Internship assessment of General Medicine posting

 MY LEARNING POINTS DURING MY POSTINGS IN GENERAL MEDICINE DEPARTMENT 

Gnana Prasanna .E( Intern )

Roll no -01

I have been posted in General Medicine department from January 4 2023- March 3 2023

MY LEARNING POINTS IN PSYCHIATRY:

JAN 4 2023 - JAN 19 2023

14yr F- De addiction counsellings done by Dr. Raj Kumar sir

43yr F- De addiction coounsellings done by Dr. Raj kumar sir and also had dental consultantion for her tooth ache and showed impacted lower 3rd molar so extraction of impacted tooth and filling of cavity was done.

74yr F - De addiction counsellings done by Dr. Raj Kumar sir and physiotherapist suggested heel stretching exercises.

19 yr F - Aphasia post depression counselling done by Dr. Sravanthi ma'am 

We also had great time with the family and suggested some places to visit in Hyderabad and after getting discharged they went for Hyderabad tourism.

MY LEARNING POINTS IN UNIT DUTIES 

(19 JAN 2023 -  2 FEB 2023)

During this period I have been under guidance of 

Dr.Susmitha ma’am(SR)

Dr .Shailesh sir (PGY3), 

Dr. Keerthi ma’am ( PGY2),

Dr. Navya ma’am( PGY1),

we have taken responsibility for managing the patients admitted under our unit 4.

Case 1 : 

http://prasannaengala2799.blogspot.com/2023/01/55-yr-old-male-with-pain-abdomen.html

http://prasannaengala2799.blogspot.com/2023/01/55-yr-old-male-with-pain-abdomen.html

The most common history findings for a patient with gastroenteritis are :

• Nausea 
• Diarrhea (watery or bloody in dysentery) 
• Vomiting
• Abdominal pain
• Fever (suggests an invasive organism as the cause)

On physical examination, the abdomen would be soft, but there may be voluntary guarding. Palpation may elicit mild to moderate tenderness. Fever suggests the cause is invasive pathogens. Signs of dehydration are the most important thing to look for while performing the physical examination; some cases may be alarming and help to identify that which patient needs hospitalization. The following are red flags:

• Dry mucous membranes (dry mouth)
• Decreased skin turgor 
• Altered mental status
• Tachycardia
• Hypotension, orthostasis
• Bloody stools
• Recent hospitalization or antibiotics
• Age greater than 65 years
• Comorbidities such as HIV and diabetes.

CASE 2 :

 This case was contributed  to every unit member as

It is a important topic 

It was taken by 

Me , Tejasree ,Sreshta 

https://54tejasreekandregula.blogspot.com/2022/12/a-26yr-old-female-with-fever-and.html

• Types of fever 

• Types of Headache

• I have learnt the importance of fever charting.
• And the importance of monitoring the patient.

Case 3: 

• I have Assisted in USG guided diagnostic pleural tap done by Dr. Keerthi Ma’am (PGY2) on a this patient.

https://sreshtaj.blogspot.com/2022/12/42-year-old-female-with-dengue.html

• Taken blood samples on various patients and had put ryles tube and foleys catheter to male and female patients.
• I had interacted with patients .

Case 4 :

http://prasannaengala2799.blogspot.com/2023/02/88-yrs-old-female-came-to-casualty-with.html

Electrolyte abnormalities in older adults

Electrolyte abnormalities, particularly dysnatraemia, should be considered in the context of water balance. Hypertonic dehydration occurs when proportionally more water than sodium is lost from the extracellular fluid compartment. This may occur as a result of age-related thirst impairment and would manifest as serum sodium concentration of greater than 145 mmol/l in the context of dehydration. Hypotonic dehydration on the other hand occurs when the proportion of sodium lost is greater than water, resulting in a serum sodium concentration of less than 135 mmol/l. This may occur with the use of diuretics. Isotonic dehydration results from proportionate loss of water and sodium and results in normal serum sodium concentrations. Isotonic dehydration may occur, for example, as a result of diarrhoea, where there is salt and water loss in similar proportions.

family history

MY LEARNING POINTS IN ICU & AMC DUTIES

(2 FEB  2023 - 6 FEB 2023)

During this period I have been under guidance of 

Dr. Vinay sir (PGY3)

Dr. Kranthi sir (PGY2)

• I have monitored vitals for patients in ICU (4 ventilator pt’s )& AMC ( BP,PR RR TEMP GRBS FEVER SPIKES, SPO2)
• Put ryles tube and Foleys catheters 
• I have taken ABG samples (from radial, femoral, brachial) 
• Done CPR on a patient and she was revived.

• Learned about intubation procedure and complications and risk factors
• Learned how to manage Status epilepticus 
• Cpap bipap difference 
• 
  
• 
  
  
  
• Learned about Light’s criteria for pleural effusion.

• Management of Hypotension .
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/

• Importance of mean arterial blood pressure for managing hypotension and ionotropes(Nor adrenaline)

MY LEARNING POINTS IN NEPHROLOGY DUTIES

(19 Feb 2023 - 25 Feb,2023)

During this period I have been under guidance of 

Dr. Kranthi sir PGY2

Dr. Sailesh sir PGY2

• Learned SOB grading

• Monitored patients during dialysis for high blood pressure, hypoglycaemia and fever spikes 
• Indications for Heparin free dialysis 

• Importance of Intradialysis blood transfusion  
• Learned about drugs like lasix,NTG, Arkemin 0.1mg

• Management of hypokalemia with oral and IV K+ supplements

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881435/

• Management of hyperkalemia with salbutamol nebulisation

          https://www.ncbi.nlm.nih.gov/books/NBK470284/

 MY LEARNING POINTS IN UNIT DUTIES

(25 FEB 2023 - 3 MARCH 2023)

Dr.Susmitha ma’am(SR)

Dr.Chandana ma’am ( PGY3)

Dr. Raveen sir (PGY3), 

Dr. Haripriya ma’am ( PGY2),

 Dr. Govardhini ma’am( PGY1)

Case Finding :

Approach to giddiness:

How much drop is significant to say it as postural hypotension ?

To check for Postural hypotension, BP is measured in supine position first and then let the patient stand for 3minutes and BP is measured in standing position 

Systolic bp- 20mmhg difference

Diastolic bp -10mmhg difference