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Virtual Patients: Patient with chronic dyspnea needs your help!

This Virtual Patients lesson is relevant for medical students and professionals working in health care. In this lesson, we are physicians working in the Institute of Agricultural Medicine in Lublin, Poland. As farmers have difficult access to specialized health services, general practitioners (family physicians) in rural areas participate extensively in diagnostic procedures. Please, join a GP in her consulting room in the Polish countryside. A farmer aged 40, gave a one-year’s history of dyspnea, reduced ability to do physical tasks, and a productive cough. She does not smoke. Symptoms occurred during the periods of intensive farm work – approximately 4-5 hours after performing activities such as threshing, herb packing, feeding pigs, changing litter. The farmer and her husband cultivate grain, and herbs (thyme, camomile, mint) and they also raise hens. The symptoms resolved after a few days.

On lung auscultation, crackles were heard. Which medical tests would you recommend? Among these are a chest x-ray and a spirometry test. Please interpret the test results. More tests followed, a high-resolution chest computed tomography, bronchoscopy, and bronchoalveolar lavage fluid. What is the final diagnosis and therapy? What is ‘personal sampling’? References.

The lesson contains 18 cards, which guide you through the diagnostic process. The cards provide descriptive texts, workplace information, all kind of test results, expert comments, questions, and feedback. Often, cards present a task or question. After sending an answer, feedback is given. After passing all cards, you will get a red or green mark (enough correct answers). If you are following a regular course in Munich, a tutor can give comments. The lesson is given in English only.

General information about Virtual Patients & Work

The series of medical cases for medical students and physicians-in-training for Occupational Medicine has been developed by the Institute and Clinic for Occupational, Social and Environmental Medicine at the LMU university (Munich, Germany). The cases, developed in 2006-2013, are still present-day in many countries, and useful for education. Nevertheless, cases might be not up-to-date or valid everywhere, for example regarding diagnostic procedures, risk assessment tools, therapeutic interventions, or figures like incidence rates. Differences may be caused by differences in time periods, contextual conditions, or populations. Discussion about such aspects in a group, with a colleague, or with a teacher, is an essential part of the learning experience.

Practical. Clicking the link below connects to the Casus website. Make an account going to ‘Register’. Use your e-mail address as LOGIN, fill in a personal password. When registration is completed, LOGIN again, select if needed the English language (see, under your name, ‘Options’, ‘Language). Go to ‘Player’, you see ‘Courses available’, select ‘Virtualpatient-Work.Net – English course’. Select this case. You can complete a case once. Changing answers after completing is not possible.



Original Authors:

M. Golec, A. Gora, C. Skorska, B. Mackiewicz

Original affiliation, ownership:

Institute of Agricultural Medicine in Lublin, Poland: . Clinical centre of the University of Munich Institute of Occupational and Environmental Medicine, Munich, Germany.

Year of publication:


Charge for use or free:

Free of charge


Target group(s):

graduate students, OSH experts; or in training

Usefulness for non-OSH-expert professionals:

More or less useful for non-OSH-expert professionals in health care or other sectors; or in training

Time demand to complete the lesson or course:

1- 1.5 hour


The lessons can be attended and completed online for free. No material may be copied. During the session, some private data will be stored. The learning materials can only be used if the user accepts these conditions prior to attending the online lesson.

Intellectual property and copyright:

Before downloading, changing, disseminating and/or using the lessons and courses, please look carefully at the conditions given by the authors or owners of the materials related to copyright or creative common conditions or other conditions for the downloading, changing, further dissemination and kind of use of the materials (non-commercial vs. commercial).

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