Jatin Sharma

Saturday 11 February 2023

Internship assessment of General Medicine posting

NAME - Jatin sharma

Roll no. - 56

ADM NO - 176046

I HAVE BEEN POSTED IN GENERAL MEDICINE FROM 12/12/2022 TO 11/02/2023

IN THIS BLOG I'M SHARING MY INTERSHIP WORK EXPERIENCE

MY MEDICINE INTERNSHIP DUTY STARTED AND ENDED WITH UNIT POSTINGS. I WAS POSTED IN UNIT II FOR THE FIRST AND LAST 15 DAYS OF MY MEDICINE INTERNSHIP DUTIES.

These are some of the things i learnt during my unit duties :-

I did Vitals monitoring of op patients

learnt how to take history of patients coming to op

learnt prescription writing for op patients and need for each medicine prescribed

leant how to evaluate/examine patient clinically based on history

Learnt how to manage cases in casualty

learnt IV cannula insertion

learnt Ryles tube insertion

learnt how to put foleys catheter

Assisted in CPR in casualty

Learnt how to use Bains circuit and ambu bag

Drew ABG samples and venous blood samples for investigations

collected investigations reports from labs

Written repeats and investigations in case sheets, did tpr charting and updated soap notes

Learnt and typed discharge of many patients

Few of my e-log documentation of patient's clinical data is shared here :-

CASE:1

https://jatinsharma56.blogspot.com/2022/12/this-is-online-e-log-book-to-discuss.html

A 77 year old male with fever, cough and abdominal discomfort

My learning points from this patient's case are:

1-The types of seizures:

Focal seizure
Generalized seizure

Focal seizure are of 2 types:

With impaired awareness
Without impaired awareness

Types of Generalized seizures:

Absence seizures
Tonic seizures
Atonic seizures
Clonic seizures
Myoclonic seizures
Tonic clinic seizures

https://www.mayoclinic.org/diseases-conditions/seizure/symptoms-causes/syc-20365711

2- Hypoglycemia and seizures

In addition to arrhythmias, severe hypoglycemia can cause seizures, and increased frequency of seizures has been associated with mortality .In previous severe hypoglycemic clamp studies, seizures were associated with both respiratory depression and premature ventricular contractions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139495/

3- What are the most common type of seizure with hypoglycemia?

Hypoglycaemia, common in diabetic patients treated with insulin, can induce various neurological disturbances. Of these, seizures are the most common acute symptom, mainly of the generalised tonic-clonic type, with focal events.

CASE-2

https://jatinsharma56.blogspot.com/2023/02/a-25yr-old-male-with-chest-pain.html

My learning points from this patient's case are

1 - learnt to diagnose DKA with clinical features and investigations

2 - learnt to diagnose old Myocardial infarction

3 - learnt to diagnose diabetic nephropathy clinically

4 - learnt to manage DKA case

CASE-3

http://jatinsharma56.blogspot.com/2022/12/this-is-online-e-log-book-to-discuss.html

My learning points from this patient's case are

1 - learnt to manage pyrexia case

2 - learnt to manage hyponatremia

3 - learnt to diagnose ckd case

4 - learnt blood transfusion

CASE-4

http://jatinsharma56.blogspot.com/2022/12/a-70yr-old-male-with-breathlessness-and.html

My learning points from this patient's case are

1 - learnt to manage copd case

2 - learnt about ct scan

3 - learnt to use cpap

PSYCHIATRY DUTIES

I WAS POSTED IN PSYCHIATRY DEPARTMENT FOR 15 DAYS

MY LEARNING POINTS IN PSYCHIATRY POSTING:

