4) ) Case based OSCE along with Bloom's learning levels achieved

First we started with ipd cases

A 80yrs old female patient from nalgonda housewife by occupation came to hospital with chief complaints of-

1.fever since 5 days

2.pain in abdomen on and off since one month

3.burning micturition since 1 month

History of presenting illness:

Patient was apparently asymptomatic one month back then she developed pain in abdomen which was diffuse,non radiating associated with burning micturition,then she started having fever since 5 days which is high grade not associated with cough,cold and headache

History of past illness:

H/o # ?rt neck of femur fracture 4yrs back since then she managed to walk with walker

H/o #? Lt knee fracture 2yrs back since then she was bed ridden

Not a k/c/o of DM,HTN, epilepsy,asthma.

Treatment history:

No treatment history

Personal history:

Diet:mixed

Appetite:normal

Sleep : normal

Bowel and bladder: irregular 

Micturition: burning

H/o no addiction

Family history: not significant

No pallor

No cyanosis

No clubbing

No lymphadenopathy

No edema

Vitals:

Temperature: 103F

pulse rate: 102 bpm

Respiratory rate:20cpm

bp:130/80mmHg 

GRBS:123mg%

Systemic examination:

Cvs:

S1 s2 heard no murmer

Respiratory:

No dyspnoea no wheeze position of trachea centre

Vesicular breath sound heard

Abdomen:

shape of abdomen obese, diffuse tenderness present 

CNS:

level of consciousness drowsy

Speech normal

Provisional diagnosis :

?Community acquired pneumonia with heart failure

right renal caliculi, 

mild right hydronephrosis

Treatment:

Iv fluids ns 50ml/hr

Inj.agumentin 1.2 gms iv tid

Inj.neomol 1gm iv sos

Tab.azythromycin 500 mg po od

T.pcm 650 mg po tid

Vitals monitering 2nd hourly

 

Questions asked based on the case

What are the sympotoms dose she had on presentation that lead to diagnosis of pnuemonia

Ans: sob ,tachypnea,  high grade fever with cough with sputum, shallow breathing epigrastic pain

 

question)What might be the reason for heart failure in this patient:

Ans:The acute or persistent inflammatory reaction and hypoxemia happening during CAP are responsible for diffuse organ dysfunction, arrhythmias, and heart failure. Many mechanisms can be used to explain how plaque-unrelated heart failure develops. Because of the ventilation/perfusion mismatch or shunt during the episode of pneumonia, the harmful inflammatory effects on the heart induce myocardial dysfunction, reduced myocardial contractility, greater myocardial oxygen demand, and lower myocardial oxygen supply, leading to heart failure

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695472/

LEVEL ONE: 

REMEMBERING

Patient was apparently asymptomatic one month back then she developed pain in abdomen which was diffuse,non radiating associated with burning micturition,then she started having fever since 7 days which is high grade  with cough , sob , tachypnea not associated with cough,cold and headache

History of past illness:

H/o # ?rt neck of femur fracture 4yrs back since then she managed to walk with walker

H/o #? Lt knee fracture 2yrs back since then she was bed ridden

 

LEVEL 2:

UNDERSTANDING

Understanding the patient condition

Pnuemonia is communicable disease she

Wasn't maintaining proper hygiene as she is bed ridden , none of the family members took care of her 

She started having symptoms like sob, tachypnea, high grade fever with cough , shallow breathing

She might land into complications like respiratory failure , sepsis, cardiovascular complications

She is also complaining of pain abdomen diffuse more on the right side of abdomen

So this could be ?renal caliculi, appendicitis,bowel or liver pathology

https://www.mayoclinic.org/symptoms/abdominal-pain/basics/causes/sym-20050728

Burning micturition may be due to? renal caliculi, uti, infections of bladder or uterus ,stds, 

LEVEL 3:

APPLYING:

Necessary investigations were done

Ultrasound shows right renal caliculi and mild hydronephrosis

Blood reports  shows no leucocytosis

Cue : no pus or epithelial cells

Chest x rays shows signs of pneumonia and heart failure 

LEVEL 4

ANALYSIS:

Though there are limited signs of pneumonia on chest x ray symptomatically diagnosed and treated with antibiotics ,

her vitals are stable so she didn't land into spesis and respiratory failure

Abdominal pain and burning micturition is due to renal caliculi

Heart failure due to CAP

LEVEL 5:

EVALUATING:

List the patient’s problems priority wise—

Fever

Abdominal pain

Burning micturition

Pajr group:

https://chat.whatsapp.com/G6E46oYOI9R49plRVTjTgx