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BIMONTHLY BLENDED ASSESSMENT JUNE

 Question 1: Competency tested for Peer to peer review and assessment : 


Please go through one particular answer of ten students in this link:
and share your peer review of each answer with your quantitative marking input as well as qualitative insights into what was good or bad about the answer. 

Answer :




Quantitative inputs
  • The history was well presented chronologically
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only bronchi and bronchioles were affected?
  • Brief info about each pharmacological and nonpharmacological technique was given but the specific mechanism of action of some of the drugs was not mentioned as well as there was no mention of any indication or efficacy of such interventions.
  • The blog lists all the possible causes for acute exacerbation in this patient as well as in other patients

Qualitative insights
  • The anatomical location and primary etiology listed would have made more sense if the disease etiopathogenesis was discussed briefly
  • The blog discusses the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was well explained.

Quantitative inputs
  • The history was well presented chronologically in bullets
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only lungs were affected?
  • Brief info about only a few pharmacological and nonpharmacological techniques was given and no specific mechanism of action of the drugs was mentioned
  • The blog doesn't list all the possible causes for acute exacerbation in this patient 

Qualitative insights
  • The anatomical location and primary etiology listed would have made more sense if the disease etiopathogenesis was discussed briefly
  • The blog doesn't discuss the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not explained and skipped

Quantitative inputs
  • The history was well presented chronologically in bullets
  • the anatomical location wasn't mentioned
  • Brief info about only a few pharmacological and nonpharmacological techniques was given and no specific mechanism of action of the drugs was mentioned
  • The blog doesn't list all the possible causes for acute exacerbation in this patient
Qualitative insights
  • The anatomical location and primary etiology haven't been explained at all
  • The blog doesn't discuss the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not explained properly



Quantitative inputs
  • The history was very well presented chronologically 
  • the anatomical location wasn't mentioned
  • Pharmacological and nonpharmacological interventions were discussed in great details
  • It also listed all possible causes for acute exacerbation 
  • overall a well-presented blog however some of the answers were incomplete and need further elaboration
Qualitative insights
  • The anatomical location and primary etiology haven't been explained at all
  • The blog discusses the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not explained properly 


Quantitative inputs
  • The history was well presented chronologically 
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only bronchi and bronchioles were affected?
  • Pharmacological and nonpharmacological interventions were discussed in great details
  • An attempt was made to explain the cause for acute exacerbation 
  • overall a well-presented blog however some of the answers were incomplete and need further elaboration
Qualitative insights
  • An attempt was made to correlate etiology with the symptomatology
  • The blog discusses the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not properly discussed



As the blog content is same as that in blog 2 hence my opinion remains the same

Quantitative inputs
  • The history was well presented chronologically in bullets
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only lungs were affected?
  • Brief info about only a few pharmacological and nonpharmacological techniques was given and no specific mechanism of action of the drugs was mentioned
  • The blog doesn't list all the possible causes for acute exacerbation in this patient 

Qualitative insights
  • The anatomical location and primary etiology listed would have made more sense if the disease etiopathogenesis was discussed briefly
  • The blog doesn't discuss the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not explained and skipped

Quantitative inputs
  • The history was well presented chronologically in bullets
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only lungs were affected?
  • Brief info about only a few nonpharmacological techniques was given and no specific mechanism of action of the drugs was mentioned
  • The blog doesn't list all the possible causes for acute exacerbation in this patient 

Qualitative insights
  • The anatomical location and primary etiology listed would have made more sense if the disease etiopathogenesis was discussed briefly
  • The blog doesn't discuss the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the causes of the patient's electrolyte disturbance were well listed out


Quantitative inputs
  • The history was well presented chronologically 
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only bronchi and bronchioles were affected?
  • Pharmacological and nonpharmacological interventions were discussed in great details
  • An attempt was made to explain the cause for acute exacerbation
Qualitative insights
  • An attempt was made to correlate etiology with the symptomatology
  • The blog discusses the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not discussed


Quantitative inputs
  • The history was very well presented chronologically 
  • the anatomical location wasn't mentioned
  • Pharmacological and nonpharmacological interventions were discussed in great details
  • It also listed all possible causes for acute exacerbation 
  • overall a well-presented blog however some of the answers were incomplete and need further elaboration
Qualitative insights
  • The anatomical location and primary etiology haven't been explained at all
  • The blog discusses the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the cause of the patient's electrolyte disturbance was not explained properly 

BLOG LINK 10

Quantitative inputs
  • The history was well presented chronologically 
  • It would have been better to explain how the anatomical location correlates clinically like why this patient had pedal edema if only lungs were affected?
  • Brief info about only a few nonpharmacological techniques was given and no specific mechanism of action of the drugs was mentioned
  • The blog lists the possible causes for acute exacerbation in this patient 

Qualitative insights
  • The anatomical location and primary etiology listed would have made more sense if the disease etiopathogenesis was discussed briefly
  • The blog doesn't discuss the usefulness of each of the given interventions for the patient.
  • They could have discussed how ATT affects or protects the lungs from the development of COPD in more detail
  • Lastly, the causes of the patient's electrolyte disturbance was discussed in great detail


Q2) Share the link to your own case report of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. 

