“MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE "
Hello and welcome! My name is Bhargavi Kantipudi and i am a medical student from india.
One of the most transformative experiences for medical students is patient case based learning, which offers a unique perspective in real world medical scenarios.
I would like to present a selection of medical cases that i have examined.
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
We began our clinical rotations in 2nd year and in our initial days of medicine postings, I remember going to the ward a few times. I can recall a few patients, an old women with dysphasia, a man with tremors and bradykinesia. I wish I can go back in time and urge my inexperienced self to document those cases!
Alas, the pandemic had arrived and then we weren’t able to visit the ward until 3rd year.
CASE 1
The very first case that I’ve examined and documented during clinical postings was of a 46 Year old gentleman who presented with pedal edema. He had diabetes since 12 years and hypertension since 3 years. He was diagnosed with chronic kidney disease and was on his maintenance dialysis. I recall as a 3rd year Medical student being fascinated about his disease progression and how his disease had impaired his daily life. Looking back one of the main questions I had in my head back then was why only a few patients were affected by this serious and debilitating disease. Through this case I learned the importance of taking a daily routine and how it can provide us more insight of the patient and their disease.
Case report:
https://bhargavikantipudirollno21.blogspot.com/2021/10/a-46-year-old-male-with-pedal-edema.html
CASE 2
This was a 34 year old male patient who presented with blurring of vision since 3 years and slurring of speech since 1 year. He was suffering from repeated episodes of falling and blackouts and was diagnosed with hypertension. On examining the patient, I was astonished to be able to auscultate a renal bruit. The ability to detect and interpret such a subtle sound fascinated me and reminded me the intricate and multifaceted nature of the human body. The patient had hyperrefflexia in the lower limbs and his 2nd and 7th cranial nerves were impaired. The patient was diagnosed with hypertension secondary to renal artery stenosis.
For a detailed case report:
https://bhargavikantipudirollno21.blogspot.com/2021/10/34-year-old-male-with-blurring-of-vision.html
This was the first case that I had to present among my batch of 200 students which I was quite apprehensive about.
A peculiar question our HOD sir asked during the discussion was what consonants and vowels the patient was able to pronounce and which vowels and consonants relate to each cranial nerve. I learned that day that we could do an examination of cranial nerves through pronunciation of consonants and vowels.
Learning points:
Goldblatt hypertension model
Vowels-CN10
Ka, Kha, Ga, Gha- 7,9, 10,12
Cha, Chha, Ja, Jha- 12, 10
Ya, Ra, la, va- CN 12
pa, ma, ba -7
ta, da, na- 12
The coming year, I was more excited for Medicine postings. I had acquired a decent bit of clinical knowledge from my previous year and was a little more confident in examining patients.
CASE 3
This was a case of a 75 year old man who came with complaints that suggested acute gastroenteritis. However he had other complaints such as cough since one year and shortness of breath since 4 months and chest pain. On prodding a bit more I found out that the patient was diagnosed with tuberculosis 10 years ago and used ATT medication. I was able to establish a rapport with the patient and his family and I could take a detailed history including his daily routine before and after. On examination, I found pedal edema , elevated JVP and was able to have cor pulmonale in my differentials. I began to understand that within the journey of each patient, there are a number of lessons that can help shape our approach to medicine.
A detailed case report:
https://bhargavikantipudirollno21.blogspot.com/2022/07/a-75-year-old-male-with-loose-stools.html
CASE 4
Another interesting case that I had seen was of a 65 year old man presenting with abdominal distension and shortness of breath. He had similar complaints 9 months prior as well. He had classical features of liver disease such as jaundice, pedal edema and ascites. I wanted to know why the patient had recurrent ascites and if we could do anything other than repeated paracentesis for it. I learned that transfusing albumin was the other option, but the patients family was not able to afford it which made me reflect about the harsh reality concerning patient care and financial issues.
https://bhargavikantipudirollno21.blogspot.com/2022/12/a-65-year-old-male-with-sob-and.html
Discussion:
Reference:
https://pubmed.ncbi.nlm.nih.gov/22129322/
"Physiopathological bases of the therapeutic use of albumin in hepatic cirrhosis consist in both hypoalbuminemia and portal hypertension consequences. In fact, cirrhotic patient with ascites, in spite of hydrosaline retention, shows an effective hypovolemia with peripheral arterial vasodilatation and increase in heart rate. Therefore the effectiveness of albumin administration in the treatment of ascites is due to its plasma volume expander property as well as its efficacy in restoring plasmatic oncotic pressure. Trials are in progress in order to define the effectiveness of the prolonged home-administration of human albumin in the treatment and prevention of ascites. Finally, it has been recently demonstrated that the binding, transport and detoxification capacities of human albumin are severely reduced in cirrhotics and this impairment correlates with the degree of liver failure"
CASE 5
25 year old male with traumatic brain injury due to an RTA.
https://bhargavikantipudirollno21.blogspot.com/2023/04/25m-with-tbi-secondary-to-rta-with-ivh.html
In a sad and moving situation, we met a young man who is struggled with a serious injury to his brain. This terrible event had completely changed his life, and he and his loved ones faced many difficult and uncertain challenges.
