Welcome to the world of medicine and my incredible experiences
INTERNSHIP ASSESSMENT
Roll no. 96
This is PRATHYUSHA MULUKALA ,A medical student from Telangana, India.I am here to share a few experiences that I have learnt from medicine clinical postings.There are case blogs done by me with the help of pgs from second year to until now that are mentioned in my blog,which are inspired by Dr. Rakesh biswas sir.
https://prathyushamulukala666.blogspot.com/?m=1
CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER
NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS/HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.
These blogs encouraged me to show a special interest in taking detailed history and clinical examination which I am not perfect at first . It helped me to take each and every minute detail of the patient and their history ,there actual problem from the start. A disease is slow process that it starts way before showing actual symptoms. When we take a detailed history with patient way of living and everything,it may lead to the actual diagnosis.
I will start with my first experience,
When I am in second year I have posted in medicine for the first time, I was so excited about the clinical postings to learn some new things.At first I went to OPD of medicine, then a patient came into the OPD with complaints of unable to walk properly and with tremors of hands since 1 year,when sir asked the patient to walk for some distance ,the patient walked with short steps and on examination there was rigidity over extremities and by the past history known that he already using levodopa and carbidopa medications.
And that was the first time I saw a clinical case and learned how to examine the patient, At that time I was known that by the gait of the patient we can diagnose some diseases .
It was the time that physiology classes learnt in first year turned into the actual clinical case with parkinsonism symptoms and signs.
From that day I understood that we can learn lot from OPD .
During those days we have known how to do a pleural tap from pgs ,they have explained us while doing the procedure.
And bone marrow aspiration procedure also
Observed.
And I have done ascitic tap in second year under guidance of pgs ,that was the first procedure I have done in my undergraduation .
Examining the patient was the most favourite part of mine which I have learnt in medicine postings and it is very important part in diagnosing a case.
When I entered into internship first of all I don't what to do but I looked forward to learn more from the medicine clinical postings.
First I did ICU duties -where I have learnt about the ventilator cases,about intubation,how to intubate a patient.
And mainly GCS of the patient and higher mental function, extubation criteria.
Most of the cases what I have observed is that the ventilator cases are more prone to ventilator associated pneumonia infections which has to be taken into consideration.
How to take an ABG sample and interpretation of ABG.
And management of diabetic ketoacidosis.
Vitals play most important role for a patient,where we can manage by seeing vitals for example a patient Blood pressure is dropping immediate action is needed so that patient doesn't go into shock
And how to read ECG
Next I have done done nephrology duties - where I have learnt how to keep central line and about hemodialysis.
And about chronic kidney disease and management.
some of the points I have learnt in clinical postings from
https://prathyushamulukala666.blogspot.com/2022/06/a-55-yr-old-female-with-fever-neck.html
*The above case is a meningitis case , from this case I have learnt
CNS EXAMINATION:-
*Higher mental functions
*GCS
Eye response
- opens spontaneously -4
- To commands -3
-To pain-3
- No response -1
Verbal
-oriented well to time ,person,place-5
-confused state-4
-inappropriate words -3
-incomprehensible sounds-2
-no response-1
Motor response
-obeys commands-6
-moves to localised pain-5
-flex to withdraw from pain-4
-abnormal flexion-3
-abnormal extension -2
-no response-1
* How to do Cranial nerve examination
* Meningeal signs examination
- neck stiffness
- brudzinki sign
- kernigs sign
* Sensory examination
*Motor examination
- power ,bulk , movements of the muscle
* Reflexes examination
*Difference between rigidity and spasticity
And learnt about upper motor neuron lesions and lower motor neuron lesions .
*Cerebellar examination - gait ,rombergs sign.
* Learnt How to make a Fever chart
* About lumbar puncture and how to do analysis of CSF report and interpretation.
https://prathyushamulukala666.blogspot.com/2023/02/60-year-old-male-with-pain-abdomen.html
From the above case; learning points are-
This a case of 60 yr old male complaining with abdominal pain in umbilical region ,left upper quadrant region which relieves on bending forward.
Pain relieves on bending forward is a classical symptom of acute pancreatitis.
On examination the patient doesn't have grey Turner's sign or Cullen sign.
Grey Turner's sign - discoloration of flanks
Cullen sign - discoloration over periumbilical region.
Abdominal examination - i learnt how to examine for abdominal distension(ascitic fluid ) by following tests;
Shifting dullness,puddle sign,fluid thrill
Lab investigation interpretation in pancreatitis and ultrasound findings - peri pancreatic edema and bulky pancreas
Management -
*At first nil by mouth for this patient - so I Put a ryles tube ,learnt how to insert ryles tube - I asked the patient to sit and flex the neck and ryles tube with lignocaine under aseptic conditions I inserted the tube through nose and asked the patient to swallow while inserting, and checked for correct position of the tube i;e in the stomach by pushing the air through the tube ,on auscultation we can hear the sound,this says tube is in correct place.
For some cases like pancreatitis and other psychosocial cases ...methods of diversion from alcohol intake, depression from financial status and other situations... the way of counseling the patient is quite encouraging.
https://prathyushamulukala666.blogspot.com/2023/03/35-yo-male-with-complaints-of-vomitings.html
This is a case of 35 y/o male with complaints of vomitings ,6-7 episodes in a day.
He is known diabetic.
No other complaints are present.
I learnt how to manage a case of diabetic ketosis.
This is a case where metabolic disturbance is absent,there is no acidosis or alkalosis in this patient. This is an early presentation of ketoacidosis.
For many more cases there are a lot of pajr groups I have created please kindly look into it.
The below pajr groups are follow up cases of mine.
https://prathyushamulukala666.blogspot.com/2023/02/edema-facial-puffiness-and-sob-this-is.html
https://prathyushamulukala666.blogspot.com/2023/03/25yr-old-male-with-traumatic-brain.html
Pajr group-https://chat.whatsapp.com/FzBkcgDMJjcKG1gIMJsIl1
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