It's health and medicine.

1. PRESENTEDBY:-
NAME:- SOUVIKBERA
STUDENTCODE:-BWU/BPA/20/014
SEMESTER:-VII
COURSE:-INTERNSHIP
COURSECODE:- BPA781
REGISTRATIONNUMBER:-20013000298 of 2020-2021
• BRAINWAREUNIVERSITYSCHOOLOf MEDICALAND ALLIEDHEALTHSCIENCES
• DEPARTMENTOf ALLIEDHEALTHSCIENCES
• BACHELOROF SCIENCEIN PHYSICIANASSISTANT
NO. OF CASE STUDIES PROVISIONAL
DIAGNOSIS
CASE STUDY 1 ?UTI
CASE STUDY 2 ?LRTI
CASE STUDY 3 ? Acute myocardial
infarction
CASE STUDY 4 ?CVA
CASE STUDY 5 ? AGE

2. ACKNOWLEDGEMENT
Firstly, I would like to express my special thanks to Department of Allied health Sciences and
Dr. Animesh Dey For sending me to NARAYAN MEMORIAL HOSPITAL for clinical
Internship.
That helps me, To get associated with a progressive organization that gives me scope to utilize
and update my knowledge in healthcare field through hard work, sincerity, dedication and
honesty.
After that I would like to thank you to Dr. samim ul haque and every Members NARAYAN
MEMORIAL HOSPITAL.

3. Introduction
NMH has the best facilities with the latest technologies and multi
departmental support. The medical infrastructure includes 200-beds,
multispecialty departments, 5 operation theatres with positive pressure,
laminar flow, well equipped with all modern gadgets for safely conducting all
complicated surgeries, 30-bedded intensive care unit, 15-bedded dialysis
unit, 5 open care system of level III NICU, Isolated pressurized ICU with
modern equipment, 6 super deluxe suits with attached guest room, sitting
room and a small pantry, specialist doctors and technicians at your service.
The ‘Patient First’ policy of NMH will redefine healthcare in the city of Kolkata.
In memory of Late Narayan Shaw, on 16 July 2019, the 200-bedded Narayan
Memorial Hospital (NMH) ceremoniously opened

4. SUMMARY OF INTERNSHIP WITH
DEPARTMENTS I’VE WORKED IN : -
I am Souvik Bera (Student code: BWU/BPA/20/014), Student of B.sc Physician Assistant Department of Allied
Health Sciences.
As a part of the curriculum, I am Undergone the mandatory clinical Internship program in the Department of
Emergency and OPD
During the period of Training, I had practical experience of all the activities of OPD and EMERGENCY.
Special Focus of the training covered the following areas:
History taking.
Progress of patients.
Daily assessment of patients.
General and examination of patient.
Basic Management of patients.
Patients counselling.
BLS
Cannulation

5. CASE STUDY 1
Patient Name:-ABC
Patient age and sex:- 37yrs/F
Patient ID:-NMH 208059
P/C :-
• c/o burning sensation during urination
•c/o pain lower abdomen (suprapubic region)
• mild fever from 2 days
• Problem in holding urine
-:History related to present
illness:-
• k/c/o hypothyroidism no other comorbidities
present
• Intakes medication for pcod
• H/O irregular period from 2007
Any other history
• No family history present
• HO LUCS AT 2019
VITALS :-
• Temp:- 99.6°F
• BP:-100/60 mmHg
• Pulse:-96bpm
• R/R:-20/min
• Spo2:-96% R/A
• CBG:- 156 mg/dl
• Allergies:-not
specific
Present sign and symptoms:-
1. SYMPTOMS:-
• Generalized weakness
• Dysuria (any discomfort during urination)
• Pain in lower abdomen or hypogastric region
2.SIGNS:-
• Vomiting with nausea
• Cloudy and strong smelling urine
• Feeling to urinate urgency
• Uneasiness for pain in suprapubic region
• Hypotension present
• Sign of Dehydration present

