Doctors in Making: Introduction
By: Tanvi Hegde, Shruti Majumder, Sam Nithish
What to expect from DIM Workshops:
A. Session 1: Introduction to all specialties
in this workshop
a. Important Lab Tests
b. Different Imaging Modalities
c. “Warning Signs” for all 3
specialties
B. Session 2 & Onwards: Simultaneous
workshops led by tutors (2 hours each)
a. 1 Case Discussion (Preclinical +
Clinical Tie-ins)
b. Review Sheet for Each Case
Our Aim:
A. To introduce specialty clinical cases that
are not taught in pre-clinical years by
emulating case discussions in hospitals
B. To create a supportive and inclusive
environment for all students to ask their
questions
C. To introduce key lab and imaging
modalities to better equip students for
clinical year studies
D. To encourage active participation in 3
specialty sessions to encourage critical
thinking
Intro to Specialties
A. Pediatrics
a. Medical care of infants, children,
adolescents and young adults
b. Subspecialties: Cardiology,
Nephrology, Neurology,
Neonatology, Pediatric ICU,
Allergy and Immunology,
Endocrinology, Gastro-
hepatology and Nutrition,
Respiratory Medicine, etc.
c. Longitudinal care
d. Counselling of children and
parents/ guardians alike
B. General Surgery
a. What to Expect-Anatomy
Detectives: A lot of the task of
General Surgery involves around
applying the Anatomy to clinical
scenarios. As a surgeon, you are
expected to treat the disease
based on what you can observe
during history and PE.
b. Pitfalls-Not being through with
your findings -Some of the major
pitfalls a young surgeon faces is
not being thorough on patient
history and missing out on
important labs and imaging. BE
THOROUGH!
c. Take Home Points- Simple,
structured Cases- The case we
will go through will aim to
simulate a real-life scenario
where one will be able to use
clinical knowledge applied in a
hospital setting.
C. OBGYN
a. “A little bit of everything”-
Fantastic mixture of Surgery,
Internal Medicine, Pediatrics
b. Care for individuals with uteruses
before, during and after
reproductive years→
Longitudinal Care
c. Main Subspecialities:
Gynecology Oncology, Pelvic
Medicine & Reconstructive
Surgery, Maternal Fetal
Medicine, Reproductive
Endocrinology, Infertility
d. Strong counseling and advocacy
component
Lab Tests

A. Complete Blood Count

a. RBCs
§ Hemoglobin (12-18)-
oxygen transporting protein
found in RBCs
§ Hematocrit (37-50%)- ratio of
RBC volume to total blood
volume (Male: 41-53%,
Female: 36-46%)
§ MCV (80-100) average
volume of an RBC, can
classify into different anemias
b. WBCs
§ Total % of WBC
§ Neutrophils- ↑ in bacterial
infections, sepsis, leukemia,
autoimmune conditions, ↓ in
malignancy, viral infections,
bone marrow irradiation,
clozapine toxicity
§ Lymphocytes- ↑ in acute viral
infections, chronic viral
infections, leukemia, ↓ in
immunosuppression
§ Eosinophils- ↑ in parasitic
infections, neoplastic
syndromes,
§ Basophils- often elevated
along with eosinophils, CML
c. Platelets
§ ↑in reactive thrombosis,
malignancy (CML), chronic
inflammation, ↓bone marrow
failure
B. Inflammation Markers
a. Erythrocyte Sedimentation Rate
(ESR)- How fast RBCs settle at
the bottom of the test tube
b. C- Reactive Protein (CRP)-
Acute phase reactant made by the
liver
c. Arteries used: Radial (preferred),
Brachial, Femoral
d. Why radial: Easy access,
superficial, has collateral vessel
feeding the circulation

