INTERNSHIP ENDPOSTING PORTFOLIO

 

 This online E-log Entry Blog is an objectively structured clinical examination method to assess the clinical competence during the course of my General Medicine Internship rotation (october'2023-november'2023) by reviewing the case reports shared below and to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs for questions surrounding the clinical vignettes borrowed from the E Log Book.


Note: The cases have been shared after taking consent from the patient/guardian. All names and other identifiers have been removed to secure and respect the privacy of the patient and the family

This is a case where I presented in the CME meet :


A 47 year old male patient came to casualty with chief complaint of spasms of both upper and lower limbs since one day
HOPI:
Patient was apparently asymptomatic one day back then he developed spasms in his both upper and lower limbs which was sudden in onset gradually progressive . No aggravating and relieving factors. 
History of perioral numbness, easy fatiguability.
No history of tonic clinical movements 
No history of loss of consciousness 
No history of bladder / bowel incontinence 
No history fever, nausea and vomiting 
No history of shortness of breath 
No history of cold and cough 
No history of loose stools.
History of similar complaints in the past( 5 years ago ) with chief complaints of sudden onset of weakness of all four limbs which progressed to complete weakness in 3 days for which he got admitted in the hospital and got treated accordingly.
PAST HISTORY:
K/c/o Hypertension since 6 years on unknown medication 
Not a known case of DM, Asthma, TB, Epilepsy, CAD, CVA,
and Thyroid Disorders.
PERSONAL HISTORY:
Moderately built and Moderately nourished. 
Appetite- normal. 
Sleep -adequate. 
Diet- mixed.  
Bowel and bladder movements regular.
Addiction- Alcoholic since 20 years (consumed approximately 360ml of alcohol per day since 10 days due to elections)

FAMILY HISTORY :
No relevant family history
GENERAL EXAMINATION 
Patient was conscious, coherent and cooperative 
Patient was  anxious at the time of admission 
No signs of pallor , cyanosis , icterus , clubbing , lymphadenopathy , generalised edema 
Trousseau sign was present
Chvostek sign was present 
 Vitals - 
Temperature: 98. 4 °F
PR : 92 bpm
BP : 150 /80  mm of hg  
RR : 28 cpm
SpO2 : 98% on room air.
GRBS : 98 mg /dl
SYSTEMIC EXAMINATION 
CNS  :  
Level of consciousness-alert 
Speech - normal
Cranial nerves function- Normal 
Motor system:   
                              Right                                        Left 

Power.   UL.            5.                                              5 
               LL.             5.                                             5 
Tone.      UL.            Normal.                              Normal
                LL.            Normal.                              Normal   
        
Reflexes. 
           Biceps.             ++                                            ++
           Triceps.             ++                                            ++
           Supinator.          ++                                            ++
           Knee.                 ++                                             ++
           Ankle.                 ++                                            ++
Sensory System :  Normal
CVS :  S1S2 heard  , No murmurs heard 
RS : Bilateral air entry clear 
Per abdomen : soft and non tender,  bowel sounds heard 

PROVISIONAL DIAGNOSIS :
TETANY FOR EVALUATION

Investigations :
ABG 
PH - 7.62 (normal 7.32-7.45)
PCO2- 19.5 mmHg(normal 35-45)
Po2 - 106 mmHg ( 85-95)
HCO3- 20.7 mmol/l (22 - 26 mEq/L)
SO2: 97.7%
Na+: 132 mmol/L
K+ : 2.7 mmol/L
Ca+2 : 0.47 mmol/L

FINAL DIAGNOSIS: 

TETANY SECONDARY TO RESPIRATORY ALKALOSIS 

Treatment 
Rebreathing mask
Inj. Calcium gluconate 2 g in 100 ml NS over 15 min 
Inj. KCl 40 mEq + 500 ml NS iv  over 6 hrs  
Tab. Telma H PO/ OD

Osce questions:
What is relation between respiratory acidosis causing hypocalcemia?
Respiratory alkalosis is an elevation in pH secondary to reduced arterial partial pressure of carbon dioxide (pCO2) in the setting of hyperventilation. It can be either acute or chronic and is the most common acid-base disturbance in critically ill patients. Hyperventilation often leads to hypocapnia, which in turn leads to a slight reduction in bicarbonate, hypokalemia, and hypophosphatemia due to an intracellular shift of potassium and phosphate, and hypocalcemia due to increased calcium binding to albumin in the setting of increased pH.

