INTERNSHIP ASSESSMENT
GENERAL MEDICINE INTERNSHIP ASSESSMENT
RITHIKA.K
ROLL NO 80
I have started my medicine duties even before our postings started
When i was posted in General surgery I've seen a case of 45 old female with septic encephalopathy with septic shock with MODS with lower limb cellulitis with ? Pulmonary embolism with grade 1 bed sore on gluteal region
Daily cuticel dressing was done to that patient for the bed sore and for the cellulitis
For the first 15 days and last 15 days I was posted in the second unit under Dr Abhinaya ma'am , Dr prachetan sir, Dr Ajay sir Dr Harika ma'am
OP DUTIES
I've always been excited to attend the op duties as there's a lot to learn there
I've looked at various ECGs during my OP duties and learnt to interpret them.
I've learnt how to take important clinical history and to examine cases and it is important not to overburden the patient with all the investigations and sent only those necessary
I've once diagnosed a case of STEMI and gave the stat doses which i think everyone should be aware of
We have referred him to a higher centre for further management as angio isn't available in our institute
The ECG of the patient is shown below
UNIT DUTIES
These are all the cases I've given a chance to blog and also follow up through the PAJR groups
1.What might be the cause of seizures in this child
1. What are the various scenarios in which a patient with diselectrolytemia presents to us
2. Explain hyponatremia
1.pathophysiology of shortness of breath in this case
Learning points
Pathophysiology of starvation ketoacidosis
Learning points
-How a patient with angioedema presents
-Treatment of angioedema
Learning points
-How to diagnose and treat a patient with dengue
-Stages of dengue
1. differential diagnosis of this case
1.What are the types of speech disturbances
2. Significance of doing a carotid Doppler in this case
1.what can be the definitive management in this case
During my medicine postings I've taken atleast 30 to 40 ABGs from femoral,radial and even brachial arteries
I've learnt how to interpret the ABGs and the importance of it
I've always wanted to do a lumbar puncture but got a chance to assist Dr narsimha sir.
I've given this wonderful opportunity by Dr Ajay sir and Dr prachetan sir to do a pleural tap and ascitic tap
I've placed in ryles tube and foleys for several patients
For this once patient with a tracheostomy tube who was in a vegetative state i found it difficult to place a ryles
It is important to check the placement of ryles
I've taken multiple venous samples
I've put multiple cannulas
I've checked on my patients and even gave them their insulin subcutaneous everyday till they got discharge
NEPHROLOGY
When i was in urology I've seen many CKD patients coming up to get a AV fistula
There was this one time at around 2 am in the morning this patient was complaining SOB.
When i auscultated him I've heard crepts all over the lung field
I've started nebulization for him and when i checked his blood pressure it was 200/160mmhg and i immediately gave him IV furosemide and we started him on dialysis
I've got a chance to assist Dr Pavan sir while doing a central line
I've sutures for the central line to be in place
I've monitored many patients who were on dialysis and the importance to monitor them as they may land up in hypoglycemia and other complications at any time
Learnt about dialysis, indications and complications
I've understood the importance of time in nephrology postings
ICU
We never know when the patients go into hypotension or when their saturations
fall
i used to monitor the patients hourly
Learnt how to start CPAP for patients and the significance of it
There was this one patient who is a 14 year old girl with SLE who had a cardiomegaly
I could hear a pericardial rub
When we did a 2Decho there was pericardial effusion
I've had many sleepless nights in my ICU duties but u see so many cases learn so much that it was all worth it at the end
WARD DUTIES
When i was posted in the ward i not only followed the ward cases but used to followup all the cases which are in ICU and AMC
I've learnt how to assess a case of fever and how to manage it
I've examined all the systems and was able to give differential diagnosis
PSYCHIATRY POSTINGS
I've always found psychiatry to be a difficult topic for me
But I've seen many cases in OP where people came with mood disorders like anxiety, depression
I've seen cases of schizophrenia, autism
I've seen a case of delirium who developed it after cholecystectomy
And had tremors due to alcohol withdrawal
I had to monitor the patient continuously for two consecutive days
I've given him IM lorazepam
The importance of mental health and how we can contribute to this society by making them aware of it
I've seen my own family members and friends having depression and anxiety and i am glad that they have me in their lives to counsel them properly,to tell them that it is okay to ask for help and to never give up on themselves
I've always been interested in surgery but after the medicine postings I've changed my mind
To use the resources given to us properly and integrating all the systems and coming to a diagnosis and treating them is somehow satisfying
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