Internship assessment of General Medicine posting
K.Teja sree ( Intern )
Roll no -64
I have been posted in General Medicine department from December 12 2022 - February 11 2023
MY LEARNING POINTS IN UNIT DUTIES
(11 DEC 2022 - 26 DEC ,2022)
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:
https://54tejasreekandregula.blogspot.com/2022/12/17year-old-female-with-pcod.html
Signs and symptoms of PCOD ?
- irregular periods
- difficulty getting pregnant as a result of irregular ovulation or no ovulation
- Excessive hair growth(hirsutism) – usually on the face, chest, back or buttocks
- weight gain
- thinning hair and hair loss from the head
- Acne
- It is also associated with increased risk for Type 2 Diabetes Mellitus and High cholesterol levels
- polycystic ovaries( on ultrasound) - ovaries becomes enlarged and contain many fluid-filled sacs (follicles)
Why testosterone levels are evaluated in PCOD?
A number of hormones influence the signs and symptoms of PCOS-even small changes in hormonal levels can cause notable symptoms.
In PCOD , LH and Insulin levels in blood are usually high.This causes the ovaries to make an excessive amount of testosterone. The majority of excess testosterone is produced by ovaries,but excess androgen can also come from the adrenal glands.
High testosterone levels are responsible for the many physical symptoms of PCOD such as facial and body hair growth, acne and hairloss
It is possible for some women with PCOD to have their hormone levels within the normal range while suffering from androgen related symptoms ( SAME AS IN OUR PATIENT- NORMAL TESTOSTERONE LEVELS BUT SHOWS SIGNS OF HIGH TESTOSTERONE LEVELS)
https://perlahealth.com/pcos-hormones/(Reference link)
What are other causes of Acanthosis nigricans ?
Acanthosis nigricans is dark, thick and velvety skin in body folds and creases. It appears in the armpits, groin and back of the neck.
- Insulin resistance. Most people who have acanthosis nigricans have also become resistant to insulin.Insulin resistance is what leads to type 2 diabetes. Insulin resistance is also related to polycystic ovarian syndrome and might be a factor in why acanthosis nigricans develops.
- Certain drugs and supplements. High-dose niacin, birth control pills, prednisone and other corticosteroids
- Cancer - lymphoma and cancers of the stomach, colon and liver.
https://54tejasreekandregula.blogspot.com/2022/12/a-60year-old-female-with-aki.html
Complications of herbal medicine 💊
Herbal medications can mistakenly be perceived as safe because they are natural products. They may produce negative effects such as
- Allergic reactions,
- Rashes,
- Asthma,
- Headaches,
- Dizziness,
- Agitation,
- Dry mouth,
- Seizures,
- Fatigue,
- Tachycardia,
- Nausea and vomiting
- Diarrhea.
- Severe side effects like hepatotoxicity (liver damage) and life-threatening anaphylactic reactions.
- Herbal medications may also interacts with other medications.
What should be done before starting herbal medicine?
- Types of fever
- Types of Headache
- I have Assisted in USG guided diagnostic pleural tap done by Dr. Keerthi Ma’am (PGY2) on a this patient.
- Taken blood samples on various patients and had put ryles tube and foleys catheter to male and female patients.
- I had interacted with patients
MY LEARNING POINTS IN WARD DUTIES
(27 DEC 2022 - 31DEC ,2022)
During this period I have been under guidance of
Dr. Narsimha sir (PGY2)
Dr. Pradeep sir (PGY3)
~>During my ward duties attended rounds,updates soap notes of the patients.
~>learned about-
- Complications of uncontrolled diabetes?
- Diff bw type 1&2 diabetes and treatment
- Learned about Absolute and corrected Retic count
- Learned how much dose of insulin should be given to patients based on GRBS values
- Learned how Scoliosis affects respiratory functions (restrictive lung disease)-The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes and chest wall muscle inefficiency
- How to differentiate Asthma and chronic bronchitis
Asthma- usually observed during childhood , normal in between the episodes of asthma, family history may be present
MY LEARNING POINTS IN ICU & AMC DUTIES
(1 JAN 2023 - 5 JAN ,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.
- Pleural tap <—(video link)
Iam very thankful to Dr. Vinay sir for the chance and helped me in doing pleural tap on a CKD patient in AMC
- Assisted in Stabilisation of patient who presented with status epilepticus to the ICU
- 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
- Importance of mean arterial blood pressure for managing hypotension and ionotropes(Nor adrenaline)
MY LEARNING POINTS IN NEPHROLOGY DUTIES
(6 JAN 2023 - 11 JAN,2023)
During this period I have been under guidance of
Dr. Deepika ma’am (PGY2)
Dr. Shailesh sir (PGY3)
- Assisted for Central line catheter insertion( video link)
- 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
- Management of hyperkalemia with salbutamol nebulisation
MY LEARNING POINTS IN UNIT DUTIES
(11 DEC 2022 - 26 DEC ,2022)
Dr.Susmitha ma’am(SR)
Dr.Chandana ma’am ( PGY3)
Dr. Raveen sir (PGY3),
Dr. Haripriya ma’am ( PGY2),
Dr. Govardhini ma’am( PGY1)
