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 75 year old male, Farmer by occupation (stopped working 5 years ago) from Nalgonda was brought to casualty by his son in an unresponsive state and altered sensorium since 3 days.

Patient presently has a history of alcohol intake 8 days ago, and he developed craving for alcohol 3 days ago and was in agitated state, irritable and also self talk.

Later he came to our hospital on 24.6.23 as they were advised that the patient is in need of mechanical ventilation

Link to the case blog 🔗-

https://140vavilikolanusowmya.blogspot.com/2023/06/75-year-old-male-with-altered-sensorium.html

Questions :

1.The patient presented in a state of altered sensorium.What was the reason for his altered sensorium?

GCS- E1V1M5 on admission.

2.The patient was diagnosed with stroke in right temporo parietal region.What are the risk factors that caused ischemic stroke in the patient?

3.What is the pathophysiology of ischemic stroke?

4. The patient had hypoxia in serial ABGs taken during his hospital stay. What is the cause of hypoxia in the patient?

5.The patient showed signs of respiratory failure. What was the cause for his respiratory failure? Was it secondary to pulmonary edema or aspiration pneumonia?

6. Patient's chest x-ray showed clear cardiomegaly and diaphragmatic palsy.

What are the respiratory outcomes in patients with diaphragmatic palsy secondary to ischemic stroke?

7. How many patients have hypoxia secondary to diaphragmatic palsy and what were the factors influencing their outcomes?

8.In how many patients of stroke with diaphragmatic palsy can we see hypoxia requiring oxygen therapy?

9. The patient was put on Tab. Ecosprin - AV. What is the efficacy of various drugs used to prevent future ischemic stroke in the patient?

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