C. Atrial Blood Gas

a. Measures levels of oxygen,

carbon dioxide and pH of blood
b. Tells us about oxygenation,
ventilation, and acid base balance
D. Lipid Panel
a. Group of tests that are used to
diagnose dyslipidemias & evaluate a
patient’s cardiovascular risk
b. Important Ones: Total Cholesterol,
Triglycerides, HDL, LDL
§ HDL- carries excess cholesterol
from CELLS to liver
§ LDL-carries cholesterol from
LIVER to cells, has HIGHEST
cholesterol content and major
carrier of cholesterol in blood →
plaque buildup
§ Triglycerides- excess associated
with CVD and increased risk of
pancreatitis

E. Blood Glucose
a. OGTT: Oral Glucose Tolerance Test
a. Measure fasting plasma
glucose and 2 hours after 75g
of glucose
b. Most sensitive, easy to
perform
b. HBA1C
a. Reflects average blood
glucose of prior 9-12 weeks
b. Can be measured anytime, no
need for fasting
c. Can be altered by other
conditions: CKD, sickle cell
trait etc
c. C Peptide:
a. helps differentiates between
Type 1 & Type 2
b. Increased: indicates insulin
resistance and
hyperinsulinemia→ T2DM
c. Decreased: Indicates an
absolute insulin deficiency→
T1DM
 F. Basic Metabolic Panel
● The 4 Electrolytes:
➢ Sodium, Potassium, Bicarbonate,
Chloride
➢ Derangements seen in
hypovolemia/ dehydration, kidney
disease, congestive heart failure,
alkalosis, acidosis
● Calcium - to monitor CKD and
parathyroid disease
● Glucose - to monitor blood sugar
● Blood urea nitrogen (BUN) -
elevated in kidney disorders or
congestive heart failure
● Creatinine - also elevated in kidney
H. Other important tests:
disorders. High levels of creatinine
in the blood and low levels in the
urine indicates a kidney disease or
decreased renal function. In
general, high levels of creatinine in
blood and low levels in urine
indicate kidney disease or another
condition that affects kidney
function. These include:
Autoimmune diseases, Bacterial
infection of the kidneys, Blocked
urinary tract, Heart failure,
Complications of diabetes
● D-Dimer - fibrin degradation
product, valuable in diagnosis of
DVT
● Liver Function Tests:
➢ AST (SGOT), ALT (SGPT), ALP,
Albumin and total protein,
Bilirubin, GGT, LD, AST/ALT
ratio
➢ Derangements indicate liver
diseases, cholestasis, hepatitis, etc
➢ Isolated rise of ALP indicates non-
hepatobiliary pathology like bone
metastases or primary bone tumors,
bone fractures, or vitamin D
deficiency
➢ Monitor the effects of certain
hepatotoxic medications.
● Renal Function Tests - BUN,
creatinine, eGFR
● Thyroid function Test - T3, T4,
TSH

G. Coagulation Studies:
● PT, PTT
○ Prothrombin, Thromboplastin -
Proteins synthesised by the liver
○ Diagnosis of liver disease,
thrombophilia, hemophilia I. Microbiology:
○ Pre-operative tests ● Blood culture and sensitivity
● INR - Helps in monitoring the dose - To detect the presence of
of anticoagulants pathogens in the blood
 - Direct treatment to be more
microbe-specific
- Check the sensitivity of microbes
to a certain antimicrobial
● Throat swab, Nasal or
Nasopharyngeal Swab
- To detect the presence of
pathogens at the respective location
● Sputum smear – mainly used in the
context of TB

J. Immunology:
● Immunoglobulins
- Allergies -
- Autoimmune diseases like lupus,
celiac disease, JIA
- Infections: e.g. IgG and IgM for
Measles
Imaging:

X-Ray:
Advantages Disadvantages
Cheap and widely available Does not provide resolution for complex illness.
Very short time to acquire results (<5 mins) It does not provide 3D information.
Non-invasive and painless Bones can block significant diagnostic data as it
Portable, so can be used to image people who cannot absorbs the radiation.
move They do not interact very strongly with lighter
Favored modality for: Bone Fracture, Pneumothorax, elements.
Pneumonia, Bowel Obstruction, etc. Due to its radiation, it mutates cells which causes
ionisation. This often leads to cancer.

