Medicine self assessment

 Name:       AMISHA JAISWAL

Roll no.09

Posted from 11/08/22 to 11/10/22

UNIT DUTY

1)

70 YEAR OLD MALE , CLINICALLY PRESENTED WITH Complains of B/L pitting type of pedal edema of grade 2 &dry cough since 15days.

https://amishajais1.blogspot.com/2022/09/this-is-online-blog-book-to-discuss-our_29.html

1 -cause of LAD occlusion in this patients?

ALCOHOL,Excessive alcohol consumption can cause a buildup of plaque in the arteries,causing occlusion 

https://www.alcoholproblemsandsolutions.org/drinking-and-coronary-artery-disease-risk/

2-cause of dry cough in this patient?

 Congested lungs. A weak heart causes fluid to back up in the lungs. This can cause dry cough.or wheeze at times.

3-effects of LAD occlusion.?

LAD supplies RV,LV,septum,conduction system below the A-V node (the His-Purkinje system), while the RCA supplies most of the conduction system at and above the A-V node 

https://teachmeanatomy.info/thorax/organs/heart/heart-vasculature/

https://www.slideshare.net/aishuanju/myocardial-infarction-45012095

4- what are the possible complications of PTCA?

Possible complications include 

1)hematoma at the femoral artery insertion 2)pseudoaneurysm of the femoral artery

3)infection of skin over femoral artery

4)embolism

5)stroke

6)kidney injury from the dye

7)vasospasm, thrombus formation

2) 

38 male with hypoglycaemic choreoathetosis

https://amishajais1.blogspot.com/2022/09/this-is-online-blog-book-to-discuss-our.html

1 -what is whipple’s triad?

-signs and symptoms of hypoglycaemia 

-low plasma glucose <54mg/dl

-resolution of symptoms once glucose level rises

2 -how does hypoglycaemia cause seizures?

 The data indicate that the seizures noted early in the course of insulin-induced hypoglycemia are temporally related to a rise in brain osmolality secondary to an increased net transport into brain of Na+ and K+, probably caused by insulin, per se. As hypoglycemia persists, there is also depletion of energy-supplying substrates (glucose, lactate, glutamate) in the brain, an event which coincides altered brain function. The brain edema observed during hypoxia is largely due to an increase in brain osmolality secondary to accumulation of lactate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301599/

3 -cause of cataract in this patient?

Pathogenesis of Diabetic Cataract.

 The enzyme aldose reductase (AR) catalyzes the reduction of glucose to sorbitol through the polyol pathway, a process linked to the development of diabetic cataract.

https://www.sciencedirect.com/science/article/pii/B9780124017177000149

3)

45 year old male with dysphagia 

https://amishajais1.blogspot.com/2022/09/45-year-male-with-dysphagia-this-is.html

1- cause of metabolic acidosis in this patient.

 diabetic mellitus.

Diabetic acidosis develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes (usually type 1 diabetes).

2 -what is the algorithm of tb diagnosis ?

https://toleylab.weebly.com/blog/what-i-didnt-know-about-tuberculosis-tb-after-over-two-years-of-research-towards-technology-development-for-tb-diagnostics

3- what was the cause of increased bladder thickness in this patient?

4 -what is weight based ATT?

https://www.researchgate.net/figure/Drug-dosage-for-adult-TB-according-to-total-body-weight-bands_tbl2_343225843

4)

A 58 year old female with fever since 10days and generalised weakness since 10days

https://amishajais1.blogspot.com/2022/09/this-is-online-e-log-book-to-discuss.html

1-how do we work up a case of thrombocytopenia?

https://www.researchgate.net/figure/Algorithm-for-workup-of-thrombocytopenia-based-on-the-observation-of-the-peripheral-blood_fig1_233411451

2-what is the mechanism for virus induced thrombocytopenia?

https://www.researchgate.net/figure/Mechanisms-of-virus-induced-thrombocytopenia-thrombocytopenia-occurs-either-via_fig3_270655718

5) 

58 year old female patient With Vomiting since 8 days, Decreased appetite and fever since 6 days and SOB from 3 days

https://amishajais1.blogspot.com/2022/08/a-58-year-old-female-patient.html

6)

A 74-year-old female patient with the chief complaints of SOB and pedal edema 

https://amishajais1.blogspot.com/2022/08/74-year-old-female.html

1-what is the pathogenesis  of developing ckd in this patient?

https://thoracickey.com/pathophysiology-of-heart-failure-3/

2—cause of anemia in this patient.?

When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells. With less EPO, your body makes fewer red blood cells, and less oxygen is delivered to your organs and tissues.

3-cause of sob in this patient

Due to fluid over load caused by CKD which also caused percardial effusion 

During ICU duty 

1-Have performed insertion of ryles tube to a 60 year old female icu bed 1

2-Assisted in central line catheter insertion

3-Performed suturing in central line catheter insertion 

4-Performed pleural tap

5-Has taken samples for ABG of several patients.

6-Has taken samples for ABG for dialysis patient.

7-Performed  insertion of foley's catheter.

8-Learned to do CPR 

During ward duty

Placed a cannula for a patinet

Have taken venous samples for routine investigAtions for patinets.

During nephrology duty

Have assisted in performing central line insertions by appyling sutures 

Collected ABG samples

Collected venous samples

Placed cannula

Saw the fundoscopy of 25 year old hypertensive male