INTERNSHIP ASSESSMENT ROLL NO:65

INTERNSHIP ASSESSMENT:

Posted in department of GENERAL MEDICINE from 12/12/22 to 11/2/23.

UNIT duties—-First 15 days (12/12/22-26/12/22)

  Last 16 days (27/1/23-11/2/23)

I would check the vitals of my patients and update SOAP notes Daily morning  and used to attend morning rounds  

Have taken samples and took the patients for required investigations 

Here are the blogs that I have done during my internship duties 

https://sannithreddykasala.blogspot.com/2023/02/a-case-of-15-yr-old-male.html

https://sannithreddykasala.blogspot.com/2023/02/a-case-of-85-year-old-female.html

https://sannithreddykasala.blogspot.com/2023/02/a-case-of-70-year-old-frmale.html

https://sannithreddykasala.blogspot.com/2023/01/a-case-of-36-year-old.html

https://sannithreddykasala.blogspot.com/2022/12/a-case-of-55-year-old.html

https://sannithreddykasala.blogspot.com/2022/12/a-case-of-60-year-old.html

https://sannithreddykasala.blogspot.com/2022/12/case-of-68-year-old-female.html

During OP DAY

I took the basic history of the patients and wrote the investigation required under the guidance of PG 

I have checked vitals of every patient 

Examined for reflexes, postural hypotension, Romberg’s sign

Have learnt basic management protocol few common conditions like headaches, fever, chestpain

NEPHROLOGY DUTY:

Monitored Blood Pressures of the patients during dialysis and in the CKD ward.

 while I was monitoring vitals , a patient had the Blood pressure-200/100 at 2:00AM.I've informed Dr.sailesh sir and he told to give Lasix and Nicardia,I got to know the role of lasix in CKD patients in clinical practice . 

I encountered another patient with SOB at 2 am then I put him on nebulization with salbutamol and ipratropium bromide and checked it's bp it's was 180/110 then we NICARDIA 10 mg after nebulization his sob reduced and patient felt releif and next day morning dialysis was done 

During ICU duty:

Monitored vitals of ICU and AMC patients.

Learnt drawing of ABG samples.

Inserted RYLES tube.

Done FOLEYS catheterisation .

Placed IV canula.

Assisted in Intubation with Dr Bharath and Dr shailesh sir 

I've Learnt the role of atracurium in patients with high Respiratory Rate. 

 learned to connect the oxygen mask and the no: of litres of water to be adjusted based on requirement and CPAP. 

WARD DUTY:

Monitored Bp for the patients with hypertensive urgency and made the chart of blood pressure recordings

Have attended the rounds.

Got SOAP notes updated of ward patients.

DURING PSYCHIATRY

Learned about importance of history taking and how history can guide us to probable diagnosis

vitals monitoring done for OP patients

Case related experience

1) Alcohol dependance- I've learnt the role of Loraz in alcohol withdrwal(1unit=30ml alcohol and we substitute 1 tablet of loraz for that) ,learnt the role of Baclofen in decreasing the cravings. Since thiamine is deficient in the we substitute that. I saw a patient who came early in morning with alcohol withdrawal tremors and he came drunk and want medication to stop drinking alcohol 

2) Schizophrenia- I saw a 60 year male having delusion of infidelity, persecution, visual hallucinations. He was given Risperidone and Trihexyphenidyl(for side effect of Risperidone). 

3) I've learnt how aggression(target oriented) is different from irritability(Generalized) for a person. 

4) panic attack- Loraz is given for the patient. 

5) I've learnt how we treat a patient with anger(uncontrolled anger, immediate- Haloperidol. Moderate anger- sodium valproate, mild anger -Loraz) 

Learnt about audit score - a parameter used in evaluating alcohol dependence

A CASE OF 15 YR OLD MALE

 Name: K.Sannith Reddy

Roll no. 65

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.