LEART HOW TO TAKE HISTORY FOR PSYCHIATRY PATIENTS

CASES I HAVE SEEN ARE

1.ALCOHOL DEPENDENCE SYNDROME

2.ADJUSTMENT DISORDERS

3..TOBACCO DEPENDENCE SYNDROME

4.SCHIZOPHRENIA

5. OBSESSIVE COMPULSION DISORDER

learnt how to manage patients in de-addiction centre

Collected investigation reports

Did vitals monitoring of psychiatry patients

learnt how to write case sheet in psychiatry department

Learnt about various psychiatric drugs

PERIPHERALS DUTIES FOR A TOTAL 15 DAYS

WARD DUTIES 5 DAYS

Attended rounds

updated soap notes of ward patients

participated in conducting a CME

ICU DUTIES 5 DAYS

vitals monitoring for patients

Drew ABG and venous blood samples

Sent investigations

Learnt how to manage critically ill patient's

Assisted in CPR

NEPHROLOGY DUTIES 5 DAYS

Vitals monitoring for patients on hemodialysis

learns managemnet of elevated BP during dialysis.

Learnt management of ckd patients

Did ascitic fluid tapping (Abdominal paracentesis)

Wednesday 8 February 2023

A 25 YR OLD MALE WITH CHEST PAIN, VOMITINGS AND SOB

This is an online E log book 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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box"

DR JATIN SHARMA

Roll no. 56

A 20 YEAR OLD FEMALE WITH FEVER AND HEADACHE

Date of admission : 7-2-23

Presenting complaints :

Fever since 1 week

Vomitings since 1 week

Dryness of mouth since 1 week

Chest pain since 1 week

Palpitations since 1 week

Shortness of breath since 1 week

History of presenting illness:

Patient was apparently asymptomatic one week back the he developed fever of high grade with chills, insidious in onset, gradually progressive, not relieved on taking medication.

Associated with vomitings contained food particles, non bilious, non projectile, 3-4 episodes/day. Associated with dryness of mouth. H/o chest pain, left sided, pricking type, non radiating associated with sob grade 3, insidious in onset gradually progressive. No h/o orthopnea.

H/o blurring of vision present

No h/o pain abdomen

No h/o dizziness, altered sensorium

No h/o decresed urine output

Ophthalmologist opinion taken on 8-2-23. Impression : no diabetic retinopathy changes noted

Past history :

K/c/o DM I since 8 yrs (diagnosed at the age of 17yrs) and on biphasic isophene insulin injection( 30% soluble insulin and 70% isophene insulin) 24U in the mrng and 20U in the night.

Not a k/c/o HTN / Asthma / CAV / CAD

Personal history :

Sleep: adequate

Appetite: normal

Diet: mixed

Bowel and bladder movements: normal

Addictions: none

Family history :

No similar complaints in family

General examination :

Patient Is conscious, coherent, cooperative moderately built and well nourished

pallor - Absent

icterus - Absent

clubbing - Absent

cyanosis - Absent

lymphadenopathy - Absent

Edema - Absent

Vitals:

TEMP-96.5 F

PR-82/MIN

RR-14/MIN

BP-110/70MMHG

SPO2-99% AT ROOM AIR

GRBS-197MG%.

Systemic examination :

CVS - S1S2 present, no murmur

RS - Bilateral air entry present, trachea central in position

CNS - Higher mental functions intact

P/A - Soft, non tender

Clinical images with investigations:

ECG DONE ON 8-2-23

ECG DONE ON PRESENTATION 8-2-23

REPEAT ECG 8-2-23

USG ABDOMEN DONE ON 8-2-23

2D ECHO DONE ON 8-2-23

BLOOD AND URINE INVESTIGATIONS

Diagnosis :

DIABETIC KETOACIDOSIS(RESOLVED) WITH OLD INFERIOR WALL MI WITH K/C/O TYPE I DM SINCE 9YRS WITH DIABETIC NEPHROPATHY

Treatment :

* IV FLUIDS NS@75ML/HR

5% DEXTROSE IF GRBS <= 250MG/DL

* HUMAN ACTRAPID INSULIN INFUSION ( 1ML +39 ML NS) @ 3ML/HR BASED ON GRBS

* TAB ECOSPRIN GOLD 75/75/10MG PO HS

* GRBS MONITORING HOURLY

* STRICT I/O CHARTING.