Motor impairments plagued him, rendering his movements slow, unsteady, and erratic. The loss of coordination and fine motor skills stripped him of the ability to perform everyday actions, leaving him frustrated and trapped within the confines of his own body.
This not only affected him but also deeply affected his family and loved ones. Their hopes were overshadowed by sadness and uncertainty. They felt helpless and longed to see him return to his former self. It felt like a cumbersome task for the man to regain his life again
Adding to the sorrow, the young man's elder brother had also experienced a similar fate and tragically passed away. This added another layer of heartbreak and loss to the family, intensifying their grief and making the situation even more challenging for them to bear.
Recovering from this traumatic brain injury seemed like a daunting and uncertain journey. The challenges he faced were immense, requiring a team of healthcare professionals from different fields to provide comprehensive care and support. Despite the difficult circumstances, there was still a glimmer of hope. The young man's caregivers showed incredible dedication and remained committed to helping him heal, relying on the strength of the human spirit to guide them through the process.
Questions surrounding this patient included the
-cause of his fever spikes
-reason for his tachycardia and tachypnea
Discussion:
1)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592694/
Patients in the intensive care unit (ICU) are at risk for dying not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients, affecting 27% of all critically ill patients (170). Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator-associated pneumonia (VAP)
2)
Reference:
"Here in our patient there is a new radiographic infiltrate, with lecocytosis of more than 11000 and persistent fever spikes satisfying criteria for VAP. But previous blood and ET cultures were negative which were done in/v/o ? Aspiration pneumonia. Though for cultures in VAP purulent tracheobronchial secretions had a sensitivity of 69% and a specificity of 75% for establishing the diagnosis of VAP .
Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 h after patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical suspicion combined with bedside examination, radiographic examination, and microbiologic analysis of respiratory secretions.
Ventilator-associated pneumonia is usually suspected when the individual develops a new or progressive infiltrate on chest radiograph, leukocytosis, and purulent tracheobronchial secretions."
SWOT ANALYSIS OF THIS PATIENT:
Strengths:
Ability to receive medical interventions and support (e.g., intravenous fluids, mechanical ventilation)
PaJR group was created and discussion was contributed
A fever chart was plotted so that we were able assess the patern of the patients fever
Weaknesses:
Loss of consciousness and responsiveness
Inability to communicate or participate in decision-making
Risk of complications, such as infections or pressure sores
Challenges in managing pain and discomfort
Opportunities:
Collaboration with specialists and consultants for further evaluation and diagnosis
Potential for neuroimaging tests to identify the underlying cause
Utilization of rehabilitation techniques to promote recovery if the cause is reversible
Emotional and psychological support for the patient's family and loved ones
Threats:
Development of secondary complications, such as pneumonia or sepsis
Potential for long-term disability or limited recovery
Emotional and psychological burden on the patient's family and caregivers
The patient was discharged in a hemodynamically stable condition with bed care, tracheostomy care and physiotherapy explained to the attenders.
This case taught me the importance of plotting a fever chart. We can observe the pattern and track the progression and pattern of the fever. This information helps in understanding the severity, duration, and fluctuations of the fever, aiding in the diagnosis and management of the underlying condition.
Other noteworthy cases that i have encountered:
70M with right sided Hemiplegia
https://bhargavikantipudirollno21.blogspot.com/2022/12/a-70-year-old-with-loss-of-speech.html
80M with Urosepsis
https://bhargavikantipudirollno21.blogspot.com/2022/11/80-year-old-male-patient-with-fever.html
45M Acute pancreatitis
https://bhargavikantipudirollno21.blogspot.com/2023/04/45-year-male-with-pain-abdomen.html
A 60 YEAR OLD FEMALE WITH AKI (RENAL) SECONDARY TO? TOXIN INDUCED /ACUTE GE(RESOLVED) WITH CKD(STAGE 3A) WITH BILATERAL LOWER LOBE CONSOLIDATION (RESOLVING) WITH GTCS SECONDARY TO? ALCOHOL WITHDRAWL? METABOLIC (RESOLVED) HYPOTHYROIDISM
https://bhargavikantipudirollno21.blogspot.com/2023/05/60-f-with-loose-stools-and-decreased.html
With that I would like to conclude that case based learning bridges the gap between theory and practice and that it gives us an opportunity to walk alongside our patients learning from their stories and experiences.
Thank you
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