Intern assessment
MEDICINE SELF ASSESSMENT
NAME:M.SRILEKHA.
ROLL NUMBER:88
The following link Is my online protofolio ,has the links of the cases I saw since I was an undergraduate during clinical postings
https://draft.blogger.com/blog/posts/1819225352251433912
Posted from 12/2/23 to 13/4/23 I I in unit -IV in medicine:
During unit duties:
*During duty day in causality I performed my first ever CPR on a 70 year old male who was brought to causality in unconscious state.it was exhilarating and the word doctor seemed much more near to my heart from then.
* accompanied 2 patients to DAC where I learnt the importance of treating a patient as a whole(both physically and mentally) rather than just dealing with the disease only.interaction with Dr.Rajkumar sir was very helpful.
*checked vitals for op patients and took history and learned to prescribe medications for few cases.learned how to manage op when the patient flow is more.
*created pajr groups for admitted patients and updated the soap notes everyday of my unit cases.
*learned about postural hypotension during op days and did CNS examination for patients who came with neurological complaints .
*learned how to explain the treatment to the patient and make them understand the importance of taking medication consistently so the compliance is good and the outcome is good as well.
*seen around 5-6 cases of myocardial infarction which came to casuality and learned how to manage them initially and refer to higher centres.
*accompanied few patients to endocrinology referral
The following are the cases I’ve seen and how did I approach the cases to get to the final diagnosis .
Case 1:
https://srilekha77.blogspot.com/2023/02/65-year-old-female-with-osteoarthritis.html
1)What could be the possible cause of tingling and numbness in this patient???how I ruled out the other causes of tingling and numbness in elderly in patients.
1.Diabetes :
patient is a known case of diabetes and on medication.(diabetic neuropathy)https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in the legs, feet and hands. It can also cause problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.Diabetic neuropathy is a serious diabetes complication that may affect as many as 50% of people with diabetes. But you can often prevent diabetic neuropathy or slow its progress with consistent blood sugar management and a healthy lifestyle.
3.vitamin B12 causing peripheral neuropathy.
4.peripheral arterial diseases ruled out since since distal pulses were intact.
Most probably it could be diabetes induced peripheral neuropathy and also partly due to vitamin deficiency.
2. In view of her bilateral knee pain orthopaedic opinion was taken and diagnosed as osteoarthritis and they suggested physiotherapy.
Case 2:
https://srilekha77.blogspot.com/2023/02/40-year-old-male-with-acute-viral.html
My approach to this case:
1) IS IT PRE HEPATIC OR HEPATIC OR POST HEPATIC JAUNDICE???
Case 3:https://srilekha77.blogspot.com/2023/02/62-year-old-male-with-shortness-of.html
Approach to shortness of breath in this case:
why is it important to evaluate cause of sob in this particular patient: patient had history of PCTA the long term known risk of angioplasty is re stenosis.
https://www.ncbi.nlm.nih.gov/books/NBK535417/
Complications
PTCA is widely practiced and has risks, but major procedural complications are rare. The mortality rate during angioplasty is 1.2%.[4] People older than the age of 65, with kidney disease or diabetes, women, and those with massive heart disease are at a higher risk for complications. Possible complications include hematoma at the femoral artery insertion site, pseudoaneurysm of the femoral artery, infection of skin over femoral artery, embolism, stroke, kidney injury from contrast dye, hypersensitivity to dye, vessel rupture, coronary artery dissection, bleeding, vasospasm, thrombus formation, and acute MI. There is a long-term risk of re-stenosis of the stented vessel.
*6 min walk test is done, learned first time about 6 min walk test and it’s importance
https://www.physio-pedia.com/Six_Minute_Walk_Test_/_6_Minute_Walk_Test
goog_1878733845https://srilekha77.blogspot.com/2023/03/45-year-old-male-with-dengue.html
learning points from this case:
As a medical student I always wondered why only platelets are affected in dengue and why not other cell lines,but never tried to find the exact patho physiology ,but as an intern who is treating a patient I felt it was necessary to find every detail of how and why the disease is occurring and I found different theories in this aspect.
