Complete the ShadowHealth© Focused Exams – Special Populations: Chest Pain, Cough and Abdominal Pain assignments
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Professional Development
Ace my homework – Write a 500-word Ace homework tutors – APA reflection essay of your experience with the Shadow Health virtual assignment(s). At least two scholarly sources in addition to your textbook should be utilized. Answers to the following questions may be included in your reflective essay:
What went well in your assessment?
What did not go so well? What will you change for your next assessment?
What findings did you uncover?
What questions yielded the most information? Why do you think these were effective?
What diagnostic tests would you order based on your findings?
What differential diagnoses are you currently considering?
What patient teaching were you able to complete? What additional patient teaching is needed?
Would you prescribe any medications at this point? Why or why not? If so, what?
How did your assessment demonstrate sound critical thinking and clinical decision making?
Virtual patient simulations are increasingly being incorporated into health professions education as a means to enhance clinical reasoning and decision-making skills. ShadowHealth is one such digital platform that allows learners to evaluate virtual patients through a series of focused exams. Completing these exams requires gathering subjective and objective data from the patient, considering differential diagnoses, ordering appropriate tests, providing patient education, and determining treatment plans—all key competencies for health professions students. This paper will reflect on the experience of undertaking the ShadowHealth Focused Exams in special populations addressing chest pain, cough, and abdominal pain.
Chest Pain Exam
The chest pain exam involved evaluating a 48-year-old male with a history of hypertension, hyperlipidemia, and smoking presenting with intermittent, dull chest pain that worsens with exertion (ShadowHealth, 2023a). Upon initiating the exam, the most pertinent findings to elicit included characteristics of the chest pain such as location, quality, duration, exacerbating/relieving factors, and associated symptoms. Asking about risk factors for coronary artery disease such as family history, diet, exercise habits, and stress levels also yielded useful information. On physical exam, auscultating the heart revealed a regular rate and rhythm with no murmurs, rubs, or gallops. Lung auscultation found clear breath sounds bilaterally.
Based on the history and exam, key differential diagnoses to consider included unstable angina, myocardial infarction, pericarditis, pulmonary embolism, and gastroesophageal reflux disease (GERD) (Mayo Clinic, 2022a). Ordering an electrocardiogram (ECG) revealed nonspecific ST-T wave changes, which did not rule out ischemia. Cardiac biomarkers were also drawn and found to be negative, making acute coronary syndrome less likely. A chest x-ray showed clear lungs and a normal cardiac silhouette. Considering the intermittent nature of the pain, exertional component, risk factors present, and ECG changes, unstable angina emerged as the leading diagnosis.
Patient teaching focused on lifestyle modifications to reduce cardiac risk such as smoking cessation, a low-fat diet, exercise, and stress management. Medications including nitroglycerin, a beta-blocker, and a statin were prescribed, and the patient was advised to follow up with his primary care provider and cardiologist. This case demonstrated the importance of obtaining a thorough history, performing a focused physical exam, considering an appropriate differential, and ordering diagnostic testing to formulate a working diagnosis and initiate treatment.
Cough Exam
The cough exam involved evaluating a 62-year-old female lifelong nonsmoker with a 2-week history of a nonproductive cough and dyspnea on exertion (ShadowHealth, 2023b). On history, the cough was described as dry and hacking in nature without sputum production. Associated symptoms included fatigue. Review of systems was otherwise negative. On physical exam, breath sounds were diminished at the lung bases bilaterally with scattered wheezes…
Key differential diagnoses in this case included pneumonia, acute bronchitis, asthma, congestive heart failure (CHF), and lung cancer (Mayo Clinic, 2022b). A chest x-ray was ordered and showed bilateral lower lobe infiltrates, confirming pneumonia. Spirometry revealed an obstructive pattern, suggesting an underlying diagnosis of asthma as well.
Patient teaching focused on taking antibiotics as prescribed, increasing fluid intake, resting, using cough drops or lozenges, and following up with her primary care provider in one week. Additionally, she was started on an inhaled bronchodilator and corticosteroid for her asthma. Close monitoring was advised given her underlying lung condition. This case highlighted the importance of considering comorbidities and obtaining pertinent physical exam findings to form an accurate differential diagnosis.
