may month assignment. T RAJESH ROLL.133
Online blended monthly assignment toward summative assessment for the month of May 2021
Name: TEJAVATH RAJESH
Roll no: 133
Batch: 2017
Semester: 8TH SEMESTER
I have been given the following cases to solve in an attempt to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment plan.
This is the link of the questions asked regarding the cases:http://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=1
Below are my answers to the Medicine Assignment based on my comprehension of the cases.
Neurology
CASE 1)
(Q.1)Is there any relationship between occurrence of seizure to brain stroke. If yes what is the mechanism behind it?
Ans. Stroke. Leads to seizures
20%of people with stroke experience seizures
Mech...
Stroke --leads to scar formation in brain----changes in electric activity----seizures
Stroke--low threshold for depolarisation,hypoxia,metabolic dysfunction
Alll these leads to seizures
(Q.2)In the previous episodes of seizures, patient didn't loose his consciousness but in the recent episode he lost his consciousness
Ans...because of ischemia caused due to stroke
Q.1) What could have been the reason for this patient to develop ataxia in the past 1 year?
Ans..Ataxia usually develops as a result of damage to a part of the brain that coordinates movement (cerebellum). History of multiple falls when inebriated and history of minor head injuries that were left unattended.
Q.2)What was the reason for his IC bleed? Does
Ans..Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself — a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma.
((((An intracerebral hemorrhage (ICH) is usually caused by rupture of tiny arteries within the brain tissue (left). As blood collects, a hematoma or blood clot forms causing increased pressure on the brain.)))
...Alcoholism contribute to bleeding diatheses ?
Ans.yes
Excessive drinking isn't good for anyone, but it is especially dangerous for people with bleeding disorders, potentially leading to falls and brain bleeds. Alcohol use is also known to raise blood pressure, and high blood pressure is already associated with blood disorders.
Case (3)
Q.no.1)
What is myelopathy hand ?
There is loss of power of adduction and extension of the ulnar two or three fingers and an inability to grip and release rapidly with these fingers. These changes have been termed "myelopathy hand
Q.2)2)What is finger escape ?
Ans.
Wartenberg's sign is a neurological sign consisting of involuntary abduction of the fifth (little) finger, caused by unopposed action of the extensor digiti minimi. ... This finding of weak finger adduction in cervical myelopathy is also called the "finger escape sign".
Q3)3)What is Hoffman’s reflex?
Ans.The Hoffman sign is an involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down. The reflexive pathway causes the thumb to flex and adduct quickly.
(Case.4)
Qn.1)1.Does the patient's history of road traffic accident have any role in his present condition?
Ans..yes RTA lead to CVA
QN.2)2.What are warning signs of CVA?
Ans..The warning signs of stroke are:
- Sudden onset of weakness or numbness on one side of the body.
- Sudden speech difficulty or confusion.
- Sudden difficulty seeing in one or both eyes.
- Sudden onset of dizziness, trouble walking or loss of balance.
- Sudden, severe headache with no known cause
Qn.3)
3.What is the drug rationale in CVA?
Supportive treatment
Anti platelets
Anti coagulants
Vaso dailators
Ans..
Qn.4)
Does alcohol has any role in his attack?
Ans..Previous research suggests that regular heavy alcohol consumption increases the risk for ischemic stroke, whereas frequent light to moderate alcohol intake may decrease the risk. However, the risk of ischemic stroke associated with transient exposure to alcohol remains unclear.
Qn.5)5.Does his lipid profile has any role for his attack??
Ans .no all clear
Case 5)
Qn.1)
What can be the cause of her condition ?
Ans .
Acute cortical vein thrombosis with hemorrhagic venous infarction involving Right posterior temporal lobe with midline shift to left by 4mm.
Q .2)What are the risk factors for cortical vein thrombosis?
Ans .The causes and risk factors of CVT include genetic and acquired prothrombotic disorders, pregnancy, oral contraceptive pills (OCP), deep vein thrombosis (DVT) and central nervous system infections. There is geographic variation in the causes of CVT..
Qn.3)What drug was used in suspicion of cortical venous sinus thrombosis?
Ans intravenous heparin is thefirst-line treatment for cerebral venous sinus thrombosis because of its efficacy, safety and feasability.
Case 6)
Q.1)1.What are the possible causes for heart failure in this patient?
Ans .anemia
Diabetes
Hypertension
Alcoholism
Qn.2)what is the reason for anaemia in this case?
Ans..
Anemia is one of the commonest and prevalent blood-related disorder occurs in patients with diabetes. It mostly occurs in DM patients who also have renal impairment. Evidence indicates that the existence of anemia among T2DM is typically associated with the failure of the kidney to produce appropriate erythropoietin
Qn.3)
3.What is the reason for blebs and non healing ulcer in the legs of this patient?
Ans..
These are known as diabetic blisters, bullosis diabeticorum, or diabetic bullae. Diabetic blisters are relatively rare but reports on how often they develop vary. Blisters typically occur in people who do not control blood sugar well. They are painless and tend to heal on their own without treatmen...
Reason ...peripheral neuropathy
Qno.4)What sequence of stages of diabetes has been noted in this patient?
Ans...stage 1: defined as DCBD 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
Qn 1)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 etiology of the patient's problem?
Ans..
* Patient was apparently asymptomatic 5 yrs back when he had painabdomen & vomitings for which he was taken to a local hospital and treated conservatively.
