My experience in CBBLE

My experiences with general medicine in a case based blended learning ecosystem's CBBLE

 Hello,

This is R sumanth raj , a medical undergraduate studying in India.
I'd like to share some of the interesting cases that helped me to learn more about medicine.

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.

Alright let's get to the details of my first encounter with a patient. She was a 38 year old female came to casuality with chief complaints of fever and vomitings since 3 days.

Link to the case:-

case 1

This is my first encounter with the patient and i've learnt to communicate with the patient, to find out the relevant history that lead to the symptomology .

I was able to localise the pain in one of the specific quadrant or region of the stomach.

My snrs and pgs helped and made me gain knowledge about the palpation method of abdomen to elicit tenderness of an organ and helped me to narrow down the accurate diagnosis of the case. Though i've failed to follow up the case as the patient is non cooperative.

Case 2:-

This is a case of aki with fever.

A 61 years old male presented with the chief complaints of 

-pain in the left loin

-decreased urine output

-Swelling in the legs

Link to the case:-

case 2

This is my second case in the medicine ward. I observed a patient of  61 years old visibly unwell with his worried family and his feet were swollen.

During my conversation with the patient ,i learnt the symptoms were from the past 15 days associated with decreased urine output.

About his past medical history, I discovered that he had been previously diagnosed diabetes mellitus (DM) 3years back and hypertension (HTN) approximately one year ago . Though he was diagnosed with HTN he did not take any anthi- hypertensive drugs which must be the potential contributory factor to his current deteriorating health. It was a reminder of the importance of medication compliance and the consequences that can arise from neglecting treatment. 

I reviewed the patient's medical records and test results. The laboratory findings revealed elevated levels of serum creatinine, urea,uric acid and grbs.

Although the exact etiology was unknown mostly it was due to the underlying diabetes mellitus and hypertension.

Then the patient undergone hemodialysis for the first time.

Case 3:- This is a case of 26 old male who was in the AMC ward.

case 3

26 year old male presented with cheif complaints of fever since 1 week

Generalised weakness and headache since 1 week

He is a dcm driver who travelled to orissa on his work.

 I started asking about the history of symptoms in chronological order from the duration after he visited to orissa.

As he is the driver by occupation,

I also asked about the sexually transmitted disease (std) as it is most common in them.

The detailed history during the travel was not described as the patient is drowsy. Pg's helped me in examination and to rule out the differential diagnosis.

This is a case of pyrexia with pancytopenia.

Management was mostly symptomatic for this patient.

Articles that i referred for thrombocytopenia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784057/