Shadow Health Tina Jones Respiratory Review Questions

Assessment Criteria Breakdown:

1. Priority Evaluation (1 point): Correct identification of the priority level for each diagnosis.

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2. Evidence Analysis (Up to 2 points): Assessment of the strength of patient cues used as evidence for each identified diagnosis.

– Required Evidence (Worth 2 points): Selection of at least one cue directly indicating the presence of a problem or risk.
– Supporting Evidence (Worth 1 point): Selection of at least one cue contributing to a problem or risk, without the presence of Required Evidence.

3. Planning Component (1 point): Development of a proposed plan to address each diagnosis, including at least one correct component.

Below are the detailed evaluations for each relevant diagnosis:

1. Acute pain of the foot:
– Points: 4/4
– Priority: 1/1
– Student Response: High
– Correct Priority: High
– Priority Pro Tip: Immediate attention to managing acute pain is crucial as other health concerns cannot be effectively addressed while a patient experiences severe pain.
– Evidence: 2/2
– Relevant: “I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet.” (Required Evidence)
– Evidence Pro Tip: Tina reports intense pain and provides a numerical scale for assessment. Additional information about the pain’s characteristics, including its one-week duration, defines it as acute.
– Planning: 1/1
– Relevant: Intervene – Prescribe: Prescribe medications to treat pain.
– Planning Pro Tip: Intervention involves reducing pain by prescribing an appropriate analgesic. Educating the patient on its effective use and potential side effects is essential. Providing options for non-pharmacological pain relief, such as RICE (rest, ice, compression, elevation), is recommended.

Tina Jones HEENT Shadow Health Objective Data Collection

2. Local infection of skin and subcutaneous tissue of the foot:
– Points: 4/4
– Priority: 1/1
– Student Response: High
– Correct Priority: High
– Priority Pro Tip: Treating this infection is a high priority, as failure to do so may lead to its spread to surrounding tissues or systemically, causing adverse events like osteomyelitis and bacteremia.
– Evidence: 2/2
– Relevant: “Yeah, it looks swollen around the scrape.” (Required Evidence)
– Evidence Pro Tip: Tina presents with an open wound on the plantar surface of the foot. The wound is red, swollen, warm, and produces purulent discharge. Tina reports that the appearance and discomfort have worsened with time, supporting a diagnosis of acute infection.
– Planning: 1/1
– Relevant: Assess – Integumentary: Assess wound parameters (size, depth).
– Planning Pro Tip: Directly assessing the wound and obtaining a culture for identification of the infectious organism is crucial. Cleaning and re-dressing the wound, along with evaluating regional lymph nodes, are important steps. As the infection is the root cause of Tina’s other acute issues, prescribing an anti-infective is recommended; adjustments can be made based on culture results. Ensuring Tina understands how to treat the wound, use the anti-infective effectively, and report worsening symptoms is essential. Educating Tina on diabetes’ impact on wound healing and the need to proactively monitor foot health is crucial.

3. Uncontrolled type 2 diabetes mellitus:
– Points: 4/4
– Priority: 1/1
– Student Response: High
– Correct Priority: High
– Priority Pro Tip: Tina’s uncontrolled diabetes will delay wound healing and poses a risk for end organ damage. Providing better glucose control for Tina makes this a high priority.
– Evidence: 2/2
– Relevant: “Random blood glucose: 238” (Required Evidence)
– Evidence Pro Tip: Tina’s current blood glucose level supports a diagnosis of uncontrolled type 2 DM. Tina reports symptoms consistent with poor control such as polyuria, polydipsia, and nocturia.
– Planning: 1/1
– Relevant: Assess – Neurological: Assess for peripheral neuropathy, by testing position sense and deep tendon reflex at the ankle.
– Planning Pro Tip: Evaluating impacts of Tina’s uncontrolled diabetes, including diminished peripheral pulses, peripheral and sensory neuropathy, and retinopathy, is crucial. Ordering labs to check renal function and abnormal lipid levels, establishing a baseline fasting glucose level, and educating Tina on monitoring blood glucose and recognizing symptoms of hyperglycemia are important steps. Providing better control by prescribing a first-line drug for glucose control is recommended. Educating Tina on appropriate diet, monitoring, and treatment regimens is crucial as her diabetes is uncontrolled.

4. Asthma:
– Points: 4/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: While Tina requires education to better manage her asthma, it is a lower priority diagnosis as she does not report active respiratory complaints.
– Evidence: 2/2
– Relevant: “Um, the only things I know I’m diagnosed with are diabetes. And asthma.” (Required Evidence)
– Evidence Pro Tip: Tina reports a personal history of asthma, including past hospitalizations for asthma attacks, and her use of an albuterol inhaler. Her sibling’s asthma is of interest, given the strong genetic and environmental factors in the development of asthma.
– Planning: 1/1
– Relevant: Assess – Respiratory: Assess lung sounds with auscultation.
– Planning Pro Tip: Although Tina does not report treatment for maintenance of her asthma, instead relying on a rescue inhaler for sporadic attacks, educating her on developing and enacting a proactive plan to manage the disease is crucial. Assessing for abnormal findings, even if Tina does not report an active respiratory complaint, is valuable.

