- Slurring of speech, deviation of mouth that got resolved the same day Anatomical location- There is a presence of an infarct in the in...

INFECTIUOS DISEASES(MUCORMYCOSIS)

  QUESTION1:  What is the 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 aetiology of the patient's problem? 1.     3 years ago- diagnosed with hypertension 2.     21 days ago- received vaccination at local PHC which was followed by fever associated with chills and rigors, high grade fever, no diurnal variation which was relieved on medication 3.     18 days ago- complained of similar events and went to the the local hospital, it was not subsided upon taking medication(antipyretics) 4.     11 days ago -   c/o Generalized weakness and facial puffiness and periorbital oedema. Patient was in a drowsy state 5.     4 days ago-   a.     patient presented to casualty in altered state with facial puffiness and periorbital oedema and weakness of right upper limb an...

INFECTIOUS AND HEPATOLOGY(A)

 A1. Locally made alcohol is not prepared under asegtic conditions ,it could be bacterially contaminated. This could have lead to liver abscess in this patient. A2. Most likely this is due to the unhygienic practices commonly seen at the drinking taverns or cottages in many tropical countries. The important finding observed in most of the studies is that majority of ALA patients are from a poor socioeconomic background and are manual laborers . Poor hygiene has been associated with increased risk of amoebic liver abscesses and is directly proportionate to disease progression and extent of liver injury Parasite cysts are transmitted through contaminated food and water, making the incidence of disease high in areas of poor sanitation.  asymptomatic intestinal amoebiasis is also common ethanol could influence several factors to make individuals infected with amoeba to develop extraintestinal invasion.  Alcohol has a significant influence on both cell-mediated and humoral i...

INFECTIOUS DISEASE HEPATOLOGY(B)

 A1. Most likely cause is Amoebic liver abscess because of the following findings:             - Age of the patient             - Single abscess             - Right lobe involvement A2.  - right hypochondriac and epigastric pain , fever ➡ can be liver, biliary or right lower lobe pneumonia -Invesigations:          -CBP : Leucocytosis          -LFT : Elevated Alkaline phosphatase          -RFT           -Urine analysis           -USG : Single hyperechoic   oval shaped mass in right lobe                               ...

INFECTIOUS DISEASES(A)

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  A1. Dysphagia associated with cough after eating due to entry of food and liquids into trachae is the common presentation of tracheo oesophagal fistula(TOF)      In adults TOF is generally seen with malignancies of mediastinum but this patient has a positive history of TB which can be the cause of TOF in this patient(due to erosion)  A2. IRIS can be prevented by initiating the ART before the development of advanced Immunosuppression i.e starting the therapy before CD4 cell count decreases more This patient has  CD4 count of 420 when ART is initiated .So this patient has very less chances of developing IRIS.

GASTROENTEROLOGY(B)

  A1. ·          The cause of pancreatitis in this case can be attributed to ALCOHOL.                                                            In acute pancreatitis                                                                  ↓                           Premature activation of zymogen granules in pancreas                                 ...

GASTROENTEROLOGY(A)

  A1. Evolution of symptomology : ·         5 yrs. back patient had pain abdomen & vomiting’s - was taken to a local hospital and treated conservatively. ·         He stopped taking alcohol - advised by the physician and was symptom free for nearly 3 yrs., again started alcohol consumption following which he had recurrent episodes of pain abdomen & vomiting  ·         Last year he had almost 5-6 episodes and got treated by a local RMP. ·         In past 20 days – he consumed increased amount of alcohol (5 bottles of toddy per day)  ·         last alcohol - 1 week back following which he again had pain abdomen & vomiting from 1 week and fever from 4 days. ·         Presently patient complained of pain in umbilical, left hypochondriac, left l...