* VITALS MONITORING 2ND HRLY.

SOAP NOTES :

Date : 08/02/23

ICU

Unit 2

DR..AASHITHA SR

DR.PRADEEP PGY3

DR. VINAY PGY3

DR.NARASIMHA PGY2

DR.AJAY PGY1

DR.PARCHETHAN PGY1

DR.JATIN INTERN

DR.SANTHOSH INTERN

STOOLS NOT PASSED

NO FEVER SPIKE

PATIENT IS CONSCIOUS COHERENT COOPERATIVE .

VITALS:

TEMP-96. 5F

PR-82/MIN

RR-14/MIN

BP-110/70MMHG

SPO2-99% AT ROOM AIR

GRBS-197MG%.

SYSTEMIC EXAMINATION:

P/A- SOFT NON TENDER

CVS-S1 S2 PRESENT,NO MURMURS

RS-B/L AIR ENTRY PRESENT,NVBS HEARD

CNS-NAD

DIABETIC KETOACIDOSIS WITH OLD INFERIOR WALL MI WITH K/C/O TYPE I DM SINCE 9YRS WITH DIABETIC NEPHROPATHY

* IV FLUIDS NS@75ML/HR

5% DEXTROSE IF GRBS <= 250MG/DL

* HUMAN ACTRAPID INSULIN INFUSION ( 1ML +39 ML NS) @ 3ML/HR BASED ON GRBS

* TAB ECOSPRIN GOLD 75/75/10MG PO HS

* GRBS MONITORING HOURLY

* STRICT I/O CHARTING.

* VITALS MONITORING 2ND HRLY.

Date : 09/02/23

ICU

Unit 2

DR..AASHITHA SR

DR.PRADEEP PGY3

DR. VINAY PGY3

DR.NARASIMHA PGY2

DR.AJAY PGY1

DR.PARCHETHAN PGY1

DR.JATIN INTERN

DR.SANTHOSH INTERN

STOOLS NOT PASSED

NO FEVER SPIKE

PATIENT IS CONSCIOUS COHERENT COOPERATIVE .

VITALS:

TEMP- AFEBRILE

PR-82/MIN

RR-18/MIN

BP-110/70MMHG

SPO2-98% AT ROOM AIR

GRBS-216MG%.

SYSTEMIC EXAMINATION:

P/A- SOFT NON TENDER

CVS-S1 S2 PRESENT,NO MURMURS

RS-B/L AIR ENTRY PRESENT,NVBS HEARD

CNS-NAD

DIABETIC KETOACIDOSIS(RESOLVED) WITH OLD INFERIOR WALL MI WITH K/C/O TYPE I DM SINCE 9YRS WITH DIABETIC NEPHROPATHY

* IVF NS @ 75ML/HR

* INJ HAI 14U---14U---14U

INJ NPH 20U---×---20U

* TAB ECOSPRIN GOLD 75/75/10MG PO HS

* TAB TELMA 40MG PO OD

* GRBS CHARTING

* STRICT I/O CHARTING.

* VITALS MONITORING

Wednesday 1 February 2023

20 YR OLD FEMALE WITH FEVER AND HEADACHE

DR. JATIN SHARMA

Roll no. 56

A 20 YEAR OLD FEMALE WITH FEVER AND HEADACHE

Date of admission : 31-1-23

Presenting complaints :

Fever since 1 week

Bloating since 1 week

Headache and neck pain since 1 week

Vomiting for 2 days one week ago

History of presenting illness:

Patient Was apparently asymptomatic one week back then she developed bloating and indigestion. She c/o fever since 1 week of high grade not associated with chills and subsidies on taking medication.