6. Clinical examination-
Routine examination-
Anemia:- present
Jaundice:- no sign
Cyanosis:-no sign
Clubbing:- no sign
Oedema:- NAD
Pupils:- BL equally reactive
Mild sign of dehydration present.
Perticular examination:-
Inspection:-
• Mild febrile conditions present
• Too much uneasiness present
• No sign of respiratory distress present
Palpation:-
• In light palpation mild fever present
• In deep palpation tenderness present in Hypogastrium
region
• Liver is palpable (Grade 1 fatty liver) in Rt.
Hypochondriac region
Auscultation:-
• chest is BL clear, soft pitched (VBS)
• CVS:- S1 S2 (+) NO MURMUR present
• ABD:- IPS is soundable
Investigation :-
• Blood for CBC,CRP,UREA,CREATININE,NA+,K+,URINE RE ,CS ,Ketone
deepstick test .
• X-ray chest(pa)[normal], x-ray for WA
• USG for W/A [Mild fluids seen in p.o.d ]
• ECG done at ER
Management Of this patient in emergency :-
• Pt. access with proper process and vitals checked & documented.
• Given medication (NSAIDS) For pain management .
• i.v fluids administered for manage hypotension & dehydration.
• Given medication (ondansetron) for manage the vomiting sos.
• Correction of electrolytes done if there any sign of electrolytes
disbalance.
• Given antibiotics if after all tests done if there any sign of
infection .
Provisional diagnosis :-
? UTI
Adviced for this patient:-
• Take prescribed antibiotics.
• Always stay hydrated.
• Avoids irritants foods.
• Use heating pads in lower abdomen during
pain.

7. CASE STUDY 2
PT. AGE & SEX –47
yrs/m
PT ID – NMHK45637
P/C-
• A 47 YRS male patient came to ER with
presented complaints of severe respiratory
distress
• C/O mild fever since 2 days .
• C/O severe cough
• C/O generalized weakness .
• H/O loss of appetite from yesterday
morning
• O/E severe SOB with desaturation
• Pt. is too much restless after entrance to er
HISTORY RELATED TO PRESENT ILLNESS-
• K/C/O HTN ,T2DM,CHAIN SMOKER
• DURATION – 4 hours
• No more comorbidities present
• H/O ischemic CVA 5 years ago
ANY OTHER HISTORY
• No surgical history present
• MI & CVA present in family history
SYMPTOMS-
• Too much respiratory distress present
• Uneasiness present
• Too much restless
SIGNS-
• Severe sob with desaturation
• Cough with light black color sputum
• Generalized bodyaches
• Mild fever present
• Mild cyanosis present in fingers and lips
VITALS –
UNSTABLE
• TEMP- 99.6 F
• PULSE-98 BPM
• BP-140/90 MM Hg
• SPO2-81% (R/A)
• R/R:-26/ MIN
• RBS-234 MG/DL
• ALLERGIES- NOT
KNOWN

8. ROUTINE EXAMINATION –
• ANEMIA – MILD +
• JAUNDICE- NO SIGN
• CLUBBING –PRESENT
• CYANOSIS- PRESENT FINGERS & LIPS
• OEDEMA –NO SIGN
• PUPILS - B/L EQUALLY REACTIVE
• SEVERE RESPIRATORY DISTRESS PRESENT
INVESTIGATION
• Blood for CBC,CRP,NA+,K+,UR,CR,VIRAL SEROLOGY
• CXR (PA)
• ECG Done (1st degree av blocked )
• Blood for ABG done ASAP (co2 respiratory acidosis present )
PERTICULAR EXAMINATION –
INSPECTION-
• Mild febrile condition present
• Severe respiratory distress
• Tachycardia
• Uneasiness present
AUSCULTATION –
• CHEST B/L WHEEZE , crepts present
• CVS S1 S2 S4 present, systolic murmur
• ABD- IPS soundable
Palpation-
• In deep palpation no abdomen tenderness ,soft
PERCUSSION
• Dull nodes present in lungs fields
PROVISIONAL DIAGNOSIS - ? LRTI, ?ACUTE ASTHMA
MANAGEMENT OF THIS PATIENT
• PT. head should prop-up
• Pt. should be in proper oxygen support
• Pt. should nebulized ASAP
• Given proper medication for desaturation
• Safe THE airway ASAP
• Given I.V fluids for hypotension
ADVISED FOR PATIENT –
• QUIT SMOKING
• INTAKES HEALTHY DIET
• LIFESTYLE MODIFIFATION

