Problem Based Learning

edicsProblem 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 Dental meeting at 6pm – 7pm, the Vet meeting at 7pm – 8pm and the Medics meeting at 7pm – 8pm on June 2021.

Renal

THE Dental PBL Case

Many medical conditions and diseases can influence oral health, as well as, the medications used to treat them. It is important for a dentist to be able to identify and appropriately treat any oral manifestations of systemic disease or medications.
Questions:
 

  1. What is renal impairment and what is chronic renal failure?
  2. How can chronic renal failure affect the oral cavity (mouth)?
  3. Name some treatments that are used to treat some of these oral manifestations? 
  4. What are the main dental considerations for managing a patient with renal failure?
  5. A patient has severe renal impairment and requires pain relief following an extraction. 
  1. How might severe renal impairment affect medications prescribed by dental practitioners? (hint: think about how drugs are metabolised and excreted)
  2. Why might paracetamol be a more appropriate pain relief medication than ibuprofen (NSAID)? 
The answers will be covered during the Virtual Society Meetings June 2021.

THE Medic PBL Case

 Jared is a 50-year-old man who lives by himself in the Manchester suburbs. One day, while working in the office, he notices that his urine is bright red in colour, and he does not recall having eaten any beetroot recently. He is concerned, so he presents to his GP the next day, who does a urine dip. This shows presence of blood and protein, but there are no nitrites. The GP refers Jared to the hospital on the ‘2 week wait’ pathway. 

 At the hospital, Jared has a flexible cystoscopy, followed by a CT scan of his kidneys, ureters and bladder. The cystoscopy does not show anything concerning, but the CT scan shows a sizeable mass in Jared’s right kidney that is 6cm in diameter. Jared is diagnosed with a renal cell carcinoma. He is surprised, as he had not lost any weight recently or felt particularly unwell save for feeling a bit more tired than usual. Following a further scan to stage the tumour, which does not show evidence of metastasis, Jared is admitted for a nephrectomy (removal of the kidney). 

While recovering on the surgical ward in hospital, Jared starts feeling very ill, and the doctors notice that he has hardly passed any urine recently. They take some blood tests, which show high levels of urea and creatinine. Jared is diagnosed as having an acute kidney injury (AKI). Following successful fluid resuscitation, he fully recuperates, and Jared is able to be discharged home, cancer free. 

  1. What are the different functions of the kidney? 
  2. What does a urine dip show? 
  3. What is the ‘2 week wait’ pathway?
  4. If there is blood in the urine, what are the different places you could be bleeding from? Give an example of what could be causing each. 
  5. What is the difference between the stage and grade of a cancer? (And why do we care?)
  6. What is an acute kidney injury, and how do you classify them? 
  7. What are the different causes of an AKI? 
  8. What is the importance of the urea and creatinine levels? 
  9. Why do you think Jared got an AKI? 
  10. Challenge: with the functions of the kidney in mind, suggest why Jared may have been feeling tired recently. 
 

 

The answers will be covered during the Virtual Society Meetings June 2021.

THE Vet PBL Case

Case 1:

Meloxicam (trade name Loxicom or Metacam) is a very commonly prescribed veterinary drug. The data sheet for this medicine states, “Avoid use in any dehydrated, hypovolaemic or hypotensive animal as there is potential risk of renal toxicity. 

Case 2:

When animals are put onto NSAIDs, we recommend routine blood monitoring of kidney parameters every 6-12 months. One of these blood parameters is Creatinine. 

Case 3:

In a 2014 study, it was found 32% of cats over the age of 15 years old were diagnosed with Chronic Kidney Disease (CKD) (Marino et al., 2014). 

Case 1:

  • What is this drug commonly prescribed for?
  • What class of drug is Meloxicam?
  • Why does this class of drug cause adverse effects on the kidneys? 

Case 2:

  • What is creatinine? 
  • How does creatinine measurement correlate to kidney damage? 

Case 3:

  • Compare CKD with Acute Kidney Injury (AKI) 
  • When staging CKD, we use the IRIS Staging system, how many stages are there?
  • One of the blood parameters used in the IRIS Staging system is ‘SDMA’, what is this and why is it particularly beneficial? 

Answers will be covered in the Virtual Veterinary  Society Meeting at the end of  June 2021.

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