28 Chikatla Laharisha

Ch.Laharisha

Roll no.28 

3rd semester

BIMONTHLY BLENDED ASSIGNMENT, AUGUST 2021

We have been given an assignment to analyze and review three long and short cases.

QUESTION-1

https://2018-21batchpgy3gmpracticals.blogs

pot.com/2021/08/18100006003-case-presentations.html?m=1

   

Long case:

The long case is presented based on acute glomerulonephritis.A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.The present illness of the patient is very well described upto the date and daily symptoms,,the difficulties of the patient ,,the task which can be performed easily and what can't be done by the patient are given.His personal history is taken in a detailed manner.The patient presented with anasarca and frothing urine which decreases the urine output in renal pathology.This is aimed as localisation of the acute problem of patient.The chronic disease of the patient is Bilaterally Symmetric Chronic Progressive Inflammatory Peripheral Polyarthritis.The clinical examination is done in all the aspects.The systemic examination is done briefly,which can be noticed that there is puffiness of the face and bilateral pedal edema.The positives for appendicular skeleton is written nicely taking the patient condition into consideration.Other investigations related to kidney dysfunction are posted and the treatment and the function of the drug are given in a proper manner which can be easy to understand.Overall the presentation was nicely done.

Short case-1

The patient is suffering with Parkinson disease.He was not able to use his thumb andright index finger.The clinical examination with sensory system and motor system are done in a nice manner.The general examination shows no abnormalities.His higher mental functions related to language,reading and writing are impaired.There is a cog wheel type of rigidity at the wrihst which shows the Parkinsonism.The cardiac examinations are done.overall the presentation is good but can add more points for reaching a diagnosis.

Short case-2

A 19year old male with Cushing syndrome.For Cushing syndrome some of the symptoms are seen like distended abdomen and dark stria over the abdomen and gynaecomastia.This patient presented with all of them which can be led to the provisional diagnosis. we take the hormone level into consideration.patient photographs are posted accordingly before one year and when the patient is presented in op.The dermatologist opinion is taken and treatment is given accordingly and the condition was taken till date.

QUESTION-2:

LONG CASE

Problem list:

A 44 year old stonemason from Miriyalguda, presented with a 3 day history of anasarca, frothy urine and gradually decreasing urine output, on a background of a 10 year history of chronic bilaterally symmetric polyarthritis (evidenced by severe pain, edema and limitation of joint movements).

Final diagnosis:Acute Glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis.

Dilutional Hyponatremia secondary to Anasarca due to Glomerulonephritis

Hyperuricemia likely due to decreased Uric Acid Excretion Precipitating Gouty Arthritis

Anemia of Chronic Disease secondary to Poorly Treated Rheumatoid Arthritis

Differential diagnosis:

Rheumatoid arthritis

Treatment:1.Free water restriction for Hyponatremia

2.Tab. PREDNISOLONE P/O 20 mg OD

3.Tab FEBUXOSTAT P/O 80 mg OD

4.Haemodialysis for worsening renal dysfunction

Short case-1

Problem list:

A 49 year old patient presented with a 2 month history of progressive asymmetric involuntary movements of his right index and middle fingers.cant able to move those fingers and the wrist is stiffened.walking became difficult with short steps.difficlty in staring up with loss of sexual desire.. irregular bowel habits are seen.not speaking properly since two months

Treatment:

1. Tab. Syndopa Plus 125 mg QID

2. Tab. Syndopa 125 mg CR OD

3. Tab. Telma 40 mg OD

Short case-2

Problem list:

A 19 year old male came with complaints of:Itchy Ring leisons over arms ,abdomen ,thigh and groin since 1 and half year .

2.Purple stretch marks all over abdomen ,lower back ,upper limbs ,thighs since 1 year .

3.Abdominal distension and facial puffiness since 6 months.4.Pedal edema since 3 months.

5.Low back ache since 3 months .

6.Feeling low , not feeling to talk to anyone.

7.Weight gain and decreased libido since 3months.

8.Loss of libido and erectile dysfunction since 2 months .

Patient presented to opd with:

Treatment:

tab telma 20 mg od .

INJECTING 0.4 ML OF ACTOM PROLONGATUM INJECTION (ACTH) INTRA MUSCULAR.

TAB HIZONE 15 mg per day in three divided doses @ 8am ,12 pm and 4 pm.

  

QUESTION-3:

Long case:

To reach the diagnosis of acute glomerulonephritis:

Hypertension (secondary hypertension in Glomeulonephritis)

Haematuria on Urine Microscopy (particularly dysmorphic RBCs in urine)

Quantification of Proteinuria

Serum Albumin / Total Proteins

Urine specific gravity / calculated urine osmolality to check for isosthenuria (to look for secondary tubular/interstitial damage) 

 Renal biopsy, if diagnosis remains uncertain

 To reach the diagnosis of inflammatory polyarthritis:

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 .

1.Febuxostat decreases the amount of uric acid in the body.

2.tab prednisolone 20mg is used to treat arthritis

Short case-1:

Nervous system examination is done to the patient because of language, reading and writing problem which showed an impairment.The wrist shows  cogwheel type of rigidity which is a feature of parkinsons.the examinations of brain are done in order to check whether cerebrum , cerebellum are involved in this.there are no intentional tremors and absence of knee jerk.the coordination tests are done which are normal.the rhombergs sign is negative.micrographia a test to elicit the bradykinesia component of Parkinson is positive.

1.syndopa plus is a combination of two medicines Levodopa and carbidopa used to treat the symptoms of Parkinson disease such as tremors, stiffness and slowness of movements

2.tablet telma is used to treat high blood pressure and heart failure

Short case-2:

General examination is a must for Cushing's patient.Pedal edema present - pitting type extending upto knee.

Abdominal distension present.

Moon face present

Pink striae noted over anterior abdominal wall and on low back and on upper arms and thighs.

Thin skin present . 

Poor healing noticed over leg ulcers and easy bruising noted .

Acne present over face .

Acanthosis nigrans noted over neck.

GYNECOMASTIA PRESENT .

Buffalo hump present .

Sparse scalp hair .

All these symptoms lead to the diagnosis of Cushing's syndrome.

  1.amlorfine is an antifungal medication.

2.tab hisone is used for allergies, anaphylaxis, asthma, rheumatoid arthritis

QUESTION-4:

I have not prepared an elog yet.will post it soon after it's done.

QUESTION-5:

This assignment which is meant to analyze the three cases is very helpful.there are three common cases which are acute glomerulonephritis,Cushing syndrome and Parkinsons disease.These are actually taught in our theory classes in first mbbs but an actual case presentation based on this diseases are introduced to us for the first time which is very helpful.the cases are explained coherently so that everything can be understandable according to our knowledge although some terms are out of box.the symptoms, examination, diagnosis and treatment are given in an appropriate manner in which we can understand .these assignments can be very helpful during the pandemic as we are not out for postings yet.i learnt a lot of new things from this and yes ,,they are really meaningful.