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 29th September 2020.

Anesthesia and Analgesia

THE Dental PBL Case

David is a 55 year old male who presents with persistent severe pain coming from his lower right seven (LR7).

He has been in constant agony for a few days and the pain worsens when he bites down on food.

Following a history, examination and relevant special tests he is diagnosed with Acute Periapical Periodontitis.

This tooth has also been deemed unrestorable.

The most appropriate treatment option is an extraction, which David consents too. In order to extract David’s LR7, two different injections of local anaesthetic are required: a buccal infiltration using articaine on the LR7 and an inferior alveolar nerve block using lidocaine on the right-hand side. 

 

  1. What different types of anaesthesia are used in dentistry?
  2. Why are different types of anaesthesia required in dentistry?
  3. How do local anaesthetics work?
  4. What is the difference between a nerve block and infiltration?
  • What is a nerve block?
  • What is an infiltration?
  1. What nerve is being anaesthetised during an inferior alveolar nerve block?
  2. What tissues are being anaesthetised during an inferior alveolar nerve block?
  3. What tissues are being anaesthetised during the infiltration of the LR7?
  4. What post-op instructions and advice would you give David after his treatment has been completed? 
  5. Challenge: what feature of the mandible results in mandibular teeth not being able to be effectively anaesthetised by just infiltration injections?

The answer will be covered during the Virtual Medical Society Meeting on 29th September 2020. The video link to the answer will be posted here there after.

THE Medic PBL Case

John is a 35-year-old man who has been living with chronic lower back pain that radiates down his right leg following a herniated disc a couple of months back. He has been managing the pain with ibuprofen, although the pain has been gradually getting worse, and he has elected for discectomy surgery in the hope that this will relieve it. 

John’s wife recently gave birth, and she opted for an epidural to help with her pain. John wonders if he will get a similar injection as part of his surgery. 

In the operating theatre, the anaesthetist puts John under general anaesthetic and uses suxamethonium as a paralysing agent to allow them to intubate him for the procedure. The operation goes well, and as part of his postoperative care, John is given some morphine to numb the pain. 

  1. What is the difference between analgesia and anaesthesia? 
  2. What is the structure of the spinal column?
  3. What is meant by a herniated disk and how might it cause pain?
  4. Where does the spinal cord finish in the adult and what is below it? 
  5. At what point of the spine would you choose to deliver an epidural anaesthetic and why?
  6. What is the difference between paracetamol and ibuprofen?
  7. What class of drug is morphine and what are the advantages and disadvantages of this?
  8. What is the action of suxamethonium at the neuromuscular junction? 
  9. Challenge: In what other ways could a drug act in order to be used as a muscle relaxant?

The answer will be covered during the Virtual Medical Society Meeting on 29th September 2020. The video link to the answer will be posted here there after.

THE Vet PBL Case

Analgesia within veterinary medicine has evolved and developed tremendously over the years and now there are a huge spectrum of pain medications to treat anything from tiny gerbils to huge Clydesdales. You are a new graduate vet working in mixed practice and have a very busy work diary today. 

Your first op of the day is a 3-year-old Labrador bitch spay. You wish to provide multi-modal analgesia for the procedure and use an opioid alongside a non-steroidal anti-inflammatory (NSAID) as well as local anaesthetic blocks. 

Upon recovery from the bitch spay, you decide to assess the patient’s pain in order to guide your analgesic plan. Animals of course can’t describe their pain to us like humans can to medical doctors but vets have developed useful tools to help this problem. 

Once you have completed the bitch spay you are called out to a difficult calving on one of your favourite farms. The calf is far too big to pass via the pelvic canal so you opt to perform a c-section. 

After some lunch, you are then called out to a lame thoroughbred. The horse has been 7/10 lame on its LH (left hind) since yesterday and the owner has already given it some ‘bute’ this morning. 

After a clinical exam, there is swelling of the left hind noted around the hock area and a mild tendon injury is suspected. You prescribe strict box rest for 1 week and a course of phenylbutazone (once daily) to go alongside. This horse is a race horse due to compete in 10 days.  

  1. What is meant by the term ‘multimodal analgesia’?
  2. Name 3 opioids commonly used in small animal veterinary practice.
  3. What is an ‘NSAID’ and do they have any side effects?
  4. Therefore, discuss pain scoring in veterinary patients, specifically cats and dogs. 
  5. How will you provide adequate analgesia for the cow pre and post-op?
  6. When giving pain-relief to food producing animals, what is meant by ‘withdrawal periods’?
  7. What is bute? And is the owner allowed to give it without a vet prescribing it?
  8. Research the involvement of bute during the horse meat scandal of 2013
  9. What is meant by ‘detection time’ within performance equestrian?
  10. Will the horse be suitable to compete?

The answer will be covered during the Virtual Medical Society Meeting on 29th September 2020. The video link to the answer will be posted here there after.

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