MY EXPERIENCES WITH GENERAL CELLULAR AND NEURAL CELLULAR PATHOLOGY IN A CASE BASED BLENDED LEARNING ECOSYSTEM'S CBBLE
Greetings to one and all!
This is Dwaram Nikhil Venkat Reddy, a medical undergraduate studying in India.
I'd like to talk about my incredible journey where I have learnt history taking and enhanced my patient interaction skills.
"Tell me and I forget, teach me and I may remember, involve me and I learn"
As a medical student, my first experience in the general medicine department was both exciting and nerve-wracking. I was excited to apply the knowledge I had learned in the classroom to real-life patients, but I was also nervous about making mistakes or not knowing the answers to questions posed by patients or attending physicians.
On my first day, I was assigned to the general medicine ward.
As I walked through the ward, I couldn't help but feel overwhelmed by the sheer number of patients and the complexity of their medical conditions. I saw patients with a variety of illnesses, ranging from diabetes to heart disease. Each patient had a unique story, and I knew that I had a lot to learn about how to diagnose and treat these illnesses.
One of the most memorable experiences during my time in the general medicine department was when I was assigned to a patient who had been diagnosed with liver cirrhosis. The patient was in a lot of pain and was struggling to breathe. I remember feeling overwhelmed and not knowing what to do. However, the attending resident was patient and took the time to explain the patient's condition to me. Together, we came up with a treatment plan that helped alleviate the patient's symptoms.
Overall, my first experience in the general medicine department was a valuable learning experience. I gained hands-on experience in diagnosing and treating patients with a variety of medical conditions. I also learned the importance of teamwork and communication in providing the best possible care to patients. Although it was challenging at times, I am grateful for the opportunity to learn from experienced physicians and to apply my knowledge to real-life situations.
This patient was asymptomatic about
20 years ago and at the age of 10, patient developed one episode of seizure for which he did not use any medication and seizures subsided by itself.
About 10 years ago the patient had developed scaly lesions over the legs and hands for which he had diagnosed as Psoriasis and since then he was on medication.
About one year ago patient developed yellowish discoloration of eyes for which he used herbal medication for about six days. Again after three months patient developed similar complaints(Yellowish discoloration of eyes) for which he used herbal medication for about seven days.
Now, since 20 days patient is having yellowish discoloration of sclera and distention of abdomen and pedal edema since 10 days.
79 y/o male with Recurrent CVA and left hemiplegia with Aspiration pneumonia and seizures disorder
I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan
A 79 y/o male was brought to casuality with c/o cough since 20 days ,
fever since 10 days
difficulty in swallowing and h/o Aspiration pneumonia since one month
C/o altered sensorium since 3 days
This Patient was apparently asymptomatic 20days back then he developed cough insidious in onset and gradually progressive. PRODUCTIVE but patient is not able to spit it out.
Difficulty in swallowing.
Series of events as follows
* Patient developed cough and cold on 25th February 2023
* Took treatment for cold on March 1st
* There were increased secretions on March 3rd but the patient was unable to spit it out
* Admitted in hospital from March 5th to March 10th and cleared secretions through suction.
H/O cough on intake of liquids.
H/O change of voice since 20 days, insidious, hoarse in character and SLURRING OF SPEECH is present
No H/O difficulty in breathing, breathlessness, hemoptysis.
Fever since 10 days - High grade.
O/E Chills and rigors + (38 spikes).
N/H/O Vomiting, Chest pain, Loose stools.
7 YEARS AGO(2016)
He developed head ache at around afternoon 2pm followed by vomtings and left hand itching and weakness.
PATIENT was awake on that night due to left hand weakness and itching
NEXT DAY
MORNING they took him to hospital
Patient can lift his hand
But unable to hold objects
AFTER 3 DAYS
PATIENT became left sided hemiplegia.
MRI REPORT shows 3 INFARCTS
Patient stayed for 40 days in hospital and there was no improvement and discharged.
He took liquids for 3 months because patient is unable to eat solid foods. He then slowing started eating solid foods.
AFTER 1 YEAR (2017)
vomitings
Fever
Shivering for 3 days
Diagnosed with urinary tract infection
Took treatment (antibiotics) for 5 days and it was resolved
AFTER 3 YEARS(2020)
Cough for 2 days
Fever on 2 nd day
Diagnosed with covid
Infected with COVID for 1st time and resolved
After 1 year(2021)
He was Diagnosed with COVID for 2nd time and resolved
1 YEARS back (2022)
He got seizures for 5 min and they took him to the hospital.
He got Typhoid fever 2times
1st time resolved in 7days
2nd time resolved in 9 days
79 Year old male who is a father of 4 children ( 2 sons and 2 daughters) used to run a shop ( kirana shop) for about 18 years.He stopped looking after his shop from 2006 and he was looked after by his sons.
He was non alcoholic,non smoker.
10 years ago , patient developed lesions on his both foot and went to the doctor and found to have diabetes and started on medication and after 1 year ,with regular check up he was found to be Hypertensive and started on antihypertensive medication.
From 7 years onwards , patient was bedridden with foleys ( changed every 15 days ) and physiotherapy was done by his attenders daily, but there was no such improvement.
PROVISIONAL DIAGNOSIS
Recurrent CVA with Hypertension, T2 DM, seizures disorder.
I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.
This is a case of 19 year old male hailing from mirylaguda who is intermediate second year student came to general medicine OPD with chief complaints of
chief complaints of Fever since 3 days ,
Lower back ache since 3 days,
Generalized weakness since 3 days.
Patient was apparently asymptomatic 10 days back then he developed high grade fever which was continuous ,no diurnal variation which got relieved on medication given by local RMP [some IV medication was given for 1 day and oral medication for 3 days].
Now again since 3 days he had high grade fever which was continuous not associated with chills and rigor ,no diurnal variation
He had one episode of vomiting today i.e 30 Nov 2022 which was non projectile contained food particles
He also complained of low back ache since 3 days which is insidious in onset ,gradually progressive, and is persistent and pain increased during inspiration and no relieving factors.[he was unable to describe the character of pain]
He also complained of abdominal pain which is insidious in onset persistent not associated with nausea and vomiting
He also complained of generalized weakness since 3 days .
PROVISIONAL DIAGNOSIS
Dengue fever (NS 1 positive)
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