Intern online assessment -General medicine
Name: Ch.Divya
Roll no: 24
Posted from 11/08/22 to 11/10/22
My learning experience :
During units duty
Case 1
https://divyaraju26.blogspot.com/2022/09/15-year-old-male-with-fever-and-burning.html
My orientation around this case:
1.What could be the possible cause if his anemia?
Ans: possibily nutritional
2.What could be the cause if UTI in this patient?
Ans: it can be secondary to phimosis
3.Is there any possibility that the patient could be having thalassemia since he has splenomegaly ,thalassemia minor and intermedia can present like a iron deficiency anemia too ?
Ans: his Hb electrophoresis reports didn't show thalassemia
4.what could be the cause of splenomegaly in him?
Ans: could be due to severe iron deficiency anemia
Causing extramedullary hematopoiesis
Reference
Case 2
https://divyaraju26.blogspot.com/2022/09/25-year-old-female-with-fever-and.html
My orientation around this case:
1.Why did she had an SDP done?
Her platelet counts were less than 20,000 and she had bleeding manifestations: as she reported to be passing back coloured stools: melena
In the discussion of the case :
It was ruled out that the patinet didnt have melena since her stool sample was not proper jet black in colour .
https://pubmed.ncbi.nlm.nih.gov/28283286/
In patients with dengue and thrombocytopenia (≤20000 platelets per μL), severe bleeding was uncommon irrespective of the use of prophylactic platelet transfusion ,
More importantly they reported that in the control group they didn't transfuse platelets even to patients with <10,000 and «5000 without any difference in outcomes.
Case 3
https://divyaraju26.blogspot.com/2022/08/29-year-old-female-with-fever-and.html
1.Why was she not given doxycycline like we do to most of the dengue patients?
Ans. Because , we has almost recovered with her fever and other consitutional dengue symptoms.
2.Why do we give doxycycline in dengue?
https://pubmed.ncbi.nlm.nih.gov/25858261/
According to the randomised controlls trials showed in the above discussion:
doxycycline can provide a clinical benefit to dengue patients at high risk of complications. This effect could be mediated by decreasing pro-inflammatory cytokine levels.
Case 4
https://divyaraju26.blogspot.com/2022/08/50-year-old-female-with-fever-and.html
My orientation around this case:
1.What could be the reason for he being suspected for leptospirosis?
Ans:Due to presence of icterus
And AKI picture( high urea and creatinine)
2.why was she put on pantop 40mg and zofer initially, even when she had high creatinine and urea?
Ans: since she had gastroenteritis picture.
3. Cause of her pedal edema is due to dengue?
Ans. Yes. Dengue causes capillaries to leak which causes fluid loss into the extracellular space which causes the pedal edema.
Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461104/
During the disscussion of the case in the clinical lecture hall:
1. What kind of AKI caused by leptospirosis is seen in this patient?
Ans : non-oliguric AKI which is noted in the patient.
Reference:
https://pubmed.ncbi.nlm.nih.gov/2362627/
https://www.karger.com/Article/Pdf/500378
Leptospirosis causes sodium transport dysregulation in the kidneys and decreased aquaporin 2 expression in the renal medulla, resulting in polyuria and natriuresis. Nonoliguria renal failure and hypokalemia are common because of tubular damage with transport defects in tubular epithelial cells.
During ICU duty
Has performed insertion of ryles tude to a 70-year-old female with cardiogenic shock in ICU bed no 1 .
Has taken samples for ABG for a 70-year-old female with cardiogenic shock in ICU bed no 1 .
Has taken samples for ABG for dialysis patinet in AMC .
Tried performing insertion of foley's catheter.
Learned to do CPR
During nephrology duty
Have assisted in performing central line insertions by appyling sutures twice
Collected ABG samples
During ward duty
Have taken venous samples for routine investigAtions for patinets.
Placed a cannula for a patinet
Went to LB nagar branch of our hospital ,hyderabad
With the patient for neurology and orthopedic consultation an to get his MRI and nerve conduction studies done.
Remove references to individuals such as here,
ReplyDelete"was ruled out that the patinet didnt have malena since she her stool sample was not proper jet black in colour by HOD sir."
You may be making many right or wrong conclusions in the course of learning but it may not be right to attribute those to particular individuals without laying open the entire context in which inferences are made
But you are supposed to share links to literature such as the article from KL that another intern presented, which showed that no sdp transfusions in minor dengue bleed even with counts reaching 5000 was safe
Also you and your HOD are supposed to know that a diagnosis of melena (or for that matter any condition) is not made just on the basis of one finding but a constellation of findings?
This comment has been removed by the author.
ReplyDelete10/1, 6:53 PM] Intern Kims 2017: Constellation of findings in the sense, with melena where there is blood loss - if the patient had any anemia , weakness due to it?
ReplyDelete[10/1, 6:56 PM] Intern Kims 2017: Do I have to post the picture of the stool sample too sir?
[10/1, 6:58 PM] Faculty : That would be great if you could you had captured it at that time and should have been posted in the case report itself with the reference link to the image.
[10/1, 6:58 PM] intern Kims 2017: I have the picture sir
[10/1, 6:58 PM] Kims 2017: I'll post
[10/1, 6:58 PM] faculty : Signs of blood loss include features of hypovolemia reflected in postural hypotension. Was it assessed at that time?
[10/1, 7:00 PM] Kims 2017: As far as I remember she didn't have postural hypotension sir
[10/1, 7:01 PM] Faculty If you had discussed this on the same day it would have been easier to remember
[10/1, 7:06 PM] Kims 2017: - Supine BP - 100/70mmHg & On Standing 100/70mmHg
[10/1, 7:06 PM] Kims 2017: We checked it sir
[10/1, 7:07 PM] Faculty : So that needed to have been also mentioned other than the color of the stool (also it's not the color alone but also the consistency like coal tar)