INTERSHIP ASSESSMENT

J SRESHTA (roll no. 58) INTERNSHIP ASSESSMENT

12-12-2022 to 26-12-2022 UNIT DUTIES

I worked with Dr Shailesh Patil sir PGY3, Dr Keerthi ma'am PGY2 and Dr Navya ma'am PGY1. 

Case 1: 17 year old female Long distance patient with PCOD 

Bloglink-  https://54tejasreekandregula.blogspot.com/2022/12/17year-old-female-with-pcod.html

This was a 17 year old female with PCOD. I learnt the importance of healthy lifestyle through this case. As Dr. Biswas sir always says, avoiding the three whites - rice, sugar, and maida is the first step to a healthy lifestyle.

CAUSES OF PCOD-

The exact cause of PCOS isn't known. Factors that might play a role include:

a. Insulin resistance:

Insulin is a hormone that the pancreas makes. It allows cells to use sugar, your body's primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can go up. This can cause your body to make more insulin to try to bring down the blood sugar level

Too much insulin might cause your body to make too much of the male hormone androgen. You could have trouble with ovulation, the process where eggs are released from the ovary.

One sign of insulin resistance is dark, velvety patches of skin on the lower part of the neck, armpits, groin or under the breasts. A bigger appetite and weight gain may be other signs.

b. Low-grade inflammation:

White blood cells make substances in response to infection or injury. This response is called low-grade inflammation. Research shows that people with PCOS have a type of long-term, low-grade inflammation that leads polycystic ovaries to produce androgens. This can lead to heart and blood vessel problems.

c. Heredity:

 Research suggests that certain genes might be linked to PCOS. Having a family history of PCOS may play a role in developing the condition.

d. Excess androgen:

 With PCOS, the ovaries may produce high levels of androgen. Having too much androgen interferes with ovulation. This means that eggs don't develop on a regular basis and aren't released from the follicles where they develop. Excess androgen also can result in hirsutism and acne.

COMPLICATIONS OF PCOD-

a. Infertility

b. Gestational diabetes or pregnancy-induced high blood pressure

c. Miscarriage or premature birth

d. Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat buildup in the liver

e. Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and unhealthy cholesterol or triglyceride levels that significantly increase your risk of heart and blood vessel (cardiovascular) disease

f. Type 2 diabetes or prediabetes

g. Sleep apnea

h. Depression, anxiety and eating disorders

i. endometrial cancer

TREATMENT OF PCOD-

Lifestyle Changes:

Losing weight may increase the effectiveness of medications your provider recommends for PCOS, and it can help with infertility.

Medications:

a. Birth control pills to regulate hormones and decrease androgen production

b. Clomiphene - anti estrogen drug

c. Metformin - to improve insulin resistance

Source: https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

Follow up: There's a Patient Journey Record (PaJR) group wherein she shares her daily activities.

Case 2: 42 year old female with left pleural effusion secondary to ?TB 

 Link- https://sreshtaj.blogspot.com/2022/12/42-year-old-female-with-dengue.html

CAUSES OF PLEURAL EFFUSION-

Light's criteria:

Follow up:

In our patient - sputum and pleural fluid cbnaat was negative. Later after getting discharged she went to a local doctor and has been diagnosed with TB. She's using ATT

Case 3: 35 year old female with seizures

Link- https://sreshtaj.blogspot.com/2022/12/32-year-old-female-seizures-under.html

CAUSES OF SEIZURES:

Case 4: 35 year old female with viral pyrexia 

Blog link- 

https://sreshtaj.blogspot.com/2022/12/35-yr-old-female-viral-pyrexia-under.html?m=1

27-01-2023 to 11-01-2023 PSYCHIATRY POSTING

Thanks to the entire psychiatry department for teaching me all that I know about psychiatry. 

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 

I learnt that history taking in psychiatry is different from medicine. Mental Status Examination (MSE) consists of 

• General appearance and behavior
• Psychomotor activity
• Speech
• Thought
• Mood
• Perception

The first thing in treatment is psychoeducation of the patient or attender. 

Case 5: 45 year old female with Acute Transient Psychotic Disorder (ATPD)

The diagnosis of ATPD is made when the duration criteria of schizophrenia is not fulfilled which is 1 months of symptoms.

