Internship assessment

 Learning points in medicine posting. 

My first duty in medical ward, 

Taken history of patients, learning medication given to particular patient by looking into the case sheets(understanding why they were given), drawn blood for lab. Tests. Learning important points by following rounds done by Rakesh biswas Sir. 

My second duty is in ICU, 

Drawn blood for ABG, foley's  Catheterization, ryle's tube 

Assisted in procedures like central line placement

Seen lumbar puncture procedure, learnt cases with medication. 

A Young patient in ICU whose bp is above 200/110mmHg consistently and when NORAD is given his bp comes down slowly and on regular monitoring and administration of bp medication and on regular hemodialysis his bp get controlled and he was discharged. 

Next duty into nephro:

Assisted in Central line placement, seen dialysis technique. 

A Young patient in nephro whose bp is above 200/110mmHg consistently and when NORAD is given his bp comes down slowly and on regular monitoring and administration of bp medication and on regular hemodialysis his bp get controlled and he was discharged. 

Next duty in unit 3:

Seen alot of cases

1) SIRS (Resolved)with MODS-Thrombocytopenia, ALI(Resolving),AKI(Resolved),HYPOKALEMIA(RESOLVED), HYPONATREMIA(RESOLVED).

DCMP-SEPTIC /ALCOHOL INDUCED.





Alcohol induced cardiomyopathy:




Link to my blog:

https://61tejarshini.blogspot.com/2022/12/general-medicine-case-discussion.html

2) DISTRIBUTIVE SHOCK SECONDARY TO SEPSIS
VIRAL PYREXIA WITH THROMBOCYTOPENIA. 


Patient has fever spikes with tachycardia with thrombocytopenia and by neomol infusion feverspikes get reduced. 

Patient is treated with adequate fluids and distributive shock get resolved

Link to the blog:

https://61tejarshini.blogspot.com/2023/01/general-medicine-case-discussion.html

3) DECOMPENSATED LIVER DISEASE, DIMORPHIC ANEMIA WITH THROMBOCYTOPENIA (RESOLVED) WITH HYPOOKALEMIA WITH HEPATIC ENCEPHALOPATHY-GRADE 1(RESOLVED) WITH DENOVO DM-2,? SBP. 





Patient came with complaints of, 

Fever on and off episodes:12 days

Loss of appetite:12 days

Pedal edema:7 days

Shortness of breath :7 days

Jaundice:7 days

He is chronic alcoholic since 25 years, Tobacco chewer since 5Days

At presentation he has severe jaundice, b/l pedal edema upto knees, raised jvp

On examination:

Per abdomen:
Inspection:
Shape of Abdomen:Distended
Umbilicus:Everted
No Dilated veins, visible peristalsis, engorged veins, scars, sinuses. 
Palpation:
No local rise of temperature, non-tender
Abdominal girth:89cms 
Liver palpable (15cm) 
Spleen not palpable
Percussion:
Resonant note heard
Auscultation:
Bowel sounds heard. 

His LFT:

TB:19.61
DB:16.08
SGOT:63
SGPT:25
ALP:268
TP:6.1
ALB:2.0
A/G RATIO:0.51

Ascitic tap done :
ASCITIC TAP DONE ON 13/01/23
ASCITIC FLUID
SUGAR:90
PROTEIN:1.0
LDH:147
ALB:0.51
SAAG:1.5

Interpretation of ascitic fluid:

High SAAG indicates Portal Hypertension

Link to the blog:

https://61tejarshini.blogspot.com/2023/01/this-is-e-log-book-to-discuss-our.html


4) Bronchial Asthma with Hypertension:1month

? Low backache. 

Patient came with complaints of, 


Breathlessness since 4days

Dry cough since 4days

Headache since 4days

Low backache 

H/O Tingling sensation of both upper and lowerlimbs present. 

C/O neck pains which get aggravated on supine position

H/o wheeze present. 

On examination:

RESPIRATORY SYSTEM EXAMINATION:

INSPECTION:
Shape of chest is elliptical, 
B/L symmetrical chest,
Trachea appears in central position,
Expansion of chest-Normal on both sides
Movements of chest Normal on both sides
Use of Accessory muscles is not present.

PALPATION:
No local rise of temperature,non tender
trachea is central
Measurement:
AP: 26cm
Transverse:30cm
Right hemithorax:50cm
left hemithorax:49cm
Circumferential:100cm
Tactile vocal fremitus:Normal on both left and rightside

PERCUSSION: Resonant note heard 

AUSCULTATION:
Wheeze heard in B/L infraclavicular, mammary, infra-mammary, supra scapular, infra scapular, inter scapular areas. 

Treated adequately with, 

NEBULISATION WITH DUOLIN 8TH HOURLY

                                        BUDECORT 12TH HOURLY

TAB. TELMA 40MG/PO/OD

CAP. PAN-D PO/OD

TAB. ULTRACET 1/2TAB PO/BD

TAB. MTV PO/OD

TAB. PREGABA-NT PO/OD

TAB. PULMOCLEAR PO/BD

TAB. MONTEK-LC PO/HS

SOB MMRC grading:





Bronchial asthma pathophysiology:



GINA guidelines of treating bronchial asthma:













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