* Following that he stopped taking alcohol as advised by the physician and was symptom free for nearly 3 yrs.
* Later he again started taking alcohol following which he had recurrent episodes of pain abdomen & vomiting
* (5-6 episodes in the past 1 year) which were treated by a local RMP.
* From the past 20 days he had increased amount alcohol consumption (5 bottles of toddy per day)
* Last binge of alcohol 1 week back following which he again had pain abdomen & vomiting from 1 week and fever from 4 days.
* abdominal pain in umbilical, left hypochondriac, left lumbar and hypogastric regions.
* Abdominal pain was incresed after food intake.
* Pain is throbbing type and radiating to back and is associated with nausea and vomiting( 1 episode) , which is non bilious, non projectile and also has food particles and water content 1 week.
* Fever was high grade, continuous and associated with chills and rigors.
* Not associated with loose stools.
* Then he developed constipation since 4 days and passing flatus.
* patient also had burning micturition since 4 days, which is associated with suprapubic pain, increased frequency and urgency
Qno.2)
What is the efficacy of drugs used along with other non pharmacological treatment modalities and how would you approach this patient as a treating physician?
Ans.. drugs mainly not clear but supportive treatment is main stay...
*Fasting. You'll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover.
*Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet.
*If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.
*Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
*Intravenous (IV) fluids. As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you'll receive extra fluids through a vein in your arm during your hospital stay.
Qn.1)What could be the reason for his SOB ?
Ans.
urine that is very dark
confusion
lower urine output
itching skin or skin rashes from waste buildup
pressure or pain in the chest
shortness of breath
swelling in the lower extremities
unexplained nausea
Sob cause may be aki
Qn.2)Why does he have intermittent episodes of drowsiness?
Ans..Sleep disorders are prevalent in patients with chronic kidney disease (CKD) in particular those with end stage renal disease (ESRD)[1]. It has been reported that 80% of ESRD patients receiving dialysis report sleep complaints, with daytime sleepiness to be the most common reported symptom
Qn 3)Why did he complaint of fleshy mass like passage in his urine?
Ans...may be acute cystitis
Glassock. Historically, persistent foamy urine noticed upon voiding is considered a warning sign of kidney disease. Foamy urine is characterized by the appearance and persistence of multiple layers of small to medium bubbles in urine voided into a container, such as a toilet bowl.
Qn.4)What are the complications of TURP that he may have had?
Ans..Bladder injury.
Bleeding.
Blood in the urine after surgery.
Electrolyte abnormalities.
Infection.
Loss of erections.
Painful or difficult urination.
Retrograde ejaculation (when ejaculate goes into the bladder and not out the penis
Qn.1)
Ans...Patient gave a history of giddiness 7 days back. It started at around 7 am when the patient was doing his usual morning routine. He suddenly felt giddy and took rest, after which it subsided briefly. This was associated with 1 episode of vomiting on the same day.
- Patient was asymptomatic for 3 days, after which he consumed a small amount of alcohol.
- He then developed giddiness, that was sudden in onset, continuous and gradually progressive. It increased in severity upon getting up from the bed and while walking.
- This was associated with Bilateral Hearing loss, aural fullness and presence of tinnitus.
- He has associated vomiting- 2-3 episodes per day, non projectile, non bilious containing food particles.
- Patient has H/o postural instability- he is unable to walk without presence of supports, swaying is present and he has tendency to fall while walking
Location of problem..CEREBELLUM
Etiology..may be alcoholism
Qn.2)Did the patients history of denovo HTN contribute to his current condition?
Ans may not be accurate. We report a rare presentation of uncontrolled hypertension with episodic vertigo and ataxia, isolated cerebellar oedema on cranial MRI and secondary obstructive hydrocephalus.
Qn.3)Does the patients history of alcoholism make him more susceptible to ischaemic or haemorrhagic type of stroke?
Ans..Alcohol causes cerebellar dysfunction and cerebellar ataxia is a common feature in alcoholics. Alcohol exposure during development also impacts the cerebellum.
Qn.1)
. Do you think drinking locally made alcohol caused liver abscess in this patient due to predisposing factors
present in it ?
Ans..yes may be. Sometimes ..mostly bloodstream infection
Qno.2)
What could be the cause in this patient ?
Ans.. alcoholism
Qno.3)What is the etiopathogenesis of liver abscess in a chronic alcoholic patient ? ( since 30 years - 1 bottle per day)
Conclusion:From our study it was undoubtedly proved that alcoholism, mainly consuming locally prepared alcohol plays a major role as a predisposing factor for the formation of liver abscesses that is both amoebic as well as pyogenic liver abscess because of the adverse effects of alcohol over the Liver.
Ans..
The usual pathophysiology for pyogenic liver abscesses is bowel content leakage and peritonitis. Bacteria travel to the liver via the portal vein and resides there. Infection can also originate in the biliary system. Hematogenous spread is also a potential etiology
Qn.4)Is liver abscess more common in right lobe ?
Ans left lobe .... blood supply.. inferior mesentric,splenic veins............RIGHT LOBE ... superior mesenteric,portal veins....so streaming effect ofportal circulation is causative
Qno.5)4.What are the indications for ultrasound guided aspiration of liver abscess ?
Ans..The indications for drainage of amebic liver abscess include the following: Presence of a left-lobe abscess more than 10 cm in diameter. Impending rupture and abscess that does not respond to medical therapy within 3-5 days.
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