In this case I learnt how to apply The Positive and Negative Syndrome Scale (PANNS), Scale for Assessment of Positive Symptoms (SAPS) and Scale for Assessment of Negative Symptoms (SANS)

Case 6: 20 year old female with Catatonic Schizophrenia

This was an interesting case as she presented with mutism since 3 years and she gradually stopped eating. We had to monitor her every hour to make sure she didn't land up in hypoglycemia.

Lorazepam challenge test:

• Was done to confirm catatonia diagnosis and to check for sensitivity to lorazepam 
• Two doses of 2mg lorazepam was given intravenously 30 minutes apart and Bush-Francis Catatonia Rating Scale was used to check the response. 
• Before the test the score was 20
• After the test score was 17

Source: https://thompsoncenter.missouri.edu/wp-content/uploads/2019/04/Bush-Francis-Scale-with-a-few-references-4-18-19.pdf

Upon adequate treatment, she started eating when fed, and would copy the shapes (apraxia charting) she even started coloring on her own. She also responded to commands by writing on a paper. 

Follow up:

She was advised to visit Institute of Mental Health, Erragadda for further treatment. 

She was taken to Osmania Medical College and Hospital, Hyderabad where she was admitted for 5days.  

She was then taken to IMH, Erragadda and has been admitted. She's now talking and eating by herself. 

Knowing that the patient has improved delights me greatly.

12-01-2023 to 16-01-2023 NEPHROLOGY DUTIES

In nephro I worked with Dr Shailesh Patil sir PGY3 and Dr Deepika ma'am PGY2.

• Assisted in placing a central line.
• Learnt how dialysis is done
• Monitored blood transfusions 
• Managed day care patients 

17-01-2023 to 21-01-2023 ICU DUTIES 

I did ICU duties with Dr Shashikala ma'am PGY3 and Dr Kranthi sir PGY2. 

ICU was hectic as there were 7 beds as opposed to the usual 6 beds. In ICU I- 

• Inserted ryles tube
• Applied a condom catheter 
• Assisted in CPR for 3 patients

22-01-2023 to 26-01-2023 WARD DUTIES:

I worked with Dr Narsimha sir PGY2.

During this time, BDS students had their final practical exams so I helped them in taking the case, preparing the blog and cleared their doubts to the best of my knowledge. 

26-01-2023 to 11-02-2023 UNIT DUTIES:

Worked with Dr Chandana ma'am PGY3, Dr Raveen sir PGY3, Dr Haripriya ma'am PGY2 and Dr Goverdhini ma'am PGY1.

I saw the following cases during this time

Case 7: 45 year old male with posterior circulation stroke

Link- https://sreshtaj.blogspot.com/2023/02/45-year-old-male-came-with-complaints.html

Through this case I learnt

• thorough CNS examination 
• management of stroke
• Different types of strokes 

SYMPTOMS OF STROKE-

CAUSES OF STROKE-

Ischemic stroke:

• Commonest type of stroke
• Decreased blood flow to the brain
• Atherosclerosis.
• Clotting disorders.
• Atrial fibrillation (especially when it happens due to sleep apnea).
• Heart defects (atrial septal defect or ventricular septal defect).
• Microvascular ischemic disease

Hemorrhagic stroke:

• Hypertension 
• Brain aneurysms can sometimes lead to hemorrhagic strokes.
• Brain tumors 
• Moyamoya disease.

TREATMENT OF STROKE-

Ischemic stroke:

• Thrombolytic drugs (within three to four and a half hours). 
• Thrombectomy (within 24 hours if there’s no significant brain damage).

Hemorrhagic stroke

• Reversal of any medication that might increase bleeding.
• Blood pressure management

As this patient has presented after the 4hr window period we started him on antiplatelet drugs - ECOSPRIN and CLOPITAB 

Source: https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113#:~:text=There%20are%20two%20main%20causes,doesn't%20cause%20lasting%20symptoms.

Case 8: 21 year old female with Acute Gastroenteritis 

Link- https://sreshtaj.blogspot.com/2023/02/21-year-old-female-with-acute.html

Learning points-