MY INTERNSHIP JOURNEY AND EXPERIENCE
MEGHANA GUNTI
INTERN
ROLL.NO 51 "
"I HAVE BEEN POSTED IN GENERAL MEDICINE FROM 12 TH DECEMBER 2022 TO FEBRUARY 11 TH 2023 , IN THIS BLOG I WOULD LIKE TO SHARE MY WONDERFUL EXPERIENCE OF INTERNSHIP IN THE DEPARTMENT , GENERAL MEDICINE , I WAS ALWAYS VERY INTERESTED IN THIS SUBJECT AS I LIKED THE DIVERSITY OF THE SUBJECT WITH EXPOSURE TO PATIENTS WITH MULTIPLE PATHOLOGIES AND DIEASES , AND IT IS INTELLECTUALLY lLIKE A GAME OF CHESS TO SOLVE , ENABLES US TO THINK MORE INNOVATIVELY, THERE ARE ALWAYS NEW PUZZLES , BEFORE WE ARRIVE AT A DIAGNOSIS , A GOOD BASIS FOR UNDERSTANDING PATHOLOGY , PHYSIOLOGY , PHARMACOLOGY , THERAPEUTICS , AND ALWAYS SOMETHING NEW TO LEARN "
Psychiatry postings :
I have been posted in psychiatry from 12 th December 2022 to 26 th December 2022
- I was always fascinated towards psychiatry as i was curious to I more about how a human mind works , and how its functioning is altered and what makes the patient experience mental health challenges
-- most often , it is attributed to constant stressors ,scenarios or one incident that could profoundly affect the mind , apart from certain inherited psychiatric illness .
-- since treatment of a mental illness is not limited to medication alone , counselling and cognitive behavioral therapy also have significant importance , knowledge about patients life and any triggers is important to the treating psychiatrist , therefore HISTORY TAKING is very important and equally challenging for effective treatment .
- In my postings , the most important thing i have learnt is the importance of preserving CONFIDENTIALITY of the patients condition , and about taking detailed history of the patient from him / her , to make them comfortable to speak up about how they feel and history from a reliable attendor
-- learnt about MENTAL STATUS EXAMINATION .
-- SOME of the interesting cases that i have seen :
- pschizophrenia
- post partum depression
- a 30 yr old woman who presented with delusion of granduer
- a 5 yr child with ADHD
- Students with panic attacks
- depression
- alcohol dependence syndrome'
- tobacco dependence syndrome
-- BPRS SCALE FOR SCHIZOPHRENIA ARE USED IN GRADING SEVERITY OF THE ILLNESS
-- ICD 10 , DSM 5
-- about atypical antipyschotics , anti depressants
- LEARNT ABOUT MIND RELAXATION EXERCISES THAT ARE RECOMMEDED LIKE
;DEEP BREATHING EXERCISES , MEDITATION ETC
" MENTAL HEALTH IS THE HEART OF PHYSICAL AND SOCIAL HEALTH "
I was posted in unit from 27/12/2022 to 26/1/23 ,
ON OP DAYS ,
-- I have done vital monitoring of the patients in op
- i have learnt how to take brief history of patients in OP ,
- i have learnt management and medicine presciption for patients with hypertension , diabetes , acid peptic disease , fever , who come to OP
-- gained knowledge about the what investigations to be advised for respective compaints
OP DAY CASUALTY NIGHT DUTIES :
-- during one of my casuality night duty , I did CPR FOR under the assistance of DR.chandana mam and dr.kiran sir fOR A 85 YR OLD woman who presented with shortness of breath , ecg was done and she was diagnosed to have conduction blockage , her relatives unwilling to transfer her to higher centre for pace maker implantation , we could not revive the patient after 30 minutes of cpr
The following are the links of blogs i have made :
case 1 :
A 64 YR OLD WHO IS UNABLE TO TALK SINCE 1 DAY
https://meghanag51.blogspot.com/2022/12/a-64-yr-old-who-is-unable-to-talk-since.html
brief history :
DIAGNOSIS : :-
Patient came to casuality with
Chief complaints of :
- cold and headache since 2 days- fever since 1 day
PROVISIONAL DIAGNOSIS : VIRAL PYREXIA UNDER EVALUATION ( SECONDARY TO URTI )
learning points :
- anatomical localisation of fever , examination for sinus tenderness
- causes for absence of aortic knuckle in an x ray
-- every morning , updated fever charts of my patients , updated soap notes time to time
-- taken the patient for various investigations
-- i have drawn samples for routine lab investigations
-- i have taken abg samples , removed foleys , inserted ryles tube and foleys catheter
- i have attended rounds about the patients discussions , rounds are a very fruitful part of the day , as there is always something new to learn everyday .
