Internal online assessment General medicine

IN UNIT DUTY:-
1/MY LEARNING POINTS:-Around this case.
http://shraddhabovolla10.blogspot.com/2022/08/80-yr-old-with-fever-and-cough.html
(1) why his platelet count is reduced ?
A:-Our patient was tested positive for NS 1.

https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/dengue-infection-how-does-dengue-impact-your-blood-platelet-count-does-every-patient-require-transfusion/photostory/87588434.cms
ACC to above article-
"The drop in platelets is caused by a condition referred to as 'thrombocytopenia', which happens either via direct bone marrow suppression or by means of an autoimmune reaction and antibodies pushed into place. Thus, while the dengue virus in itself doesn't destroy the platelets, it can unleash complications which harm platelet function and count"

(2)why this patient is having Anemia?
A:- most possibly it can be nutritional anemia.

2/
A 12 yr old female with decreased HB levels
(a) I assisted her in transfusion of blood.
(b)also learnt the indication of blood transfusion  - she underwent transfusion only becoz of reduced hb levels i.e 3.2gm/dl which is less than 6 gm/dl(indication of blood transfusion)
3/
A 25 yr old male with recurrent fever spikes & weakness.
(a) we sent him for all the pathological & microbiological test
A:- Then it turned out to be vitamin B12 DEFECIENCY.
(b) Treatment given was?
A:- INJ.methyl cobalamine 1500mcg for 1 year .
4/ 
A 70 yr old female in altered sensorium diagnosed to have urosepsis, AKI with CKD.
(a) I assisted in her for dialysis.
(b) took the ABG samples.
(C) I sent the blood samples for culture & senstivity.
(,d) She underwent 1 St session of dialysis after which there was fall in saturation levels.
(e) I assisted in doing the CPR & also gave the ambu ventilation through bains Circuit .

5/
 A 80 yr old female with cardiogenic shock.
(a) I took the blood samples for aerobic & anaerobic cultures whose results turned out to be 
Central line blood culture postive for pseudomanas aeuroginosa.
6/
A 22 yr old male with pain Abdomen & vomitings diagnosed to have AKI with DENOVO HYPERTENSION.
(1) what is the reason for his young on set hypertension?
A:-
It might be the primary cause of hypertension.
(2) He under went 4 sessions of dialysis  .after which his serum creatinine got reduced from 5 to 3mg/dl
http://shraddhabovolla10.blogspot.com/2022/09/22-yr-old-with-pain-abdomen-vomitings.html

7/
A 17 yr old female with involuntary movements diagnosed to have Neurocysticercosis 
(a) I have assisted her to the MRI contrast.
(b)InMRI reporting there was a ring enhancing lesion in the right frontal lobe
http://shraddhabovolla10.blogspot.com/2022/09/17-yr-old-female-with-involuntary.html
MY PRESENTATION OF THIS CASE WAS DONE( video link below)

https://youtu.be/Mh5ihnM3eV4

MY LEARNING POINTS around this case-
(1)How to approach a case of seizure?
Reference image from harrison's textbook Of Internal Medicine.
https://images.app.goo.gl/CKLrQNDoFLfdVYTr7
In our patient ,
(1)ON CNS Examination  - No focal neurological deficits found.
(2)According to the above picture...
We ruled out the metabolic causes.
(3)Then we go with the MRI scan which gave impression as
Ring enhancing lesion in the right frontal lobe with perilesional edema.
Then we diagnosed the patient as NEUROCYSTICERCOSIS stage 3/TUBERCULOMA.
(2)How to differentiate NCC from TUBERCULOMA?
https://www.scirp.org/journal/paperinformation.aspx?paperid=70607
Based on this research we differentiated them-In our patient MRI - Ring enhancing single lesion was at the junction of grey matter ...
In Tuberculoma - there will be multiple lesions in the posterior fossa .
So,we diagnosed her with NCC stage 3
(3) Efficacy of Dexa in NCC?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721198/
The above study says-

"The only published controlled studies of corticosteroid use in NCC relate to the management of single enhancing granulomatous lesions (SEL). In the Indian subcontinent, SELs (a single T. solium cyst undergoing degeneration with associated edema and inflammation) are the most common clinical presentation of NCC and a frequent cause of seizures"
It is mainly used to control the inflammation & perilesional edema.
IN ICU DUTY:-
(1)I have taken ABGs of all the ICU pts .
(2) Also taken the blood sample to lab for investigation.
(3) 70 yr old female with cardiogenic shock was expired on ICU bed 1
(a) Then i have done the cpr for her
& Also before she expired assisted to put her back on ventilator. I have learned how to put the patient on ventilation.

(4) A 72 yr old female with AKIbon CKD
Her blood urea levels were 172 mg/dl.
She was in altered sensorium & was not cooperative.
(a) she was taken to dialysis .
(b) After which her blood urea has been reduced in her blood.
(c) I assisted in putting the central line to this patient.

(5) A 80 yr old male was unconscious  was kept on ventilation as he was diagnosed to have severe pneumonia.
(a) In this case  I kept the ryles tube .
(b) I have taken the ABG samples .

IN NEPHRO DUTY:-
(1) A 65 yr old male diagnosed with CKD on MHD 
(a) I have done  the foleys cathetarisation.
(b) I assisted him during dialysis .

(2) A 50 yr old male diagnosed with CKD on MHD
(a) I Assisted him during dialysis.
# I HAVE DONE ASCITIC TAP FOR A PATIENT WITH ASCITIS
During Psychiatry postings:
(1)I have learnt how to take history taking
(2)I have learnt Different ways on how to counsel the patient 
(3)Seen cases of Alcohol dependence, schizophrenia,obsessive compulsive disorders, depression.
(4) Attended DAC rounds .
(5) I have learnt how the medication are prescribed for cases of alcohol dependence.

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