Intern assessment and extension sample:
Name : Jai Abhiram.B
Posted from 11/10/2022 till 11/12/2022
Current online learning portfolio (OLP) linked here 👉
https://abhirambhashyakarla.blogspot.com/
Learning impact assessment from cases recorded in OLP :
1)CASE 1
https://abhirambhashyakarla.blogspot.com/2022/11/a-case-of-78-year-old-female-with_25.html?m=1
Brief History
65 yr old female with c/o complaints of loose stools since 5 days and pain
Diagnosis
ALTERED SENSORIUM secondary to HYPONATREMIA (hypovolemic hyponatremia) ( TRUE HYPONATREMIA) ? secondary to GI loss ?Dysentry with anemia under evaluation and history of hypertension.
Questions around the case :
1)How Would Hyponatremia cause altered sensorium?
When hyponatremia occurs, the resulting decrease in plasma osmolality (with the exception of the rare cases of non-hypoosmotic hyponatremia) causes water movement into the brain in response to the osmotic gradient, thus causing cerebral edema.The cells most involved in swelling are the astocytes, a kind of glial cells that are a constituent of the blood-brain barrier and have a fundamental role in maintaining the fluid and electrolyte concentration of the extracellular space in the brain .
This causes altered sensorium
From the below link:
2)What are the types of Hyponatremia ?
Pseudo (normo-osmolal) or isotonic hyponatremia is due to presence of hypertriglyceridemia or increase in plasma proteins in conditions such as multiple myeloma.
Translocational (hyperosmolal) or hypertonic or redistributive hyponatremia is due to presence of osmotically active solutes in the serum e.g., mannitol or glucose.
True (hypoosmolal) hyponatremia is associated with reduction in serum osmolality and is further classified as euvolemic, hypervolemic and hypovolemic
From the below link:
2)CASE 2
Brief history
A 45 year old male with complaints of fever since 6 days ,arthralgia,Headache-4 days,Nausea since 9 days
Diagnosis
Diagnosis
AUTOIMMUNE POLYGLANDULAR SYNDROME -2
ENDROCRINE
1)Hashimoto Thyroiditis
2)Addisons disese
NON-ENDOCRINE
1) Pernicious anemia
2)Alopecia(early)
1)What is Autoimmune polyglandular syndrome?
The autoimmune polyglandular syndromes (APS) are clusters of endocrine abnormalities that occur in discreet patterns in subjects with immune dysregulation and that permit treatment and anticipation of associated systemic or other hormonal deficiencies.
There are 3 major entities
APS1, APS2 and APS3; the rare X-linked syndrome of immunodysregulation, polyendocrinopathy, and enteropathy
APS1 is a syndrome characterized by chronic muco-cutaneous candidiasis, hypoparathyroidism, and primary adrenal insufficiency, as well as ectodermal dystrophy
APS2 is characterized by type 1 diabetes mellitus (T1DM), Addison Disease, and Hypothyroidism
APS3 is characterized by type 1 diabetes mellitus (T1DM), and Hypothyroidism
2)Details about APS2
The onset of APS-2 typically appears mostly in young adulthood. Currently, there are no unique tests to detect patients with APS-2, but testing for autoantibodies may be helpful in assessing disease risk.
Treatment of APS-2 should focus on replacement of missing hormones according to current guidelines for treating the main components of APS-2
From the below link
CASE 4
Brief history
Generalized body pains since 2 months.
PSYCHIATRY POSTINGS
Learning points
1) Difference between History taking from the pt and from the attenders
2)Witnessed the following cases
OBSESSIVE COMPULSIVE DISORDER
SCHIZOPHRENIA
DEPRESSION
BIPOLAR DISORDER
ALCOHOL DEPENDANCE SYNDROME
TOBACCO DEPENDANCE SYNDROME
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