CT Scan:
Advantages
Higher contrast resolution. Hence it can distinguish
tissues having differences of less than 1% in their
physical densities.
More affordable and quicker than MRII.
Motion artifacts are of less concern in CT scan than
MRI.
Favored modality for: Brain Hemorrhage,
Contusions, cancer (All organs)
Disadvantages
Expensive for routine clinical use.
Exposure to much higher dose of ionizing radiation
than X-ray so chance of cancer in the future.
Not portable, so work needed to bring patient to the
radiology wing in the hospital.
More time consuming than X-Rays.

Ultrasound:
Advantages Disadvantages
Absolutely no Ionizing radiation, safe to use in An Ultrasound technician needs to have a lot more
pregnant women. training to master US.
Portable, able to be used anywhere and on less Bone blocks US waves. As such imaging of the spine
mobile patients is increasingly difficult with increasing age.
Widely accessible Artefacts are common. If a structure can only be seen
Good resolution. in one plane it is likely to be an artefact.
Favored modality for: Pregnant women, Baby, Increased depth means a lower frequency is required
Cannulation, Ascites, etc. for optimal imaging. As a consequence, there is a
lower resolution.

MRI Scan:
Advantages
No ionizing radiation, safe to use on all individuals
Provides better soft tissue contrast for tendons,
cartilage, heart and brain.
Provides information about blood circulations so
useful in the diagnosis of blood vessel related
disorders.
Favored modality for: Brain cancers, Cartilage and
tendon disorders, Heart valve dysfunction.
Disadvantages
Very expensive for the general population
Long time to obtain results, thus very slow
Motion artifacts can distort image, thus patient needs
to lay still
Patient can become claustrophobic due to tiny space.
Loud banging noises make for an unpleasant session.
Not good for emergencies
General Warning Signs § ≤ 3: require immediate
resuscitation
A. Neonatology
a. Signs
§ Fast
breathing
§ Persistent
cyanosis of the
skin
§ Grunting,
wheezing,
whistling while
breathing
§ Flaring of
nostrils or
retraction of ribs during breathing
§ Yellowing of the sclera or the skin
that worsens over time (see below)
§ Crying or irritability that cannot be
calmed
§ Excessive sleepiness
§ Fever
§ No bowel movement in the first 48
hours
§ No urine in the first 24 hours B. General Surgery
a. Shock is the most common
emergency that is encountered.
§ Fluid Resuscitation is the aim of
the game here and understand
the cause of the shock and
rectify it.
b. Use the Glasgow coma scale to
check patient mental status prior to
encounter and operation

b. APGAR Scoring

§ Total out of 10:

§ 8–10: normal newborn c. Using pain to localize the
§ 4–7: may require some diagnosis of which organ is affected
resuscitative measures
C. OBGYN
a. Ages 0-10 years
§ Vaginal Bleeding of any kind
§ Vaginal Discharge, burning
while urinationà rule out UTI
§ Pelvic Painà Uncommon in
childhood, find cause
§ Genital Mutilation, Bruises,
Scratches anywhere in the
pelvic region à Rule out
assault and sexual assault
b. Reproductive Years
§ Profuse Vaginal Bleeding à
Many causes refer to picture
below

§ Bleeding between periods

§ Sudden session of periods or
irregularity of periods
§ Severe abdominal/pelvic pain
not relieved by NSAIDsà
ovarian torsion ectopic
pregnancy
§ Sores or Lumps in/on
genitals à STDs, Non-STD
skin lesions
§ Vaginal discharge with an
unpleasant or unusual odorà
Bacterial Vaginosis,
Candidiasis
c. Post-Menopausal
§ Any vaginal bleedingà Refer
to pic above
§ Pelvic fullnessà Many causes
§ Feeling of “something is
coming out of my vagina” à
Uterine Prolapse