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 27th October 2020.
Managing Infections
THEDental PBL Case
Millie is a 40 year old female who presents with a slight facial swelling and severe pain coming from her Upper left five (UL5). She has been in persistent agony for a few days and the pain worsens when she bites down on food. She is also feeling unwell and has a slight fever. Following a history, examination and relevant special tests she is diagnosed with an Acute Periapical Abscess. This tooth is deemed restorable.
The treatment options are either root canal treatment (RCT) or an extraction. Millie opts for RCT and is also prescribed antibiotics to treat this.
1. What are the potential risks to a patient who has a facial swelling?
2. What is meant by an Acute Periapical Abscess?
3. The patient has a fever. Why might she have a fever?
4. Root canal treatment (RCT):
- What is RCT treatment and what is the purpose of it?
- Why is RCT appropriate in this case?
Antibiotics:
- What are antibiotics and how do they work?
- Why might antibiotics be appropriate in this case?
- Are there any risks associated with antibiotics?
6. Challenge: why do you think it is more painful when Millie bites down on food?
THEMedic PBL Case
Mr Bloggs is a 40-year-old man living in Bristol who presents to hospital with a short 1-day history of fever and breathlessness.
On arrival, his blood pressure is 65/50, his heart rate is 110 bpm and his respiratory rate is 30. The doctors took some blood tests and listened to his heart. There was an audible murmur, and his blood tests showed raised inflammatory markers, raised lactate levels and acidaemia.
The doctor taking a history found that Mr Bloggs is an ex-smoker, an intravenous drug user, and has a family history of lung cancer. They did an echocardiogram, which found abnormal vegetations on the tricuspid valve.
A diagnosis was made of sepsis secondary to endocarditis.
Firstly: Look up any medical terms or investigations that you don’t know.
- What are signs that a person might have an infection (localised and systemic)?
- What is endocarditis?
- What are the possible complications of endocarditis?
- Given the history, what is the most likely cause of Mr Bloggs’ infection?
- What is sepsis?
- What are the sepsis six and why are they important?
- What do the numbers mean in a blood pressure reading?
- What causes the heart sounds that you can hear with a stethoscope and what might a murmur mean?
- Challenge: It is unusual for the tricuspid valve to be affected in endocarditis. Thinking about the route that blood takes through the body, why might intravenous drug users have a higher risk of tricuspid valve involvement?
- Challenge: What is the relationship between sepsis, low blood pressure, raised lactate and acidaemia?
THEVet PBL Case
A. Imagine you are a first opinion vet consulting on a busy Saturday morning. Mrs Fields brings in her cat Toby who has a large tangerine-sized swelling on the base of his tail. Mrs Fields only noticed the swelling yesterday and thought it was unusual. Toby is an outdoor cat and often fights with the neighbourhood Tom.
Following a clinical exam, you suspect the swelling is a cat-bite abscess (CBA).
B. After Toby’s consultation, there is a routine post-op check for you to see. Diesel is an 8-month old male JRT who was castrated 3 days prior. The owners decided not to keep Diesel’s buster collar (lampshade) as he hated waring it. This is a photo of the castrate wound 3 days post-op.
C. Your final appointment of the morning is Felix the 3-year old British Short Hair, unvaccinated, male neutered cat. Felix’s owner has 6 cats in total and they don’t all get along unfortunately. Felix presents with a sneeze as well as red eyes with bilateral green discharge. You are concerned Felix may have an infection of his eyes.
A. Toby
- What is a ‘CBA’ and how do they form?
- What is the treatment of choice in treating a cat bite abscess?
- What makes up ‘pus’ and what is it an indication of?
B. Diesel
- What do you think has happened to the wound? Is it healing as it should?
- What is meant by the ‘5 Pillars of Inflammation’?
- What recommendations do you have for the owner about managing this wound?
C. Felix
- What would Felix’s eye infection be called?
- What may be the cause of this infection? (bearing in mind Felix’s home environment other symptoms)
- Discuss the use of ‘topical antibiotics’ vs ‘systemic antibiotics’ and give examples of both.
