DEPARTMENT OF GENERAL MEDICINE ACADEMICS ( NOVEMBER 2022 )Date 1-11-2022
Morning 9:00-12:15pm - ICU ROUNDS
ICU Bed 1
22F with hellp syndrome
https://snehajaju148.blogspot.com/2022/11/25-year-old-female.html
ICU Bed 2
53 M with chronic renal failure
Mechanical ventilator,post CPR status
Bed 3
60F with viral pyrexia with polyserositis
Blog link : https://saichennuru.blogspot.com/2022/10/old-female-with-fever-and-sob.html
Demonstration on the complaint of the patient (difficulty/?pain in swallowing )
Cause of her hypoxia
Bed no 5
54M with Rt heart failure with AKI on CKD with history of lt lowerlimb cellulitis (20 days ago)
Case report link
http://rsubhiksha128.blogspot.com/2022/11/a-case-of-55-yr-old-male.html
Bed no 6
34M with Right heart failure with AKI
Xray image seen and its suggestive of miliary Tb
Questions around this patient:
Alcohol effects on heart and kidney
Uncooked alcohol causing formation of methanol leading to toxicity
Acute hypoxia cause right heart failure
AMC Bed no 1
57 M with Altered sensorium secondary to hepatic encephalopathy
https://rishithareddy30.blogspot.com/2022/10/57yrs-old-male-patient.html
Bed no 2
14 M with PUO with ?Hodgkins lymphoma
http://aishwaryagannoji35.blogspot.com/2022/10/this-is-online-e-log-book-to-discuss.html?m=1
Questions around this patient:
Critical limb ischemia and Hodgkin’s lymphoma
Bed no 3
60F with community acquired pnemonia
http://bejugamomnivasguptha12.blogspot.com/2022/11/60-yr-old-female-with-fever-difficulty.html
Amc bed 4
50 Mwith IDA secondary to GI malignancy
http://savanthreddy.blogspot.com/2022/10/50-year-old-male-came-to-casuality-with.html
Planned for endoscopy and endoscopy showed growth in the antrum of stomach with oozing of blood.
Amc bed 5
50M with viral pyrexia with polyserositis with uncontrolled sugars
http://savanthreddy.blogspot.com/2022/10/50-year-old-male-came-to-op-with.htm
Amc cubicle 1
55M with viral pyrexia with viral hepatitis
(Aki with mods)
https://manogna33.blogspot.com/2022/10/60-year-old-male.html
Amc cubicle 2
60M with altered sensorium secondary to dyselectrolytemia
https://divyasree1999.blogspot.com/2022/10/54m-with-hiccups-and-altered-sensorium.html?m=1
Cause for his altered sensorium
Amc bed 6
45M with chronic liver disease with portal hypertension
https://divyasree1999.blogspot.com/2022/10/45m-with-abdominal-distension-and-pedal.html?m=1
Can acute heart failure seen in 2D echo
2-4 class
You tube link
https://youtu.be/jKSY2ImjOks
Presentation by :Dr.Venkat sai PgY1
Class attended by:
Dr Haripriya,Dr pavani.
Date 2-11-2022
Icu bed no 1
35M with CKD Started on dialysis
Cause of his young onset hypertension
Icu bed no 2
58M ,with CKD ,post CPR status on mechanical ventilator
Icu bed no 3
65M ,with CKD on came for hemodialysis
Indication for his dialysis:
Pulmonary edema and his raising creatinine levels
Icu bed no 5
54M with right heart failure with direct hyperbilirubinemia with AKI with history of left lower limb cellulitis
Amc bed 1
22F with HELLP syndrome
Amc bed 2
60F with viral pyrexia with polyserositis
Amc bed 3
60F with community acquired pnemonia
Discussion on her xray regarding the findings of the consolidation and the aortic knuckle
Amc bed 4
17F with dimorphic anemia with hypothyroidism with ?Addisons disease
http://abhirambhashyakarla.blogspot.com/2022/11/17-year-old-female-with-vomitings-and.html
Discussed to start her on iron and b12 . Discussed regarding addisons , not likely, and wait for basal cortisol and asked specificity of basal cortisol levels .
And update the case on pjr group .
