INTERNSHIP ASSESSMENT

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 Internship assessment

I , DR.N.Deepa got posted in the department of general medicine from 13th April 2023 to 12th June 2023.


Unit duties:

I had worked in the unit for the first 15 days.I was guided by Dr.Nishitha mam (PGy2), Dr.Navya mam (PGy1).


Later I worked under the guidance of Dr.Deepika mam (PGy2) , Dr.Ajay sir (PGy1).


Case 1:

A 48 year old male, auto driver by occupation came to the opd with chief complaints of 


- Abdominal distension since 20 days

- Bilateral pedal edema since 15 days

- Decreased urine output since 10 days

- Shortness of breath since 10 days

-Blood in stools since 5 days

- Loose stools since 4 days



I did an ascitic tap in this patient.




This patient had a history of chronic alcoholism and developed chronic liver disease.

We got an endoscopy done was he was found out to have grade 4 oesophageal varices and on proctoscopy he had grade 2 internal haemorrhoids.

DISCUSSION:

What more can we do for him sir?

Problems to tackle at present:
*Varices
Ascites*

Long term problems:
Rehabilitation
Alcohol abstinence

For *varices* :
Secondary prophylaxis can be started with,
Non selective B blocker(oral propranolol can be started)

Endoscopic esophageal banding and anal varices can be banded
But there is a chance of recurrence because of existing portal hypertension.

TIPS ,shunts is only useful for short term and indicated for refractory acute bleed,
And as it can cause hepatic encephalopathy ,it is not recommended and used only if medical and endoscopic therapy fails

For *Ascites*
Therapeutic paracentesis is already being done and patient is feeling better as of now,but due to hypoalbuminemia it gets reaccumilated and there will need for repeated paracentesis

I.v albumin as they are not affordable and also less half life can't be adviced for this patient

Adequate fluid restriction and diuretics should be given

LEARNING POINTS:

- Learnt ascitic tap procedure
- How to interpret the diagnostic ascitic tap - SAAG ratio 
- various causes of ascites based on SAAG
- Got to see how esophageal varices and internal haemorrhoids look
- Learnt indications of liver transplantation
- How to counsel a patient to quit alcohol 
- How to manage hypotension 


Case 2 :


57 M came to casualty with c/o generalised  weakness since 1 month ,fever since 1 week,altered sensorium since 3 days.




This is the case with longest hospital stay in the GM department during my posting.

There is continuously interesting discussion happening around this patient . This patient had multiple episodes of hypoxia following suctioning. He had continuous fever spikes for which we couldn't formulate any reason mostly thinking that it might be due his large grade 4 bed sore .


LEARNING POINTS:

- Indications of tracheostomy
- Tracheostomy tube change
- Tracheostomy tube and stoma care
- How to diagnose to a case of pneumothorax
- Needle thoracocentesis
- ICD insertion and follow up
- Drawing an ABG and it's interpretation




Case 3 : 


Patient was brought to the opd with complaints of fever since 4 days and blisters over the left lower limb since 1 day.



This is a case of lower limb cellulitis which lead to aki on ckd.
The patient presented with huge blisters.The images and history is mentioned in the above blog.


LEARNING POINTS:

- Management of cellulitis
- Wound debridement
- Mgso4 dressing
- Management of AKI


Case 4 : 


Patient was brought to the casualty with complaints of inability to speak since 6 hrs, weakness in right upper and lower limb since 6 hrs and deviation of angle of mouth to left since 6hrs.



LEARNING POINTS:

- Localisation of stroke
- Post stroke fever
- Placing ryles tube
- Placing foleys catheter
- CNS examination
- Management of a stroke case
- Causes of recurrent stroke


Case 5 : 

Patient was brought to the opd with chief complaints of

Fever since 1week

c/o generalised weakness and headache since 1 week 

c/o vomitings since 3 days

c/o loose stools since 3 days





LEARNING POINTS: 

- Causes of hematuria
- when to suspect leptospirosis
- FFP transfusion and it's reactions
- How to manage post transfusion reaction
- How to manage hypotension



PSYCHIATRY POSTING: 


In psychiatry, I learnt history taking, presentations of psychiatric conditions and their management. 

The cases I saw in the OPD-

Alcohol Dependence Syndrome

Tobacco Dependence Syndrome 

Depression

Generalised Anxiety Disorder 

Obsessive Compulsive Disorder 

Schizophrenia

Psychosis

Adjustment disorder 



NEPHROLOGY DUTIES: 

LEARNING POINTS:

- Learnt how a central line is placed

- Central line care

- Palpated and auscultated Av fistula and it was fascinating.

- How exactly the dialysis machine works

- What is UF and how is UF volume decided

- Monitored blood transfusions

- Managed day care patients 


ICU DUTIES: 

LEARNING POINTS:

- How to draw an ABG and it's interpretation

- How to place a ryles tube

- How to place a foleys catheter

- Cardiopulmonary resuscitation

- Ventilator and it's modes 

- Care of stroke patients

- How to insert IV cannula

- Drawing blood samples

- Interpretation of chest x rays



WARD DUTIES: 

LEARNING POINTS:

- Managing a case of anemia

- Counseling a patient with scabies regarding its cause,how it's spreads and what are the measures to be taken by him and his family members.

- Took detailed history of many patients and made Pajr groups -  a 65year old male with paraesthesias was an interesting case.

- Took a class to 8th Semester students regarding abdominal examination and respiratory system examination.



OPD DUTIES: 

Attended 4 OPD days from the unit.

Took histories of many patients and helped to deal with their medical problems who couldn't get admitted due to various reasons.

Audited histories of various patients in the OPD.






























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