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

 Hello, 

This is N Vamshi krishna, a medical student from india. 

I’ll be sharing few of my experiences in General medicine department.

Before that I would like to thank my HOD sir and mentors who will be always available to clarify our doubts and help us to approach the patient in the most practical way. They taught us how to apply the theory knowledge in the clinical postings. They always gave us inspiration to learn the subject in more practical way. Also we had an open platform where we can discuss things with our HoD sir and our professors about patient and also we approach our HOD sir directly during our rounds, he will enlighten us without any judgement. 

Medicine is a beautiful way of diagnosing and healing patient. I have always seen a patient as a mystery box yet to be solved and there clinical signs are like key to the diagnosis. I have learned to notice and observe the patient very keenly and it’s importance in diagnosis and exposure with patient has opened a new dimension within me in understanding medicine in practical way.

FIRST ENCOUNTERS:

My first encounter in general medicine clinical postings.

At first It was difficult for me to relate the theory knowledge to the practically approach. And for me I have low knowledge about how to approach the patient and in taking history deeply. But then with the help of our professors, mentors and my colleagues I had learnt a lot of things and also our general medicine department made it easy to learn for me by making online portfolios for learning and we were asked to get interacted with our SR’s, our own PG’s and mainly our HOD sir.

I was able to message at any time to HOD sir and our mentors, they was always there to guide and assist me without any hesitations.

In my journey I would like to share few experiences with you:

https://nvamshikrishna107.blogspot.com/2023/04/55-year-old-with-weakness-of-left-upper.html 

             I had noticed a man of 55 years age, lying on bed with deviated mouth. I was curious to know the cause the cause. I went towards him, he was unable to speak clearly and his wife helped to know the history of the patient.

I would like share some Cheif complaints of this patient: weakness of left upper limb and lower limb since 3 days, C/o deviation of mouth to right side since 3 days, C/o slurring of speech since 3 days.

patient was normal around 4 days ago, then he started complaining tingling and burning sensation of left upper limb and lower limb for which he went to local doctor, where he was given some unknown medication and got relieved of his tingling sensation.

I was wondering what could be the reason for his tingling sensation.

On very next day(26/3,Sunday) early in the morning he was unable to get up from his bed because of weakness in his left upper limb and lower limb ,he also noticed deviation of mouth towards right side and slurring of speech.

My question was what will be the cause of deviated mouth:

Bell’s palsy?

Gillian barre syndrome? Neurologic

Neuroma of facial?

Ramsay hunt syndrome? Infective

Trauma?

CVA/cerebral aneurysms? Vascular causes

Past history:

H/O CVA 3 years ago

K/c/o HTN since 3 years

On clinical CNS examination:

Tone hypertonic

Power of left upper limb and lower is decreased i.e; 3/5

Superficial plantar reflex on left side shows extension

Deep tendon reflexes are deminished in left upper and lower limbs 

Dysdianokinesia negative

Finger nose test and knee heel test on left side negative 

Provisional diagnosis: left upper limb and lower limb hemiparesis?

My learning points: 

LMN and UMN lesions differences and how to differentiate -> Motor homenculus

Stroke could be the cause?

Could HTN? Predisposing factor 

Medication to reduce blood clots?

Also learnt CNS examination clinically in more precise way