Following is the view of my case : 

CHEIF COMPLAINTS: 

15 year old male student resident of Nalgonda complains of pain abdomen since yesterday

Vomitings Since Yesterday.

HOPI: 

Patient was apparently asymptomatic until 2 days ago then he had sudden onset of epigastric pain since yesterday morning non-radiating.

5 Episodes of vomitings since yesterday morning

first episode after one hour of lunch, food as content

Vomitings are green in colour bilious ,projectile 

Second episode is after 15 mins of drinking milk

Third episode after 20 mins of drinking Pulpy orange.

fourth episode after having grapes, last episode yesterday evening

No c/o Fever, Headache; Giddiness

NO c/o chest pain,sweating, palpitations,orthopnea,pnd,cough,sob 

NO c/o burning micturition,loose stools,nausea

No h/o DM,HTN,TB,ASTHMA,CVA,CAD

PERSONAL HISTORY

Diet mixed 

appetite normal 

sleep adequate 

no addictions 

bladder and bowel movements regular 

NO SIGNIFICANT FAMILY HISTORY

GENERAL EXAMINATION: 

Pt is c/c/c 

NO pallor,icterus,cyanosis,clubbing, lymphadenopathy, edema

vitals: 

BP-110/70mm hg 

pr- 75bpm

RR 17cpm 

Spo2 -98% ra

grbs 125mg/dl

SYSTEMIC EXAMINATION: 

CVS S1,S2 heard ,no murmurs 

RS- BAE + ,NVBS

P/A soft,nontender 

CNS: NFND 

INVESTIGATIONS: 

DIAGNOSIS: 

?ACUTE PANCREATITIS

TREATMENT: 

NBM Till further orders 

IV FLUIDS NS and DNS @100 ML /HR IV 

INJ TRAMADOL 1 AMP IN 100 ML NS IV TID 

INJ ZOFER 4MG IV STAT (NEXT SOS)

A CASE OF 85 YEAR OLD FEMALE

 Name: K.Sannith Reddy

Roll no. 65

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.

Following is the view of my case : 

CHEIF COMPLAINTS : 

85 year old female came to the causalty with c/o shortness of breath and chest discormfort since 1 week 

HOPI: 

pt was apparently asymptomatic 27 years ago, had expiry of his husband (reason: attenders are saying because of old age, huaband was died).

20 years back, patient developed fever with Generalized weakness along with neck pain, where she was diagnosed with Diabetes and Hypertension and started on Medication.

She is a vegetarian and has no addictions. She stays along with her son, who has kirana shop, and her daily routine was she used to stay at home, not used to go outside and do Pooja, have food and watches television.

15 days back, patient developed sudden onset shortness of breath, 3 hours after having dinner, along with chest discomfort and sob aggravated on lying down position,along with cough.The attenders called RMP, but due to unavailability of vehicles, the patient was at home till 5am.At around 5 am in the morning, patient was taken to the area hospital, ECG was taken, told that it was heart stroke,where where she was given a injection (taking all the consents ??Thrombolysis) and she was taken

to the private hospital in warangal.

The treating doctor performed coronary angiography and advised for conservative management.

But upon request / force by attenders, PTCA was done to LAD and discharged after 3 days with

medication.

For 1 week, patient was fine and after that she again developed sudden onset shortness of breath,

where she was taken to the same hospital and conservative management was done, but due to

some issues, the attenders left the hospital and came here for further evaluation.