C/o vomiting for 2 days 1week ago contained food particals, non projectile, non bile stained

No h/o cough, cold, burning micturition

Her daily routine :

She wakes up around 5am then she goes to train herself to become a police officer for 2hrs, after which she gets ready and has her breakfast which usually comprises of one bowl rice with curry or idly or dosa etc. Then she leaves to study (bsc). She has her lunch at college around 1-2pm which comprises of homecooked rice and curry or chapati with curry. She returns home around 5pm and helps out her family in the house. After which she has her dinner around 8pm which usually comprises of rice and curry or chapati with curry. She then goes to sleep around 10pm.

Past history :

Not a k/c/o HTN / DM / Asthma / CAV / CAD

Personal history :

Sleep: adequate

Appetite: decreased

Diet: mixed

Bowel and bladder movements: normal

Addictions: none

Menstrual history :

Age of menarche - 13yrs

28/5 days cycle

LMP 23-1-23

Dysmenorrhea present

Family history :

No similar complaints in family

General examination :

Patient Is conscious, coherent, cooperative moderately built and well nourished

pallor - Absent

icterus - Absent

clubbing - Absent

cyanosis - Absent

lymphadenopathy - Absent

Edema - Absent

Vitals:

Temp. - 97.6F

Bp - 110/70 mmhg

PR - 102 BPM

RR - 18 CPM

Systemic examination :

CVS - S1S2 present, no murmur

RS - Bilateral air entry present, trachea central in position

CNS - Higher mental functions intact

P/A - Soft, Tenderness present in epigastrium

Clinical images with investigations:

chest xray PA view done on 1-2-23

ECG done 31-1-23

USG abdomen done on 1-2-23

blood investigations done on 31-1-23

Fever chart

Diagnosis :

Pyrexia under evaluation ?UTI with primary dysmenorrhea

Treatment :

* IV fluids 1 unit NS @100ml/hr

* inj neomol 1gm iv sos

* Inj pan 40 mg iv od

* Inj zofer 4mg iv sos

* tab pcm 650mg po 6th hrly

* vitals monitoring

SOAP NOTES :

Ward patient admission date 31-1-23

Date - 2/2/23

Unit-2

Dr Aashitha (Sr)
Dr pradeep (Pg 3)
Dr vinay (pg 3)
Dr narsimha (pg 2)
Dr ajay (pg 1)
Dr prachethan ( pg 1)
Dr Santosh Kumar (intern)
Dr Jatin Sharma ( Intern)
Dr preethi (intern)

S
Burning micturition
Headache
Pain in umbilical region
No fever spike
No vomiting

O
BP- 110/80 mmhg
Pulse- 82bpm
RR-16cpm
Afebrile
CVS- s1s2 +, no murmurs
RS- b/l air entry +, no added sounds
P/A- soft, tenderness +
CNS- HMF intact

A
pyrexia under evaluation ?UTI

P
* IV fluids 10NS @50ml/hr
* Inj pan 40 mg iv od
* Inj zofer 4mg iv tid
* tab pcm 650mg po tid
* vitals monitoring

Sunday 25 December 2022

A 70yr old male with breathlessness and dry cough

DR JATIN SHARMA

Roll no. 56

A 70yr old male agriculturer brought to casualty with
C/o dry cough since 4 days
C/o breathlessness since 4 days

HOPI :
A 70 yr. Old male agriculturer brought to casualty with complaints of dry cough since 4 days, insidious in onset, more during night then daytime, not associated with Sputum, blood tinge, chest pain. H/o seasonal variations present. Not associated with positional variation. Aggravated with fever (if present) and cold (if present). Relieved with medication.
H/o breathlessness since 4 days, upon walking to some distance(100-200mt.) mmrc grade 2-3, gradually progressive, insidious in onset, more at night compared to day, no seasonal variation since 3 yrs. diurnal variation present, no positional variation. Aggravated on exertion, relieved at rest, orthopnea present, postural nocturnal dyspnea present since 3 yrs.

