SUMMATIVE ASSESSMENT 3

 QUESTION 1:

  https://2018-21batchpgy3gmpracticals.blogspot.com/2021/08/18100006003-case-presentations.html?m=1

LONG CASE

A 44 year old man presented with a 3-day history of bilaterally symmetrical rapidly progressive generalized edema.

• The history presentation was done in a very commendable manner, each and every detail was paid attention to.
• Step by step explanation was given about the case which include each and every aspect of what is required for a detailed and Crystal clear understanding about the case
• The localization of acute problem and chronic problem were also explained which I found very helpful
• The examination details are explained very well
• The investigation reports/pictures were posted along with explaination of each which helps in easy understanding 
• 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.

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 very detailed and well presented 
• Investigation pictures given along with explanations
• The examination details included explaination of certain terminology which I found very helpful
• Problem representation was also well described.

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 .

• Pictures of the patient were posted wherever necessary in which purple strips were visible very clearly
• History was described well
• The treatment plan was also presented well
• Examination details given in detail

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

1.) Poorly treated RA causing Secondary Amyloidosis (most likely)

        Secondary amyloidosis is most commonly seen in chronic poorly treated systemic inflammatory syndromes. This study shows that secondary amyloidosis is the most common cause of rapidly progressive glomerulonephritis in patients who were untreated for more than 10 years. [4] Coupled with features of amyloidosis of the heart, this is the most likely cause of his renal dysfunction.

2. Vasculitic Glomerulonephritis (IgA Mediated)

        The incidence of IgA nephropathy in patients with RA is similar to that in the general population. [5]

3. Primary Glomerulonephritis (Idiopathic)

        These include Mesangial / Mesangio-proliferative glomerulonephritis; Membranous Nephropathy; FSGS [6]

4. Renal Dysfunction secondary to drug use (less likely)

        Most commonly implicated drugs causing nephritic/nephrotic syndrome are Gold and Pencillamine, neither of which the patient used. The patient had chronic intermittent use of Etoricoxib but NSAIDS usually cause Tubulo-interstitial nephritis and not nephrotic syndrome.

5. Crystal Nephropathy (less likely)

        Gout crystals precipitate at a pH of 7.0 and often precipitated in the collecting ducts in the medulla, causing Acute Tubular Necrosis with little interstitial or glomerular involvement.

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

walking has become difficult with small, short steps and a forward stoop

stiffness in his wrists 

stiffness is present throughout the range of motion

he hasn't been having morning erections since 2 months and also reports a loss of sexual desire

The patient might be having

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

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 .

IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

TINEA CORPORIS

DENOVO HTN . 

The patient might be having endogenous Cushing also as he is slowly responding to treatment.

QUESTION 3 :

LONG CASE:

• All the possibile scenarios along with their probability of their occurrence have been explained in detail which are:

1. Poorly treated RA causing Secondary Amyloidosis (most likely)

•         Secondary amyloidosis is most commonly seen in chronic poorly treated systemic inflammatory syndromes. This study shows that secondary amyloidosis is the most common cause of rapidly progressive glomerulonephritis in patients who were untreated for more than 10 years. [4] Coupled with features of amyloidosis of the heart, this is the most likely cause of his renal dysfunction.
  
  2. Vasculitic Glomerulonephritis (IgA Mediated)
          The incidence of IgA nephropathy in patients with RA is similar to that in the general population. [5]
  
  3. Primary Glomerulonephritis (Idiopathic)
          These include Mesangial / Mesangio-proliferative glomerulonephritis; Membranous Nephropathy; FSGS [6]
  
  4. Renal Dysfunction secondary to drug use (less likely)
          Most commonly implicated drugs causing nephritic/nephrotic syndrome are Gold and Pencillamine, neither of which the patient used. The patient had chronic intermittent use of Etoricoxib but NSAIDS usually cause Tubulo-interstitial nephritis and not nephrotic syndrome.
  
  
  5. Crystal Nephropathy (less likely)
          Gout crystals precipitate at a pH of 7.0 and often precipitated in the collecting ducts in the medulla, causing Acute Tubular Necrosis with little interstitial or glomerular involvement.
• Each and every symptom was taken into consideration before arriving into a final diagnosis 
• Explaination was given for each and every symptom which rules out the possibilities of other diagnoses 

The efficacies of febuxostat and allopurinol were compared and an abstract was given which I found very helpful

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 was diagnosed with 

1. Idiopathic Parkinson's Disease Stage 1 with denovo HTN.

2. Multiple System Atrophy - Parkinsonian Type (MSA-P).

 

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 final diagnosis was IATROGENIC CUSHINGS SYNDROME SECONDARY TO TOPICAL CLOBETASOL APPLICATION ALL OVER BODY FOR APPROXIMATELY ONE YEAR.

• It was mentioned that the patient might also be having endogenous Cushing as he is responding slowly to treatment, however it had to be reviewed after 15 days.

QUESTION 4:

https://13medhabaswa.blogspot.com/2021/07/general-medicine-e-log.html

QUESTION 5:

This logging experience had been  very good as I got to learn new things, the logs given to us were very wonderful in which the case was presented in a commendable way, especially the history. This had taught me how to present a case ,what should be kept in mind while presenting, and also, what should not be done. I am glad to have got this opportunity of making blog as a bimonthly assessment in which I get to see amazing work of my seniors and learn from them.