PAST HISTORY : 

K/C/O HTN SINCE 20 YEARS ON regular medication on metoprolol 25 mg 

K/C/O DM SINCE 20 YEARS on regular medication metformin 500 mg 

HISTORY OF CAD on medication ecosprin 150mg ,atorvas 40 ,clopidogrel 75 

PERSONAL HISTORY: 

Diet - mixed

Appetite- normal

Bowel and bladder movements regular

sleep- adequate

no addictions 

SURGICAL HISTORY: 

PTCA FOR LAD DONE ON 21/01/23

NO SIGNIFICANT FAMILY HISTORY 

GENERAL EXAMINATION: 

Pt is c/c/c 

NO icterus,cyanosis,clubbing,lymphadenopathy,edema

Pallor present 

vitals: 

BP-90/50mm hg 

pr- 108bpm

RR 20cpm 

Spo2 -100 on6lit o2 

grbs 216mg/dl

SYSTEMIC EXAMINATION: 

CVS S1,S2 heard ,no murmurs 

RS- BAE + ,Crepts present in B/L infrascapular region 

P/A soft,nontender 

CNS: NFND 

INVESTIGATIONS: 

2d echo: 

ECG: on 5/2/23

On4/2/23

On 3/1/23

Cxray: 

USG abdomen and pelvis: 

DIAGNOSIS: 

HEART FAILURE WITH REDUCED EJECTION FRACTION WITH S/P PTCA TO LAD 15 DAYS BACK 

CAG: TRIPLE VESSEL DISEASE WITH ANEMIA OF CHRONIC DISEASE WITH AKI ON CKD? 

K/C/O HTN,DM SINCE 15 YEARS 

TREATMENT : 

INJ MONOCEF 1G IV BD 

INJ LASIX 40MG IV BD 

INJ HUMAN ACTRAPID INJECTION S/C ACC TO GRBS AFTER INFORMING 

T CLOPIDOGREL 75MG PO BD 

T ECOSPRIN 150 MG PO HS 

T ATOCOR 20 PO HS 

INTERMITTENT CPAP 

INJ NORAD 1 MCG /KG/MIN (4ML+46ML NS)@ 2ML/HR INCREASE /DECREASE TO MAINTAIN MAP>/= 65MMHG

A CASE OF 70 YEAR OLD FEMALE

 Name: K.Sannith Reddy

Roll no. 65

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.

Following is the view of my case :

COMPLAINTS AND DURATION

A 70year female house wife by occupation brought to the Casuality

c/o fever since 4 days

slurring of Speech since 4 days.

SOB since 4 days

B/L pedal edema since 4days 

Left upper limb and lower limb weakness since 10years 

HISTORY OF PRESENT ILLNESS :

Patent was apparantly asymptomatic 4 days back then she developed fever low grade associated with chills and rigor Assosiated with shortness of breath grade 2 & associated with slurring of Speech and b/l pedal edema pitting type

weakness of left upper limb and lower limb from 10years

For fever they took treatment at local Rmp

HISTORY OF PAST ILLNESS

Is k/c/o HTN since 10 years on telma 40mg 

IS N/K/C/O DM/ASTHMA/CAD/EPILEPSY 

underwent craniotomy 10 years back at gandhi hospital for cerebral hemorrhage where she was diagnosed to have hypertension and started on medication

H/o NSAID Abuse

PERSONAL HISTORY: 

Diet - mixed

Appetite- normal

Bowel and bladder movements regular

sleep- adequate

Addictions: 

Alcohol (toddy) consumption occasional once in 6 months

DRUG HISTORY : 

On telma 40 medication since 10 years for hypertension.

SURGICAL HISTORY: 

Underwent craniotomy for cerebral hemorrhage 10 years back in Gandhi hospital 

From then pt had weakness in left upperlimb and lower limb 

GENERAL EXAMINATION: 

Pt is c/c/c 

No ,icterus,cyanosis, clubbing, lymphadenopathy

Pallor present

edema present (pitting type)

vitals: 

temp - 99°F

pr: 102bpm,bp: 100/80 mm hg 

rr:16cpm spo2 95% at ra 

grbs- 160mg%

SYSYTEMIC EXAMINATION: 

CVS: S1, S2 heard no murmurs

RS: BAE presnt ,NVBS heard

P/A: distended ,non tender 

CNS:

pupils -B/L NSRL              

Tone:

Normal in both upper limb and lower limb on right side but decreased on left side 

POWER : 

Right side: UL 4/5,LL 4/5

Left side: UL 3/5 ,LL 3/5 

REFLEXES: 

                  B T. S. K. A. PLANTAR 

RIG       ++. ++. +. ++. +.  

