General Medicine Assignment-

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

 Please go through one particular answer of ten students in this link:

https://generalmedicinedepartment.blogspot.com/2021/06/bimonthly-formative-and-summative_19.html?m=1

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 1: Link chosen- https://shareenabegum124.blogspot.com/2021/05/medicine-blended-assingment.html

Case 1:

A1: Evolution of the symptomatology and event timeline is given in a concise point based manner which is qualitatively and quantitatively sound. however anatomical localization and primary etiology is not mentioned clearly. 

A2: Mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological intervention is given in a point based manner which is qualitatively and quantitatively sound. 

A3: causes for her current acute exacerbation is provided in a concise manner which correlates with patient history. 

A4: the question has been answered by evaluating case timeline and patient state. 

A5: cause for her electrolyte imbalance has been given after rational thought about the case. 

Case 2: 

A1: symptomology, anatomical localization and primary etiology is given under proper subheadings which is easy to understand. 

A2: mechanism of action, indication and efficacy over placebo of each of the pharmacological and non pharmacological intervention is given in a point based manner with proper spacing, it is easier to understand than the previous case. 

A3: question has been properly answered with correct definition and explanation of the condition. 

A4: The question has been answered with correct reason for thiamine administration however cause of thiamine deficiency is not mentioned. 

A5: reason of kidney injury is correctly given after correlating with patient history. 

Question 2: 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 2: https://shaardul124.blogspot.com/2021/07/3rd-sem-general-medicine-e-log.html

Question 3: (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 3: Link:https://60shirisha.blogspot.com/2021/06/medicine-case-discussion_14.html?m=1

The case is presented in a concise systemic manner. Patient history seems inadequate as occupational history is missing and family history is flagged as insignificant. examinations are provided in a systematic point-wise manner. Investigations done are shared with respective anomalies however, abnormal hemoglobin, PCV and leucocyte count isn't mentioned. There has been no investigations about the thyroid disorder mentioned in the patient history. Patient seems to come with hypothyroidism in patient history but has hyperthyroidism causing atrial fibrillation?  Treatment plan shows the drugs administered but does not tell why and what their mechanism of action is. Patient died during a defibrillation for her atrial fibrillation and passed away. No suspected reason for death is given. 

Question 4: 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 literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient. 

Answer 4: Diagnostic and therapeutic uncertainty- 

• Patient history shows hypothyroidism but biochemical report before death shows hyperthyroidism? 
• Patient has akinetic segments near LAD indicating infarction and ischemia and IHD.
• Patient also has severely low ejection fraction of 35% indicating heart failure with reduced ejection fraction (HFrEF)
• Patient has atrial fibrillation which may stem from HFrEF for which she is taking amiodarone 
• Patient had anemia, which increases mortality in IHD as per a study which also concludes that aggressive treatment of the anemia increases chances of survival of the patient. ( https://pubmed.ncbi.nlm.nih.gov/14740503/#:~:text=The%20mortality%20rate%20was%20higher,disturbance%20and%20higher%20mortality%20rate )  

Question 5: Please reflect on and share  your telemedical learning experiences from the  hospital as well as community  patients over the last month particularly while you were E logging their case report while even in the hospital or perhaps when locked down at home.

Answer 5: Although the pandemic has taken from me the experience of clinical postings, online interactions with the faculty have helped. throughout this process I have learned how to access the internet and research scholarly articles based on the case presented to me and understand the care given. The WhatsApp group although disorganized has exposed me to clinical information that I would never have gotten during lockdown. Overall I appreciate the efforts of the faculty in making General Medicine interactive and fun to learn.