Amc bed 5
60F with left upper lobe ?mass ?malignancy (came from pulmonology for Bp monitoring)
Planned for biopsy from the mass
And
34M with right heart failure with AKI
Discussed about his miliary tuberculosis
Amc cubicle 1
55M with viral pyrexia with viral hepatitis
Amc cubicle 260M with altered sensorium secondary to dyselectrolytemia
12-1pm
Class and case discussion by Dr rakesh biswas
case discussion about
66M with left hip joint pain and tinea corporis
Seen the motility of strongyloides stercoralis and discussed about the lifecycle
Case presented by 8th sem student
presented by :Vishal
Evening 2pm -4pm
Practical examination for final year referred students
Conducted by:
Dr.Nikitha(senior resident)
Dr.zain(Senior resident)
Dr.Sushmitha(Senior resident)
Practical was taken bedside
Examination questions asked by
Dr.Nikitha
Case taken by student:
Case of 60F with viral pyrexia with polyserositis
Respiratory system examination
1)what do we look on inspection in respiratory system
2)How to look for position of trachea (Trails sign)
3)How to look for organomegaly,percussion of abdomen,how to look for perabdominal bruits
4)What are the areas of lung auscultation
5)Significance of the percussion over the apex of the lung
6)most common condition involving the apex of the lung pathology
And differentiating hyperpigmentation
Clubbing causes
Questions asked around Short case :
1)Areas where we look for pallor
2)murmur heard in anemia
Examination questions asked by Dr.zain
Case taken by students
Spotters asked at bedside
1)Foleys catheter
2)Ryles tube
3)sizes of cannulas
4)HME filter
3-11-2022
Morning 9am to 10am meet in mini auditorium
10:30am to 12pm rounds
New case admission
23M with dengue IgM positive with thrombocytopenia
12pm to 1pm
Case discussion by Dr Rakesh biswas and
Questions asked and topic explained
1)How to palpate for apex beat
Explained by images
2)murmurs heard in CKD patient (The murmur which is present before dialysis and disappeared post dialysis-murmur of pericarditis)
3) class taken on murmurs by Dr Rakesh biswas
Afternoon class taken by
Dr.Nikitha (senior resident)
Case presented by
Dr.kranthi PGY1 and Dr.Shashikala PGY3
Class attended by:
PG’s :Haripriya,kranthi,pavan,Nishitha
Durga krishna,chandana,manasa,shailesh,vamsi krishna.
Interns:manogna,suhitha
4-11-2022
Icu bed no 1
35 M with CKD started on dialysis
Auscultated for murmurs
Icu bed no 2
58M with CKD,post CPR status on mechanical ventilator
1)Planned for MRI brain to rule out hypoxic brain injury and serial EEG’s to look for electrical activity inside brain and to check if it evolves
"initially burst-suppression with high amplitude polyspikes, then longer burst duration with lower amplitude of polyspikes, followed by loss of amplitude and complexity, and finally generalized periodic discharges progressing to diffuse attenuation"
2)Cause for his involuntary moments of the limbs
?myoclonic moments or ? Focal seizures
From an anatomical and neurophysiological perspective, myoclonus can be cortical, subcortical or spinal.
Post-hypoxic myoclonus is not as well understood, and there are several clinical challenges related to diagnosis and treatment.
In addition, prognosis and decisions regarding withdrawal of medical care have been linked to the presence of acute myoclonus after cardiac arrest.
MSE occurs in comatose patients, begins within the first 72 h after cardiac arrest and usually stops after a few days. In contrast, LAS has historically been considered to begin later when patients are awake, and to be persistent (English et al., 2009).
There are no standard treatment guidelines or large clinical trials for MSE or LAS. Response to treatment is largely based on anecdotal evidence and the presumed origin (cortical or subcortical). Antiepileptic drugs, benzodiazepines, anesthetic agents and serotonergic drugs (5-HTP, methysergide) have been used for both conditions
Clinicians are faced with the dilemma of distinguishing between “good” (LAS) and “bad” (MSE) myoclonus in the acute post-cardiac arrest setting in order to avoid the “ugly” situation of either a self-fulfilling prophecy from premature withdrawal of care or unnecessary prolongation of treatment.
Clinicians are faced with the dilemma of distinguishing between “good” (LAS) and “bad” (MSE) myoclonus in the acute post-cardiac arrest setting in order to avoid the “ugly” situation of either a self-fulfilling prophecy from premature withdrawal of care or unnecessary prolongation of treatment.
