GENERAL MEDICINE Internal assessment answer sheet

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A 65 yrs old female with difficulty in moving left upper and lower limbs.

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This is an online elog documenting de-identified patient health data after taking his signed consent to enforce a greater patient centered learning.  The privacy of the patient is being entirely conserved. No identifiers shall be revealed through out the piece of work whatsoever. CASE DISCUSSION : A 65 yr old female coming from Rajavaram  was brought to the casualty with   CHIEF COMPLAINTS of: Weakness in right and left upper limbs and lower limbs since 5 days Difficulty in moving left upper limbs and lower limbs since 4days. Inability to speak since 4 days.   Fever since 4 days. HOPI Patient was apparently asymptomatic 5 days back she developed weakness on Saturday in left upper and lower limbs which was sudden in onset , gradually progressed and is completely unable to move since 4 days. She is also unable to speak due to deviation of mouth later that day Next day ,the weakness of both limbs of left side became severe and completely lost her speech and not respondi...
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OSCE AND LEARNING POINTS.

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OSCE:  1)Therapeutic window of stroke                   The main treatment for an ischemic stroke is a tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. A healthcare provider will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke symptoms start. Drugs like  alteplase, reteplase, and tenecteplase can be used. 2)Fibronolytic therapy:        streptokinase, anisoylated plasminogen-streptokinase activator complex, urokinase, and recombinant human tissue-type plasminogen activator. All 4 of these drugs activate the fibrinolytic system by converting plasminogen to the active enzyme, plasmin. 3) Dual antiplatelet therapy vs aspirin therapy:    https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.033033 4)Frontal lobe functions parietal lobe functional tests Parietal lobe:   ...
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44 yr old chronic alcoholic with acute on chronic pancreatitis

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 Greetings to one and all going through my E log!!    This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment.  A 44 yr old man , daily wage laborer R/O Miryalaguda came to the OPD on 5th September 2023 with chief complaints of abdominal pain , vomitings and constipation and fever at nights  since 5 days. HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 18 days back and then developed pain in the epigastric region and left hypochondriac region followed by high grade fever(at nights only = nocturnal), intermittent a...
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