General Medicine Internship Real Patient OSCEs

Introduction: This online E-log Entry Blog is an objectively structured clinical examination method to assess the clinical competence during the course of my General Medicine Internship rotation (October '2023-November 2023) by reviewing the case reports shared below and to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs for questions surrounding the clinical vignettes borrowed from the E Log Book.

Note: The cases have been shared after taking consent from the patient/guardian. All names and other identifiers have been removed to secure and respect the privacy of the patient and the family.

This is 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 patients 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 comment box is welcome."

I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan "

Clinical profile:

 Cheif complaints:

fever since 4 days

Cough since 3 days

Chest pain since 3 days

Hopi:patient was apparently asymptomatic 4 days back and then developed:

Fever since 4 days high grade,intermittent relieved on medication 

Not associated with chills and rigor 

Sob grade 4

Associated with right side localised pain increased on respiration 

Decrease in iron output relived on foleys catherization 

C/o productive cough a/s with sputum since 3 days 

B/L lower limbs tingling sensation 

No H/o pain abdomen, vomitings burning mitcuration 

K/c/o dm2 since 5 yrs ( tab. Glicazide,metformin)

Not a k/c/o htn tb asthma epilepsy

Past history: known case of diabetic dm2 since 4 years 

No history of asthma epilepsy,cad cva 

H/o pulmonary tb 20 yrs ago used att for 3 months 

General examination:

Pt is conscious coherent cooperative well oriented with time place and person 

No signs of clubbing, cyanosis, pallor ,icterus,lymphendenopathy 

Vitals:

Bp:110/70

Pr:82bpm 

Rr :26cpm 

Temp :97.3

Grbs: 583 ——->>> 485

Systemic examination:

Cvs s1 s2 heard 

Rs:  nvbs heard 

Cns: no focal neurological deficits 

Per abdomen: bowel sounds

Investigations:

• • Vitals 19/10

Bp: 100/80

Pr: 90

Temp 97.6

Grbs: Rx: INJ HAI 40 units in 39 ml ns 

Iv fluilds 

INJ monocef 

INJ neomol

Tab dolo po od

Syp ascoril po od 

20/10/23

21:10:23

Repeat chest xray:

Plan of treatment:

Rx: INJ HAI 40 units in 39 ml ns 

Iv fluilds 

INJ monocef 

INJ neomol

Tab dolo 

Syp ascoril

Osce questions:

1)[Rakesh Biswas Sir GM Hod Kims: Still tachypneoac? 

On room air?

[ Navyatha: Yes sir pt has rr of: 24 cpm with spo2 98%

[Navyatha: Could the case be related to HHS?

[] Navyatha: Patient has similar complaints as:

Confusion, high glucose levels,extreme thirst etc

2] Rakesh Biswas Sir GM Hod Kims: Creatinine? 

HCo3?

pH?

3[ Rakesh Biswas Sir GM Hod Kims: On room air?

[] Rakesh Biswas Sir GM Hod Kims: Everywhere you have mentioned normal sensorium?

[ Navyatha: Creatinine is 3.0 sir

[ Navyatha: Yes sir

[] Navyatha: Tachypnea may be due to consolidation seen on chest xray

[] Navyatha: Ent examination was done and crests were found on the right side with atrophy of right turbinates

[4] Rakesh Biswas Sir GM Hod Kims: Then wouldn't have had normal saturations in room air

[] Rakesh Biswas Sir GM Hod Kims: It's due to his metabolic acidosis. 

Because of tachypneoa he's able to maintain his pH normal by decreasing his pCO2

[] Rakesh Biswas Sir GM Hod Kims: pH is 7.42👆 ‎<This message was edited>

[04/11/23, 16:09:48] Rakesh Biswas Sir GM Hod Kims: When and from where? 

How did you get this image?

[] Navyatha: We sent his sputum for fungal culture around a week back sir

[ Navyatha: I took some lil help from micro dept sir

[] Navyatha: *geotricum species