Medicine Department Bimonthly Assessment JULY 2021

 

MEDICINE  DEPARTMENT

                BIMONTHLY ASSESSMENT

                                          JUNE 2021

Max marks:100[5 x 20marks]
BY MUNUKUTLA SAI MYTHILI 88
Submit by : 25/7/2021

QUESTION 1: Competency tested for peer to peer assessment
Students considered for review: Roll Numbers:87



QUESTION 1 :What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem?

The student has has presented in a different way
the student has given a proper grading for the quantitative and explained the qualitative in a few words however the individual questions were not explained
The different students were considered but in each students questions were not described
Each student had many answers but all the answers were clubbed and hence no specifics were given
Overall work is well presented but precise.
QUANTITATIVE : 15/20
QUALITATIVE: Overall work is well presented but precise.

QUESTION 2:FAILED TO DO
QUANTITATIVE : 0
QUALITATIVE:FAILED TO DO

QUESTION 3: 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 
Student has only done a single case when all the cases had to be done
the student has written a brief case history with no regard to correctness or therapeutic uncertainty 
However the  completeness of the case is mentioned
QUANTITATIVE : 9/20
QUALITATIVE: Needs improvement

QUESTION 4 :Problem list for each patient and the diagnostic and therapeutic uncertainty around solving these problems.
The student has given the problem list well however there is no mention of therapeutic uncertainty
The student once again has done only one case which was decently done
QUANTITATIVE : 7/20
QUALITATIVE: Needs improvement but what id done is good
QUESTION 5: log book
The students problems were well described and precise
QUANTITATIVE : 15/20
QUALITATIVE: Well written

QUESTION 2 : MY CASE REPORT

CASE 1 : HEART FAILURE
http://munukutlasaimythili.blogspot.com/2021/06/a-case-of-heart-failure-under-guidance.html
CASE 2 : 
http://munukutlasaimythili.blogspot.com/2021/07/a-case-study-under-guidance-of-dr.html

QUESTION 3 : 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 

CASE 1:AKI :
[https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1 ]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

CASE 2:Acute on CKD :

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
History of present illness is very well taken
Additionally the treatment given is very well written
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION:
 again it will help to narrow down the possible list of provisional diagnosis

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis


CASE 4:Patient with coma and renal failure  :
a.[https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

b.[https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis


The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

b.[https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

c.[https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1]


The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

CASE 7:Patients with AKI :
a.[https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

b.[https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis

c.[http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1]

The above case can be considered complete because it has all the characteristics of a long case, from bio data, history proper to physical examination involving general and systemic examination and it ends with the treatment given
However the discharge summary is pending
Additionally there is Consent given which lacks in a lot of other case
Another plus point of this case is that the time line is mentioned which is again mediocre in many of the cases
However when it comes to the correctness of a case as a third semester student I do not have the required ability or knowledge to determine the rightness of a case apart from the history and normal pathological findings which as per my knowledge seem correct
When it comes to analyzing the uncertainties in therapeutics 
1]TIME LINE : the time line usually provides the basis of diagnosing the disease along with the chief complaints
2]PRESENT ILLNESS HISTORY: the majority of the uncertainties for example a lower back ache can mean any thing from an muscle pull to lumbar spondylitis or due to any fall with fracture.
3]PAST HISTORY: this will lead to eliminate many uncertainties for example any past indicator of tuberculosis might lead to spondylitis absence we can rule out
4]GENERAL EXAMINATION: it will help to find additional markers which help to remove uncertainties such as hyper tension
5]SYSTEMIC EXAMINATION: again it will help to narrow down the possible list of provisional diagnosis


QUESTION 4 :Problem list for each patient and the diagnostic and therapeutic uncertainty around solving these problems.

PROBLEM LIST: 
A] Problems with which the patient arrived
-lower abdominal pain

-burning micturation

- low back ache after lifting weights

- decrease of urine out put

-fever 

- SOB 

B] Problems revealed in general examination

 Obese

-tenderness present


C]Problems revealed while using diagnostic tools

mild hepatomegaly with Grade-1 fatty liver 

plenty of pus cells in urine

Anemia

UNCERTAINTY: The most reliable way of reducing the problems is to determine the  underlying cause and treat it
Even though you can reduce the symptoms it is not permanent and as long as the underlying cause is left untreated the patient will experience recurring symptoms 
Only when we know the problems can we formulate an action plan to reduce the problems


SENSITIVITY AND SPECIFICITY OF DIAGNOSTIC INTERVENTIONS:

Hemogram :Results of hematology tests provide information on the function of the bone marrow and yields clues or even diagnosis as to the presence of underlying disease. Hematology tests should always be interpreted with respect to what is known about the patient (signalment, history, clinical signs, results of other diagnostic testing) and should not be interpreted in isolation. 

