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


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





The journey of becoming a medical professional begins with a unique experience—the first interaction between a medical student and patient .This initial encounter holds immense significance as it sets the foundation for our understanding of patient care, empathy, and the ethical responsibilities associated with the medical profession.




My first patient interaction was in 3rd semester.it was first day of my general medicine postings..I was posted in OP ,a patient of28 years old  female came with complaints of fever associated with chills and rigors, my PG asked me to check BP , that was my first time checking BP to a patient.

I felt surreal that I started interacting with patients.I was there taking her history completely and our PG asked about differential diagnosis. I checked her temperature.we thought it may be dengue so we sent for  investigations.I was with my patient taking her to investigations.on that day I got to learn how to ask history and ask leading questions which takes us to diagnosis.


First case - 



This patient was 32 years old , I saw him in AMC .I went to him to ask about his complaints but he was soo weak and his was barely speaking, he told me that he is having high fever with chills so I approached his wife to take his history.after taking history I examined his respiratory system..

on examination I found there was decreased vocal fremitus on right lower side and on percussion there was dullness note heard in mammary,axillary,infraaxillary areas.on auscultation normal vesicular breath sounds not heard in mammary area.

After seeing X-ray we found that it was pleural effusion (blunting of costophrenic angle)

Pleural tap was done.but even after giving analgesics and antibiotics there was no decrease in fever. 

Pleural tap fluid was sent to investigations there we found increase in lymphocytes .so we suspected it may be TB, and we sent for ADA levels..and there was increased. Then we we sent sputum sample for CBNAAT which was positive.

While dealing with this patient I got to learn how to correlate our clinical examination with the investigations.i ve learned about pleural effusion and TB.





My experience with taking CNS case:





This is the case i came across during my clinical rounds


During my postings I saw this old patient with his wife she came to me asking about his husband condition then i approached him and asked about his complaints he responded that he could not remember things.  I was bit aback to take a CNS case as i was not sure and good at examination is this part but I took it as a challenge and I started taking his history patient was very good at telling his problem I did examinations on patient and I got confidence this was the first time I got to do lobar function tests and MMSE


During the encounter, I performed thorough neurological examination. This typically includes evaluating cranial nerves, motor and sensory function, reflexes, coordination, and gait. As i proceeded through the examination, you may find yourself recalling anatomy and physiology lessons, recalling the intricate details of the nervous system and its functions.


Higher mental functions  

MMSE score - 16 

Conscious, oriented to person , place and time .

Speech : normal 

Memory: loss of recent memory 

No Visual hallucinations

No delusions 

No emotional lability. 

CRANIAL NERVE EXAMINATION:


1st   : Normal


2nd  :  visual acuity is normal


                  

3rd,4th,6th  :  normal 

                        

5th             :  sensory intact


                      motor intact


7th             :  normal


8th             :  No abnormality noted.


9th,10th     : palatal movements present and equal. 


11 th : intact 

12 th : normal 


Motar examination 

                      Cns         R.              L

Tone                 UL               N                N

                          LL   hyper.     Hyper

 Power               UL 4/5.       4/5

                           LL   4/5.      4/5

Reflexes 

     B                             -.            -

     T.                            -              -

     S.                             -.            -

     K.                             -.             -

     A.                            -.             -

      P.                           Extensor flexor


Lobar function tests 

Frontal 

  1.   He know about hospitalization
  2.   did not give history  properly 
  3. No able memorize numbers orderly  
  4. able to say phalam , Samayam , cinema 
  5. Able to 10 names of vegetables, animals in one minute  
  6.   Motor luria test - done
  7. proverbs - able to say 
  8. Luria graphic test - able to draw triangle and square 

Orbital and  basal 


Go and no go test 


 1. Direction - 2 errors 

2. color -able to say 


Parietal lobe

Ideational apraxia - able to perform folding of paper as shown . 

Right  left orientation- present 


Temporal lobe

Recent memory - absent 

Remote Memory - present but not able to recall some events 

Immediate memory present 

Delusion and hallucinations - absent 


Occipital lobe 

Prosopagnosia - present 

Visual memory 



SENSORY EXAMINATION:  

SPINOTHALAMIC SENSATION:

                              R                          L 

Crude touch : Normal                 Normal 


pain : Normal                              Normal 


temperature : Normal                 Normal 


DORSAL COLUMN SENSATION:

                                    R                         L 

Fine touch :         normal                    Normal 


Vibration sense : normal                    Normal 


Proprioception : normal                   Normal



CORTICAL SENSATION:

                                               R                   L 

Two point discrimination : normal           Normal 


Tactile localisation :  normal                   Normal 


CEREBELLAR EXAMINATION:


 Slight tremors are present  

Nystagmus -absent 


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Link of this case:


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