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M varshith roll no 85

General medicine monthly assignment 


Question 1

LONG CASE

This is a case of Acute Glomerulopathy (Glomerulonephritis / Nephrotic syndrome)

REVIEW

I appreciate the diagnostic approach given in the blog, it paid attention to all the possibilities, ruled out one by one and arrived to a final diagnosis.The localization of acute problem and chronic problem were also explained which I found very helpfulThe examination details are explained very wellEvolution of symtomatology was described in detail manner. There was also a detailed explanation of the patient's acute and chronic problem.There are 5 pedagogic questions were explained in the case which was given pinpoint explaination related to the case

Short case 

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.

Present illness with evolution of symptomology is perfectly described,Other histories with examinations done are given,Pictures provided clearly indicate it as a case of cushings syndrome, They also explained ruling out endogenous cushings syndrome and giving a final diagnosis of iatrogenic.

Question 2

Long case 

Problem list:-Generalized edemaFacial puffiness with pedal edema Bilaterally symmetric, pitting type pedal edemaBreathlessness, palpitations or chest painFrothing of urine Decreasing urine outputSevere joint painsWeight loss and loss of appetite Subcutaneous swellings in proximal joints of his fingers Proteinuria causing anasarca
Diagnosis:-Acute Glomerulopathy (Glomerulonephritis/Nephrotic syndrome) Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral PolyarthritisAcute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.Dilutional Hyponatremia secondary to Anasarca due to GlomerulonephritisHyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthriti Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis

Treatment:-*Free water restriction for Hyponatremia

*Tab. PREDNISOLONE P/O 20 mg OD*

Tab FEBUXOSTAT P/O 80 mg OD,Haemodialysis for worsening renal dysfunction.

Question 3

INVESTIGATIONS 
 
X-rays can help detect bone damage (erosions) that occurs as a result of long-standing rheumatoid arthritis. They can also detect a narrowing of the joints space, which occurs when cartilage degrades and the bones.
ESR
People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sedimentation rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body
TREATMENT   Tab. PREDNISOLONE  Low doses of prednisone are safe and effective in the management of RA. Yet, some clinicians continue to manage their RA patients with glucocorticoid doses that are too high or avoid them altogether. Glucocorticoids in low doses have proven to be very effective in suppressing the inflammation associated with RA.
Tab FEBUXOSTAT
ebuxostat (Uloric) is a medication that lowers the levels of uric acid in the body. It is used for the chronic management of gout. It blocks the active site on xanthine oxidase, preventing the conversion of hypoxanthine and xanthine to uric acid.


 Question 4

I did not get chance to do  this month's  elog .


Question 5 

  It has been an wonderful  experience  till now. with the help of e log we are able to read multiple patient  cases and also give peer review  of it  .and we were also given  chance to create our own e logs and I  have learnt a lot from thanks tho the general medicine department and our hod sir it has been a good experience 




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