Can alcohol cause hypokalemia?


Yes, alcohol can affect your potassium levels. Consuming large amounts of alcohol can cause your body to excrete potassium in the urine. This can lead to decreased potassium levels in your bloodstream.

Furthermore, drinking excessive amounts of alcohol can cause dehydration which can cause the levels of potassium in your body to become dangerously low. Additionally, the consumption of some alcoholic beverages, such as cocktails and beer, provides large amounts of simple sugars, which can result in an increase in potassium retention in the body.

Alcohol dependence vs alcohol abuse?


Alcohol dependence causes people to keep drinking to avoid experiencing withdrawal symptoms. Alcohol abuse, on the other hand, involves drinking excessively without having a physical dependence. Both have serious health risks.While the two are no longer differentiated in the DSM, understanding their original definitions can still be helpful.

Alcohol dependence:

Alcohol dependence was originally defined as a chronic medical condition characterized by experiencing symptoms of withdrawal when the person stops consuming alcohol. To avoid experiencing withdrawal symptoms, the person has to keep consuming alcohol

Alcohol abuse:

Alcohol abuse was defined as a condition in which a person continues to drink despite recurrent social, interpersonal, health, or legal problems as a result of their alcohol use.A person who abuses alcohol may also be dependent on alcohol, but they may also be able to stop drinking without experiencing withdrawal symptoms.

Learning points:

Eliciting chcostek sign and trousseau’s sign

Respiratory alkalosis vs acidosis




ABG interpretation: as




In the rotations of medicine department I’ve assisted in central line



Learnt about 2d echo machine techniques 


PAJR group links of the cases I’ve worked on:

https://chat.whatsapp.com/KXzmKmNwqXgHkcwxOhfmfW


https://chat.whatsapp.com/FRrAC1DK3OR7xbhiaJHMxH







Showing areas to search in image



Comments

Post a Comment

Popular posts from this blog

A 60 year old came with chief complaints of left temporal vision loss

Image
COMPLAINTS Patient came with chief complaints of right temporal visual loss since 20 days HOPI Patient was apparently asymptomatic 20 days back then he developed dizziness, which was sudden onset,non progressive associated with loss of consciousness followed by vomiting,non bilious ,non blood tinged. No H/O deviation of mouth, loose stools,incontinence,fever, On the day of incident: He was going to his work then his right leg suddenly started shivering and dizziness .After around 20 mins he lost his right temporal vision. PAST HISTORY  K|c/o HTN Since 2months on medication ( Amlodipine 5mg) H/o trauma to left eye 30 years back, followed by complete loss of vision (in Left eye). Not a k/c/o DM, TB, epilepsy,thyroid disorders Daily routine: Patient wakes up at 6 AM then does his morning activities,drinks tea at7:30 am , breakfast (rice, dal) at 10 am, goes to work in farm and comes back at 1pm and does lunch ( rice,sambar, curry) and have tea and snack at 5pm , watches tv , dinner at 9 p
Read more

27 year old male with chief complaints of headache and dizziness

Image
  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 solveb 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 is welcome. A 27 year old male who works in printing press came to hospital with chief complaints of: Headache since 4 years Syncopal attack since 4 years ,last episode was 10 days ago. HOPI: Patient was apparently asymptomatic 4years back then he developed headache which is sudden in onset,gradually progressed in occipital region to neck not associated with nausea and vomitings it aggrevated by lifting heavyweights and climbing stairs and relieved spontaneously. Syncopal attack w
Read more

MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE

Image
MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE The journey of becoming a medical professional begins with a unique experience—the first interaction between a medical student and patient .This initial encounter holds immense significance as it sets the foundation for our understanding of patient care, empathy, and the ethical responsibilities associated with the medical profession. My first patient interaction was in 3rd semester.it was first day of my general medicine postings..I was posted in OP ,a patient of28 years old    female came with complaints of fever associated with chills and rigors, my PG asked me to check BP , that was my first time checking BP to a patient. I felt surreal that I started interacting with patients.I was there taking her history completely and our PG asked about differential diagnosis. I checked her temperature.we thought it may be dengue so we sent for    investigations.I was with m
Read more