MONTHLY INTERNAL ASSESSMENT - JANUARY

 

26 year old woman with complaints of altered sensorium somce 1 day,headache since 8 days,fever and vomitings since 4 days

https://harikachindam7.blogspot.com/2020/12/26-year-old-female-with-complaints-of.html

a). What is the problem representation of this patient and what is the anatomical localization for her current problem based on the clinical findings?

ans) presented to casualty in a state of altered sensorium & irrelevant talk

History of B/L hand small joint pains 6 yrs back Multiple joint pains 3 yrs back and diagnosed as SLE  and using treatment which she stopped 10 days ago.

C/o headache since 1 month which increased in last 10 - 15 days associated with vomitings since 1 week and fever, neck pain , generalized weakness since 4 days and altered sensorium with irrelevant talk since 1 day.

Anatomical localization:

Headache,neckpain, fever: tubercular meningitis

Acute infarct in thalamus

Hyponatremia -kidney

b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? 

ans.)Mycobacterium tuberculosis

H/o meningitis symptoms and also family history (Her uncle has been active pulmonary Koch’s and finished his course of medication six months ago)

c) What is the efficacy of each of the drugs listed in her prior treatment plan that she was following since last two years before she stopped it two weeks back? 

ans.)Hydroxychloroquine-https://doi.org/10.1517/14740338.2011.566555

Sulfasalazine-

https://pubmed.ncbi.nlm.nih.gov/16840889/

Methlprednisolone-

https://journals.sagepub.com/doi/abs/10.1191/0961203302lu243oa?journalCode=lupa

Alendronate-

Gabapentin-

d)Please share any reports around similar patients with SLE and TBmeningitis

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.researchgate.net/publication/273691193_Tuberculous_Meningitis_in_a_Patient_with_Systemic_Lupus_Erythematosus&ved=2ahUKEwjQndXc8aTuAhXaT30KHaLlC7cQFjANegQIDhAB&usg=AOvVaw3LQAbmpErKbVgP9w19kB46&cshid=1610952561973

e)What is the sensitivity and specificity of ANA in the diagnosis of SLE? 

ans)

s://www.google.com/url?sa=t&source=web&rct=j&url=https://pubmed.ncbi.nlm.nih.gov/8678710/&ved=2ahUKEwjtk5Gr8KTuAhUWeysKHRdRDEQQFjABegQIAhAE&usg=AOvVaw28_1EL4TfcHFF-bvgHCLF3&cshid=1610952333525

2) Please go through the two thesis presentations below and answer the questions below by also discussing them with the presenters:

1)https://youtu.be/sw8o8y5Yw_I

What was the research question in the above thesis presentation? 

ans) Association of serum magnesium with type 2diabetes 

What was the researcher's hypothesis? 

ans) The hypothesis is that magnesium levels are low in the people of DM-2,also,in the normal population,those with low values of magnesium are at an increased risk of developing diabetes,than those with normal levels.

Also the magnesium levels affect the outcomes and the rate of progression of the disease,that is the complications like nephropathy, neuropathy, retinopathy develop faster in those with low serum magnesium

What is the current available evidence for magnesium deficiency leading to poorer outcomes in patients with diabetes? 

What is the current available evidence for magnesium deficiency leading to poorer outcomes in patients with diabetes? 

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.healthline.com/health/diabetes/magnesium-and-diabetes&ved=2ahUKEwjy0bDYnqXuAhXKbn0KHcUICjcQFjABegQIAhAE&usg=AOvVaw08MrSFwj3nceFQ87aN0xz-&cshid=1610964602909

2)https://youtu.be/jXVS5J1-RNE

What was the research question in the above thesis presentation? 

ans)24 hour urinary sodium excretion in newly diagnosed hypertensive patients.

What was the researcher's hypothesis?

ans) 24 hours urinary sodium in newly diagnosed hypertensive patients 

The hypothesis is that, the amount of salt consumed is almost equal to the sodium excreted in the urine, which could lead to increase in the blood pressure

What is the current available evidence for the utility of monitoring salt excretion in the hypertensive population? 

ans) https://www.google.com/url?sa=t&source=web&rct=j&url=https://pubmed.ncbi.nlm.nih.gov/29458447/&ved=2ahUKEwjojOep_qfuAhUh7XMBHVtLDocQFjAKegQIJxAB&usg=AOvVaw0HE4yPpaY4ddacLawDN6Ve

3) Please critically appraise the full text article linked below:

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2003.01233.x

What is the efficacy of aspirin in stroke in your assessment of the evidence provided in the article. Please go through the RCT CASP checklist here 

https://casp-uk.net/casp-tools-checklists/ and answer the questions mentioned in the checklist in relation to your article

4) Please mention your individual learning experiences from this month.

ans) Central line guided by Dr. Ajith sir 

Ryle's tube insertion

Ascitic Tap guided by Dr. Vinay 

Acute pancreatitis management

Learned about TRALI

5) a) What are the possible reasons for the 36 year old man's hypertension and CAD described in the link below since three years? 

https://vamsikrishna1996.blogspot.com/2021/01/36-year-male-presented-to-casualty-at.html?m=1

ans) The history of chronic alcoholism and smoking may be one of the reason

Obesity might also lead to blockage of coronary arteries leading to CAD

b) Please describe the ECG changes and correlate them with the patient's current diagnosis. 

ans) Rhythm is irregular 

Broad QRS COMPLEXES

c) Share an RCT that provides evidence for the efficacy of primary PTCA in acute myocardial infarction over medical management. Describe the efficacy in a PICO format. 

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.112.970954&ved=2ahUKEwjsi7iU36fuAhVafisKHaDpCmgQFjABegQIARAB&usg=AOvVaw3X4gNBSmhAgmD2PxuAwYVW