General medicine Internship Real patient OSCE towards optimising clinical complexity

 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 (June'2023-August'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.

CASE REPORT : 

A 50 year old, homemaker presented to the Surgery Opd with complaints of swelling of left foot and leg since 1 week. The patient was referred to GM i/v/o vomitings and headache. 10 episodes of vomitings, non bilious, non blood stained, non projectile with food as content. Patient was shifted to GM for the stabilisation of general condition of the patient. Patient is a k/c/o of DM - 2 since 3 years and is using Tab. Voglibose 0.2mg + Tab. Glimiperide 1mg + Tab. Metformin 500mg.

https://preityarlagadda.blogspot.com/2023/07/50-year-old-female-with-left-lower-limb.html

QUESTIONS :

1. Did the patient have Hypertensive emergency or Hypertensive urgency? What is the criteria for Hypertensive emergency?

2. What is the efficacy of the different interventions used to treat the hypertension in the patient? 

3. What is the reason for periorbital edema in this patient? What is the pathophysiology behind it?

4. What are the different renal parameters that can indicate renal damage due to the hypertension? What effect does the Hypertensive emergency have on the kidneys?

5. What are the most common signs and symptoms indicating end organ damage in Hypertensive emergency?

6. The patient had an albuminuria of 4+

What signs and symptoms in the patient attribute to this? What other signs and symptoms are present in a patient with albuminuria?

7. For her cellulitis, Debridace ointment and papaya dressing was used. What is the mechanism of action of them?

8. The patient is a k/c/o DM - 2 since 3 years. What is the role of Diabetes mellitus in the pathophysiology of Cellulitis?