PBL 44‘The haunt of past sins’ by Praveinesh Rasaa https://padlet.com/rpraveinesh/9efazdged9jfce0y en-us 2023-03-19 02:38:38 UTC 2025-11-02 05:54:14 UTC hello@padlet.com Trigger A rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555550893 Mr Raju, a 37-year-old man, has been diagnosed to have HIV infection on highly active anti-retroviral
therapy (HAART), was admitted with three months history of worsening shortness of breath. It was
associated with intermittent fever with chills and dry cough.
On physical examination, his temperature was 38.5ºC with pulse rate of 110 beats/minute,
respiratory rate of 24/minute, blood pressure of 100/60 mmHg and oxygen saturation of 85% (room
air). He looked emaciated and lung auscultation revealed generalised fine end inspiratory
crepitations. Other systemic examinations were unremarkable]]> 2023-04-16 02:46:11 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555550893 Mr Raju 37 yr old man rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555556838 - middle aged 
- marriage status unknown 
- ]]> 2023-04-16 03:08:38 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555556838 Diagnosed to have HIV infection on highly active anti-retroviraltherapy (HAART) rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555558703 - patient immunocompromised 
- maybe side effect 
- HIV could be risk factor 
- learn more on treatment 
- stages of HIV ]]> 2023-04-16 03:15:05 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555558703 Admitted with three months history of worsening shortness of breath. It was associated with intermittent fever with chills and dry cough. rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555560171 - prolonged 
- Systemic review SOB due to cvs, respi, cns, 
- dry cough, no sputum 
- fever infection 
- lungs can be affected , originates from lungs and gives a systemic review
eg, TB ]]> 2023-04-16 03:20:41 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555560171 his temperature was 38.5ºC with pulse rate of 110 beats/minute, rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555560790 - pulse rate increased 
- High temperature ( low / border line grade )
-High PR ]]> 2023-04-16 03:23:07 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555560790 respiratory rate of 24/minute, blood pressure of 100/60 mmHg and oxygen saturation of 85% rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555561617 -High RR 
-Normal but at the lowest limit for diastolic, hypotension 

- Low O2 saturation (Normal: 95%) 

]]> 2023-04-16 03:26:22 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555561617 He looked emaciated rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555562458 - Abnormally thin and weak due to illness or lack of food (indicate weight loss and fatigue)
- pale 
- muscle wasting , cachexia??? 
- havent reached cachexia 
- reduction of body weight is more than 20% ]]> 2023-04-16 03:29:37 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555562458 Lung auscultation revealed generalised fine end inspiratory crepitations rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555563717 - visceral or bronchial sound 
- learn more on breath sounds ]]> 2023-04-16 03:34:14 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555563717 rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555563882 2023-04-16 03:34:56 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555563882 FBC rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555564649 FBC
  • Hb: Low
  • TWBC: Low
  • Platelet: Low
PANCYTOPENIA 
Bone marrow suppression, infection of bone marrow
]]> 2023-04-16 03:37:13 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555564649 ABG rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555564927 pH: High, ALKALOSIS 
pCO2: Low
pO2: Low, 
Bicarbonate: Low
Base Excess: High

To assess lung and kidney bcoz both of these relate with acid base balanceAlkalosis 
(check whether respiratory or metabolic alkalosis)
Low pCO2 and pO2 indicate respiratory alkalosis – that’s why he hyperventilating to remove CO2 
Low bicarbonate and high BE show respiratory alkalosis with metabolic compensation

]]> 2023-04-16 03:38:10 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555564927 Bronchial alveolar lavage (BAL) for Pneumocystis jiroveci : Detected rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555568652 - definition 
- learn more ]]> 2023-04-16 03:51:32 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555568652 CD4 low rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555568815 normal - 500-1500cells/mm3]]> 2023-04-16 03:52:11 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555568815 He was diagnosed to have pneumocystis pneumonia (PCP) with AIDS rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555569343 - AIDS main factor due to low immune system 
-]]> 2023-04-16 03:54:13 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555569343 rpraveinesh https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555575135 LO1 Relate the pathophysiology of opportunistic infections in immunocompromised host to its
clinical presentations

- Opportunistic infection: Pneumocystis jiroveci (disease, epidemiology, virulence) 

- Stages for HIV (briefly)

- Pathogenesis, risk factors, complication for PCP

- Pathophysiology of symptoms (Worsening SOB, intermittent fever with chills, dry cough)

- Pathophysiology of emaciation, pathophysiology of crepitation, breath sounds (briefly)


LO2 Interpret the investigation results for PCP and HIV

- Pathophysiology of PE (PR, RR, BP, O2 Saturation) – state normal range, Interpretation and pathophysiology of FBC

- Interpretation and pathophysiology of ABG, mechanism of respiratory alkalosis and compensation 

LO3 Apply the knowledge of pharmacology to treat PCP

- Treatment and management (antimicrobial agent MOA and HAART) 

LO4 Discuss the ethical concerns with regard to PCP and HIV

- MERCI – advice, relationship, transmission mode for HIV]]> 2023-04-16 04:16:56 UTC https://padlet.com/rpraveinesh/9efazdged9jfce0y/wish/2555575135