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I worked in kamineni institute of medical sciences as a post graduate in general medicine for 3 years. In this span I have to say that I saw the most interesting cases especially in the first half of my post graduation before covid. 

A few cases I’ve found interesting are

1. A case of 24/M who had history of red coloured urine during night came with complaints of weakness, easy fatigueability and turned out to have paroxysmal nocturnal hemoglobinuria confirmed later on flow cytometry with minimal splenic vein thrombus covering about 30% of the lumen and is on followup

2. A 22/F came with history of chronic anemia turned out to be thalassemia trait with family history

3. A 21/F came with status asthmaticus( previous history of intubation and status asthmatic is present) and status epilepticus and was intubated for 7 days and was my first case that was extubated.

4. A case of 58/M with olanzapine induced dilated cardiomyopathy on maintainance haemodialysis well maintained over a year with only 1 hospitalisation history despite dialysis and heart failure

5. A case of 32/M with prosthetic valve and infective endocarditis of mitral valve

6. A 56/M with long standing diabetes mellitus with severe autonomic dysfunction presented with severe diabetic diarrhoea about 30 episodes of stools of normal consistency which responded to ondansetron after 5 days

7. A case of 16/F unmarried woman came with recurrent vomitings, raised liver parameters and turned out to self abort herself just before she got admitted in the hospital

8. A 30/M who came with community acquired pneumonia which was minimal on radiology and on examination on the first day with severe respiratory alkalosis turned out to involve the entire inferior sub pleural region of the right lung and had severe pleural pain

9. A 15/F came with recurrent diabetic ketoacidosis with poor control and increased food intake and got intubated twice in the same year 

10. A 16/M with type 1 diabetes mellitus presented with green coloured urine, was suspected to have small intestinal bacterial overgrowth with vitamin b12 deficiency 

11. A 24/M with vitamin e deficiency induced myelopathy which reduced over 6 months with treatment and followup

12. A 35/M who was referred from psychiatry for complaining of frequent change in colour of fingers during nights, turned out to have Raynaud’s phenomenon and had interstitial lung disease on examination was found to have systemic sclerosis on followup

13. A 25/F presented with severe shortness of breath and normal chest, heart findings, with respiratory alkalosis and metabolic acidosis turned out to have an exacerbation of systemic lupus erythematosis

14. A 18/M presented with complaints of acute pancreatitis without any history of alcoholism or prominent cause and turned out to have pancreas divisum on further investigations.

15. A 63/F with history of diabetes came with unilateral involvuntary movements was diagnosed to have diabetic chorea with hyper intensities on the caudate lobe.

16. A 42/F came with history of organophosphorus poisoning is a known case of left ventricular and septal aneurysm with descending thoracic aorta aneurysm, which might be worsened if given atropine as treatment for the poisoning.

17. A 18/F with nephrotic syndrome with focal segmental glomerulosclerosis on biopsy.

18. A 60/M came with post viral severe myocarditis and pericarditis with multiple episodes of paroxysmal atrial fibrillation ? Secondary to chikungunya, learnt that cardiovascular involvement in chikungunya is the second most common system involved and is frequently under diagnosed. 

Along with these few cases I’ve seen while working here, some interesting cases I’ve seen in my peripheral postings are

1. A large cardiac thrombus in the left ventricle in an asymptomatic patient

2. A case of severe pulmonary artery hypertension with multiple valvular abnormalities 

3. A diagnosed case of wegeners granulomatosis in end stage renal failure

4. A patient with bmi- 46 and metabolic syndrome on end stage renal failure

If I have to say that I learnt a procedure well, I would have to say that I developed a special interest in cardiology while working here and went to the 2d echo machine everyday in the evening with a patient and started to learn on normal hearts first. Overtime I started seeing abnormalities by myself which was overwhelming to me.

I gained a lot of experience dealing with multiple acute kidney injuries, chronic kidney disease cases with the exposure any nephrology post graduate would have normally, and gained confidence in managing an emergency patient with renal failure.

I gained a lot of experience in placing central venous catheters, right jugular, left jugular and femoral catheters. I placed atleast 73 catheters during my nephrology peripheral postings.