Wijdicks et al. (1994) have also previously stated that the presence of MSE in comatose patients after cardiac arrest must strongly influence the decision to withdraw life support.
There is growing evidence to suggest that acute post-hypoxic myoclonus should not be used as the only criterion for prognosis and decisions regarding treatment withdrawal.
3)Cause for his inferior gaze of eyes (? due to involvement of inferior rectus muscle and increased pressure in brain leading to herniation)
How to take detailed history bedside
Icu bed no 4
22F in CKD on MHD with k/c/o nephrotic syndrome
Etiology of her early age CRF
Amc bed no 1
22F with HELLP syndrome
Planned for kidney biopsy
Amc bed no 2
54M with direct hyperbilirubunemia
Asked for radiology reporting and HRCT chest
Steroids affecting central fat deposition as he is on steroids Since 10 years
Patients on glucocorticoids had higher mediastinal (deep) and identical or increased posterior cervical, buccal, and midthigh (superficial) fat areas when compared with normal subjects.Since patients on prednisone exhibit increased or normal thigh fat depots in the presence of increased mediastinal fat, the current concept that glucocorticoids induce redistribution of body fat from peripheral to central fat compartments has to be revised
Patients on glucocorticoids had higher mediastinal (deep) and identical or increased posterior cervical, buccal, and midthigh (superficial) fat areas when compared with normal subjects.Since patients on prednisone exhibit increased or normal thigh fat depots in the presence of increased mediastinal fat, the current concept that glucocorticoids induce redistribution of body fat from peripheral to central fat compartments has to be revised
New admission
Amc bed 6
54F with viral pyrexia with rt loin pain(?pyelonephritis)
PULMONOLOGY CASE
40 M with LEFT SUPERIOR PULMONARY VEIN THROMBUS WITH BILATERAL PULMONARY TUBERCULOSIS ON ATT WITH ?SUPER INFECTION WITH ? PCP ? CAP WITH RVD +VE ON ART with ?MARFANS SYNDROME
Images suggestive of marfans
Chest assymetry and the hands are too long reaching upto knees and lidlag of eyes seen (Von Graefe's sign )
Questions asked
1)Is there any causal association between pulmonary vein thrombosis and outcomes
Treatment of PVT should be determined on the basis of the obstructing pathological finding and can include antibiotic therapy, anticoagulation, thrombectomy, and/or pulmonary resection .Systemic anticoagulant is frequently initiated, at least until resolution of the clot is observed. In several cases of postoperative patients in whom anticoagulant was contraindicated, spontaneous lysis of small, untreated thrombi without sequelae was observed. Thrombectomy has been successfully performed when medical therapy fails. Lobectomy may be indicated when PVT is complicated with massive hemoptysis or pulmonary necrosis
His hypotension appears to be because of LV hypokinesia with severe reduction in LVEF.
It's not pulmonary embolism.
Afternoon 2pm to 4pm
Bi monthly exam
5-11-22
Icu bed no 2
58M with CKD,Post CPR status on mechanical ventilator
MRI brain suggestive of hypoxic injury
New admission
Icu bed 4
78 M with altered sensorium under evaluation ?Acute ischemic stroke with HFref with HTN ,DM and Post CABG
1)parkinsons features examined
2)Examination of the tone and examined for pyramidal and extrapyramidal features
3)Non traumatic causes of cerebral edema treated with mannitol infusion?
