PBL 26: Valve Trouble by Zayn Zaki https://padlet.com/ilyummy00/pblgp8 en-us 2022-07-19 04:05:51 UTC 2022-11-15 18:12:10 UTC hello@padlet.com TRIGGER PART A nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384043245 Wong, an 18-year-old male, complained of two weeks history of fever and breathlessness. He had tooth extraction prior to the onset of fever. He had acute rheumatic fever at 10 years of age. He had however defaulted treatment. ]]> 2022-11-15 03:08:52 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384043245 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384049659 1. 18 years male 
- student
- early adulthood
- right after SPM 
- do not need parent consent (but need some advice from parents )
- part time job 

]]> 2022-11-15 03:14:07 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384049659 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384058341 2. two weeks history of fever and breathlessness
- chief complaint
- abnormal fever
- prolonged fever :
- pyrexia unknown origin : described as a persistent fever above 38.3Β°C (100Β°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital.
- etiology of prolonged fever ]]> 2022-11-15 03:20:53 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384058341 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384066359 3. breathlessness
- frequency of occurrence
- nature of sleeping 
- onset 
- possible of respiratory infection 
- term for breathlessness in CVS
     * paroxysmal nocturnal dyspnea 
     * orthopnea 
 - elaborate in history of breathlessness
      *associated symptoms
      *medication to relief 
      * asthma?
* acute exacerbation?]]> 2022-11-15 03:26:23 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384066359 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384072990 4. tooth extraction
- removal of the teeth
- infection 
- oral hygiene 
- possible of having fever due to pain 
- systemic infection cause fever 
- oral cavity is port for microorganism to be alive (contamination from food) ]]> 2022-11-15 03:31:24 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384072990 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384081657 5. rheumatic fever
- once diagnosed : antibiotics 
- reason to follow up the patient :
     * duration of antibiotic longer 
     * cardiovascular complication - valvular  heart disease 
- fever happen due to tooth extraction or reoccurrence of rheumatic fever?
    * 
- cannot rely on history taking only & need to do physical examination & investigation]]> 2022-11-15 03:38:11 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384081657 Trigger (Part B). nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384082182  General examination revealed poor dental hygiene and presence of splinter haemorrhages.

His blood pressure was 120/70 mmHg, pulse rate was 110 beats/min with regular rhythm, respiratory rate was 18 breaths/min, and body temperature was 38.9 ΒΊC. The jugular venous pressure was at 5 cm. The apex beat was at the 6th left intercostal space lateral to the midclavicular line and forceful in nature.
On auscultation, the first heart sound was soft. There was a high-pitched, grade 3/6 pansystolic murmur at the mitral area. It was rumbling in nature and radiated to the left axilla. There were fine basal crepitations in both lungs. The liver was not enlarged. The spleen was palpable 1 cm below the left costal margin. A provisional diagnosis of infective endocarditis (IE) was made. Empirical intravenous antibiotics were started. ]]> 2022-11-15 03:38:36 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384082182 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384096123 BP = normal 
Pulse rate = high
respi rate = normal
body temperature = high 
jvp = elevated 
apex beat = displaced 
S1 = soft 
high pitched murmur ?


]]> 2022-11-15 03:51:13 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384096123 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384097947 poor dental hygiene
- low income family - do not care about the oral hygiene 
- cause of infection from oral cavity 
- more bacteria , more prone to get infection]]> 2022-11-15 03:53:01 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384097947 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384100764 splinter hemorrhages 
- explain about the pathophysiology 
- no pain 
- if caused by trauma = feel pain
   ]]> 2022-11-15 03:55:40 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384100764 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384113391 Apex beat 
- displaced 
- indicates cardiomegaly 

]]> 2022-11-15 04:09:13 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384113391 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384117930 JVP 
- Pathophysiology of elevated JVP  (chronology how it happens) 
- overview of how cardiac backflow occur
 - cause by increase right atrium pressure ]]> 2022-11-15 04:14:39 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384117930 ilyummy00 https://padlet.com/ilyummy00/pblgp8/wish/2384121194 2022-11-15 04:18:05 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384121194 nransh2002 https://padlet.com/ilyummy00/pblgp8/wish/2384138383 - why rheumatic fever tend to affect mitral valve rather than others?
- why inefective endocarditis like to stay at mitral valve ?
-Type and characteristic of murmur
- inefective endocarditis :  definition , classification, investigation(imaging), management(antibiotic), diagnostic criteria (major &minor) ,causes ,type of microorganism,prognosis , merci 
- pathophysiology of spinter hemorrhage  ]]> 2022-11-15 04:35:32 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384138383 https://padlet.com/ilyummy00/pblgp8/wish/2384140978 LO1 Apply the knowledge of surface anatomy to interpret chest physical examination findings
a. why JVP is raised? 🌲
b. how splenomegaly occur? (relate with chronic infection) 🌲
c. types and characteristics of murmur + grading 🌴


LO2 Relate the pathogenesis and pathophysiology of infective endocarditis to its clinical
presentations
d. Definition + Classification + Infective causes (type of microorganism) πŸŽ‹
e. Pathogenesis of IE πŸŽ‹
f. pathophysio of fever & breathlessness πŸ₯—
g. pathophysio splinter hemorrhage πŸ₯—
h. relation between bp / pulse rate / respi rate / body temp.
+ why rheumatic fever tend to affect mitral valve rather than others?
+ why does ineffective endocarditis like to stay at mitral valve ? 🏑🏑


LO3 Outline the principles of management of infective endocarditis
i. Investigation (lab + imaging) πŸ”°
j. Diagnosis criteria (major n minor) πŸ“—
k. Prognosis πŸ“—
l. Management (antibiotics) πŸ€

LO4 Discuss the psychosocial implications of infective endocarditis
m. Psychosocial impact (MERCI) πŸ€]]> 2022-11-15 04:38:20 UTC https://padlet.com/ilyummy00/pblgp8/wish/2384140978