My experience with general cellular pathology in a case based blended learning ecosystem’s CBBLE

 WARM REGARDS,

I'm shivani tunia, a passionate medical student from India. Welcome to my blog, where I share captivating real-life cases that have not only deepened my understanding of history taking and clinical examination but also enhanced my patient interaction skills and overall patient care approach. These cases have been invaluable in shaping my medical journey, and I'm excited to share them with you.

Together, let's delve into the captivating world of patient care, where every interaction holds the potential for learning, growth, and making a positive impact on the lives of those we serve.

Thank you for joining me on this incredible journey!


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. 

Introduction:

Embarking on my journey as a medical student in the General Medicine Department in 2018, I was filled with a mix of excitement, curiosity, and a deep sense of purpose. Over the course of five transformative years, I had the privilege of immersing myself in the world of medicine, witnessing the triumphs, challenges, and profound impact of healthcare on patients' lives. In this blog post, I will share a detailed account of my journey in the General Medicine Department from 2018 to 2023, highlighting the milestones, experiences, lessons, and personal growth I experienced along the way.


Within the confines of this blog post, my utmost aspiration is to offer a glimpse into the profound encounters I've had with Case Base Blended Learning Ecosystems and PaJR. These transformative educational approaches have played a pivotal role in shaping my learning experience and equipping me with invaluable knowledge.


My first encounter with a patient was during my 5th semester, A 55 year old male, auto driver by occupation came for dialysis. He was regular patient came for dialysis 2-3 times a week.                                                       I took his history, whereas came to know he was having grade-3 Sob along with orthopnea, he was a alcoholic and smokes daily around 1 pack per day, 3 years back he was diagnosed with ckd,a few months back he visited a hospital in Hyderabad as he was diagnosed with aortic stenosis. He had pitting type pedal edema.                                                         

 “( You can't suffer in silence when you need other people's help. I've adopted the mindset that kidney disease doesn’t have to stop everything. It's one more thing we integrate into life so it’s not intrusive.").       

Since, this was my first encounter with the patient I was lacking in my knowledge due to which my history was very brief and incomplete, then I approached one of my professors he guided & explained me on how to take a case.                                                                                 

That day I went back home bought a clinical book for reference and learned taking history, the very next day I went to same professor..since I had doubts about my case he further guided me and asked me to take the same case again, that day I took a better history and presented it to the professor. After presenting I felt happy & motivated.

CASE 1:-

 14 year old female with shortness of breath 

A 14 year old female came to casualty with the chief complaints of SOB since 2 days

she had a fever with generalised body weakness and polyuria and was diagnosed having type 1 DM and started on insulin.

2 years ago patient had similar complaints after an episode of fever and was admitted at our hospital and was treated here. 

2 days ago then she developed sudden onset shortness of breath since 2 days, gradually progressive and progressed to stage 4. Shortness of breath started after patient missed taking 2 doses of insulin. No orthopnea, no PND. 

Fever since 1 day, high grade associated with chills and rigors, relieved on taking medication, no diurnal variation.

Abdominal pain since 1 day epigastric region alter progressed to diffuse abdominal pain.

No h/o vomiting, loose stools, giddiness.

Headache present, vomiting 1 episode- non bilious, non projectile, not blood stained, content- food material.

On respiratory system examination:- on auscultation:-diffuse crepts heard, bilateral air entry is present.

On laboratory investigations:-hemoglobin is low, serum creatinine is high, blood urea is increased

2D ECHO:-MAF+ , DILATED RA/LA, EF =50% , MODERATE TO SEVERE MR
 

https://shivanitunia06.blogspot.com/2023/04/14-yr-old-female-with-shortness-of.html?m=1

CASE2:-

A 55 year old male presented with fever chest pain and loss of appetite

Patient was apparently asymptomatic 8 months ago then he developed fever , cough, shortness of breath on exertion

fever is of high grade associated with chills and rigors diurnal variation ,relieved with medication 
cough was initially dry cough then progressed to productive cough with scanty sputum ( white non-bloodstained type) , not foul smelling . The sputum was more produced during night;

—>Patient was evaluated with Bronchoscopy and diagnosed with the right lower lobe aspergilloma and started on itraconazole (300mg) BD for 6 months patient was recovered symptomatically and was well till the last 13 days ;

—>13 days ago patient developed fever which was low grade, not associated with chills and rigors .
Chest pain was sudden in onset 10 days ago , pain increased with chest movements associated with SOB grade 2 progressed to grade 3


patient was evaluated and found to have LV (left ventricular) strain and tall tented T waves and was treated symptomatically , loss of appetite since 10 days . Bilateral pedal oedema is present , facial puffiness is present.