Answer:


Q3) (Testing peer review competency of the examinees) :


Please go through the cases in the links shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.

Answer

  • The history seems to be self-contradicting as it says the patient was diagnosed with DM2 5 yrs ago in HOPI but again says it was diagnosed 10 yrs ago in past history
  • In chief complaints and HOPI patient gave a history of high-grade fever for 10 days but in vitals, it was documented as afebrile?
  • the unit for measurement of oxygen saturation has been mixed up with that of blood pressure
  • The systemic examination has been well described covering all systems 
  • The investigations carried out have been mentioned date wise thus allowing one to see the trends in rise and fall of values
  • The day-wise treatment plan is giving an indirect insight into the condition of the patient 
Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient-centered data as in their 'original' answers to the assignment for May 2021):

Please analyze the above-linked patient data by first preparing a problem list for each patient (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. Also include the review of the literature around sensitivity and specificity of the diagnostic interventions mentioned and same around the efficacy of the therapeutic interventions mentioned for each patient. 

Answer :

Problems expressed by the patient
  • Pedal edema
  • Decreased urine output
  • Burning micturition
  • fever
Problems discovered during the examination
  • Pallor
  • Pitting type of pedal edema
Diagnostic interventions
  • complete urine examination - done for differential diagnosis of AKI
  • Serum creatinine - gives an indirect estimate of functioning of kidneys as it correlates with GFR but may get affected by other factors too and hence is not considered the most specifc test
"isolated use of sCr concentration may not reflect the actual degree of kidney function of a certain patient. This is because multiple factors affect the concentration of sCr and because the inverse relationship between sCr and GFR is nonlinear, especially in patients with near-normal renal function."
  • Hemogram - done to diagnose anemia which might indicate the disease severity
"The contributory effects of anemia to AKI are likely multifactorial. The presence of lower hemoglobin predisposes patients to renal hypoxia and oxidative stress. In addition, many anemic patients have a subclinical renal disease which increases the susceptibility to renal insults "
  • Bacterial culture and sensitivity - done to rule out the organism responsible for sepsis
  • Serum electrolytes - Electrolyte disturbances are very commonly associated with AKI and need to be corrected promptly 

therapeutic interventions 
  • LASIX ( furosemide)- It was used both as a loop diuretic to decrease the pedal edema as well as an antihypertensive to control the high blood pressure again by its diuretic property to reduce the blood volume. It also provided the added advantage of increasing the renal excretion of potassium thus correcting the hyperkalemia.
  • NORFLOX -Norfloxacin belongs to oral fluoroquinolone antibiotics chiefly eliminated by kidneys and therefore useful in the treatment of urinary tract infections.
  • OROFER - Its a combination of iron and folic acid to correct the anemic status of the patient however if it is renal anemia simply prescribing iron won't suffice and erythropoietin injections may be needed
  • SHELCAL CT- It contains vit D3 and calcium and is prescribed to prevent their deficiency due renal loss
Q 5) Testing scholarship competency in logging reflective observations on your concrete experiences of this last month : (10 marks) 

Ans

This past month has been an exhilarating experience with a whirlwind of emotions ranging from feeling scared to getting excited. As fresh interns posted for the first time in the medicine department I got to experience firsthand how patient-centered care was provided and put theoretical knowledge into practical practice

Here are some of the cases that I saw this month and had a chance to interact with the patient and their attendant and understand how the disease affected not only the patient but also those around them

The first case that I saw on my first day of internship was a case of parotid abscess

An 85 yr old male presented to the casualty at around 2 am and was diagnosed to be in shock secondary sepsis due to an infected parotid abscess
The details of this case were well recorded by my junior Dr. Shradha  from the 2017 batch in her blog: https://shraddhabovolla10.blogspot.com/2021/06/85-yr-old-male-with-swelling-on-right.html?m=1

On interacting with the patient's son who was a pastor by occupation and didn't earn much, I realized how the disease had impacted his life also in the sense that it had exhausted his finances and he was forced to borrow money from others to pay for his father's medical expenses and was having a hard time financially. We tried to address some of his concerns and decided to stick to cheaper options of diagnostic and therapeutic interventions.

Another case where I had the opportunity to interact with the patient and their attendants was a case of 40 yr old female who was diagnosed with febrile neutropenia

Here her parents as well as her cousin brother and her sons were all worried about her but had to leave on LAMA again due to financial constraints as they were daily wage workers who spend what they earned that day itself and were facing problems to put even food on the plate.

Here are links to some of the other cases that I saw this month

 








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