CUE :Urine analysis helps diagnose conditions such as urinary tract infections, kidney disorders, liver problems, diabetes or other metabolic conditions.

RFT  and LFT :A liver function test is recommended for the following reasons:  

  • To screen for any infections such as hepatitis C in the liver
  • If you are consuming any medications that might have a side effect on the liver functions
  • To monitor an already existing liver disease and its status during treatment
  • If you have any symptoms of any liver problems or liver disease
  • Planning for pregnancy 

RFT blood test is significantly suggested to patients who show a sign of improper functioning of kidneys.

ECG : The electrical signals generated from the electrodes are processed to obtain the heart’s electrical activity from 12 different angles, each of which shows a separate tracing.

2D Echo :Echocardiography, or 2D Echo is majorly done to detect the following:

  • Any underlying heart diseases or abnormalities
  • Keep a check on the heart valve for its functioning
  • Congenital heart diseases and blood clots or tumours

Chest X-ray :

A chest x-ray is typically the first imaging test used to help diagnose symptoms such as:

  • breathing difficulties
  • a bad or persistent cough
  • chest pain or injury
  • fever
CASE 2:Acute on CKD :

PROBLEM LIST:
A] Problems with which the patient arrived

• Lower backache since 10days
• dribbling of urine since 10days
• Pedal edema since 3days 
• SOB at rest since 3days 
• Increased involuntary movements of both upper limbs 

B] Problems revealed in general examination

Bilateral pedal edema
Left upper limb edema 

C]Problems revealed while using diagnostic tools

Multifocal infectious
Hyperuricemia



UNCERTAINTY: One of the complexities in the diagnostic process is the inherent uncertainty in diagnosis. As noted in the committee's conceptual model of the diagnostic process, an overarching question throughout the process is whether sufficient information has been collected to make a diagnosis. This does not mean that a diagnosis needs to be absolutely certain in order to initiate treatment. Kassirer concluded that:

Absolute certainty in diagnosis is unattainable, no matter how much information we gather, how many observations we make, or how many tests we perform. A diagnosis is a hypothesis about the nature of a patient's illness, one that is derived from observations by the use of inference. As the inferential process unfolds, our confidence as [clinicians] in a given diagnosis is enhanced by the gathering of data that either favor it or argue against competing hypotheses. Our task is not to attain certainty, but rather to reduce the level of diagnostic uncertainty enough to make optimal therapeutic decisions. (, p. 1489)


[https://www.ncbi.nlm.nih.gov/books/NBK338593/#]


SENSITIVITY AND SPECIFICITY OF DIAGNOSTIC INTERVENTIONS:

Hemogram :Results of hematology tests provide information on the function of the bone marrow and yields clues or even diagnosis as to the presence of underlying disease. Hematology tests should always be interpreted with respect to what is known about the patient (signalment, history, clinical signs, results of other diagnostic testing) and should not be interpreted in isolation. 

CUE :Urine analysis helps diagnose conditions such as urinary tract infections, kidney disorders, liver problems, diabetes or other metabolic conditions.


PROBLEM LIST:
A] Problems with which the patient arrived

Fever
Generalized weakness
vomiting

B] Problems revealed in general examination
Pallor
Restricted movement in the right  wrist joint .

C]Problems revealed while using diagnostic tools

Amisopokilocytosis with microcytes , macrocytes , macro-ovalocytes and few tear drop cells 
Bilateral grade 2 RPD 

SENSITIVITY AND SPECIFICITY OF DIAGNOSTIC INTERVENTIONS:

Bone marrow aspiration and bone marrow biopsy can show whether your bone marrow is healthy and making normal amounts of blood cells. Doctors use these procedures to diagnose and monitor blood and marrow diseases, including some cancers


A] Problems with which the patient arrived
Fever and Diarrhea 
Back pain
severe breathlessness and pain in the chest region.

