My experiences with general cellular and neural cellular pathology in a case based blended learning ecosystems CBBLE.

 Hi! I’m Penmetsa Sri Harsha, currently pursuing final year of MBBS. In this space I share my experiences and learning points of my encounters with PaJR and CBBLE.

These encounters have thought me a lot about the knowledge pertaining to clinical skills and knowledge.

As I was in my clinical posting, I happened to encounter a 35year old female farmer by occupation came with complaints of fever,burning micturation,abdominal pain,lower back pain since 6 days.dry cough ,soar throat since yesterday. She was apparently asymptomatic 6 months back and then developed b/l small joint pain for which she was treated in private hospital at miryalaguda and now came with complaints of fever which was associated with chills and rigor,evening rise of temperature and with burning micturation,associated with abdominal pain which was  diffuse and lower back pain and dry cough. 6 months back (when pt was normal) she used to getup at 5am and do house chores and then after having her breakfast she used to go for work on farm from 10am to 5pm, she used to have her lunch there itself. After coming back from farm she used to do her chores and sleep by 9pm.(After getting joint pains) Pt used to get up at 6am and stopped going to farm used to do some house chores and then used to take rest and sleep by 10pm. Provisional diagnosis was viral pyrexia.

 https://penmetsasriharsharollno198.blogspot.com/2023/05/a-35-year-old-female-with-co-of-fever.html

During my rotations, I encountered a case of 50 year old male with complaints of fever and epigastric pain since 5 days. Patient was apparently asymptomatic 5 days ago. Then he developed fever. It lasted for a day and was associated with chills and rigours and subsided with antipyretics. Then later in the evening he developed epigastric pain after the fever subsided. Pain is in the epigastric and right hypochondriac region primarily, gradually progressive in onset, it is of a dragging type of pain, he says its radiating to his flanks and lower back. He has decreased appetite since 4 days and has not been passing stools. The pain is exacerbating when he has food. 

He also says he had shortness of breath of grade 2, two days back, but it has relieved now. No history of orthopnea or PND 

DAILY ROUTINE:

The patient wakes up at around 4 am and completes his daily morning activities. He is a labourer by occupation so he goes to work at 5 am and comes back home at 8 am to have food. Depending on the type of work he does that particular day, the time he comes home sometimes varies. At around 9:30 he goes back to work and doesn’t come back home at around 6 pm. He has food and sleeps by 9 pm. He consumes alcohol everyday regularly at 6 pm of 90 ml since the past 10-15 years. He also smokes one beedi a day since the past 30 years.

Events leading to the present day:

The patient as usual woke up and went to work. He said his work that day was spraying fruits with some chemicals. He came home around at 11 am that day to have food. He had rice and dal and developed fever insidiously after eating. His fever subsided in the evening and then he developed epigastric pain. He has not been going to work since the past few days and is at home taking rest since the pain is so severe. No one else in the family had similar complaints. 

He also says he had shortness of breath of grade 2, two days back, but it has relieved now. No history of orthopnea or PND 

DAILY ROUTINE:

My conversation with the patient is as follows: The patient woke up at around 4 am and completed his daily morning activities. He is a labourer by occupation so he goes to work at 5 am and comes back home at 8 am to have food. Depending on the type of work he does that particular day, the time he comes home sometimes varies. At around 9:30 he goes back to work and doesn’t come back home at around 6 pm. He has food and sleeps by 9 pm. He consumes alcohol everyday regularly at 6 pm of 90 ml since the past 10-15 years. He also smokes one beedi a day since the past 30 years.On the day I took his case,the patient as usual woke up and went to work. He said his work that day was spraying fruits with some chemicals. He came home around at 11 am that day to have food. He had rice and dahl and developed fever insidiously after eating. His fever subsided in the evening and then he developed epigastric pain. He has not been going to work since the past few days and is at home taking rest since the pain is so severe. No one else in the family had similar complaints. I did not follow up the case thoroughly, but the differential diagnosis were liver abscess, viral hepatitis, cholecystitis.          

 https://penmetsasriharsharollno198.blogspot.com/2022/06/a-50-year-old-male-with-epigastric-pain.html

Thank you.