Case based OSCE along with Bloom's learning levels achieved

 

Case based OSCE along with Bloom's learning levels achieved

Objective Structured Clinical Exam

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

I was asked to go to the biochemistry laboratory and learn about the process by which UPCR is calculated. 

Thanking DR RAKESH BISWAS SIR HOD for giving me opportunity to learn

Thanking biochemistry department for helping me able to complete my osce

Thanking B SHANKARA CHARI, BIOCHEMISTRY TECHNICIAN

24 hr urine protein creatinine ratio

MEASURING AND MIXING URINE BEFORE TAKING TEST SAMPLE FOR 24HR UPCR

https://youtu.be/9fVE5WLrIu8?si=FA3njXRTS7WKz2I8

Thymol crystals one pinch used as preservative are added to urine can before giving

It has pungent smell

24 hr urine sample collected after discarding the first sample at 6:00 am and  urine is collected from next sample till next day morning first sample

Urine samples as given by attenders

Measuring cylinder 1 lt

Measuring urine volume using  measuring cylinder

Urine measured=2300 ml

Mixing of urine

https://youtube.com/shorts/2TvGq1E43Lo?si=LMW8Blgc9Wga5a99

After mixing both urine samples 3 ml test sample is taken and centrifuge slowely to saparate sediment and supernatant

Took 3 test tubes labeled as test, standard and blank, 

Add 2ml of sulpho salicylic acid to each test tube

Sulpho salicylic acid

Add 0.5 ml urine sample to test tube marked T

Add 0.5 ml standard protein to standard tube marked S

Standard protein

Nothing should be added to blank tube

Wait for 10 minutes 

I could appreciate Cloudy appearance in test sample test tube

Comparison between blank and test

I kept blank in calorimeter and made zero cal

Blank

Reading 0.00 cal

Following this standard solution is placed in calorimeter

Reading  0.44 cal

Following this the test sample is placed

Reading 0.22 cal

All readings are notes

Calculating protein values

Calculating spot urine protein

=calorimeter test value x concentration of standard solution/ calorimeter standard value

[Concentration of standard solution =60mg]

=0.22 x 60/0.44

= 30 mg/dl

Spot urine protein = 30mg/dl

 Calculating 24 hr protein 

= spot protein x 24 hr urine volume/100

=30 x 2300/100

= 690mg/dl

24 hr urine protein  is 690mg/dl

Calculating urinary creatinine

The test sample is diluted with distal water in ratio 1:10

100 u test sample + 900 u diatal water = dilution

This is done in BS 390 auto analyser

BS 390 auto analyser

The value obtained for 1 :10 dilution= 1.96

Calculating spot urinary creatine

= value obtained x 10

[10 is constant-linearity range for Creatinine

= 1.96 x 10 = 19.6 mg/dl

 spot urinary creatine = 19.6 mg/dl

24hr urinary creatinine=

Calculated value x 24 hr urinary volume /100

=19.6 x 2300/100 = 450.8 mg/dl

Converting to gms = 0.45 gm/dl

24hr urinary creatinine= 450.8 mg/dl

24 hr Urinary protein creatinine ratio 1.5