INTERNSHIP LEARNING AND PROCEDURES PERFORMED
This is N.Rakshitha Reddy of 2k18 batch posted in General medicine department as an intern.
My general medicine posting is from October 1 to November 30
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.
This E log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box is welcome."I've 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 a diagnosis and treatment plan.
In ICU :
- taken ABG sample
- done ascitic tap of a patient , link given below
- done CPR
- Assisted in 1 intubation
- learnt how to use BIPAP
Procedures done- 2 ryles, 3 foleys
In NEPHRO -
- learnt about the procedures like central line , assisted one and did sutures
- monitoring Vitals
- learnt the process of dialysis , types , complications
Ward duty hasn't started yet
PSYCHIATRY-
In psychiatry posting I have seen cases like schizophrenia , alcohol withdrawal , OCD , Dissociative disorders , ADHD
CASE :
According to OD mother and brother C/O decreased social interaction ,occasional self smiling and irritability since 6 months
Decreased sleep and appetite , decreased selfcare and hygiene since 3 months
HOPI :
Patient was apparently asymptomatic 6 months ago then OD observed decreased social interaction with family members and isolating herself from family members and self smiling , these symptoms increased since 3 months.
Since 3 months Patient is not sleeping at nights and not taking food regularly and decreased selfcare and hygiene ( Patient passing stools and urinating in the bed and not taking bath for days )
Not doing any household work
H/O head injury head injury at the age of 8 years , no scan taken
Family history:
No psychiatric illness in the family
Past history :
N/k/c/o DM , HTN , TB , asthma , epilepsy , CVA , CAD
Treatment :
1. OD psychoeducated
2. T. Olanzapine 5mg po/od
I also visited deaddiction centre where patients are taught the consequences of taking alcohol and also given medication
UNIT -
These are the cases I've documented
1. CASE 1:
Seen a SLE case , assisted in skin biopsy of the Patient in dermatology department
25F WITH FEVER SINCE 3 MONTHS
25 year female got married 8 years ago 2nd degree consagunious marraige
1st son -3 years after marraige
During her second pregnancy which is 6 years after marraige she had hyperpigmented lesion over her cheeck initially small in size which latter progressed to butterfly shaped lesion over both cheecks
Since 3 months she is having high grade fever and went to rmp and used medication and she also has abdominal pain for which she was admitted in our hospital on 26/8/23 and treated as acute gastritis
After discharge she developed skin lesions over b/l lower limbs associated with itching which later progressed to painful pus filled ulcers over b/l lower limbs ,over left elbow and lumbosacral region
Since 3 months she has hairfall and multiple joint pains elbow,wrist joint,interphalengeal joints ,knee joint
5days back she had 2 episodes of generalized tonic seizures for about 2 minutes with uprolling of eyes ,with lip bite ,and no involuntary micturition or defecation ,no frothing
No previous abortion history
Since 3 months she has ammenorhea
S :
No fever spikes , abdominal pain decreased
O :
Patient is conscious/coherent/cooperative
Bp: 90/60 mmhg
PR: 72 bpm, regular
GRBS : 97 mg/dl
SPO2: 98% at RA
CVS: S1 S2+ , no murmurs heard
RS: Bilateral air entry+, NVBS heard
CNS: NFAD
P/A: Soft, no organomegaly, bowel sounds heard
A :
SYSTEMIC LUPUS ERYTHEMATOSIS
P :
1.inj.neomol IV/ SOS
2. IV fluids NS,RL
3. inj.MONOCEF 1gm IV/BD
4.inj.PAN 40mg IV/OD
5. T.prednisolone 30mg then tapered to 20mg
Pajr link -
Blog -
OSCE :
1.What is the criteria for SLE ?
2. Symptoms and signs of sle ?
3. Specific test used for confirmation of sle ?
A- ANA profile
4. Role of immunosuppressants in treatment of SLE
A- Systemic lupus erythematosus (SLE) is an autoimmune disease that happens when your immune system mistakenly attacks different parts of your body, like your skin, joints, kidneys, heart, lungs, and brain.immunosuppressants, which work by dialing down your overactive immune system.
5. What is the most common complication that can lead to death for patients with SLE?
Renal failure and sepsis are two main causes of death in patients with SLE. The kidney is the most commonly involved visceral organ in SLE.
CASE 2 :
Seen a neurocysticercosis case and seen the procedure of EEG
I was in casuality duty on one fine Monday, here comes a 19 year old girl with seizures
Seizures link below -
Patient was apparently asymptomatic
Then the Patient developed headache which is frontal , associated with nausea ,non radiating , intermittent type
H/O vomiting , 1 episode today after coming to the hospital , food as content, non bilious, non projectile
In the course of hospital , she developed 2 episodes of seizures , each lasted for 2 minutes , generalized tonic clonic , with frothing, post ictal confusion , no tongue bite, no uprolling of eyes and gained consciousness after 1 min
No H/O SOB , chest pain ,palpitations, sweating , orthopnea , pnd
No h/O fever ,cough, cold
No H/O blurring of vision
No H/O burning micturition, loose stools , abdominal pain
Past history :
Known case of neurocysticercosis 8 months back because of which she developed 3 episodes of seizures . She didn't have any episode of seizure since then .
N/K/C/O DM, HTN, CAD, CVA, TB ,asthma , thyroid disorders
Blog -
OSCE :
1. What are the risk factors for neurocysticercosis?
Neurocysticercosis is a preventable parasitic infection of the central nervous system and is caused by the pork tapeworm Taenia solium. Humans become infected after consuming undercooked food particularly pork or water containing eggs or poor hygiene
2. How does neurocysticercosis leads to seizures ?
A - The tapeworm eggs hatch in the intestine and spread throughout the body, including the brain, where they cause the most problems. When they reach the brain, they form cysts, leading to neurocysticercosis. This leads to increase the pressure in brain which leads to seizures
3. Symptoms of neurocysticercosis?
A- seizures and headache are the most common symptoms. The other symptoms are confusion
4. What is an EEG used to diagnose?
The electroencephalogram (EEG) is a medical test used to measure the electrical activity of the brain. A number of electrodes are applied to your scalp. EEG can help diagnose a number of conditions including epilepsy, sleep disorders and brain tumours.
CASE 3 :
3. An 80 year old male patient, farmer by occupation, resident of Nalgonda came to the hospital with
CHIEF COMPLAINTS of cough and difficulty in breathing since 2 years, which aggravated since 2 months
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 2 years ago then he had complaints of shortness of breath which was insidious on onset and gradually progressive , initially it was MMRC grade I to MMRC grade IV
No associated wheeze
No orthopnea
No seasonal variations, no pnd
No history of recurrent upper/ lower respiratory tract infections
Also complaints of cough since 2 years
Associated with sputum, copious in amount, mucopurulent, yellowish colour, foul smelling
Not associated with blood
Cough aggravated on lying down
No seasonal variations
No chest pain, palpitations, syncopal attacks
PAST HISTORY
K/C/O TB 30 years back, used medication for 4 months
K/C/O HTN since 5 months
N/K/C/O DM, CAD, Asthma , epilepsy
On examination: drooping of shoulder present towards left side
Vocal resonance and Tactile fremitus increased on left side
Percussion - decreased on left side
Auscultation - Bronchial breath sounds present on left side
Pajr link -
Blog -
4. Seen a case of retroviral disease and TB
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