INTERN ONLINE ASSESSMENT - GENERAL MEDICINE

MADHU KUMAR BALAGONI

ROLL NO -18

MY LEARNING EXPERIENCE:

DURING ICU DUTY: 

1.Learnt and performed CPR for 3 patients 

2.Assisted For intubation

3. Drew ABG samples via  femoral and radial routes 

4. Assisted Central lines

5. Placement of Foley's catheter 

6. Placement of Ryle's catheter 

7. IV cannula insertion in various patients

DURING NEPHRO AND WARD DUTY

Monitoring patients 

Took venous samples for investigations 

DURING CASUALITY DUTY:

Took an unstable MI patient to Nalgonda, continuously monitored his vitals. Was taught how to intervene a case of cardiac arrest in MI patients. 

DURING PSYCHIATRY DUTY:

Learned about importance of history taking in a psychiaty case and it's importance in reaching a provisional diagnosis.

Saw cases like:

Psychosis in alcohol withdrawal

Alcohol dependence syndrome

Schizophrenia

Learnt how to Counsel the patients in DAC 

Learnt about the mechanism of action, dosage and adverse effects of various Anti-psychotics and anti-deppresant drugs. 

MY CASES:

CASE 1

https://blendedasessmentmadhukumar.blogspot.com/2022/10/a-26-year-female-g4p1l1a2-with-25-weeks.html

BRIEF HISTORY OF THE PATIENT 

We didn't reach a diagnosis initially, but worked on ruling out all of the possible conditions.

THE DIFFERENTIALS

1.Viral causes - No fever spikes at all,no history suggestive of viral etiology

2.Gestational thrombocytopenia-on review of literature 

Usually GT diagnosis is made when

a.asymptomatic patient with no h/o abnormal bleeding

b.mild thrombocytopenia (more than 70K)

c.usually detected incidentally on routine prenatal screening

d .no specific diagnostic test to definitively distinguish GT and Mild ITP

e.usually develops in mid second or third trimester

(This happens due to accelerated platelet activation at placenta,accelerated platelet consumption due to reduced platelet life span in pregnancy)

In our patient thrombocytopenia is severe and not mild as in GT and has h/o bleeding gums

3.ITP-Points in favour-petechia,mucocutaneous bleeding,No hepatospleenomegaly

Not in favour 

BT is usually prolonged in ITP,it is normal

4months back when she got tested her platelets were 2lakhs

4.APLA-The patient should have clinical episodes.of arterial or venous thrombosis-not there

-One or more unexplained death of morphologically normal fetus after 10 weeks gestation-we don't know the fetal morphological status in her previous abortions,but as she was told that she did not have any problem as such and only the baby was weak during abortions

-one more premature births which is not there

-three or more consecutive, unexplained spontaneous abortions before 10weeks,our patient had 2abortions

APTT is usually prolonged and is normal in our patient 

APLA is unlikely

5.Acute fatty liver of pregnancy -ruled out by no h/o pain abdomen,tenderness,normal bilirubin levels

6.HELLP- ruled out again by normal liver enzymes,no high bp recording,spot upcr 0.28

No hemolysis

 QUESTIONS

1.Efficacy of steroids for ITP in pregnancy?

The treatment for ITP during pregnancy is administered after making a complete assessment of the bleeding risk, taking into account primarily the obstetrical criteria. The treatment methods used for classical ITP (corticotherapy, immunosuppression) may produce iatrogenic effects and represent an additional source of complications both for the mother and the fetus.

2.Will ITP present only in pregnancy without previous history of ITP?

Immune thrombocytopenia (ITP) occurs in one or two of every 1,000 pregnancies , and accounts for 5% of cases of pregnancy-associated thrombocytopenia.

CASE-2 

https://blendedasessmentmadhukumar.blogspot.com/2022/08/is-online-elog-book-to-discuss-our.html

CASE-3

https://blendedasessmentmadhukumar.blogspot.com/2022/08/52-year-old-male-with-fever.html