On respiratory examination:- Dyspnoea is present

On investigations:- 2D ECHO- no RMWAEF; 62% ivc 0.8 CMS, RVSP 35MMHG, good LV systolic function, diastolic dysfunction+
Bronchoscope is done 
  
Provisional diagnosis:-
right lower lobe aspergilloma.

Treatment:-

Tab DOLO 650 mg po/ TD
tab itraconazole 200mg po/BD
Tab hifenac BD
Tab Zofel 


CASE3:-

70 yr old female with fever and left sided chest pain.

A 70 year old female came to casuality on 05-01-2022 with 
Cheif complaints:-
*fever since 1 day. 
*Left sided chest pain since yesterday night and vomiting since 5th Jan morning 1 episode at 4 am.

She was apparently asymptomatic and then she developed 
  1. Fever, lowgrade, continuos relieved on taking medication - not associated with chills and rigors
  2. Left sided chest pain - radiating, pricking type of sensation to the left hand, associated with sweating, heaviness to the chest and chest tightness present. 
  3. Vomitings in the morning at 4am - non projectile, non bilious, contains food particles and non foul smelling. 
  4. Patient is a known case of diabetes and hypertension since 20 years  
PAST HITORY:-
  1. Patient is a known case of diabetes and hypertension since 20 years. 
  2. Patient is using vildaglitin(50 mg) and metmorfin(500mg) and telma(40 mg). Patient is regular with medication. 
  3.  2007, patient had similar complains, and had a PTCA with stent implantation. She was diagnosed with triple vessel disease.   
  1.  2015, RCA CABG done, when patient had a repeat of similar complaints. 
  2. 2017, patient again had similar complaints, was admitted in NIMS, and conservatively treated. 
On investigations:- blood urea is slightly high 

Abdominal examination:- usg abdomen report:- impression:- raised echogenicity of both kidneys.

Provisional diagnosis:-
dka with anteroinferior wall MI




TREATMENT:

1. Inj. HAI 1 ml (40 U) + 39 ml NS at 8 ml/hr to maintain GRBS less than 200 mg/dl
2. IVF. 1 unit NS continuous infusion at urine output + 30ml/hr
3. TAB ECOSPORIN 75 MG PO OD 
4. TAB CLOPIDOGREL 75 MG PO OD
5. TAB CARDIVAS 3.125 MG PO BD
6. INJ. CLEXANE 60 MG S/C BD FOR 5 DAYS
7. TAB MONIT GTN 2.6 MG PO OD
8.TAB ATORVASTATIN 40 MG PO BD


CASE4:-
         35 year old male with sle

35 year old male came with the chief complaints of itchy skin lesions all over the body since 8 months 

History of illness:-

Patient was apparently alright 8 months back then he developed small papules over the cheek after which it transformed into erythematous scaly plaques first on the nose and cheek then over the entire face,neck,back,hands and legs.

H/o itching over the plaques,H/o photosensitivity 

C/o Tenderness in wrist joint, metacarpophalangeal joint,interphalangeal joint 

H/o fever 4 episodes in last 8 months,last episode 20 days back.fever lasts for one day releived after taking medication.

H/o oral ulcers on hard palate since 10days

No chest pain,sob, palpitations

No abdominal pain,nausea vomiting 

No increased or decreased output 

H/o cva, left UL ,LL weakness and slurred speech 10 years back.,,H/o appendectomy 8 years back , Used Ayurvedic medicine  1 month back for 15 days.

Past history:- not a known case of diabetes mellitus, hypertension, tuberculosis, asthma, epilepsy

Personal history:- 

Appetite :- decreased since 3 days

Diet:- mixed

Sleep :- adequate

B& B :- regular                                                            Addictions :- toddy drinker since 20 years                           Bedi smoker since 25 years(15 per day)

On investigations:- 

2D echo report:-shows (>)SGOT(AST), >SGOT(ALT),            > Alkaline phosphate and low albumin levels 

Usg report:- shows small shrunken kidney with grade-III rod changes                                                                        Grade-II fatty liver with hepatomegaly &                          Renal cortical cyst 

Provisional diagnosis:-

Systemic lupus erythematous?lupus nephritis( grade lll rpd changes)?with CKD stage ll, viral pyrexia with bicytopenia(thrombocytopenia,leukopenia)


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477208/

k/c/o CVA 10 years back

https://medlineplus.gov/stroke.html

Treatment:-                                                                  SUNCROS AUQAGEL SPF 50 L/A.                      MUCOPAIN GEL L/A TID.                                             T.PCM 650 MG PO TID,                                      T.BENFOMET PLUS PO OD

https://shivanitunia06.blogspot.com/2023/04/35-yr-old-male-with-sle.html?m=1



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