OSCE

General Medicine OSCE with real patient 

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 -1: 

A 14 year old female presented to casualty with C/O SOB since 2 hours,sudden onset ,grade 4 .No orthopnea and PND .Fever since 8 hours ,high grade a/w chills and rigors .Rash over the abdomen since 3 days ,no itching or redness,no discharge ,no pain

https://lasyasakilam27.blogspot.com/2023/07/diabetic-ketoacidos.html

Q>What is the given skin lesion and how can it be treated? 

It is most likely post inflammatory hyperpigmentation 

Treatment: Oint T Bact L/A 

                      Venusia max lotion L/A

Q>What are the causes of DKA ?

Diabetic ketoacidosis (DKA) is primarily caused by a lack of insulin in the body, which leads to high blood sugar levels and the breakdown of fats for energy. This breakdown produces ketones, resulting in the acidic environment seen in DKA. It's often triggered by factors like infections, missed insulin doses, illness, or stress.

Q>What is the Treatment protocol for DKA ?

Q>What is the cause of DKA in this patient ?

--The rash could probably indicate underlying infection which triggered the DKA 

--Patient's non compliance to treatment could also have led to this current state, i. e. 

Woke up at 7 am 

Missed the morning dose of insulin and breakfast because she was late to school 

Went to school at 8 am 

Felt giddiness and told the Teacher about it. Teacher asked her to eat. 

Refused to eat due to nausea 

Had Vomiting at 11 pm - water content 

At 12:30 vomited once again - water content 

Informed her grandfather and went home at 1 pm

At home she started developing SOB so didn't eat again

Went to local doctor due to SOB at 5 pm

She was put on O2 there and when it didn't resolve the doctor advice to go to higher centre 

Came to kamineni at 7:30 pm