-- during rounds we have discussed about the patients symptoms , how to perform examination , we then proceed to investigations and what investigations to be done further apart from medical profile , also how to question and channel our thinking accordingly in various clinical scenarios , and how our understanding of the diagnosis evolves over a period of time , and accordingly managing the patient , discussing the patient's prognosis day to day , thaanks to DR.Rakesh biswas sir , dr.Nikitha mam , DR. Vamshi sir , dr . Nishitha mam , Dr. govardhini mam and dr . kiran sir
-- creates PAJR groups of my patient blogs
-- i have learnt how to evaluate xray chest , basics of an ECG, significance of hemogram , lft , rft , to evaluate 2 d echo , to following up investigations closely .
-- I have done dressing of bed sores.
-- seen an interesting case of a 17 yr old boy with uncontrolled diabetes , and how to manage it
-- besides patient work , and medical therapy , i believe knowing about patients life style and their dietary habits , and accordingly giving them suggestions is crucial .
- there was a 60 yr old male patient in my unit , who had elevated levels of sugars constantly , he had c/o blurred vision , diagnosed with diabetic retinopathy , probing into his dietary habits , i observed that patient consumes lot of sweets and eats without discretion , thereby counselled patient to make necessary changes in food habits .
WARD DUTIES : from
- monitoring of the patient vitals '
- grbs charting
-- learnt about management of hypertensive urgency
-- referred patients with h/o chronic alcohol consumption to DAC after discharge
--- I have done vital monitoring of all the patients in ICU and AMC .
- learnt significance of 7 pOint profile in GRBS charting in a diabetic .
- significance of I/ O charting
-- I have inserted ryles tube in 3 patients , inserted foleys in a male and 2 female patients .
--- I have taken ABG samples for 5 patients, taken venous samples .
-- in one of the night duties , i have done CPR for a 36 YR OLD patient with CKD on MHD who was shifted from nephro ward to ICU at midnight , under the guidance of Dr. Kranthi sir and Dr.Pavan sir , CPR was done for 30 mins , but the patient could not be revived .
• During ICU ROUNDS, i here recall some of my learning points:
--- In a patient with hypoxia , why did we keep her on ventilation and not directly given oxygen ?
Ans ) To enable more recruitment of alveoli in the lungs , and ensure more gaseous exchange takes place through ventilation .
-- what are the causes for increased ALP ?
Ans ) pathology of placenta/ liver / intestine / bone marrow
-- What is diabeticorum bullosa ?
Ans ) Bullous diabeticorum is a rare cutaneous complication of diabetes mellitus (DM). It is a spontaneous, non inflammatory, blistering condition usually found in long-standing diabetic patients with poor glycemic control
It can mimic other vesicobullous disorders, and is often underdiagnosed
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518582/
--- causes of bradycardia with hypotension ?
-- VASOVAGAL SYNCOPE, A NEURALLY mediated syncopal syndrome, is the commonest cause of recurrent unexplained syncope . Sudden and transient decline in cerebral perfusion in this condition is due to hypotension caused by abrupt vasodilation, often accompanied by a vagally mediated reflex bradycardia
--that the occurrence of bradycardia or asystole in the face of acute severe hypotension is a mechanism to possibly minimize further blood loss, prevent myocardial damage, and increase ventricular filling; and that fainting, which occurs as a consequence of this, is a homeostatic mechanism that serves to restore venous return and cerebral blood flow before blood pressure is normalized by neural reflex mechanisms
-- antihypertensive overdose
-- hyperkalemia
-- possible hypothyriodism
-- sinus node dysfunction
link here :https://journals.physiology.org/doi/pdf/10.1152/advan.00027.2004
--- what is polymorphic VT ?
Polymorphic (or polymorphous) ventricular tachycardia (VT) is defined as a ventricular rhythm at a rate greater than 100 beats per minute (bpm) with a continuously varying QRS complex morphology in any recorded electrocardiographic (ECG) lead. The simultaneous recording of more than one ECG lead is often necessary to detect these changes. Most polymorphic VTs are rapid (often >200 bpm), but an absolute rate has not been established, and VT at a slower rate can manifest changing QRS morphology . Some episodes of polymorphic VT cause hemodynamic collapse, and some degenerate into ventricular fibrillation (VF); however, many episodes terminate spontaneously.
Polymorphic VTs are classified based upon their association with a normal or prolonged QT interval. Spontaneous polymorphic VT in the presence of a normal QT interval usually occurs in the setting of coronary heart disease or nonischemic cardiomyopathy. However, some patients have no structural heart disease or may have a familial syndrome.
Catecholaminergic Polymorphic VT associated with a prolonged QT interval, which has a different etiology and mechanism, is known as torsades de pointes ("twisting of points")
link : https://www.uptodate.com/contents/catecholaminergic-polymorphic-ventricular-tachycardia
what is osmotic demyelination syndrome ?
- osmotic demyelination syndrome (ODS) has been a recognized complication of the rapid correction of hyponatremia for decades.
- the pathogenesis of ODS may be more complex and involve the inability of brain cells to respond to rapid changes in osmolality of the interstitial (extracellular) compartment of the brain, leading to dehydration of energy-depleted cells with subsequent axonal damage that occurs in characteristic areas.
- Features of the syndrome include quadriparesis and neurocognitive changes in the presence of characteristic lesions found on magnetic resonance imaging of the brain.
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