Problem Based Learning
Problem based learning (PBL) is a popular method of learning, currently used by most health professional courses in the UK.
The aim of PBL is for you to read through a complex and broad series of information, to identify areas of interest and areas you would like to explore further, in order to further your knowledge of specific topics, through self-directed learning.
The questions our mentors have provided offer ideas of topics to explore and are written in three streams for aspiring medics, dentists and veterinarians; focus on all three or simply what interests you!
THE Dental PBL Case
Mrs Kay Neine is a new patient to the practice. She is 85 years old with a history of stable angina. She attends with a large facial swelling and severe pain from a back tooth and wants an extraction. You decide to numb her up to make her more comfortable before taking an x-ray of the tooth. You pick up the syringe and notice that it is an aspirating syringe (Appendix 1).
Shortly after giving the local anaesthetic Kay Neine starts holding her chest and complains of a crushing pain radiating to her left arm.
The ambulance arrives 5 minutes later and Kay Neine is taken to hospital. Your hear nothing more for 2 months, then Kay Neine calls to book another appointment to continue with her treatment.
Pal Ates is a patient you have been seeing for years for quarterly check-ups. He is getting married in 3 weeks and has asked to have a scale and polish and teeth whitening (Appendix 3) to look his best on the day.
Pal Ates is 45 years old and had artificial heart valves fitted 10 years ago. He mentions as he sits in the chair, that he had a chest infection 2 weeks ago.
- What is the advantage of using an aspirating syringe (Appendix 1) versus a non-aspirating syringe for dental procedures?
- The back of the anaesthetic cartridge (Appendix 2) reads 1:80,000 adrenaline. What does this mean?
- What is the advantage of using adrenaline with local anaesthetic in dentistry.
- What medical emergency is this and what do you need to do?
- What drugs found in every dental surgery will help with managing Kay Neine?
- What drug might Kay Neine have with her to help her feel better?
- How would you handle this?
- What does this photograph show? (Appendix 4)
- Should you be concerned about performing a scale and polish on Pal Ates?
- How would you manage this?
THE Medic PBL Case
During physical exercise James has retrosternal gripping pain – a condition called angina – for 8 years now.
This pain was always relieved by rest or the medication his GP prescribed. Despite medical advice he carried on smoking, and if anything, gained some more weight.
This morning, whilst sitting down, he had the same retrosternal pain but this time it was more severe, started at rest, and was not relieved by the medication his doctor prescribed for him.
The pain radiated to his left arm, neck and jaw and he also appeared pale and sweaty. When the paramedics checked him his heart rate was 110 and his blood pressure was 105/65.
- What is the role of the circulatory system?
- Describe the differences between arteries, veins and capillaries
- Describe the blood supply to the heart
- What is angina and what are the main symptoms?
- What are some risk factors for angina?
- What are the normal heart rate and blood pressure values? Does bob have hypo or hypertension?
- What are atherosclerotic plaques and how are they caused / what do they cause?
- Define preload, ejection fraction and stroke volume and how does a high heart rate affect these?
- What is the main treatment for angina? Initial management / what’s the mechanism of GTN?
THE Vet PBL Case
Case 1: Small Animal
You are presented with a 8yo female neutered cavalier king Charles (Appendix 1) that has recently spent less time going on walks, as the owner informs you that she has difficulty breathing and less energy to exercise. The owner brushes it off due to ‘old age’ and informs you that the dog is otherwise fine. You conduct a clinical examination and hear a grade 5 (out of 6) murmur.
Case 2: Equine
You are presented with Milo, a 1yo Welsh Section A pony that has a heart murmur. Upon further diagnostic investigations, he was diagnosed with a heart condition that is shown in Appendix 2.
Case 3: Farm
You are presented with a dairy cow that has stopped eating for a few days and is producing less milk. See Appendix 3. During your clinical exam, you noticed that the cow grunts when pressure is placed on the xiphoid. The cow also has an increased heart rate, muffled heart sounds and other signs of pain. The farmer then tells you that they noticed this problem recently in a few cows when they switched to a different batch of hay. You suspect it might be traumatic reticuloperitonitis (TRP).
Case 1: Small Animal
- Describe the structure of the heart, include the number and names of the chambers and valves.
- Describe the function of heart valves and what happens if they do not function normally?
- What diagnostic tests would you recommend to the owner to investigate heart issues?
- What treatment options are available for mitral valve disease in dogs?
Case 2: Equine
- Given the breed and the age of the animal, what condition do you think Milo has?
- What clinical signs would you expect in an animal with this condition?
- What type of diagnostic tests would you use to investigate this condition further?
Case 3: Farm
- How can you identify if a cow is in pain?
- Quick anatomy question: where is the heart located in a cow, and where is the stomach (reticulum) located?
- Based on your anatomical knowledge, can you describe the disease process which led to TRP?
- What treatment options are available for this cow?
- What other causes of endocarditis (inflammation of the heart) can you think of?
Answers will be covered in the Virtual Veterinary Society Meeting in December 2021.
And will be available to re-watch HERE
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