9. PATIENT NAME -
ABGF
PRESENT COMPLAINTS-
• C/O sudden onset chest pain
• c/o retrosternal pain
• c/o SOB but not sign of desaturation
• O/E uneasiness with sweating
• c/o vomiting with nausea
• c/o mid dizziness from yesterday
• No H/O loss of consciousness
• c/o chest tightness from yesterday
HISTORY RELATED TO PRESENT
ILLNESS-
• K/C/O HTN,
• PT. is chain smoker
• Pt. intakes medication for hypertension
• Pt. got hospitalized for pancreatitis 3 month
ago
Any other history-
• No family history present
• No surgical history present
SYMPTOMS-
• CHEST PAIN
• CHEST TIGHTNESS
• MILD DIZZINESS
• UNEASINESS WITH SWEATING
• VOMITING
• SIGNS-
• RETROSTERNAL PAIN
• SOB BUT NO SIGN OF DESATURATION
• VERTIGO
•
VITALS –
TEMP- 98.2
PULSE-78 BPM
BP-160/90 MMHg
SPO2-98% (R/A)
R/R-23/MIN
RBS-111mg/dl
ALLERGIES-not
known
PATIENT AGE & SEX-
PT. ID-
CASE STUDY 3

10. ROUTINE EXAMINATIONS-
• JAUNDICE- NO SIGN
• ANEMIA-++
• CLUBBING-PRESENT
• OEDEMA-NO SIGN
• CYANOSIS –MILD SIGN IN NAILS
• PUPILS –B/L EQUALLY REACTIVE
• PALLOR:- MILD SIGN PRESENT
PERTICULAR EXAMINATION-
INSPECTION:-
• Uneasiness present
• Too much sweating
• Bradycardia present
AUSCUITATION
• CHEST – B/L Ronchi & rales present
• CVS S1 S2 S4 Present
• ABD ips (+)
PALPATION :-
• IN DEEP Palpation in abdomen pain and
tenderness present in Rt. Hypochondriac
region
• Liver is palpable
INVESTIGATION:-
• BLOOD FOR CBC,CRP,NA+,K+,UR,CR,TROP-T,TROP-I
• CXR (PA)
• ECG SHOULD BE DONE IMMEDIATELY(ST elevation in leads ii,iii,avf)
• 2D ECHOCARDIOGRAPHY SHOULD BE DONE (LVEF:- 34% RWMA:-
INFERIOR WALL HYPOKINESIS)
MANAGEMENT OF THIS PT.
• PT. HEAD SHOULD PROP-UP
• PATIENT SHOULD IN PROPER OXYGEN SUPPORT
• ECG SHOULD DONE IMMEDIATELY
• GIVEN MEDICATION FOR CHEST PAIN (SORBITRATE, NIKORAN )
• PT. SHOULD NEBULIZED WITH BRONCHODIALATORS
• GIVEN MEDICATION FOR BRADYCARDIA {ISOLIN ,ATROPIN}
• URGENT SHIFTED TO CATH LAB FOR CAG +- PTCA
ADVISED FOR PREVENT THIS SITUATION :-
• QUIT SMOKING
• FOLLOW HEALTHY DIET
• LIFESTYLE MEDICATION
• AVIOD TOO MUCH OILLY FOOD
• AVOID OBESITY
PROVISIONAL DIAGNOSIS :-?ACUTE MYOCARDIAL INFRACTION

