Intro to diagnosis/managment Flashcards
The process of clinical reasoning is: Collaborative Reflective Conscious Unconscious All of the above
All of the above
Clinical reasoning is based on what aspects (3)?
- Clinical findings
- Patient choices
- The clinician’s judgment (knowledge, experience, evidence)
Pattern Recognition (system 1) of problem-solving methods -
- “Forward reasoning”
- Faster
- More efficient
- Developed “scripts” or prototypes
Hypothetico-Deductive (System II) of problem-solving methods -
- “Backward reasoning”
- Heavy Reliance in Novice Practice
- Utilized by experts when faced with unfamiliar presentations
Mixed (diagnostic reasoning) of problem-solving methods most common in what level of clinicians?
Most common among expert clinicians
Probabilistic reasoning -
ex: Hx of ACL injury ->
- Assessing likelihood of a clinical hypothesis
- Statistic
- Approximated
ex: high probability of degenerative ACL
Causal reasoning uses inferences from _____ findings to reason a _____ relationship of variables.
- Inferences from clinical findings
- Cause and effect relationships of variables
- Based on normal/abnormal physiology
Case-based reasoning -
- Knowledge stored in a symbolic “script”
2. “Script” recalled in subsequent encounters with similar circumstances
Narrative reasoning -
Concerns the understanding of patients’ stories in order to gain insight into their:
- Experiences of disability or pain
- Their subsequent beliefs, feelings, and health behaviors
Strategy of seeking data to reduce suspicion of unlikely hypothesis
Elimination strategy
Negative likelihood ratio -
What values are of importance?
ex: Canadian c-spine rules
how many times more likely a negative test will be seen in those with the disorder than those without the disorder
Values <0.2 of importance
Values < 0.1 of significant importance
ex: Canadian c-spine rules - if test in negative then we can rule out need for x-rays
T/F Low negative likelihood ratio is good earlier in examination.
True rule out serious or other health conditions
Strategy seeking data to support a highly likely hypotheses
Confirmation strategy
positive likelihood ratio -
What values are of importance?
ex: Wainner’s Test Item Cluster for cervical Radiculopathy
how many times more likely a positive test will be seen in those with the disorder than those without the disorder
Values >5 of importance
Values >10 of significant importance
ex: Wainner’s Test Item Cluster for cervical Radiculopathy - if positive, will likely have diagnoses
T/F High positive likelihood ratio is good earlier in examination.
False, high positive is good but administered later in examination
What type of tests aids in narrowing hypothesis and therefore examination procedures?
Special tests
Tests with low (-) Likelihood Ratio (-LR) good to -
refute a diagnostic hypothesis
Tests with high + Likelihood Ratio (+LR) good to
confirm a diagnostic hypothesis
Discrimination Strategy -
- seeking information to discriminate between likely hypotheses
- We will have strategies that help us be confident with one diagnosis over another
Ockham’s Razor
the simplest solution may be the best
Hickam’s Dictum
Patients can have as many diseases as they d[ar]n well please
What are the steps of Diagnosis: the differential process to come to a diagnostic hypothesis?
- Chart review/patient interview
- visual inspection
- systems review
- elimination tests
- structural stress testing
- palpation and joint mobility tests
- confirmation tests
What are the steps after the diagnostic hypothesis?
- Performance measures/functional improvement
- Continued testing
- Response to interventions
- Clinical progress
T/F In many cases, special clinical tests are also used early to rule out the presence of red flags or conditions
True