Internship assessment

My internship started started with unit duty 
In 1 and 2 week  these are the blogs I have done 
With detailed history and examination 


http://52-santoshkumar.blogspot.com/2022/12/65-yr-old-male-patient-with-soband.html

This is a case of 
CHRONIC DECOMPENSATED LIVER DISEASE WITH HIGH SAAG LOW PROTEIN ASCITES SECONDARY 

TO ALCOHOLIC LIVER DISEASE WITH B/L LOWER LIMB EDEMA GRADE 2 WITH HYPONATREMIA AND HYPOKALEMIA here in this case  

I learned per ABDOMINAL examination in detail 

New learning points 

Grades of ascites 

Grade 1 clinically inevident ascites but by ultrasound

Grade 2. Moderate ascites with symmetrical abdominal DISTENSION  with flanks fullness

Grade 3 large or gross abdominal DISTENSION 

Child Pugh score for portal hypertension 


Grades of hepatic enchephalopathy

http://52-santoshkumar.blogspot.com/2023/01/60-yr-old-female-with-headache-and-neck.html

Here this female complaints symptoms similar to Rheumatoid arthritis  
New learning points 
Other systemic disorders associated with rheumatoid arthritis 

CVS. Pericarditis
 Hematology  Feltys syndrome. Neutropenia + splenonomegaly+ RA 
RS. Pleural effusion 
GI. Mesenteric ischemia due  to vasculitis 


http://52-santoshkumar.blogspot.com/2022/12/40-yr-old-female-presented-in.html
 This is the 1 St death  case I have seen  in unit duty 
Pt came with altered sensorium which later progressed to coma 

I learned different stages of coma 

Next I was posted  in nephrology department
In nephrology department 
I used to took some  histories of patient and how they landed in this condition 
One of the history is 

60 year old female came to casualty with complaints of swelling of legs and sob from 15 days 

She was apparently asymptomatic 15 days ago. 
-she is experiencing SOB on exertion since 15 days which has been progressive (didn’t relieve with diuretics)
- pedal edema and facial puffiness since 15 days

- H/o abdominal DISTENSION
- H/o decreased urine output 
-H/o low back pain since 3 years 
- h/o NSAID use 

No history of orthopnea and paroxysmal nocturnal dyspnea
No history of fever, vomiting,pain abdomen,loose stools,chest pain, palpitations.

Past history:
Diagnosed with diabetes since 15 years and on Inj HAI 4U TID
Hypertension since 20 years, on amlodipine 10mg.
- H/o gynecological surgery .

 Diagnosis - Renal failure secondary to NSAID use 
Know case of Dm2 and HTN


My learning points
How NSAID will cause renal failure  and other causes of renal failure 

In ICU  my workings are
ICU duty:
 Monitored vitals of all the patients in ICU and AMC

 I have inserted Foleys ,ryles tube to some patients

I assisted pgs in inserting central cannula 

I  have inserted iv cannula to many patients  and monitored pt during blood transfusion 

My learning points

1 how to check pulses paradoxes 
2 heared S3 heart sound in heart failure pt ( how to recognise  ) 
3 treating pt with liver failure and heart failure 
learned to took abg samples 
From radial artery 
Later I learned taking abg from brachial artery and 
Femoral artery 

Ward duty 

Here I conducted prefinal examination practical for final year student 
Learning points  ( learned during taking viva for students)
1 examination of respiratory system indetail
2 difference between type 1 and 2 respiratory failure 
3  how to approach a case / diagnosing a case based on only clinical history 
4 asking negative history to rule out other differentials 
5 treating a case  of epilepsy 

Unit duty in last 15 days 
http://52-santoshkumar.blogspot.com/2023/02/68-yr-old-male-with-intermittent-fever.html

This is a pt diagnosed as  ANEMIA UNDER EVALUATION SECONDARY TO ? GI blood loss associated with infection
K/C/O DIABETIC NEPHROPATHY SINCE 2 YEARS 
K/C/O OSA SINCE 3 YEARS 

Learning points 
I learned how to diagnose gi blood loss clinically
Role endoscopy and colonoscopy in diagnosing gi blood loss 
I took samples of stool  and urine to know progression and cause of blood loss


http://52-santoshkumar.blogspot.com/2023/02/34-yrm-with-compressive-myelopathy.html

This was a case of compressive MYELOPATHY 

Learning points 
 CNS examination in detail 
 How to diagnose compressive MYELOPATHY by reading MRI 
How to treat this patient 

My CNS examination that I have done in detail 
 CENTRAL NERVOUS SYSTEM EXAMINATION- 

Higher mental functions
- Conscious
- Oriented to time,place and person
- Memory - Intact
- Speech - no deficit

Cranial nerve examination 

          • 1 - olfactory sense - normal

          • 2- Direct and indirect light reflex present

          • 3,4,6 - no ptosis and nystagmus
All eye movements were normal
 • 5- Touch - 
Sensory -by cotton and pin felt
 Motor - chewing movements seen             

           • 7- no deviation of mouth, no loss of nasolabial folds, forehead wrinkling present

          • 8- Hearing normal 

          • 9,10- position of uvula is central
No regurgitation after drinking water

          • 11- looked for trapezius muscle - contraction present

          • 12- no deviation of tongue on protrusion
Motor system 

Attitude - left and right lower limb slightly flexed at knee joint in lying down posture

Reflexes 
                          Right Left            
Biceps - -
Triceps - -
Supinator - -
 Knee. . +3 +2
Ankle. +2. +2
Babinski. B/L extension of great time is seen      
                            
Power
Upper limb -5/5

Lower limb -5/5                                         
               

TONE. Lt. Rt
 Upper limbs N N                
 Lower limbs N N                 

No involuntary movements
SENSORY SYSTEM

I – SPINOTHALAMIC R L
1. Crude touch N N 
2. Pain. N. N
II – POSTERIOR COLUMN
1. Fine touch. N. N
2. Vibration sense not felt on Lt lower limb but it slightly felt on rt lower limb             
3. Position sense. N. N
4. Romberg’s sign - positive
III – CORTICAL
1. Two point 
    discrimination.               
2. Tactile localisation. Not localised at some points and he delayed to localise the point at other regions in both lower limbs 
3. Graphaesthesia. N. N
4. Stereognosis. N. N
Finger nose Coordination present 
No dysdiadokinesia 
Knee heel coordination present 
Gait. Appear to be normal 
         Swaying seen when he walks on narrow path
And discomfort seen while walking down stairs

http://52-santoshkumar.blogspot.com/2023/02/65-yr-old-female-with-involuntary.html

This a case of hyper glycemia  with chorea 

Learning points 
How hyperglycemia will cause chorea ? What is the pathogenesis 
Difference between HHS and diabetic keto acidosis 
Acute and chronic complications of diabetes
Types of DM 
Diabetic nephropathy stages 

During OP days  and other works ihave done are 
I learned to take history for different cases
I have seen a case of facial nerve palsy and I diagnosed it as LMN type 
Sending appropriate investigations  for diagnosis 
Collecting report s , updating fever chart , updating glucose trends 
https://youtu.be/8TW-n6UAJ5o

PSYCHIATRY DUTY :

learnt about the importance of history taking and cases like

ALCOHOL DEPENDENCE SYNDROME

TOBACCO DEPENDENCE SYNDROME 

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