Past history :
H/o similar complaints in past started from 15yrs.
Dry cough + breathlessness was present, occasionally having seasonal (winters) + diurnal (night >day) variation since 3 yrs.
His breathlessness showed no seasonal variation.
H/o RTA 20 yrs ago, which has lead to deformity in spine ( thoracic scoliosis)
H/o similar complaints in dec, 21 2d echo showed LV hypokinesia, RWMA +, EF - 48%
K/c/o HTN since 1 yr.
No H/o Dm , asthma , TB, epilepsy

Personal history :
Appetite - normal
Diet - mixed
Sleep - normal
Bowel and bladder movements - normal
Addictions - 1.previously occasional beer drinker, stopped 3 months ago
2. Started smoking beedi/chutta since 17yrs of age stopped 5days ago.

General examination :
Patient is conscious, coherent and cooperative, moderately built and moderately nourished.
Pallor: absent
Icterus: absent
Cyanosis: absent
Clubbing: absent
Lymphadenopathy: absent
Pedal edema: absent
Vitals:
BP-140/90mmhg
PR- 80
RR- 37bpm
SpO2- 95% on RA in sitting position
100% on supine
GRBS-173mg/dl
Systemic Examination :
CVS- S1S2 ; no murmur heard
RS- BLAE; diffuse ronchi heard
P/A- soft non tender
CNS- HMF intact

Clinical images :

Investigations :

Chest xray PA view 25-12-22

Chest xray lateral view 25-12-22

Usg abdomen 25-12-22

Ecg 25-12-22

Abg 25-12-22

Investigations chart

Provisional Diagnosis ?COPD - Chronic bronchitis with old MI with Bi fascicular block with k/c/o HTN since 1 yr.

Treatment :
* Inj. Hydrocort 100mg iv stat
* NEB 2 respules duolin, budecort, mucomist every 6th hourly
* inj. Pan 40 mg iv od
* inj. Optineuron 1 amp. In 100 ml NS iv over 30min.
* o2 inhalation @ 2-4 L/min. ( target spo2 - 92%)
* inj. Hydrocort 100mg iv bd
* T. ASPIRIN(GASTRO-RESISTANT) 75mg
T. CLOPIDOGRIEL 75mg
T. ATORVOSTATIN 20mg
* T. Amlong 5mg po od
* monitor vitals

Wednesday 21 December 2022

A 77 year old male with fever, cough and abdominal discomfort

DR JATIN SHARMA

Roll no. 56

77 YR OLD MALE WITH FEVER, COUGH AND ABDOMINAL DISCOMFORT

Date of admission 20-12-22

C/o fever associated with chills & rigours since 6-7days

C/o Seizures, 1 episode-3days ago

C/o cough with Sputum since 2-3 days

C/o abdominal discomfort since 2-3 days

HOPI :

Patient was apparently asymptomatic 6-7days back, then he developed fever of mild to moderate grade, which was insidious in onset, gradually progressive in nature associated with chills, cold, cough with sputum which relieved on medication. Then he had an episode of seizures 4days ago where all 4 limbs were stiff, up rolling of eyes were present, frothing from mouth and passed urine during the seizure episode. He also developed bloating and abdominal discomfort.

PAST HISTORY:

Patient is a known case of DM since 1 year and he is on medication.

Not a known case of HTN, Asthma,epilepsy,tuberculosis and thyroid abnormalities.

PERSONAL HISTORY:

Sleep: adequate

Appetite: decreased

Diet: mixed

Bowel and bladder movements:

Addictions: none

FAMILY HISTORY:

No similar complaints in the family

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative, moderately built and moderately nourished.