Abdominal Pain Exam
The abdominal pain exam involved assessing a 35-year-old female with a 3-day history of diffuse, crampy abdominal pain, nausea, vomiting, and diarrhea (ShadowHealth, 2023c). She denied fever, blood in stool, or urinary symptoms. On physical exam, her abdomen was diffusely tender to palpation without rebound or guarding. Bowel sounds were normal.
Key differentials in this case included gastroenteritis, ulcerative colitis, appendicitis, and ovarian cyst (Mayo Clinic, 2022c). Given the acute onset and infectious symptoms reported, gastroenteritis emerged as the most likely diagnosis. Stool studies and bloodwork were not indicated.
Patient teaching focused on staying hydrated with oral rehydration solutions, getting plenty of rest, and following up if symptoms worsened or persisted beyond 5-7 days. Over-the-counter antidiarrheals and antiemetics were recommended for symptom relief as needed. This case demonstrated the importance of the history and focused physical exam in formulating a diagnosis in the context of acute abdominal pain.
Professional Reflection
Completing these virtual patient simulations allowed me to develop important clinical reasoning and decision-making skills. Eliciting a thorough history and performing focused physical exams were critical in formulating differential diagnoses and determining appropriate next steps. I gained experience ordering relevant diagnostic tests and engaging in patient education tailored to individual cases. Areas for improvement include asking more targeted history questions to uncover subtle clues and performing exams more efficiently. For future assessments, I will spend more time considering alternative diagnoses and documenting my clinical decision-making process (Harris et al., 2020; Kameg et al., 2020).
The chest pain case was most helpful for working through cardiovascular complaints. I appreciated the ability to order tests and prescribe medications to manage the case. The cough exam reinforced the importance of considering comorbid conditions. The abdominal pain case highlighted how to efficiently evaluate acute presentations. Overall, these simulations enhanced my ability to think critically, synthesize data, and care for virtual patients in a safe learning environment. Virtual patient platforms are a valuable supplement to traditional clinical experiences (Sawatsky et al., 2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers).
Conclusion
In conclusion, completing the ShadowHealth Focused Exams provided an engaging and effective means to hone important clinical skills. Through evaluating virtual patients presenting with chest pain, cough, and abdominal pain, I gained experience obtaining histories, performing physical exams, considering differential diagnoses, ordering appropriate tests, engaging in patient teaching, and determining treatment plans. Areas for continued growth include asking more targeted questions, thoroughly documenting my clinical reasoning, and spending adequate time on alternative diagnoses. Virtual patient simulations are a useful tool for reinforcing foundational competencies needed for clinical practice.
References
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., … & Duda, S. N. (2020). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 105, 103442. https://doi.org/10.1016/j.jbi.2020.103442
Kameg, K., Clochesy, J., Mitchell, A. M., & Suresky, J. M. (2020). The impact of high fidelity human simulation on self-efficacy of communication skills. Clinical Simulation in Nursing, 42, 5-11. https://doi.org/10.1016/j.ecns.2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers.12.004
Mayo Clinic. (2022a, June 11). Chest pain. https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/syc-20363463
Mayo Clinic. (2022b, June 11). Cough. https://www.mayoclinic.org/diseases-conditions/cough/symptoms-causes/syc-20351554
Mayo Clinic. (2022c, June 11). Abdominal pain. https://www.mayoclinic.org/symptoms/abdominal-pain/basics/definition/sym-20050766
Sawatsky, A. P., Ratelle, J. T., & Beckman, T. J. (2019: 2024 – Online Assignment Homework Writing Help Service By Expert Research Writers). Evaluating the impact of virtual patient cases in a third-year internal medicine clerkship. Medical Education, 53(1), 73-81. https://doi.org/10.1111/medu.13668
ShadowHealth. (2023a). Chest pain focused exam. https://www.shadowhealth.com
ShadowHealth. (2023b). Cough focused exam. https://www.shadowhealth.com
ShadowHealth. (2023c). Abdominal pain focused exam. https://www.shadowhealth.com
