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Case based learning experience

 Medicine has always fascinated me...involving a lot of integration and every time while taking a case....i have learnt something new and added new perspectives into me looking into the diseases and their presentations...it was challenging without having a direct in person history taking with the patients, but we had telephonic conversations with the patients to take their history and subsequently document elogs or online case logs.

I  recall the case of an old lady who came  to us by consuming rat poison and cpr was being done in the background  and she eventually passed away infront of us... thats when i understood the importance and procedure of CPR. Well delving into my learning experiences from the cases that i have seen 

 https://pranathi105.blogspot.com/2022/09/60-year-old-male-with-multiple.html?m=1

This is a case which has actually made me integrate the various clinical concepts which till then i never got a chance to apply on real case scenario... Well, this is a case of a 60 yr old male who came to us with the chief complaints of Dragging type of pain in both upper limbs , Lower back pain ,Shortness of breath grade 2, and chest pain. Through the seniors who guided me , i have known importance of informed consent and also have tried to improved my skills of history taking. The patient was in so  much of pain so i had to take the history from patient's attender. On the very first encounter w with patient i have noticed some involuntary movements in  his hands as if he is rolling something... which striked to me as differential for parkinson but then my mentor has guided me through the case that only with pill rollling movements we cant diagose it as  parkinsons so we had to examine the patient closely..on examination i could see a visible apex beat on chest and upon cns examination there was a delay in motor response.. the patient even complained of shortness of breath..upon chest xray i was told that there was bilateral consolidation of lower lobes....eventually i also learnt x ray reading from my mentors.

Upon cbc , there was a bicytopenia and blood smear was done on which  i could identify with my knowledge of haematology from 2nd yr of monocytes, monoblasts and promonocytes and , dysplastic neutrophils..

Interestingly, i got a hands on printed report of patient's MRI taken a yr ago that revealed that he had empty sella... this raised a lot of curiosity in my mind and i started my research on if the empty sella made huge impact on clinical symptamotology of my patient and so i asked our HOD of General Medicine about the same for which he told me that it was a very common finding. That was one of the learning point for me in the case... research based learning has actually changed the way i looked at medicine.

Initially after having looked at the clinical picture  there were a few differentials of EBV monocytosis, Acute lymphoblastic leukaemia...

To confirm the diagnosis , bone marrow biopsy was done for which i saw my mentors juggling to take consent  from the patients attender and looking at his age .... whether he  could tolerate that? Bone marrow biopsy was done and here comes a new challenge... there was a plasma cell dyscrasia in the report and so it was probably poitning towards multiple myeloma... and also urine bence jones proteins was postive ...there was very high probability of multiple myeloma.

I have tried to look up on few research articles for the association between haematological and neurodegenerative disorders...

The mystery was still unsolved.... what was the reason for his resting coarse tremors....upon looking at the research articles for which i found about the leucoencephalopathy and tremors..

It was diagnosed as community BICYTOPENIA  SECONDARY TO PLASMA CELL DYSCRACIA WITH COMMUNITY ACQUIRED PNEUMONIA WITH (BILATERAL LOWER LOBE CONSOLIDATION) WITH MODERATE HEPATOSPLEENOMEGALY WITh

HYPONATREMIA (RECOVERED )2 TO SIADH? 
ALTERED MENTATION

 https://movementdisorders.onlinelibrary.wiley.com/doi/full/10.1002/mdc3.12623

On a whole, this case has given me a great opportunity to do research based learning and interacting with our Professor with all the questions that were running in my mind... I have learnt the importance of detailed history taking. Iam looking forward to get out of my comfort zone and  unveil  many such case scenarious ahead and  and integrating the clinical concepts and add new learnings to my life.... Thank you for patiently  reading my learning experience till the very end .. 

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