Medicine posting assessment
UNIT DUTY :
Learnt how to take history in the op and how to manage the basic treatment to the patients .(under guidance of dr.Pradeep sir dr Durga Krishna sir dr.Vinay sir dr pavan sir)
Case1 :
https://rishithareddy30.blogspot.com/2022/11/13yrs-old-female -with-vomitings.html
Patient presented with loss of consciousness pt skipped her afternoon insulin dose .pt has a past history of type 1 diabetes Mellitus .
Pt condition was managed by giving insulin infusions through monitor and controlled her sugars . And also had a Optha referral for any diabetes retinopathy findings in patient .
After stabilising the patient and after three days observation and pt recovery patient was shifted to AMC and has given NPH and HAI injections and the dose prescribing is managed by 7 point glucose monitoring .
And the dose is adjusted according the values in the 7 point profile .
1.What is 7 point profile?
The 7points include
1.fasting
2.2hrs after breakfast
3.before lunch
4.2hrs after lunch
5.before dinner
6.2hrs post dinner
7.midnight 2 pm
2.what are the types of insulin?
3. What is criteria for diabetes?
4. Pathophysiology of type 1 diabetes Mellitus ?
From this case I learnt the 7 point profile and how to adjust the dose of insulin according to patient GRBS levels
And also how to explain the diabetes patient to take a limited diet and eat small quantities in small intervals .and also about the dietary foods to advise the patient .
Case 2:
https://rishithareddy30.blogspot.com/2022/10/57yrs-old-male-patient.html
Patient presented to casualty with altered sensorium and confusion state , constipation patient is shifted to icu after taking history and collecting samples patient was sent to icu and then given treatment .
Patient was monitored and neurological examination is done to patient .
Patient reports shows increase in urea levels in serum and said to observe the urine output to further proceed to dialysis if patient is having AKI .
Things I have learnt?
1.What are symptoms of Uremic encephalopathy?
2.How Uremic toxins affect on vasculature?
1.Learnt how to do the neurological examinations
2.learned indications for dialysis .
Case 3:
https://rishithareddy30.blogspot.com/2022/11/30-yrs-old-female.html
Nephro case:
Patient presented to the casualty with loss of consciousness and seizures. Patient is stabilised and then sent for MRI and sent the blood and urine samples and the shifted to ICU .
Patient was examined and taken brief history of course of her SLE .
And medications were prescribed and dialysis is planned to reduce her fluid overload and treat her symptoms
Things that I learnt :
1. What is slicc criteria
2.how to manage a patient presented with sob acute pulmonary edema and pedal EDEMA
3. For the first time noticed all the clinical features of SLE in patient
4.got interest to take history briefly to know the exact causative factor for the SLE in this patient ?most probably in this patient it might be the genetic cause
1.What is slicc criteria?
2. How does nephro patients presents with acute pulmonary EDEMA?
3. Causative factors for lupus nephritis ?
4.effects of SLE on body ?
4. Pathophysiology of ckd patients having hypertension?
1. Learnt approach to a patient with fever. And learnt how to use the researches thesis to identify the cause of fever in this patient despite using all antibiotics
2. For first time saw patient presented with peripheral cyanosis. Examined cervical, axillary,inguinal lymphnodes and lymphnodes were palpable suggesting generalised lymphadenopathy
3. Learnt about raynauds phenomenon and performed test for 14 M and also control 16M to see the changes on palms on exposure to cold.
4. Saw the procedure of cervival lymphnodes FNAC.
5. Learnt and had seen the procedure of excisional lymphnode biopsy of cervical and inguinal lymphnodes.
6. Learnt based on patient clinical status and probable differentials , what antibiotics should be started.
8. Learnt for the first time what is automated blood culture is and when to use that lab technique.
9. Learnt main inmpirtance of the fever charts and lab investigations writing in a place
9.Follow up of the patient after referring.
Final diagnosis of the patient:
SLE with secondary antiphospholipid syndrome
AIHA.
He has ana positive, ds DNA positive, bone marrow provisional report says hypocellularity
According to new EULAR CRITERIA FOR SLE
Fever :-2
Thrombocytopenia:- 4
Anti-ds dna :- 6
Complement c3 and c4- 4
Score more than 10 is diagnostic.
8. Learnt about SLE and management.
Case 5:
58 YEAR OLD FEMALE WITH SHORTNESS OF BREATH AND PEDAL EDEMA
Learning points:
1. Learnt approach to a patient with complaints of shortness of breath whether it could be CVS or respiratory cause.
2.learnt approach to a patient with Complaints of B/L
Pedal edema.
Importance of lights criteria to differentiate between transudate and excudate.
Learnt causes of transudate type of pleural effusion and exudate type of pleural effusion
Case 6:
Nephro duty :(Dr.charan Sir Dr.Keerthi mam)
1. Assisted in central line placement and learnt the procedure and got a chance to lastly secure the line by suturing with silk.( under guidance of dr.sashi mam
2. Monitored the vitals of the day care patients in dialysis .
3. Collected ABG samples
4. Saw the fundoscopy of 25 year old hypertensive female
5.sent samples for automated blood cultures in culture bottles
Icu duty :(Dr.Nishitha Mam Dr.Vinay sir Dr.deepika mam Dr.Venkat Sai sir Dr.Bharath sir)
1. Learnt how to do CPR for patients (under guidance of dr.Pradeep sir dr Durga Krishna sir dr nishitha mam)
2.learnt to do AMBU for patient (under guidance of dr.Pradeep sir dr Durga Krishna sir dr nishitha mam)
3.seen the procedure for intubating the patient (by dr.Vinay sir dr.durgakrishna sir dr .Pradeep sir )
4. Have inserted ryles for two patient (under guidance of Dr.Venkat Sai sir Dr .Bharath sir ,dr .Narsimha sir)
5. Taken ABG And venous samples for patients (dr.Nishitha mam)
6.monitored BP and vitals for ICU and AMC patients
7 . Have done platelet and blood transfusion(under guidance of dr.Vinay sir)
8. Inserted cannula to patients.
9.learnt how to change the setting in the ventilator(dr.Sai charan sir )
10.learnt how to manage a ventilator case in icu by monitoring the patient (dr.Vinay sir Dr.Raveen sir ,dr .Sai charan sir dr Deepika mam)
11.seen a ascitic tap procedure ( dr.Raveen sir )
Ward duty :(dr.Sailesh sir dr.Haripriya mam)
1. Helped nephro interns for preparing the soap notes
2.Taken venous samples
3. Attended classes along with Pgs
4. Have explained respiratory system examination briefly to my juniors
PSYCHIATRY DUTY:(12/11/22 to 26/11/22)
Learned about importance of history taking and how by history we can reach to a provisional diagnosis.
Saw different patients and learned how to take basic history
Examples like :
1.GENERALISED ANXIETY DISORDER
2.TOBACCO DEPENCE SYNDROME
3.ALCOHOL DEPENDENCE SYNDROME
4. DELUSIONAL DISORDER
5.MR
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