Oasis of Knowledge

DIRE DAWA UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES
SCHOOL OF MEDICINE

PBL case scenario

By:

 Sisay Abiy
 Ahmed Ale
 Feven Tigstu
 Dr Helen
 Dr Rabira

Hamle/2014

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STUDENT COPY

Module name and code: infectious module

Problem: cough
Allocated time: 2 hr (in two sessions)

PART ONE: Trigger and relevant history [Subjective data]

A60 years old man came to out-patient department of x hospital with complain of
productive cough of two weeks duration. In association to this he has fever, shortness of
breath, night sweating, loss of appetite and chest pain when he is coughing of the same
duration also he has history of un quantified weight loss. He has history of cigarette
smoking 1 pack per day for the past 20 years. He has history of working in cement factory.
Other-wise he has no hx of body swelling, orthopnea, PND and easy fatigability .
Discussion questions
1. Clarify unfamiliar terms and concepts
2. Identify and analyze presenting problems and risk factors that you will use to
develop an initial hypothesis list
3. Make a list of hypotheses on the mechanisms causing the patient's problems
4. What clinical examination data do you need to know to test your hypotheses?
N.B. Identify and document agreed-upon learning issues from this discussion

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PART TWO: Physical examination and investigations [Objective data]

GA. ASL

BP 120/80 mmhg , RR 30 ,T 38 co Po2 90 with room air

Respiratory System

Inspection

 Has nasal flaring

 No central and peripheral cyanosis
 No clubbing

Palpation

 Trachea is central
 tactile fremitus is equal billateral

Percussion

 there is relative dullness on right upper one third of lung field

Auscultation

 There is fine crepitation on right upper one third of lung field

Discussion questions
1. Summarize the new information you received and explain how it helped you in
rearranging your hypotheses.
2. Explain the mechanisms of important problems identified
3. Rearrange the hypotheses
4. What should principles could help to manage the patient’s problems
N.B. Add and finalize learning issues from session 1. Take these issues for self-study.

References
 Insert references here…

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TUTOR GUIDE

Module name and code: infectious module

Problem: cough
Allocated time: 2 hr (in two sessions)
Learning objectives: At the end of this session the students will be able to:
1. Discus the normal structure and function respiratory system
2. Explain the mechanism of respiration
3. Discuss risk factors associated with cough
4. Identify and interpret basic investigations required in patient with cough
5. Discuss the pharmaco-kinetics and dynamics of different classes of drugs used for
management cough
6. Discuss the psychosocial impact of cough
7. Identify ethical issues associated with cough

SESSION ONE
Duration: 60 minutes

PART ONE: Trigger and relevant history [60 minutes]

First. Start by sharing part one data (trigger and relevant history) and allow students to
read it.
Second. Ask students to identify and clarify unfamiliar and unclear terms and concepts
in the presented data so that everyone understands the given information.
Third. Allow students to identify problems from the given data and continue this
discussion until all problems are documented, while also ensuring that the
predicted issues listed below are included.
 How does TB result in cough and shortness of breath?
 How could TB result in weight loss?
 How patients with cough can be managed?
 How could TB affect individuals and the community psychosocially
(psychosocial effects)?
 What ethical concerns could arise when handling TB patient?
Fourth. Allow students to brainstorm as many ideas and concepts as they can from their
prior knowledge to help them understand the identified problems. Then, engage
students through in-depth discussions of the concepts they generated earlier to
better understand each problem.

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 Fifth. Based on the given data, ask students to develop hypotheses (which could be a
working diagnosis) that can connect and explain the individual problems. Make
sure that the following hypotheses are forwarded:
 TB
 Pneumonia
 COPD(Chronic obstructive pulmonary disease)
 Chemical pneumonitis
Along with this, allow students to identify their learning issues from the
discussion made so far. Ensure the following points are included:
 Pathophysiology of primary and secondary TB
 Complication of TB
 Management principles of TB
Sixth. Ask students what physical examination, laboratory, and imaging results they
need to revise their hypothesis. In the meantime, ask them what ethical issues
care rise in relation to the clinical care of this patent?

PART TWO: Physical examination and investigations [60 minutes]

Seventh. Start by providing part two data (physical examination and investigations) and
allow students to read it. Follow the below steps for facilitation.
Eighth. Ask students to identify and clarify abnormal clinical examination and
investigation findings in the presented data and discuss the mechanism of how
these key findings resulted (pathophysiology). Ensure that the following issues
are raised:
 CBC WBC-12,500, Lymph-65%, Grn- 32%, Hb-10.5gm/dl , Hct-33% ,
Plt-250,000 ul,
 ESR- Raised 80 MM/hr
 CXR-there is cavitation over upper right one third of lung , no hyper
inflation
 AFP
 PICT- non reactive
 Gen x pert +ve for Mycobacterium Tuberculosis
Ninth. Based on the given new data, ask students to prioritize their hypotheses (which
could be a working diagnosis) that can connect and explain the individual
problems.
Along with this, allow students to identify their learning issues from the
discussion made so far.
Tenth. Ask students to organize all learning issues identified so far and remind each of
the students to research all the learning issues using the suggested resources.

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SESSION TWO
Duration: 120 minutes

PART ONE: Trigger and relevant history [60 minutes]

Start by welcoming students to the session.
First. Allow students to share their learning and debate on the learning issues
identified in session one. Then, summarize the session using the below list of
PBL case summary points.
 Anatomy and physiology of respiratory system
 Mechanisms of cough
 Socioeconomic impacts of pulmonary TB
 Management principles of pulmonary TB
Second. Allow students to review what they have learned from working on the problem.
Third. Allow students to reflect on self and each person’s including tutor contribution
to PBL process. Document each student performance in the assessment sheet
(assessment tool annexed).

