Warm greetings!
I'm Ankit pachipulusu , a passionate medical student from India. Welcome to my blog, where I share captivating real-life cases that have not only deepened my understanding of history taking and clinical examination but also enhanced my patient interaction skills and overall patient care approach. These cases have been invaluable in shaping my medical journey, and I'm excited to share them with you.
The experiences of a medical student during college are heavily shaped by their inquisitiveness and often times teacher and peer pressure, as we pass through the treacherous waters of medical education in our rickety boats we come learn that doctors have many more obstacles in the form of beuracracy , testing targets etc. Apart from diagnosing and treating patients , All of these experiences have crafted a curiosty in me to explore the wider healthcare delivery system and various forms it is available in the world ranging from universal healthcare in the EU to private healthcare in the USA.
These experiences also shaped my interest in family medicine which is a comparitively young branch In India which involves following a panel of patients throughout their lifetime and engaging the community to encourage them to make positive lifestyle choices to further health outcomes in our country
CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER
NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.
CASE 1 : 42 YEAR MALE WITH FEVER AND HEADACHE SINCE 20 DAYS
This was the first case that I made an online blog about, I encountered this case in my 3rd semester, armed with my naive personality and a shabby history taking framework I approached this patient to ask him about the history that led to him being hospitalised , a brief excerpt of which I have given below:
Patient was apparently asymptomatic 20 days back then developed fever of insidious onset ,gradually progressive which increases during the night and relieves on taking medication,not associated with any rash.The day before the onset of fever patient was spraying pesticide in his field ,he supposedly wanted to finish two days of work in a single day and said that he was exposed to the fumes of the sprayer for a longer period of time since usual.
Pain abdomen is non radiating and not associated with nausea /vomiting ,not associated with diarrhoea
Headache is non radiating and mostly in the front and sides of the head .
Loss of appetite since 15 days
Patient noticed a scab on his left shoulder 5 days after admission to the hospital ,suspicion of an insect bite while he was asleep in his field 20 days ago
Later upon further testing it was revealed the patient had rickketsial fever
This case ellucidated to me on the importance of continuous contact and making notes of the disease progression of the patient for had we not noticed / been informed of the bite mark on the patient's shoulder which showed up as a scab days later after his initial presentation we would have assumed he was suffering from viral pyrexia and gravely missed his actual diagnosis
For further details;
https://ankitpachipulusurollno13.blogspot.com/2021/10/42-year-male-with-fever-and-headache.html?m=1
CASE 2 : 35 year old female presenting with fever and ulcers on feet and hands since 5 days
The patient was apparently asymptomatic up until 5 days ago when she developed low grade fever sudden in onset , continuous in not associated with chills,sweating, dizziness, fatigue and body pains, nausea, vomiting .
Second day after onset of fever she went to her farm for work in the early morning and injured her left toe while spraying fertilizer . From third day she noticed progressive painful lesions appearing on both lower limbs and upper limbs chest and neck . Not associated with loss of sensation, itching, joint pains.
Difficulty in swallowing and burning sensation in the mouth post consumption of food due to small ulcers in the mouth
No complaints of headache, burning micturition, giddiness, chest pain, shortness of breath, palpitations, cough ,insomnia, loose stools, loss of appetite.
History of usage of semecarpus anacardium for one day. Following whish she went a local practitioner and was prescribed an tablet containing deflazocort 6mg for five days itraconazole ,tofloxacin, orividazole, clobetalol propionate, and megaheal ointment for five days.
PAST HISTORY and treatment : History of psoriasis vulgaris from 2 years for which she used tab METHOTREXATE 7.5mg BD for one month and capsule itraconazole.
DISCUSSION:
Reference:
1) https://link.springer.com/article/10.1007/s13555-014-0056-z
most cases of methotrexate-induced ulceration have been reported in patients with psoriasis on low-dose treatment rather than in those on high-dose oncology regimens
It is postulated that that the increased proliferation of keratinocytes within psoriatic plaques makes them particularly vulnerable to the effects of folate-antagonism.
Lawrence and Dahl described two patterns of methotrexate-induced ulceration: type 1 as superficial ulceration of existing psoriatic plaques and type 2 as ulceration of non-psoriatic skin.
Diagnosis:
Diagnostic biopsy is rarely required, however, histological features of methotrexate-induced ulceration include swollen keratinocytes with diminished nuclear and cytoplasmic staining and occasional vacuolated or dyskeratotic cells indicative of incipient epidermal necrosis
Treatment:
In cases of ulceration, withdrawal of methotrexate supported by skin-directed therapy usually leads to rapid improvement in ulceration with many patients showing signs of healing within a few days; however, in isolated cases ulceration persists for years
Prevention:
Pharmacogenomic evaluation of methotrexate may allow for future pre-treatment testing for risk of efficacy and toxicity.
MY INSIGHT : This was the first case that showed me the importance of both reviewing and publishing once own case reports so that the rest of the world can see and draw insights and help treat their patients
This was the first time I had to do spend a significant amount of time to look for the relevant literature regarding my patients conditions , the rarity of occurrence of this highlights the importance of publishing case reports of rare presentations
This case also provided an insight on safe medical prescribing and the importance of pharmacogenomics in modern medicine.
CASE 3: 20 YEAR OLD MALE WITH UNSTABLE GAIT
Link: https://ankitpachipulusurollno13.blogspot.com/2023/03/18010060008-long-case.html?m=1
patient was apparently asymptomatic 12 years ago then he started taking alcohol in the form of ARRACK for the first time with his friends and mentions that he enjoys drinking it , as it was available in his farm he started drinking every alternative day about 1-2 glasses a day
2 years later his mother passed away in a tragic accident and to alleviate that stress he started drinking heavily , over the next few months his consumption gradually increased to 3 glasses a day further to 6 glasses a day.This continued upto 5 years after he started drinking
Around 5 years later he shifted to WHISKY due to ARRACK being banned by the government.He drink around 2 units of whisky daily before going to work and upon returning in the evening he used to feel tired thus used to drink again.
In a few months time his drinking increased upto 12 units a day .
He also complains of sleep disturbances,decreased appetite and sweating if he does not consume alcohol .
Patient also complains of visual hallucinations, tremors and pins and needles sensations .
His family then enrolled him in a deaddiction programme
patient also started chewing tobacco since the last 9 years , around 1 packet every 2-3 days
no history of any psychiatric conditions
no history of any head injury
no history of any loss of consciousness
no history of any epilepsy or involuntary movements
No fever , vomiting or stiffness of neck
No weakening of limbs , no wasting or thinning of muscles
PAST HISTORY:
Not a known case of hypertension, diabetes mellitus , epilepsy, asthma ,tb , cad , cvd , thyroid
Patient had a history of fracture to the left arm following an accident resulted in him getting fixed with a DCP PLATE
INSIGHT : this case provided me with the opportunity to do a complete CNS evaluation on my own as elucidated by the video links and examination finding in the blogpost, though the task was daunting at first , it gave me huge confidence boost after I successfully receiwed the literature and made a provisional diagnosis and ended up diagnosing the patient.
Now I have the confidence to perform a full CNS examination thanks to this patient interaction.
Thank you for reading this post!!!!
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