11. PATIENT NAME:-PQRST
CASE STUDY 4
PRESENT COMPLAINTS:-
• C/O WEAKNESS IN LT. SIDE SINCE PAST 2 DAYS
• C/O SLURRING OF SPEECH
• O/E MILD DROWSY
• H/O VOMITING 3 EPISODES FROM TODAYS MORNING
• PT. HAS RT. SIDE FACIAL DEVIATION
• PT.HAS PROBLEM IN SWALLOWING .
• NO H/O SYNCOPE OR LOC
• NO SIGN OF ANY RESPIRATORY DISTRESS
ANY OTHER HISTORY :-
• P/C CAG+PTCA DONE AT 2017
• NO FAMILY HISTORY PRESENT
BACKGROUNDS OF THE PT:-
• K/C/O HTN,T2DM,OBESITY,CHAIN SMOKER
• PT. TAKES MEDICATION FOR HTN
• PT. TAKES PSYCHIATRIC MEDICATION (AS PER PT.
RELATIVES)
SIGNS :-
• PT CAN’T TALK PROPERLY
• PT CAN’T STANDS IN PROPER WAY
• PT HAVE TREMOR
• VOMITING 3 EPISODES
SYMPTOMS:-
• SLURRING OF SPEECH
• WEAKNESS IN LT. SIDE
• RT. FACE DEVIATION
• PT HAS PROBLEM IN SWALLOWING
• O/E MILD DROWSY
PATIENT AGE & SEX :- 54/
M
PT ID :-NMHK23459
VITALS:-UNSTABLE
• TEMP-98.7 F
• PULSE-96 BPM
• BP-170/90 MM Hg
• SPO2-96% (R/A)
• RBS-164 Mg/dL
• ALLERGIES-NOT
SPECIFIC
• R/R-21/MIN

12. ROUTINE EXAMINATION:-
• PALLOR:- MILD SIGN
• ANEMIA:-++
• JAUNDICE:-NO SIGN
• CYANOSIS:-NO SIGN
• OEDEMA:-NO SIGN
• CLUBBING:- SIGN PRESENT
• PUPILS:-RT. SIDE DIALETED
• GCS ;- E4V4M5= 13/15
ADVICED FOR PREVENTION :-
• QUIT SMOKING
• AVOID UNHEALTHY DIET
• DON’T STOP MEDICATION FOR HTN
• STOP ALCOHOL IMMEDIATELY
PERTICULAR EXAMINATION :-
1. INSPECTION
• LT. SIDE LIMBS WEAKNESS
• RT. SIDE MOUTH DEVIATION
• SLURRING OF SPEECH
2. AUSCULTATION:-
• CHEST CREPTS PRESENT , B/L CRACKLES PRESENT
• CVS S1 S2 S4 PRESENT SYSTOLIC MURMUR PRESENT
• ABD IPS (+)
3. PALPATION:-
• SOFT, NO TENDERNESS PRESENT IN ABDOMEN
PROVISIONAL DIAGNOSIS -?CVA
INVESTIGATION :-
• BLOOD FOR CBC,CRP,NA+, K+,UR,CR
• CXR (PA)
• NCCT BRAIN PLAIN [SOME BLOOD CLOTTED IN RT. SIDE IN BRAIN
TISSUE]
• ECG SHOULD BE DONE TO SEE ANY CARDIAC MUSCLE DAMAGE
MANAGEMENT OF THIS PT.
• PT. SHOULD BE IN OXYGEN SUPPORT
• INTRA CRANIAL PRESSURE SHOULD RELEASE WITH
MEDICATION
• GIVEN MEDICATION IF THERE ANY SIGN OF SEIZURE
• GIVEN MUSCLE RELAXANT MEDICATION IF THERE ANY
SIGN OF RESTLESSNESS