Molecular mimicry
Peripheral serotonin causes dengue virus–induced thrombocytopenia through 5HT2 receptors
Done HESS TEST for the first time ( taught by Dr.Govardhini mam py1)
Case 5:
https://srilekha77.blogspot.com/2023/02/57-year-old-with-acute-ischemic-stroke.html
Learning points:
1.This patient had developed left sided weakness in the afternoon itself,but he presented to hospital at 9 pm. Would the prognosis had been better if he was brought early to hospital ???
Yes, I read this following article https://www.physio-pedia.com/Stroke Which stated:
Regardless the type of stroke, it is important to know that with each minute of large vessel ischemic stroke untreated, close to two million neurons die. This is the most important "time is brain" concept in understanding acute stroke and its treatment.
2.Impending heart failure??? He also had shortness of breath,his CXR showed right sided pleural effusion and the same finding on usg thorax as well,2D echo showed EF of 29% only.
Cause of heart failure in this case??? Difference between ejection fraction reduced and ejection fraction preserved heart failure.......
PSYCHIATRY POSTINGS (14/3/23-28/3/23)
I’ve learnt the Importance of psychiatry postings in internship throug few cases I saw.
I’ve always wanted to become a psychiatrist ,these 15 days of psychiatry posting gave me an idea about the department overall.
There are some medical conditions which presents as / have psychiatry component in them, so we as doctors should be able to differentiate them and help patients in giving them what exactly they want.
1.I’ve learned how Parkinson’s disease and psychiatry symptoms can occur together , so when we treat a case of Parkinson’s we should also look into the mental aspects of the patient to help them more.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236081/
2.seen very interesting cases of schizophrenia, adjustment disorder, panic attacks,depression and got an overview about how the subject is.
3. Seen a case where patient present with altered behaviour and having visual hallucinations, when asked about detail history, his family said that he had an episode of stroke (TIA)few months back and started behaving oddly after that. I’ve read this following article after seeing this case .this case fascinated me if the history of stroke was not given it would have been a pure psychiatry case but the history of stroke changed the diagnosis to Organic psychosis!!!!!!!!
https://www.verywellhealth.com/hallucinations-2488618
Visual hallucinations can result from strokes that occur either in the visual centers of the brain located in the occipital (Latin for "back of the head") lobes or in the brainstem.4
4.Monitored a patient with visual hallucinations who was admitted in icu when I was posted in psychiatry
5.seen many cases of alcohol and tobacco dependence syndrome in DAC(de addiction centre)and how are they managed with pharmacotherapy and psychotherapy together.
PERIPHERALS (29/3/24-13/4/23)
NEPHROLOGY DUTIES:
* Performed an ascitic tap in patient patient who is k/c/o CKD and had gross ascites, approximately 1.5-2 litres of fluid was removed and the patient’s symptoms of shortness of breath,abdominal pain and fullness decreased .
[under guidance of Dr.Bharath sir ( pgy2)]
* Assissted in a therapeutic pleural tap procedure with Dr.Nishitha mam (pg2) under guidance of Dr.Durga Krishna sir(pgy3) in patient who had massive pleural effusion in left side .
* tried taking an ABG sample,but ended up drawing venous blood for the first time
* monitored patients under going dialysis and learned how to manage fluctuating blood pressure during dialysis
During ICU Duty:
*inserted a ryles tube for the first time in a male patient under guidance of Dr.Keerthi(pgy2)
* inserted a foleys catheter in a male patient.
*placed IV cannula
*took ABG samples 5 times from radial artery first one with the help of ICU sister and the next ones on my own .Tried taking femoral artery sample.
* did CNS examination on a stroke patient who is admitted in icu.
*learned how to read x-rays of cases like pleural effusion,pulmonary edema,cardiomegaly and got a basic idea of ecg interpretation .
*did blood pressure,grbs,input / output monitoring of patients in icu.
WARD DUTIES:
*collected venous samples for camp cases
*inserted iv cannulas for admitted patients.
*attended rounds. Attending rounds everyday was very helpful and learned many new points during the discussion
I’ve learnt so many things during my 2 months of internship in general medicine department which are my first hand experiences as a doctor . Special mention to the psychiatry postings as I always wanted to become, these 15 days helped me to get know more about my dream branch.
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