B] Problems revealed in general examination
Pallor
Patient was initially conscious on arrival. Later she had become unconscious.
GCS (coma scale) :E 3 V 4 M 5 ( before arrest )  and After arrest E 1 V T M1 
 
C]Problems revealed while using diagnostic tools
Left Kidney , increased size, abnormal echogenicity of раrenchyma noted with hуро and hyper echoic regions.


b.[https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1]

PROBLEM LIST:
A] Problems with which the patient arrived

Abdominal Distension.
Constipation
altered Sleep patterns
hiccups 
pedal edema
Alcoholic Liver Disease,
AKI secondary to UTI on CKD, secondary to ? Diabetic nephropathy,
Hepatic encephalopathy grade 2

B] Problems revealed in general examination

There is icterus and pedal edema.
Ejection systolic murmur heard in all areas (aortic, pulmonary, tricuspid and mitral areas) radiating to carotids.


C]Problems revealed while using diagnostic tools

Multiple acute small infracts involving bilateral cerebellar and cerebral hemisphere
Tri cuspid valve calcification


A] Problems with which the patient arrived
Fever
Pus in urine
Post megaly
Transurethral resection of the prostate (TURP) 

B] Problems revealed in general examination


C]Problems revealed while using diagnostic tools

Bilateral Hydroureteronephrosis, severe on  right side and moderate on left
 Both dilated in entire course with  tortuosity of lower portion
Urinary bladder shows diffuse circumferential wall thickening( 6 -7mm)
Tiny calcific focus in pelvis on right side - outside the urinary tract - phlebolith

A] Problems with which the patient arrived
Shortness of Breath
Chronic renal failure
heart failure
Diabetes mellitus
Hypertension

B] Problems revealed in general examination
Edema of feet

C]Problems revealed while using diagnostic tools
Anemia
High blood glucose before and after lunch
Heart failure

SENSITIVITY AND SPECIFICITY OF DIAGNOSTIC INTERVENTIONS:

Bacterial culture and sensitivity:

The bacterial culture and sensitivity test checks for the presence of bacterial infection in a particular body fluid or area of the body.

PULMONARY FUNCTIONS TEST:
 Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. The tests measure lung volume, capacity, rates of flow, and gas exchange.

c.[https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1]

PROBLEM LIST:
A] Problems with which the patient arrived
Pedal edema 
Decreased urine output
pneumonitis with Type 1 Respiratory Failite

B] Problems revealed in general examination
Pitting edema

C]Problems revealed while using diagnostic tools
High Blood urea
High serum creatine
Right heart Failure
Pulmonary edema

CASE 7:Patients with AKI :
a.[https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1]

A] Problems with which the patient arrived
loose stools
 Pedal edema  
 Abdominal distension 
 
B] Problems revealed in general examination
Pallor
Dialated abdomen 
Distended Veins

C]Problems revealed while using diagnostic tools
Moderate left ventricular dysfunction

b.[https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1]

A] Problems with which the patient arrived
Pedal edema
Fever
Decreased urine output

B] Problems revealed in general examination
Pallor

C]Problems revealed while using diagnostic tools
Hyperkalemia
Normocytic normochromic anemia with leukocytosis

c.[http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1]

PROBLEM LIST:
A] Problems with which the patient arrived
Pain in abdomen
Shortness of breath
vomiting

B] Problems revealed in general examination
NVBS heard
BAE+, decreased BS on right infra axillary area
epigastric and hypo gastric tenderness
Presence of tremors

C]Problems revealed while using diagnostic tools
Presence of mesothelial cells in ascitic fluid

SENSITIVITY AND SPECIFICITY OF DIAGNOSTIC INTERVENTIONS:
To detect abnormalities in the body, such as tumours, abscesses, abnormal blood vessels, etc, when they are suspected by symptoms or other tests.
To give a surgeon a clear picture of an area of your body before certain types of surgery.
To pinpoint the exact site of tumours prior to radiotherapy.
To help doctors find the right place to take tissue samples (biopsies). 

QUESTION 5 : MY LOG BOOK

Our clinical classes have started from 21 June and continuing


we have started our clinical class and have been briefed about the case history taking and many cases for referral

*We have learnt about Blood pressure management and details about stroke through a interactive session through social media by interaction with the help of a case
*Sub arachnoid hemorrhage we learnt and through many cases we learnt about Acute kidney injury 
Renal failure
We can always read the text all over the world however the retaining capacity we obtain through live cases in the best
Even in times of crisis we have learnt to evolve and obtain better means of learning through the net
Though the live practical do not match these live classes we are trying to compensate learning through these means

However the most important thing I learnt is Integration 
Medicine is a vast single subject, though we divide for learning purpose through this we some times divide the case telling we have not completed this or that how ever comprehensive and integrated learning removes this errors
We have started to use the blogs created for general medicine into various subjects and started to categorize various cases we are learning into proper cases



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