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Case 2

STUDENT COPY

Module name and code: CVS

Problem: leg edema
Allocated time: 2 hr (in two sessions)

PART ONE: Trigger and relevant history [Subjective data]

A 40 years old woman came to EOPD of x hospital with complain of leg swelling of one
month duration which is bi lateral initially swelling at foot area then progress up to thigh
area. Associated with this she has history of easily fatigability with ordinary activities she
need two pillows while sleeping also intermittently awaked from sleep at night to open
window and door to get relief. She has history of non-productive cough and shortness of
breath. Otherwise she has no loss of appetite, and fever. She has no trauma to the leg and
has no pain to the leg area. She has no history of yellowish discoloration of the eye; she has
no history of chronic diarrhea. She has no previous hx of leg edema and she has no hx of
radishes disclorashin of urine.
Discussion questions
5. Clarify unfamiliar terms and concepts
6. Identify and analyze presenting problems and risk factors that you will use to
develop an initial hypothesis list
7. Make a list of hypotheses on the mechanisms causing the patient's problems
8. What clinical examination data do you need to know to test your hypotheses?
N.B. Identify and document agreed-upon learning issues from this discussion

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PART TWO: Physical examination and investigations [Objective data]

GA. ASL

VS – BP 118 /70 mmhg , PR 80, RR 28 ,T 36.7 co

Respiratory System

 Decreased air entry and fine crepitation on bilateral lower third of lung field

CVS

Inspection

 No central and peripheral cyanosis

 Active pericordium

Palpation

 Apical impulse on 6th ICS lateral to mid-clavicular line

 tactile fremitus is equal bilateral
 no hive and trile

Auscultation

 There is holosystolic murmer

Mss

 There is gread III bilateral pitting edema

Discussion questions
5. Summarize the new information you received and explain how it helped you in
rearranging your hypotheses.
6. Explain the mechanisms of important problems identified
7. Rearrange the hypotheses
8. What should principles could help to manage the patient’s problems
N.B. Add and finalize learning issues from session 1. Take these issues for self-study.

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References
 Insert references here…

TUTOR GUIDE

Module name and code: CVS

Problem: leg edema
Allocated time: 2 hr (in two sessions)
Learning objectives: At the end of this session the students will be able to:
8. Discus the normal structure and function of the structures cardiovascular system
9. Explain the mechanism of unidirectional blood flow in the heart
10. Discuss risk factors associated with CHF
11. Identify and interpret basic investigations required in patient with CHF
12. Discuss the pharmaco-kinetics and dynamics of different classes of drugs used for
management CHF
13. Discuss the psychosocial impact of CHF
14. Identify ethical issues associated with CHF

SESSION ONE
Duration: 60 minutes

PART ONE: Trigger and relevant history [60 minutes]

Eleventh. Start by sharing part one data (trigger and relevant history) and allow students to
read it.
Twelfth. Ask students to identify and clarify unfamiliar and unclear terms and concepts
in the presented data so that everyone understands the given information.
Thirteenth. Allow students to identify problems from the given data and continue this
discussion until all problems are documented, while also ensuring that the
predicted issues listed below are included.
 How does CHF result in leg swelling
 How could CHF result in cough?
 How patients with CHF can be managed?
 How could cardiac disease affect individuals and the community
psychosocially (psychosocial effects)?
 What ethical concerns could arise when handling CHF patient?
Fourteenth. Allow students to brainstorm as many ideas and concepts as they can from
their prior knowledge to help them understand the identified problems. Then,

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 engage students through in-depth discussions of the concepts they generated
earlier to better understand each problem.
Fifteenth. Based on the given data, ask students to develop hypotheses (which could be a
working diagnosis) that can connect and explain the individual problems. Make
sure that the following hypotheses are forwarded:
 CHF
 CLD
 Glomerulonephritis
Along with this, allow students to identify their learning issues from the
discussion made so far. Ensure the following points are included:
 Pathophysiology of CHF
 Complication of CHF
 Management principles of CHF
Sixteenth. Ask students what physical examination, laboratory, and imaging results they
need to revise their hypothesis. In the meantime, ask them what ethical issues
care rise in relation to the clinical care of this patent?

PART TWO: Physical examination and investigations [60 minutes]

Seventeenth. Start by providing part two data (physical examination and investigations)
and allow students to read it. Follow the below steps for facilitation.
Eighteenth. Ask students to identify and clarify abnormal clinical examination and
investigation findings in the presented data and discuss the mechanism of how
these key findings resulted (pathophysiology). Ensure that the following issues
are raised:
 CBC WBC-20,000, Lymph-65%, Grn- 80%, Hb-12 gm/dl , Hct-33%
ESR- 40 sec ,
 CXR-cardiomegaly and opacity on lower lung field bilaterally
 RFT –creatinin-0.8 and urea 26
 ECG-
o
Nineteenth. Based on the given new data, ask students to prioritize their hypotheses
(which could be a working diagnosis) that can connect and explain the
individual problems.
Along with this, allow students to identify their learning issues from the
discussion made so far.
Twentieth. Ask students to organize all learning issues identified so far and remind
each of the students to research all the learning issues using the suggested
resources.

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SESSION TWO
Duration: 120 minutes

PART ONE: Trigger and relevant history [60 minutes]

Start by welcoming students to the session.
Fourth. Allow students to share their learning and debate on the learning issues
identified in session one. Then, summarize the session using the below list of
PBL case summary points.
 Anatomy and physiology of CVS
 Pathogenesis of CHF
 Socioeconomic impacts of CHF
 Management principles of CHF
Fifth. Allow students to review what they have learned from working on the problem.
Sixth. Allow students to reflect on self and each person’s including tutor contribution
to PBL process. Document each student performance in the assessment sheet
(assessment tool annexed).

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