Pallor: absent

Icterus: absent

Cyanosis: absent

Clubbing: absent

Lymphadenopathy: absent

Pedal edema: absent

VITALS:

Temperature: Afebrile

Pulse: 82 beats/minute

Blood pressure:110/70mm Hg

Respiratory rate: 18 cpm

SYSTEMIC EXAMINATION:

CVS: S1 and S2 are heard

RS- Bilateral air entry present

B/l infra axillary area and infra scapular area crepts present

CNS: E4V5M6, higher mental functions intact

P/A- soft ; non tender bowel sounds present, mild splenomegaly present

CLINICAL IMAGES :-

INVESTIGATIONS:

ECG DONE ON 20-12-22

ECG DONE ON 24-12-22

2D ECHO DONE ON 21-12-22

USG abdomen and pelvis done on 20-12-22

20-12-22 chest xray PA view

21-12-22 chest xray lateral view

23-12-22 chest x ray PA view

Fever chart

Hemogram from 22-12-22 to 25-12-22

PROVISIONAL DIAGNOSIS

pyrexia under evaluation secondary to ? Clinical malaria with renal AKI on ? CKD with panctopenia secondary to ? hypoprolifrative marrow ? inflammation ?chronic disease with h/o seizures 1 episode 3 days ago secondary to hypoglycemia? with hyponatremia(resolved) with k/c/o type 2 DM since 2 years with acute liver injury

TREATMENT (updated)

* Tab doxycycline 100mg PO BD

* IV fluids NS at 100ml/hr

* T. Pantop d po/od

* Inj. zofer 4mg iv BD

* Inj. Human Act rapid insulin sc. TID

* T. Levipil 500mg po BD

* T. Dolo 650 mg PO BDI

* Inj. Neomol 1mg iv if temperature is more than 101F

* Vital monitoring 4th hourly

* GRBS 6 th hourly

* SYP. creamaffin 15ml/PO/HS

* T. Riboflavin 5mg po BD

* oral mucopan gel for L/a

* Neb. Salbutomol 1resp. P/N TID

* plenty of oral fluids

Wednesday 8 June 2022

A 40yr old male patient with emphysematous pyelonephritis

This is online E log book 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 series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.

SHORT CASE : FINAL PRACTICAL

Name : Jatin Sharma

Hall ticket no : 1701006066

CASE PRESENTATION :

A 46 year old male came with chief complaints of:

Burning micturition present since 10 days

Vomiting since 2 days ( 3 - 4 episode)

Giddiness and deviation of mouth since 1 day

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 10years back, he complained of polyuria for which he was diagnosed with Type 2 diabetes mellitus he was started on OHAs, 3years back OHAs were converted to insulin.

2 days back, he developed vomiting , containing food particles and non bilious. He also complained of deviation of mouth and giddiness 1 day

His GRBS was also recorded high , for which he was given NPH 10 IU and HAI 10 IU

No history of fever/cough/cold

No history of previous UTIs

No history of chest pains/palpitations/syncopal attacks

PAST HISTORY:

10yrs back patient complained of polyuria and was diagnosed with Type 2 DM and started on OHA( oral hypoglycemic agents).

OHAs were converted to insulin 3 years back

3 years back , he underwent cataract surgery

1 year back, he had h/o small injury on leg which gradually progressed to non healing ulcer extending upto below knee eventually ended with below knee amputation i/v/o development of wet gangrene

Not a k/c/o HTN/Epilepsy/TB/BA/Thyroid disorder/CAD/CVD

PERSONAL HISTORY:

Diet - Mixed

Appetite- normal

Sleep- Adequate

Bowel and bladder- Regular

Micturition- burning micturition present

Habits/Addiction:

Alcohol-

Not consuming alcohol since 1 yr.

Previously (1yr back) Regular consumption of alcohol, about 90mL whiskey consumed almost daily.Also 1 month on & off consumption pattern previously present

FAMILY HISTORY:

Not significant

GENERAL EXAMINATION:

Vitals @ Admission:

BP: 110/80 mmHg

HR: 98 bpm

RR: 18 cpm

TEMP: 101F

SpO2: 98% on RA

GRBS: 124 mg/dL

Pallor present

No Icterus/Cyanosis/Clubbing/Koilonychia/Lymphadenopathy/Edema