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


This is C Preetham Reddy, an undergraduate medical student from Telangana, India. 

With this blog,I aim to share the insights I've gained  while posted  in General medicine department.

 Over the past 2 years,I've had the privilege of observing and interacting with numerous patients suffering from diverse medical conditions.I quickly realised that this opportunity to witness and learn from real-life patient cases,under the guidance of my professors and PGs  is an invaluable part of my 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.

70 Y male with B/L pedal oedema and shortness of breath
I was assigned to a patient with Bilateral pedal oedema and shortness of breath.

On enquiring, patient said he was apparently asymptomatic 2 weeks back then he developed bilateral pedal oedema(which was gradually progressive and of pitting type) up to knee joint.
He developed Shortness of breath 12 days ago which  progressed gradually from grade 2 to grade 4.
Based on these clinical symptoms, we adviced the patient some tests whose results I have interpreted below-

Test results-
Urea-73 md/dl. (normal-17-50mg/dl)
Creatinine-4.2mg/dl.  (Normal-0.9-1.3 mg/dl)
Chest X ray- Radio-opacity showing meniscus sign and Blunting of costo-phrenic angle in both lungs


Provisional diagnosis
Based on the above data, my provisional diagnosis was chronic renal failure with pleural effusion




Learning points-
The learning outcomes from this case were
1)Increased creatinine levels  causes fluid overload and increases capillary permeability of visceral and parietal pleura which results in pleural effusion
2) Lights criteria to differentiate between transudative and exudative types 




We admitted the patient and adviced dialysis.



Case link-

65 Y Female with loose stools
On enquiring, the patient's attender said she had been experiencing sleep disturbances for the past 10 days.She would get up screaming in the middle of the night .Over the past 5-6 days, she had been eating only curd rice. Additionally, her bowel movements have increased over the past 13 days.She said he stools were watery in consistency, foul smelling and blood tinged(4-5 episodes /day).

On general examination, the patient appeared to be irritable and uncooperative. Pallor was present.Vital signs were within normal limits.

CNS examination indicated the patient is well oriented to person, time, and place. However, repeatition and recall are absent, and language is impaired. The Glasgow Coma Scale score was E4 V4M6. Motor power was 3/5 in both upper and lower limbs, and reflexes were intact and there were no signs of meningeal irritation.

Based on this history, we ordered serum electrolytes, complete blood picture, stool microscopy and liver function tests
Test results
Sodium- 111mEq/L
Potassium- 3.0 mEq/L
Chloride-89 mEq/L
Stool positive for occult blood


Provisional diagnosis
Based on the test results ,my provisional diagnosis was Altered sensorium 2° to hyponatremia due to GI loss  w/ liver cirrhosis? Hypovolemia?

Case link

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