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!

  • Remeber you can leave a comment if you have any questions and we will be sure to answer them.
  • We will  be discussing and answering the PBL cases in the VMS meeting at 7pm – 8pm on 26th January 2021.

Gastrointestinal Disorders

THE Dental PBL Case

Background:

Many systemic medical conditions and diseases can result in oral symptoms e.g. recurrent oral ulcers. 

 

Scenario

Mrs Caine, a 55 year old woman presents to you with recurrent oral ulcers. She provides the following history of these ulcers:

  • The ulcers are painful and sore, sometimes prevents her from eating and brushing her teeth
  • 1-4 ulcers occur at a time
  • The ulcers are small (<10mm)
  • They last for <2 weeks 
  • They do not scar
  • These have been occurring for years 

Mrs Caine has no relevant medical history or indication of the cause of these recurrent ulcers. 

Further information:

Following a further history and appropriate investigations, Mrs Caine is diagnosed with iron deficiency anaemia.

Part 1: Questions 

  1. What is an ulcer?
  2. What does an oral ulcer look like?
  3. What are possible causes of oral ulcers?
  4. What types of recurrent oral ulcers are there? What type of recurrent oral ulcers do you think Mrs Caine has from the history? 
  5. You refer Mrs Caine to her General Medical Practitioner (GMP) for some blood tests to potentially identify the cause of her recurrent ulcers. What blood tests might the GMP request?
  6. Why is it important to try and identify the cause of Mrs Caine’s recurrent ulcers?
  7. How are oral ulcers treated? 
  8. If an oral ulcer lasts longer than 3 weeks, what might this be a sign of? 
  9. What are the main risk factors for the condition in question 8? 

 

Part 2: Questions 

  1. Apart from recurrent ulcers, what other oral symptoms can present in a patient who has anaemia? 

VMS Study Guide Meeting on the 26th January 2021.

THE Medic PBL Case

Mary is a 40-year-old woman who attends the emergency department in the afternoon with severe right upper quadrant (RUQ) abdominal pain. She says that it has been going on since this morning and that it came on very quickly. When asking her if she has ever had anything like this before, she says that she has had a similar type of pain in the same place intermittently over the past few months, but it has always gone away after a few minutes. After it did not go away this time, and after she started feeling quite unwell, she decided to come to the hospital. 

 On examination, Mary is found to be overweight, has a high temperature and is tachycardic. Upon palpating her abdomen, she is very tender in the right hypochondrium, and she is positive for Murphy’s sign. The doctors order some blood tests and find that her inflammatory markers, white cell count and alkaline phosphatase are raised. A pregnancy test is performed, which comes back negative. An urgent RUQ ultrasound is ordered, and small stones are found in the gallbladder, which had thickened walls. 

Mary is admitted to hospital, given IV fluids, analgesia and antibiotics. She is kept in for a few days for monitoring and is then discharged with a cholecystectomy booked for a few weeks later. 

  1. What are the two different ways of dividing up the abdomen? 
  2. Considering the nine zones of the abdomen and the anatomy beneath, what are different causes of pain in each area?
  3. What is the most likely diagnosis for this woman and why? 
  4. What does the gallbladder do?
  5. What are the different risk factors for gallstones? 
  6. Considering the structure of the biliary tree as shown, what other problems can gallstones cause? 
  7. What is the significance of the intermittent (colicky) pain that she had before this?
  8. Why was she booked for a cholecystectomy? 
  9. Challenge: What would the diagnosis be if she had a similar history, i.e. fever and RUQ pain, but also turned yellow? 
  10. Challenge: In patients like this presenting with abdominal pain, what conditions must you absolutely rule out? 

VMS Study Guide Meeting 26th January 2021.

THE Vet PBL Case

Vet’s deal with a lot of different species and each species brings about slightly different anatomical quirks. Digestive tracts show huge variation between veterinary species, the cow, horse and dog will all digest their food differently and its important we know the anatomy of each animal.

Horses are ‘hind-gut fermenters’ what does this mean? And name 2 other species, which also digest their food like this.

Cows famously have 4 stomachs and are foregut fermenters– name the 4 compartments to the bovine gastro system. 

Case 1:

Imagine you are an ambulatory equine vet and are called to a colicing pony. The owner says the horse has been rolling in its stable and hasn’t passed any faeces overnight. When you arrive the horse is tachycardic (54bpm) and on rectal palpation has a pelvic flexure impaction.

Case 2:

You are on farm placement at a Holstein milking herd. The farmer is worried about one of his older cows who has gone off her food and dropped her milk production. She has an arched back and is the last to enter the milking parlour, albeit very slowly. 

Case 3:

Finally, a 8 week old puppy comes to your clinic with haemorrhagic diarrhoea and profuse vomiting. The puppy was rescued from a puppy farm and hasn’t had any vaccinations. Due to the presentation, you are concerned the puppy could have parvovirus and decided to ‘barrier nurse’ this patient. 

Case 1:

  • What does the term ‘colic’ mean?
  • What does the term ‘impaction’ mean and where is the pelvic flexure?
  • What treatment would you give as the vet overseeing this case?

Case 2:

  • The farmer is worried she has ‘wire disease’ – research this disease and explain how it develops in the cow. 
  • Is there any treatment option available for this cow? 

Case 3:

  • What does ‘barrier nursing’ mean?
  • How does parvovirus cause bloody diarrhoea?
  • Is parvovirus preventable? 

VMS Study Guide Meeting 26th January 2021.
https://youtu.be/YsC53sm7LDE