LEFT.     ++. ++ +. ++. +.  

INVESTIGATIONS: 

ECG: 

29/1/23

28/1/23

NCCT KUB: 

2D ECHO: 

USG ABDOMEN AND PELVIS: 

XRAY CHEST: 

ABG: 

28/1/23

29/1/23

30/1/23: 

31/1/23: 

BLOOD C/S : E.COLI WAS ISOLATED

URINE C/S : NO GROWTH FOUND 

PROVISIONAL DIAGNOSIS: 

SEPSIS WITH AKI (RESOLVING)

?EARLY EMPHYSEMATOUS PYELONEPHRITIS WITH RIGHT RENAL CALCULI WITHODERATE RIGHT HYDROURETERONEPHROSIS

K/C/O HTN since 10 years 

TREATMENT GIVEN: 

On28/1/23

) IVF RL and NS @100ml/hr 

2)INJ PIPTAZ 2:25 mg IV/TID

3)INJ NEOMOL 1GM IV IF TEMP > 100F

4)INJ PAN 40MG IV/OD

5)INJ ZOFER 4mg IV SOS

6)INJ OPTINEURON 1 AMP IN 100ml NS IV OD

7)T Dolo 650MG PO sos

8)T NODOSIS 500MG PO BD 

9)T ECOSPRIN- AV 75/10 mg PO OD 

10) T NICARDIA 10MG PO SOS

On 1/2/23

S

chills present at night but no fever spikes 

O 

Pt is c/c/c 

Temp 98.6°F°F 

pr -90bpm 

Bp: 100/70mmHg

spo2 98% on ra 

grbs- 98mg/dl

i/o 2300/1150

CVS : s1,s2 herad 

RS: BAE + 

CNS: NFND 

p/A : soft ,NT

Hb: 12.1---10.3---9.7---10---9.3

TC- 25.9k----17.1k---10.5k---11.6k---23.4k(raised)

RBC -4.23---3.64---3.4---3.52---3.2

PLT- 1.2L---65000---1L---1.43L---1.94L 

SERUM ELECTROLYTES: 

Na+ 137---138---136---137---136

k+. 5.6---4.5---4.9---5.1---5.3

Cl-114---102---104---104---10

A

SEPSIS WITH AKI (RESOLVING)

?EARLY EMPHYSEMATOUS PYELONEPHRITIS WITH RIGHT RENAL CALCULI WITHODERATE RIGHT HYDROURETERONEPHROSIS

K/C/O HTN since 10 years 

P

1) IVF 2unit NS @75ml/hr 

2)INJ PIPTAZ 2:25 mg IV/QID STOPPED AFTER GIVING FOR FOUR DAYS AS COUNTS ARE INCREASING AND STARTED ON INJ MEROPENEM 

3)INJ NEOMOL 1GM IV IF TEMP > 100F

4)INJ PAN 40MG IV/OD

5)INJ ZOFER 4mg IV SOS

6)INJ OPTINEURON 1 AMP IN 100ml NS IV OD

7)T Dolo 650MG PO sos

8)T NODOSIS 500MG PO BD 

9)T ECOSPRIN- AV 75/10 mg PO OD 

10)T CLINIDIPINE 10MG PO/BD 

11)SYP CREMAFIN 15ML PO/HS 

12)OINT THROMBOPHOBE FOR L/A 

13)PROTEIN XPOWDER 1 SCOOP IN 100ml milk PO/TID

14) NEBULIZATION WITH DUOLIN 8TH HOURLY

15)MONITOR VITALS 2ND HOURLY

16) STRICT I/O CHARTING 

WAITING FOR BLOOD C/S REPORTS