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Problem-Based Learning (PBL): Cardiac Medical Challenge

Problem Based Learning

Problem based learning (PBL) is a popular method of learning, currently used by most health professional courses in the UK.

The aim of PBL is for you to read through a complex and broad series of information, to identify areas of interest and areas you would like to explore further, in order to further your knowledge of specific topics, through self-directed learning. 

If you have a passion for Problem-Based Learning (PBL) and are intrigued by witnessing how doctors navigate critical decision-making moments, we invite you to enrol in our Free Virtual Work Experience programme!


Mr Jack Smith is a 67-year-old male who lives with his wife, Deirdre, in a semi-detached house. He has been quite stressed for about a year now due to his two children both going through difficult divorces. For the past few months he has been experiencing a pounding in his chest and a feeling of breathlessness, both of which get worse after going up the stairs to the bedroom. He found that he had to rest on the landing for a few minutes to catch his breath after each ascent and felt lightheaded. Deirdre became concerned after Jack nearly fainted one morning, and she took him to the hospital the next day for a check-up, even though he thought it was probably nothing.

On arrival, the doctors ran an ECG and took blood and urine samples. Serum creatinine was found to be raised, and the urine was low in volume and very dark. Troponin levels and liver function were normal.

On examination, Jack had a raised BMI and capillary refill time was >5 seconds. His mouth and mucus membranes were very dry, and his legs were slightly swollen. His blood pressure was 80/50.

On auscultation, heart sounds: I + II + 0 and there were fine crackles at the base of each lung.

The doctors decided to put Jack on Warfarin and drugs for heart rate and rhythm control, gave him plenty of fluids, and kept him in hospital for monitoring. Jack began to feel better.

However, 3 days later in the morning while he was reaching for a glass of water by his bed, he realised that he couldn’t move his right arm properly and knocked the glass over onto the floor. He also experienced tingling and numbness in that hand, as well as tunnel vision. He felt as though he was drunk, even though he had not had any alcohol recently. The doctors were alerted immediately, and Jack was taken for a CT scan of his head.

After treatment for thrombolysis and several weeks of physiotherapy, Jack was able to return home with Deirdre, albeit with several more medications that he had to take.

Problem Based Learning Challenge Questions:

  1. What is the structure of a medical history?
  2. Discuss the positives and negatives of a CT scan. Why was it used in this case?
  3. What are the impacts of chronic stress on health and wellbeing?
  4. How do you clinically assess someone for dehydration?
  5. What is meant by a reference range?
  6. What condition are the doctors hoping to rule out by checking Jack’s troponin levels?
  7. What are the two types of stroke and how do the treatments differ?
  8. What type of arrhythmia does the ECG show?
  9. What complications can this condition cause?
  10. What is the Jack’s range in heart rate on the ECG trace?
  11. Summarise what you think has happened to Jack and suggest how his chronic condition has caused acute problems to develop.

For aspiring medical students just starting to delve into Problem-Based Learning scenarios, here are some guidance hints to help give you a starting point of where to research:

1. Medical History Structure:

Research the components of a comprehensive medical history, including key questions related to lifestyle, stress factors, and family history.

2. Positives and Negatives of CT Scan:

Explore the advantages and drawbacks of CT scans, focusing on radiation exposure, imaging clarity, and the specific clinical scenarios where CT scans are preferred.

3. Impacts of Chronic Stress:

Investigate articles on the physiological and psychological impacts of chronic stress on health and well-being.

4. Clinical Assessment for Dehydration:

Review medical literature on clinical signs and assessments used to identify dehydration in patients.

5. Reference Range:

Understand the concept of reference ranges in medical diagnostics and how they are used in interpreting test results.

6. Troponin Levels and Conditions:

Explore conditions associated with elevated troponin levels and the specific condition the doctors are hoping to rule out in Jack’s case.

7. Types of Stroke and Differential Treatments:

Distinguish between ischemic and hemorrhagic strokes, and delve into the differential treatments for each.

8. ECG and Arrhythmia:

Study the different types of arrhythmias, particularly the one depicted in Jack’s ECG, and understand its clinical implications.

9. Complications of the Condition:

Investigate potential complications associated with Jack’s medical condition and their impact on overall health.

10. Heart Rate on ECG Trace:

Analyse the heart rate range displayed on Jack’s ECG trace and its significance in the clinical context.

11. Summary of Jack’s Case:

Synthesise the information to formulate a comprehensive understanding of Jack’s case, linking chronic conditions to the development of acute problems.

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