13. PATIENT NAME:-
ASDF
CASE STUDY 5
P/C
• C/O PAIN ABDOMEN FROM TODAY 6 P.M.
• H/O FEVER BUT NO SIGN OF FEVER WHEN
ARRIVED IN ER
• C/O LOOSE STOOL OF 7 EPISODES FROM
YESTERDAY
• H/O OF VOMITING WITH NAUSEA
• O/E PAIN IN EPIGASTRIC REGION
• C/O GENERALIZED WEAKNESS
• C/O ANOREXIA FROM YESTERDAY.
HISTORY RELATED TO PRESENT
ILLNESS:-
• PT. INTAKES PPI FOR ACIDITY
• NO MORE COMORBIDITIES PRESENT
• ADMITTED HOSPITAL FOR UTI
ANY OTHER HISTORY :-
• FAMILY HISTORY OF T2DM PRESENT
• NO SURGICAL HISTORY PRESENT
PT. AGE & SEX:- 23YRS/ F
PT. ID:-NMH23456
VITALS :-
TEMP:-98.4F
PULSE:-76 BPM
BP:-100/60 MM
Hg
R/R:-21/MIN
SPO2:-97% (R/A)
RBS:-101 Mg/dl
ALLERGIES:- N/K
SYMPTOMS:-
• LOOSE STOOL
• VOMITING
• PAIN ABDOMEN
• MILD FEBRILE CONDITION
SIGNS :-
• LOSS O APETITE
• EPIGASTRIC PAIN
• GENERALIZED WEAKNESS(MALAISE) WITH
BODYACHE
• MILD DROWSY FOR DEHYDRATION
• NAUSEA PRESENT
• DIARRHEA
• HYPOTENSION PRESENT

14. ROUTINE EXAMINATION
PALLOR:- ++
JUNDICE:-NO SIGN
ANEMIA:-+
OEDEMA:- NO SIGN
CYANOSIS:-NO SIGN
CLUBBING:-NO PRESENT
PUPILS:- B/L EQALLY REACTIVE
SEVERE DEHYDRATION PRESENT
PERTICULAR EXAMINATION :-
1. INSPECTION :-
• MILD FEBRILE CONDITION
• UNEASINESS FOR PAIN
• PALLOR PRESENT FOR DEHYDRATION
2. AUSCULTATION:-
• CHEST B/L CLEAR SOFT PITCHED(VBS)
• CVS S1S2 PRESENT NO MURMUR PRESENT
• ABD IPS (+)
3.PALPATION:-
• TENDERNESS & PAIN PRESENT EPIGASTRIC AND
HYPOGASTRIC REGION
• NO SIGN OSF ANY ORGANOMEGALY
PROVISIONAL DIAGNOSIS:-? AGE
ADVISED FOR THIS PT. :-
• ALWAYS HYDRATED
• INTAKES ORS
• AVOID SPICY FOOD & STREET FOOD
• QUIT SMOKING
• DON’T STAY EMPTY STOMACH FOR LONG TIME
• TAKE REST
INVESTIGATION:-
• BLOOD FPR CBC,CRP, NA+,K+,UR,CR,AMYLASE,LIPASE
• ECG FOR ROUTINE EXAMINATION (NORMAL SINUS
RHYTM)
• X-RAY FOR ABDOMEN (AP/LAT)
• USG W/A SHOULD BE DONE IMMEDIATLY
MANAGEMENT OF THE PT.:-
• I.V FLUIDS ADMINISTERED FOR DEHYDRATION
• GIVEN MEDICINE (ANALGESIC) FOR PAIN
MANAGEMENT
• GIVEN ANTIEMETICS FOR TREAT NAUSEA &
VOMITING
• GIVEN OXYGEN SUPPORT IF THERE ANY SIGN OF
DESATURATION

15. ALL OF THE MEMBERS AND DOCTORS OF NARAYAN MEMORIAL HOSPITAL. ALSO
I THANKS TO BRAINWARE UNIVERSITY’S FACULTIES AND HOD OF ALLIED
HEALTH SCIENCES