PBL 5 session 2

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PBL 5 session 2 by Mind Map: PBL 5 session 2

1. Step 8

1.1. Diagnostic decision

1.1.1. cryptosporidium parvum infection

1.2. Mechanism

1.2.1. reduced immunity from HIV

1.3. Presentation

1.3.1. diarrhea, abdominal pain, near fecal incontinence

1.4. Supporting data

1.4.1. culture

1.5. 10 minutes

2. Step 7

2.1. Inquiry plan and info gathering

2.1.1. History of presenting complaint

2.1.1.1. watery diarrhea, abdominal pain, near fecal incontinance

2.1.1.2. 2 weeks ago, diarrhea. 10 times per day

2.1.1.3. watery stool, no mucus or blood

2.1.1.4. pain over a week

2.1.1.5. incontinace several times last week

2.1.1.6. waight loss 7 kg over 6 months

2.1.1.7. no tenisumus

2.1.1.8. unable to carry out exercise program

2.1.2. Previous medical / surgical history

2.1.2.1. appendectomy

2.1.2.2. 6 y ago

2.1.2.3. presented with painless lump. CD4 was 600

2.1.2.3.1. lymphoma was suspected

2.1.2.4. fell to 300 cells

2.1.2.5. side effect of treatment: diarrhea. discuntinued therapy

2.1.2.6. count fell to 200

2.1.2.7. most recent count is 40 cells

2.1.2.8. HIV load 480,000

2.1.3. Drug history / allergy

2.1.3.1. antiretroviral therapy

2.1.3.1.1. abacaver

2.1.3.1.2. zalasetavin

2.1.3.1.3. endenovir

2.1.3.2. TMP SMX with azethromycin

2.1.4. Family history

2.1.4.1. no malignancies

2.1.4.2. seperated parents since age 10. lived with mother untill 20

2.1.4.3. no siblings

2.1.4.4. didn't tell his parents about his condition

2.1.5. Social / occupational history

2.1.5.1. lives with HIV positive partner

2.1.5.2. homosexual. 15 partners in the past

2.1.5.3. drinks socially. No drugs

2.1.5.4. He was a runner. HIV reduces his capacity to exercise

2.1.5.5. not smoker

2.1.5.6. mainly vegetarian diet

2.1.6. Systemic review

2.1.7. Physical examination

2.1.7.1. vitals

2.1.7.1.1. PB 115 over 70

2.1.7.1.2. pulse 90

2.1.7.1.3. temp 37.4

2.1.7.1.4. weight 50 height 160

2.1.7.2. general inspection

2.1.7.2.1. no juandice

2.1.7.2.2. no lymph nodes

2.1.7.2.3. moderately dehydrated

2.1.7.2.4. upper arm fat loss

2.1.7.2.5. wight plaques in the tongue and palate

2.1.7.3. Respiratory

2.1.7.3.1. few cripitations at both bases

2.1.7.4. Cardiovascular

2.1.7.4.1. normal

2.1.7.5. GI

2.1.7.5.1. old scar

2.1.7.5.2. scaphid

2.1.7.5.3. paplbe spleen and liver but not enlarged

2.1.7.6. CNS

2.1.7.6.1. subjective reduction in light touch at finger tips

2.1.8. investigation

2.1.8.1. cbc

2.1.8.1.1. hempoglobin 11.2

2.1.8.1.2. white cells 2.5

2.1.8.1.3. neutrophils 90%

2.1.8.1.4. platlets 185

2.1.8.2. biochem

2.1.8.2.1. cholesterol is 7.4

2.1.8.2.2. mild abnormalities in lever function

2.1.8.2.3. triglysrides 6.5

2.1.8.3. cryptosporidium parvum cultured

2.2. 50 minutes

3. Step 6

3.1. Review session 1

3.2. Report new knowledge

3.2.1. AIDS

3.2.1.1. definition

3.2.1.1.1. stages

3.2.1.2. risk factors

3.2.1.3. pathophysioloy

3.2.1.4. sign & symptoms

3.2.1.5. complication

3.2.1.5.1. common infections

3.2.1.5.2. immunosupression

3.3. 30 minutes