MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEMS CBBLE

 Hello, 

I am Sree niketh of final year MBBS, I would like to share my experience with some of my patients and their problems which have helped me learn and understand the way medicine works and how important it is to monitor the work through the logbook entries and follow the patient up with case based blended learning system and PaJr.

These new generation educational approaches has made learning and understanding medicine very effective and exposing students and new doctors to a very wide reference of cases through these studies, CBBLE and PaJr have played a vital role in my education and learning of medicine

Through this blog post, I hope to motivate medical professionals and students to embrace these cutting-edge learning environments and take use of the tremendous potential they offer. Together, we can open the door to a more promising and successful future for healthcare education.

CBBLE PAJR PARTICIPATORY LEARNING ACTION RESEARCH DISCLAIMER

NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.  

CASE 1

I had my first encounter with a patient when I was in the third year of my medical school(MBBS) on the day I was posted to the general medicine department, I was given this case to resolve in an effort to understand the subject of "patient clinical data analysis" in order to improve my clinical data reading and comprehending skills which include the ability to read and comprehend history, clinical findings, investigations and come up with a diagnosis and treatment plan

My patient was a 20 year old male who presented to the out patient department with a chief complaint of fever associated with vomiting for the past nine days, on further questioning the patient reveals the details about his vomiting which were initially watery and non projectile and later had 2 episodes with blood in his vomit. he first visited the local hospital and was prescribed medication and advised to undergo endoscopy, which reveled pan gastritis.

My patient then developed continuous high grade fever without associated vomiting and was admitted in the local hospital for conservative management. However, his condition worsened, and he had increasing number of non projectile vomiting episodes then he was transferred to a high level health care center where we are now and he complains of vomiting 8 episodes after consuming food on further questioning and interacting with the patient he reveals he has fever spikes, head aches and body pains 

The patient denies symptoms such as burning micturition, cough and cold, neck stiffness, abdominal pain, and loose stools these questions were asked to rule out any involvement of other systems in the body and localize the disease and help me as a junior doctor to point me towards the diagnosis

Upon taking the personal history the patient reveals that he has a very bad food habits like consuming food in unhygienic places and at irregular intervals and was not taking care of the food habits or the food he was consuming this questioning points us towards the problem he is facing 

On general examination reveled a conscious and coherent patient with no obvious abnormalities with vitals being in the normal range and the patient can be taken to further examination

On examining the abdomen the patient shows scaphoid shaped abdomen, inverted umbilicus and a mild enlargement of the liver was noted with a palpable spleen

Provisional diagnosis included fever under investigation and pangastritis 

various investigations were ordered including blood tests, endoscopy and imaging.

treatment involved tablets, intravenous medication, monitoring vitals and symptomatic management.

LEARNING POINTS 

1) IMPORTANCE OF THOROUGH HISTORY TAKING

                   us as medical students and junior doctors obtain a detailed history of the patients symptoms including the timeline, characteristics of vomiting, associated symptoms, reveling past and personal medical history. This information helped in formulating a provisional diagnosis and plan further investigations and the treatment required

2)CLINICAL REASONING AND DIFFERENTIAL DIAGNOSIS

                    based on the presenting symptoms and examination findings we as students and doctors use our knowledge to characterize the symptoms to a disease. This highlights the importance of the integrating clinical knowledge and applying the clinical reasoning skills to arrive to a diagnosis.

3)IMPORTANCE OF PROPER PHYSICAL EXAMINATION

                    us students and doctors have to perform a thorough physical examination including systemic examination, general examination, abdominal, cardiovascular, respiratory, CNS examinations.

this examination allows us for the identification of specific findings like hepatomegaly, palpable spleen, breath sounds which contribute to the diagnostic process

4)ORDERING APPROPRIATE INVESTIGATIONS

                    The doctors and students have to order for appropriate investigations to support their diagnosis and to see and evaluate the degree of damage, Appropriate and relevant investigations may get us to a different diagnosis depending upon the test results. This demonstrates the importance of selecting appropriate investigations based on the clinical scenario and clinical features for better understanding the condition.

5)TREATMENT AND MANAGEMENT

                       we initiate appropriate treatment based on our knowledge including tablets, intravenous medications, symptomatic management and close monitoring of vital signs for the cure and relief of the patient. This emphasizes the significance of early intervention and appropriate management in improving patient outcomes

overall this case highlights the significance of clinical knowledge , practical case taking skills and the ability to integrate information from history, examination and investigations for making a provisional diagnosis and provide appropriate treatment, this is what I learnt by following newer methods of learning like CBBLE and PaJr

 

clinical case:  https://sreeniketh2222.blogspot.com/2022/12/20-year-old-male-with-fever-and.html

case 2

During my clinical rotations I came across a 55-year-old male farmer who presented with chief complaints of 15 episodes of loose stools, low-grade fever, and vomiting over the past two days. The patient reported a history of sunstroke, alcohol intake, and consumption of outside food prior to the onset of symptoms. physical examination revealed pallor, normal vitals except for low blood pressure and tenderness in the epigastric region

The patient history reveals a possible association with sunstroke, alcohol intake, and eating outside food. These factors may contribute to GI infections and inflammation

on physical examination pallor was found with low blood pressure and tenderness in epigastric region rest of the vitals were normal which may suggest hypovolemic shock and dehydration

provisional diagnosis includes hypovolemic shock secondary to GI losses (gastroenteritis) with AKI along with potential right sided heart failure

The initial treatment plan included IV fluids to treat the hypovolemia and dehydration, inotropic support with noradrenaline, furosemide to maintain a mean arterial pressure above 65 mmHg

Thiamine supplementation is required in this case as the patient has consumption of alcohol in the history and to treat any deficiency. aspirin is given prophylactically to be safe from cardiovascular conditions like heart failure.

This case pulled me into the depths of basics of pathology and also the clinical exposure and practical knowledge I gained from this case are of great worth.

clinical case: https://sreeniketh2222.blogspot.com/2023/04/55year-male-hypovolemic-shock.html

learning points:

the key elements in patients history that led me to my diagnosis are reported episodes of loose stools, suggesting significant fluid loss from the body, and the low blood pressure indicates the hypovolemia. The patient is a farmer which also suggests that he might work out door for longer times and may be having dehydration.

hypovolemic shock progresses into multi organ dysfunction syndrome and may affect the kidneys first and the patient is at a high risk of acute kidney injury if not treated properly .