Amc bed 5
54M with CKD underwent 1st dialysis i/v/o pulmonary edema and metabolic acidosis
Amc bed 6
54M with direcr hyperbilirubinemia
1)Cause of his obstructive jaundice
?viral hepatitis A or E
2) Restarting steroids and Tapering of steroid dosage
3)Detailed clinical history of the patient and timeline of the events
12pm to 1pm
Case presented by 8th sem student
And discussion by
Dr Durgakrishna PGY3
Topic: jaundice and bilirubin metabolism
Class attended by
Dr.Haripriya and Dr.vinay
6-11-2022 sunday
7-11-2022
1)25F with ?HELLP ?c -TMA ?APLA
?Gestational trophoblast induced MODS
Questions around the patient
1)Trophoblastic invasion in pregnancy
2)MgSO4 effect on eclampsia
3)Efficacy of hydralazine over nifidepine on afterload reduction
4)use of uterine curettage in eclampsia with MODS in this patient
5)cause of bleeding in CRF (post partum AKI)
6)Endometritis a cause for her increased temperature and increased counts
7)Difference between automated and conventional blood cultures
8)Fosfomycin sensitive and resistant klebsiella
Bed no 2
58M with CKD with postCPR status on mechanical ventilator
Involuntary moments still persisting
Bed no 3
30F with?LUPUS NEPHRITIS
1)The antigen causing her autoimmunity reaction?gestational trophoblast as the insult started one year after the pregnancy
2)reasons for her pulmonary edema
Amc
Bed no 1
40F with AKI with Denovo HTN
Bed no 2
60F with left CVA
Bed no 3
70 F with NS1 postive with generalised weakness
Bed no 5
14M with NS1 postive with thrombocytopenia
Bed no 6
17F with DKA secondary to missed insulin dosage
Cubicle 1
35M with viral pyrexia
Cubicle 2
40M with chest pain secondary to Acute gastritis
Afternoon (2-4)class by Dr.pavan PGY1
Class attended by
Dr Haripriya
Dr venkat sai
Dr pavani
Dr Bharath
Dr Shailesh
8-11-2022
Icu bed 1
22F with AKI
1)Asymptomatic bacteremia
Icu bed 3
Icu bed 4
Icu bed 5
2-4 mortality meet
Case presentation by
Dr.venkat sai and Dr.Bharath
9-11-2022
Morning rounds and ug class
10am to 1pm
Case presented by final year ug student
Afternoon class by Dr Sushmitha
Case presented by Dr Nishitha
10-11-2022
Morning 9-10am
Central meet
10am to 1pm
Ug class in clinical lecture hall
2-4pm class by Dr Nikitha mam
Case presented by Dr Bharath
11-11-2022
Morning ug class from 10am to 1pm
Afternoon 2-4pm by Dr.Aditya
Bedside class
12-11-2022
Morning ug class
From 10am to 1pm
Afternoon class by Dr Zain
13-11-2022 SUNDAY
14-11-2022
Morning class presentation by Ug student
Afternoon 2-4pm by Dr pavan
16-11-2022
Morning 11-1pm class
By akhila(5th sem)
Wednesday afternoon
2-4pm meet
TOPIC
SLEEP DISORDED BREATHING by Dr Saleem Mohammad(HOD of pulmonary medicine)
17-11-2022
Morning 9-10am meet
11:00 am to 1pm
Ugs class
Class taken by Dr Raveen
Respiratory system examination
2pm to 4pm
Class by Dr.Nikitha
Case presented by Dr.Nishitha
Case presentation blog
Video link
18-11-2022
10-1pm
Case presentation by
5th sem students
And discussion around the cases
2-4pm
Internal assessment examination
19-11-2022
10:30 to 12:00pm rounds
12:00pm to 1pm
Class by Dr.Rakesh Biswas
(All pgs meeting in principles offc)
2:00pm to 4:00pm
Class by Dr.Zain (sr)
Case presentation by Dr.Pavani(pgy1)
20-11-2022 SUNDAY
21-11-2022
10am to 1pm
Class presentation by Dr.Ganesh (5th sem student)
Topic taken by Dr.Haripriya (OHA induced hypoglycaemia)
2:00pm to 4:00pm
Class taken by Dr Sri harsha(SR)
Class taken bedside
Case presented by Dr.pavan(Icu bed 1)
And case 2(ICU Bed 3)
22-11-2022
10-11 am Rounds
11:00am to 1:00pm
Case presentation by 9th sem student
Discussion by Dr Haripriya (Pgy1) and Dr vamsi krishna (pgy3)
2:00pm to 4:00pm
M&M meet
Frst presentation by pediatrics dept
Second presentation by Dr.Deepika(dept of gen med)
23-11-2022
9:30 to 10am
Rounds
10:00 am to 11:30am meet by MD
11:30am to 1:00pm
Class to ugs
2:00pm to 4:00pm
Central meet
24-11-2022
8:00 am to 9:00am
Final year thesis presentation
By Dr.Vinay and Dr.Durgakrishna
9:00am to 10:00am
By Dept of ENT (Nasal polyposis)
10:00am to 1:00pm
Case by 9th sem students
And discussion by Dr Haripriya (PgY1)
2:00pm to 4:00pm
Class by Dr.Nikitha
Presented by Dr.Nishitha
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