INTERNSHIP COMPLETION ASSESSMENT

November 26, 2023

Period of posting - from 1st Ocotber 2023 to 30th November 2023

1/10/23 to 15/10/23 - Posted in psychiatry department

My medicine posting started with Psychiatry department which is more or less a sub branch of medicine. Without this branch, medicine is incomplete.

During these postings I used to sit in the OP and listen to my PGs take case history. The history taking in psychiatry is quite elaborate with attention to detail.

Some of the cases that I have seen are -

Anxiety disorder

Dissociative disorder

Schizophrenia

Depression

Tobacco and alcohol dependence syndrome

On my night duty I was put incharge of a patient who had dissociative disorder. He would get agitated and start making animal sounds. I learnt how to manage this case by giving drugs like lorazepam and haloperidol.

I helped take surveys on impact of electronic gadgets in our day to day lives and role of religion in our lives.

I was a part of the skit group that performed on World Mental Health Day on 10th October. Through our skit we wanted to remove the taboo from mental health and help break the stigma. The theme for this year was - Mental Health is A Universal Human Right.

16/10/23 to 31/10/23 -Posted in peripherals

ICU DUTY -

My peripherals duty started with ICU. This is where are all the critical patients are for whom utmost care is required. I was apprehensive as it is a big responsibility but with time I got the hang of it.

During my icu duty I was mainly responsible for hourly monitoring of the patients. Checking vitals including BP, PR, RR, temp, sugar levels and 02 saturation.

I learnt about some emergency drugs like noradrenaline, atropine,etc.

During this period I also learnt how to take blood sample, ABG sample, do foley’s catheterisation and ryles tube insertion.

I also saw an intubation being done by the PGs and gave Ambu bag ventilation. At the same time we performed CPR for the patient. The CPR was a collective effort of us interns and the patient was revived and put on mechanical ventilator but eventually he succumbed to death next day morning.

I learnt how and when certain medications are given as infusions for example lasix infusion, norad infusion and insulin infusion.

Another aspect that these icu duties taught me is how important it is to counsel the patient’s attendees, to guide them through the patient treatment journey. I was also very touched by how a simple reassurance can go a long way.

NEPHROLOGY DUTY -

This was indeed one of the most hectic duties but also one where I had the most learning experience. I was amazed to see how these dialysis units work. I realised how necessary dialysis is for the CKD patients and saw even may of them come on a daily basis.

On one day , a case had come from the casuality and the man had severe grade 4 sob and generalised body selling. His creatinine levels were high which required for him to be dialysed immediately. PG sir put a central line for his femoral vein and I assisted him and did the suturing to secure the line.

I also learnt about AV fistulas

WARD DUTY -

This mainly consisted of monitoring BP and sugar levels of unit patients and even hypertensive and diabetic patients transferred from ophthalmology department and making sure that they get timely treatment.

Learning to do USG - detection of Ascitic fluid

Performed an Ascitic tap with my colleagues

This link to video is here 👇🏻

Ascitic tap

Diagnostic tap wherein about 1litre of Ascitic fluid was drained

1/11/23 to 30/11/23 - posted in UNIT 1

Saw a number of cases such as Parkinson’s disease, cervical spondylosis, osteoarthritis, vestibular migraine, chronic liver disease, splenomegaly, stroke, altered sensorium and seizures, viral pyrexia, hydrocephalus, anemia and GERD, pancytopenia, heart failure, MI, septic shock with MODS, diabetic foot, diabetic ketosis and pancreatitis, bronchial asthma and uncontrolled sugars, community acquired pneumonia and oral candidiasis, tubercular pericardial effusion.

The blogs made by me are -

Case 1

https://manvisharma88.blogspot.com/2023/11/43-yo-woman-with-co-headache-since-2-yrs.html

1.What is the final diagnosis ?

A. Vestibular migraine

Criteria for vestibular migraine -

1. Vestibular migraine

A.
At least 5 episodes with vestibular symptoms of moderate or severe intensity lasting 5 min to 72 hours
B.
Current or previous history of migraine with or without aura according to the International Classification of Headache Disorders (ICHD-3)
C.
One or more migraine features with at least 50% of the vestibular episodes:
- –
  headache with at least two of the following characteristics: one sided location, pulsating quality, moderate or severe pain intensity, aggravation by routine physical activity
- –
  photophobia and phonophobia
- –
  visual aura
D.
Not better accounted for by another vestibular or ICHD diagnosis

2. Probable vestibular migraine

A.
At least 5 episodes with vestibular symptoms of moderate or severe intensity lasting 5 min to 72 hours
B.
Only one of the criteria B and C for vestibular migraine is fulfilled (migraine history or migraine features during the episode)
C.
Not better accounted for by another vestibular or ICHD diagnosis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9249276/

Case 2