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PBL Case /Session A Block 2: Hematology/Neoplasia Part 1 and 2, Possible…
PBL Case /Session A
Block 2: Hematology/Neoplasia
Part 1 and 2
Learning Objectives on the Differential Diagnosis
Minor Objectives (Part A2)
Alcoholic
Depression (lonely in a town house)
Impairment in Activities of Daily Living (former energetic lifestyle)
Weight Loss (15 kg last 6 months)
Macroglossia (difficulty and painful eating and talking)
Immunodeficiency
Paleness (sign of anemia)
Major Objectives (Part A2)
Progressively increasing fatigue (1 month history)
Low Back pain for months
Weight loss for Six months
Learning Objectives on the History Taking
Major Objectives (Part A1)
Low back pain for months
Progressively increasing Fatigue [one-month history]
Dyspnea possible type 1
Minor Objectives (Part A1)
Paleness (noted by family members)
Immunodeficiency
59 yeas old and frequent exposure to influenza and cold
Chief Complaint
Part A1
59 year old male
1 month history of progressively increasing fatigue
more than 1 month history of lumbar pain
dyspnea with little exertion
pale appearance
Part A2
59 year old male
no history of chronic disease or hospitalization
lumbar pain aggravated by movement [began 6 months ago]
dyspnea and palpitation on mild exercise [recent weeks ago]
extreme fatigue; formerly active lifestyle
low nutritional intake
use of OTC analgesics
increased influenza and common cold infection [over the last year]
increasing dysarthria [last 6 months]
macroglossia with occasional pain
unintentional 15kg weight loss [last 6 months]
Possible Diagnostic measures:
CBC with WBC Differential
Ultrasound of lower back
Reticulocyte Count
Platelet Count
EKG/ECG
Physical Examination
Possible Diagnosis and Solutions (Tentative)
Anemia (microcytic)
Examples of treatments include:
Surgical repair of a bleeding wound
Iron replacement
Vitamin B6 supplements4
Treatment of an underlying illness, such as cancer
Treatment of lead toxicity
Management of thalassemia:
Generalized Infection
Tentative solutions: Antibiotic treatment and afterward recovery including vitamin intake
Cancer (unspecified) Lab results pending
Tentative Solutions: surgery, radiotherapy, chemotherapy and/or immunotherapy
Thrombocytopenia
Tentative solutions:
Blood or platelet transfusions. If platelet level becomes too low, the doctor can replace lost blood with transfusions of packed red blood cells or platelets.
Medications. If the condition is related to an immune system problem, the doctor might prescribe drugs to boost the platelet count. The first-choice drug might be a corticosteroid. If that doesn't work, stronger medications can be used to suppress your immune system.
Surgery. If other treatments don't help, the doctor might recommend surgery to remove the spleen (splenectomy).
Plasma exchange. Thrombotic thrombocytopenic purpura can result in a medical emergency requiring plasma exchange.
Possible COPD
Tentative solutions:
Treatments include:
stopping smoking
inhalers and tablets – to help make breathing easier
pulmonary rehabilitation – a specialized programme of exercise and education
surgery or a lung transplant – although this is only an option for a very small number of people