My experiences with general cellular pathology in a case based blended learning ecosystem's CBBLE
Hello,This is sathwika ammanabolu final year mbbs student from india.
Iam here to tell my journey in medicine department. it started in 2019 (3rd sem) but never ends(learning is a lifetime process). through the experience I came to know each day u learn something new.
Learn.learn.learn.........
The first day of my posting in 5th sem .I entered in to amc .where pg's assigned cases to us .I was overwhelmed and little anxious too,
The first question asked to patient was what is your problem,then he complained of epigastric pain then I started thinking what to ask next.................... with my minimum basic knowledge learnt from lectures,friends
Then I asked detailed history about pain(onest, duration,aggrevating and relieving factors,progression )also associated factors,also he consumes alcohol .
By the end of the interaction with my patient I came to diagnosis with the history itself (acute pancreatitis)
That day was most happiest (it was first interaction with my patient).
Later,interacting with many patients I came to know there are different kinds of patients so I started to mingle with patients to get proper history from patients.
I also learnt one must make patient comfortable (doctor -patient relationship)
Doctor -patient relationship is a part of healing process
Patient came with epigastric pain insidious in onset ,continuous, stabbing pain,radiating to back,aggrevated on eating food,relived on bending forward
associated with vomitings(10episodes per day which is non-bilious, non-projectile,non blood tinged,content-food material).
H/O constipation since 4 days
Tenderness present over the left hypochondrium and epigastric region
It was found to be acute pancreatitis
Positive points favouring pancreatitis:
Epigastric pain
Pain radiating to back
Relieved on bending forward
Tenderness over epigastric region
By the history itself I came to know the diagnosis (based on type of pain, relieving factor)
https://sathwikaammanabolurollno12.blogspot.com/2021/10/sathwika-ammanabolu-rollno12.html?m=1
Case-2
A 36 yr old male with vomitings and abdominal pain
This is a case of alcholic gastritis,diabetic ulcer
Patient was apparently asymptomatic 7yrs ago then he had episode of dizziness for which he went to the hospital there he diagnosed with dm and metformin was given
2yrs ago again he had episode of dizziness then his medication has changed to gm1
Then 2months back again he had episode of dizziness then he shifted to gm2
3yrs ago he used to consume alcohol occasionally
3yrsago patient had consumed too much of alcohol continuously then he had vomitings and abdominal pain for which he went to the hospital where he diagnosed with acute pancreatitis and he got treated.
He also noticed callus over left big toe which turned in to ulcer and 1year back went to the hospital where debridement was done .
Since 1year he is experiencing tingling sensation and burning sensation over the calf and feet
Since 2yrs he is consuming alcohol for every 3-4days and for 4days
when ever he consumes alcohol he vomit. he complained of vomitings since 3days which is non bilious and non projectile and blood stained
https://sathwikaammanabolurollno12.blogspot.com/2022/03/36yr-old-male.html?m=1
Case-3
A 55 yr old male with sob
This is case of copd
Patient was apparently asymptomatic
3yrs ago then he developed sob( grade -1)mmrc which is insidious in onset,non progressive till 10/4/23
Aggrevated on exposure to cold weather and dust relieved on medication and on rest
Not associated with orthopnea and pnd
On 10/4/23 patient developed sob( grade -4) which is sudden in onset ,non progressive associated with wheeze
No aggrevating and relieving factor
H/o High grade fever since 2days sudden in onset, intermittent,not associated with chills and rigors and relieved on medication
H/o dry cough since 1day
No H/o chest pain
haemophttps://sathwikaammanabolurollno12.blogspot.com/2022/07/a-50yr-old-female-with-pedal-edema.html?m=1tysis
Case-4
A 14 yr old female with sob
This is a case of diabetic ketoacidosis
The patient was apparently asymptomatic 4 years ago, then 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.
Points favouring towards dka
Like she is type -1diabetic after skipping her insulin dose e developed dyspnea ,fever, epigastric pain,
And abg was done her pH is low
https://sathwikaammanabolurollno12.blogspot.com/2023/04/14yr-old-female-with-sob.html?m=1
Case-5
A 37yr old male with skin lesions
This is case of sle
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
Points favouring sle:
Skin lesions
Tenderness in small joints
Oral ulcer
Ana profile is positive
https://sathwikaammanabolurollno12.blogspot.com/2023/04/37yr-old-sle.html?m=1
Case-6
A 48yr old male with abdominal distension
This is a case of chronic liver disease
Patient was apparently asymptomatic 20 days back then he developed abdominal distension which was insidious in onset and gradually progressed to present size and not associated with abdominal pain.
10 days back , he went to a local hospital where was given medication, but didn’t give him relief.
H/o SOB ( grade 1 to 2 ) according to mMRC since 20 days, gradually progressive from grade 1 to grade 2 . It increased on exertion and relieved on taking rest.
H/o increased frequency of stools on 15th and 16th April, hard in consistency, green in colour, 5 episodes per day, blood stained and had 5 to 6 drops of blood at the end of defecation. It is not associated with pain and relieved on medication.
H/o bilateral pedal edema since 15 days which is pitting type and extending till the knee joint.
He has decreased urine output since 10 days.
No history of burning micturition.
No H/o orthopnea , PND
No H/o fever, nausea, vomiting
No H/o chest pain, giddiness, cough.
https://sathwikaammanabolurollno12.blogspot.com/2023/04/a-48yr-old-male-with-abdominal.html?m=1
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