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Problem-Based Learning (PBL): Stress And Anxiety 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!

Stress & Anxiety

Rebecca is an 18-year-old woman who has recently started studying medicine in London. She has been very stressed lately due to upcoming exams, and she has not had much sleep in the last week, but she has decided to take the night off to see the fireworks with her friends. 

During the display’s finale, her friends heard her cry out and collapse, falling stiffly to the floor. They notice that, after half a minute of trying to rouse her, she starts twitching her limbs. 

A couple of minutes later, she stops and wakes up to find herself suddenly on the ground with her friends gathered around her, concerned. She is very confused and drowsy, and she has no memory of collapsing. 

Her friends called the ambulance, and Rebecca is taken to the local hospital, where the doctors carry out a full ABCDE investigation. As part of this, they test her blood glucose levels, do some blood tests, take her blood pressure, and do an ECG. These tests all come back normal. Since Rebecca is still a little confused, they take a collateral history from one of her friends who came with her. The doctors discharge Rebecca that same night, and she is referred to a ‘first fit’ clinic at the same hospital in a couple of weeks. There, she is told that she has had a generalised tonic-clonic seizure and is prescribed lamotrigine to try to prevent any more in future. 

Problem Based Learning Challenge Questions:

  1. What are some of the different causes of collapse? What would you want to rule out?
  2. What is the difference between a seizure and epilepsy?
  3. What are the stages of a generalised tonic-clonic seizure?
  4. What are the risk factors and common triggers for this type of seizure?
  5. Are there any complications that can occur from seizures?
  6. What is an ABCDE assessment and what does it cover?
  7. What is the general structure of a medical history?
  8. Are there any specific questions that doctors would want to ask her or her friend to try to narrow down the diagnosis?
  9. Challenge: What are some potential risks with giving Rebecca anti-epilepsy drugs, like lamotrigine, and would you tell her about anything else at the hospital or have her make any changes to her daily life for the near future once you suspect a seizure?

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. Causes of Collapse:

– Research different medical conditions or situations that can lead to a sudden collapse.
– Explore how medical professionals rule out potential causes in emergency situations.

2. Seizure vs. Epilepsy:

– Investigate the distinction between an isolated seizure and a diagnosis of epilepsy.
– Understand the criteria for diagnosing epilepsy and the implications for treatment.

3. Stages of a Generalised Tonic-Clonic Seizure:

– Research the phases and characteristics of a generalised tonic-clonic seizure.
– Explore how medical professionals identify and manage each stage.

4. Risk Factors and Triggers:

– Investigate common risk factors and triggers for generalised tonic-clonic seizures.
– Understand how identifying these factors can guide treatment and lifestyle recommendations.

5. Complications of Seizures:

– Explore potential complications that may arise from seizures, both immediate and long-term.
– Understand how healthcare professionals address and manage these complications.

6. ABCDE Assessment:

– Research the ABCDE assessment process in emergency medicine.
– Understand what each component (Airway, Breathing, Circulation, Disability, Exposure) entails and how it guides medical intervention.

7. Medical History Structure:

– Explore the typical structure of a medical history.
– Understand the key components and how a comprehensive medical history contributes to diagnosis.

8. Specific Questions for Diagnosis:

– Investigate the types of questions doctors might ask to narrow down a diagnosis in cases of seizures.
– Understand the importance of gathering information from both the patient and collateral sources.

9. Risks of Anti-Epilepsy Drugs:

– Research potential risks and side effects associated with anti-epilepsy drugs like lamotrigine.
– Explore how healthcare professionals weigh the benefits and risks when prescribing such medications.

10. Hospital Advice and Lifestyle Changes:

– Explore recommendations and advice that healthcare professionals might provide to someone who has experienced a seizure.
– Understand if and how lifestyle changes may be recommended to reduce the risk of future seizures.

By delving into these areas, aspiring medical students can gain a comprehensive understanding of the scenario and develop critical thinking skills in diagnosing and managing patients with seizure disorders.


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