5. Dysmenorrhea:
– Points: 4/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: This is a lower priority diagnosis for Tina because she is not currently menstruating; her current pain must be addressed immediately, but it is due to her foot wound.
– Evidence: 2/2
– Relevant: “My periods are always the same–they’re bad. Cramps. Lots of bleeding for more than a week.” (Required Evidence)
– Evidence Pro Tip: Dysmenorrhea is the symptom of excessive pain with menstruation, which Tina directly reports when asked about the characteristics of her periods.
– Planning: 1/1
– Relevant: Assess – Genitourinary: Perform pelvic exam.
– Planning Pro Tip: Reducing menstrual pain can be achieved through the use of NSAIDs and/or oral contraceptives. Providing these options to Tina and educating her on their pros and cons is recommended. Urinalysis and a manual pelvic exam are useful tools to rule out causes other than her metabolic and endocrine issues.

6. Hypertension:
– Points: 4

/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: Tina’s hypertension should be addressed in this visit, but it is a lower priority than her acute complaints as her hypertension will not be significantly improved in a single visit.
– Evidence: 2/2
– Relevant: “Blood pressure: 142/82” (Required Evidence)
– Evidence Pro Tip: Hypertension is established via measurement of elevated blood pressure (systolic > 140 or diastolic > 90) on two separate occasions. Tina’s records reveal an elevated BP at the time of her ER visit, so the elevated BP at today’s visit establishes Tina’s diagnosis of hypertension. Tina’s risk factors include: race, family history of hypertension, diet, and diabetes.
– Planning: 1/1
– Relevant: Assess – Cardiovascular: Assess renal arteries for bruits, with auscultation.
– Planning Pro Tip: Educating Tina regarding hypertension, its pathophysiology, associated risks, and lifestyle interventions is crucial. Considering Tina’s risk for secondary hypertension and auscultating for renal artery bruits, which may be present in renal artery stenosis, are important steps. Exploring other causes of secondary hypertension, including hyperaldosteronism and pheochromocytoma, is also recommended.

7. Menorrhagia:
– Points: 4/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: Menorrhagia is a secondary issue caused by Tina’s endocrine and metabolic disorders and thus is a lower priority diagnosis.
– Evidence: 2/2
– Relevant: “My periods are always the same–they’re bad. Cramps. Lots of bleeding for more than a week.” (Required Evidence)
– Evidence Pro Tip: Tina reports menstruation lasting longer than 7 days, with heavy bleeding. Tina reports no recent sexual activity or potential for pregnancy, ruling out a common cause of irregular bleeding. Other potential causes ruled out by Tina’s history are hormone use, oral contraceptives, and intrauterine devices.
– Planning: 1/1
– Relevant: Intervene – Labs: Order a test of free androgen index.
– Planning Pro Tip: The cause of Tina’s heavy and irregular menstruation is endocrine disorders, so ordering labs to evaluate poly-cystic ovarian syndrome and thyroid disease is recommended. Inspecting for hair growth indicative of excessive androgen production or deficiency, and acanthosis nigricans, is crucial. Educating Tina on keeping a menstrual calendar to identify irregularities and using oral medications to reduce symptoms is advised.

8. Obesity:
– Points: 4/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: Although Tina’s obesity should be addressed in this office visit, it cannot appreciably alter the patient’s health in a single visit.
– Evidence: 2/2
– Relevant: “BMI: 31” (Required Evidence)
– Evidence Pro Tip: Based on the WHO’s BMI classification, Tina’s BMI of 31 identifies her as obese.
– Planning: 1/1
– Relevant: Intervene – Labs: Order a fasting lipid panel to evaluate for dyslipidemia.
– Planning Pro Tip: Advising Tina during this visit on diet and exercise interventions to reduce body weight is crucial. Educating her on the risks of obesity and comorbidities is important. Assessing Tina for comorbidities such as hirsutism, acanthosis nigricans, sleep apnea, dyslipidemia, and non-alcoholic fatty liver disease is recommended. Testing the patient’s thyroid function to rule out hypothyroidism is also advised.

9. Oligomenorrhea:
– Points: 4/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: Oligomenorrhea is a secondary issue caused by Tina’s endocrine and metabolic disorders and thus is a lower priority diagnosis.
– Evidence: 2/2
– Relevant: “It’s not regular. Sometimes it’s every month, but sometimes it’s more like every two months. I don’t write it down or anything. I probably get…six periods a year.” (Required Evidence)
– Evidence Pro Tip: Tina reports having about 6 periods per year, meeting the criteria for oligomenorrhea, which are periods more than 35 days apart or 9 per year. Her periods occur fewer than 90 days apart, making oligomenorrhea the correct diagnosis rather than amenorrhea.
– Planning: 1/1
– Relevant: Assess – Integumentary: Assess for the presence of axillary and pubic hair by inspection.
– Planning Pro Tip: Endocrine disorders are the cause of Tina’s irregular menstruation, so ordering labs to evaluate poly-cystic ovarian syndrome and thyroid disease is recommended. Inspecting for hair growth indicative of excessive androgen production or deficiency, and acanthosis nigricans, is crucial. Educating Tina on keeping a menstrual calendar to identify irregularities in her cycle is advised.

10. Polycystic Ovarian Syndrome (PCOS):
– Points: 4/4
– Priority: 1/1
– Student Response: Low
– Correct Priority: Low
– Priority Pro Tip: PCOS is the root cause of several of Tina’s symptoms and should be addressed. However, it is a lower priority than Tina’s acute problems; addressing her pain and hyperglycemia are more immediate needs to improve her status.
– Evidence: 2/2
– Relevant: “Patient has hirsutism and irregular menstruation.” (Required Evidence)
– Evidence Pro Tip: PCOS is supported by Tina’s presentation of hirsutism and irregular menstruation, aligning with the typical manifestations of the syndrome.

Shadow Health Tina Jones Respiratory Review Questions