My experiences with general cellular and neural cellular pathology in a case based blended learning ecosystems
Self -reflective writing on my Medical student career
Hello and welcome to this space!
I’m Manvi Sharma an MBBS intern currently posted in the Dept of Medicine in a college in Telangana,India.
This is my blog through which I will give you a glimpse of the ‘splendid journey’ that my medicine posting has been.
It all started on a weary Friday evening in March 2022. I was still a budding medical student. I was giving company to my senior who had duty when I noticed that a case was brought to the casuality. The man, about 70 yrs old had come with complaints of shortness of breath and giddiness since 1 year and decreased urine output since few months. I was perplexed as to what could be the reason. One of the PGs told me to go ahead and take the case. Initially, I was reluctant but under the guidance of my senior friend I went ahead and asked him his history. I was guided as to how to do a general examination too. It was my first ever experience which gave me immense satisfaction and insights into -
Proper history taking
Doctor-patient communication
Doing a general physical examination
Counselling the patient regarding lifestyle modification as he had a high BMI and truncal obesity. I learnt that all his health problems are directly or indirectly related to his abdominal fat.
Here’s a link to my first ever reported case -
Early into the posting I hadn’t imagined that I would see cases that I haven’t even heard of before. One such case was that of a mere 30 yr old woman who was diagnosed with dermatomyositis.She had the typical textbook described presentation of heliotrope rash, Gottron’s papules, Holster sign and shawl sign. This was a while ago. Now she had come with complaints of shortness of breath, pedal edema and joint pains. She also had cough and high grade fever. Going by her history it was suspected that she had developed interstitial lung disease and pft was done to rule out the same. This was quite an intriguing case where I discovered that few diseases have rather an autoimmune etiology where no amount of lifestyle modifications could really help from preventing the disease or stopping it’s progression which to be honest is very sad.
Case link -
A hemoglobin value of 2.1 g/dl! How is that even possible? Goes on to say what human body is capable of enduring and sustaining is truly unbelievable. A 28 yr old male post graduate student had come to us with complaints of blood in in stools since 1.5 yrs and dyspnea and weakness since 1 yr. The predicament was such that we had to immediately start blood transfusion while simultaneously assessing him for the underlying etiology.
Number of tests and physical examination was done. Based on these the differentials that were obtained were -
Iron deficiency anemia(?nutritional deficiency from childhood) low serum iron, microcytic hypochromic picture
Fissures on PR examination, hookworm infestation?
Another interesting differential was - autoimmune polyglandular syndrome(thyroiditis, vit B 12 deficiency, Addison’s disease)
Learning points -
How to arrive at a diagnosis by ruling out various causes through specific tests
Thyroid gland examination
PR examination
Indications and pre-requisites of blood transfusion
The human brain is a very mind-boggling organ(pun intended :p). Over the course of time another interesting case that I came across was that of a lady in her early seventies who came with a rather bewildering brain problem. Her brain was firing impulses at such a high level that it gave her fits in her right upper and lower limbs. She felt totally weak in those limbs and couldn’t get up. Surprisingly she couldn’t recall any of this except for the faint memory of being carried to the hospital in an auto. When she was brought to our hospital she was conscious but not coherent and not oriented. What baffled me most was that she had lost her speech a day before such seizure episode took place. Her body electrolytes had an imbalance with low sodium and potassium levels. Also she had really uncontrollable sugars since the time she came. MRI wasn’t suggestive of anything but senile cerebral atrophy. Digging deeper it was concluded that seizure activity was due to uncontrolled sugar levels which caused neuronal excitability.
Case link -
Research link -
Learning points -
Drugs to be prescribed in case of seizures
Control of hyperglycaemia through continuous insulin infusion
My first encounter with a case of altered sensorium- I saw him in the icu , he was unable to talk or open his eyes even on pain stimulation. His condition looked bad and worrisome. He was on oxygen support. His complaints of cough and fever ,clinical examination - crackles + and reports of X-ray chest opacifications were suggestive of a respiratory system problem but the altered consciousness, inability to speak pointed towards a spread of infection to the brain. Lumbar puncture was performed and it showed a 60:40 lymphocytic and neutrophilic picture pointing towards meningoencephalitis. Family had history of tb however he had been reported negative for TB. RFT too suggested a pre-renal AKI picture.
Here’s a detailed case report -
My learning’s from this case -
Respiratory system examination
Interpretation of CXR
Sensorium evaluation using GCS
CNS system examination
CSF analysis interpretation
Pre -renal AKI criteria
Adios! That’s it for now! Thank you for reading this far!
This is just a drop of the ocean that medicine is from which I have shared few of my personal experiences. Hope to see more and learn more!
Comments
Post a Comment