T1-Diagnostic Reasoning/Health Promotion

Question 1

Read Goolsby Ch1

Question 2

Mary Breckinridge and Dixie - Frontier Nursing in Appalachia
Lilian Wald - Henry Street Settlement in New york

Question 3

Heuristics
Bayesian
Illness Scripts
Bernoulli Equation

Answer 3

What sticks? Trial and Error -potential for bias
Pre-test probability of diagnosis directly affects the post-test probability of that disease
Extensive experience, knowledge driven model of pattern recognition
Logic equation/utility hypothesis

Question 4

What is the VINDICATE acronym for DDx?

Answer 4

V Vascular
I Infectious
N neoplasticism
D Degenerative
I Iatrogenic/intoxication
C Congenital
A Autoimmunie
T Traumatic
E Endocrine/Metabolic

Question 5

What are some pivotal points to consider when evaluating DDx’s?

Answer 5

Epidemiology
Time Course
Typical Features
Mechanism of Illness

Question 6

Make a template for slide 16 (Troutman)
Make a Excell template for condition tracking.

Question 7

What is a scarletiniform rash?

Answer 7

Sand paper, red, pinpoint, rough — associated with Strep.

Question 8

Probability of disease if the screening test is POs = probability of a positive test in presence of disease (sensitivity) x prevalence (probability of disease in the population) / overall probability of a positive screening test.

Question 9

Strep - usually no cough, sudden onsiet, palatial petichiae, cervical adenitis, scarlatiniform rash +/- vomiting.

Question 10

DOC for strep

Answer 10

PCN.

Question 11

Ottawa ankle rules
Gail model for breast cancer screening.

Question 12

Amenorrhea AFMS clinical decision tree.

Question 13

Rule Algorithm links on slide 34 trautmann.

Question 14

Health promotion theories are on board exams - look into some:
Health belief Model
Pender’s Health Promotion Model
Lewin’s Theory of Change
Roger’s Theory of Diffusion
Transtheoretical model of change TTM

Question 15

What influences health-related behavior

Answer 15

Desire to avoid getting sick or get better if sick (perceived susceptibility)
Belief that a certain health action will prevent or cure illness.
(Perceived benefit)

Question 16

Pender Health Promotion belief Model increase ____ rather than _____ of ______
Used more for _____ diseases.

Answer 16

Wellness
Disease
Chronic

Question 17

Individual characteristics and experiences + behavior-specific cognitions and affect = behavioral outcome = Pender’s Model.

Question 18

Lewin’s Theory of change:
1. Unfreezing
2. Moving
3. Refreezing
Driving and restraining forces battling for change

Question 19

Stages of Roger’s theory of diffusion and innovation:

Answer 19

Knowledge (exposed to new idea)
Persuasion (develop attitude about the idea)
Decision (adopt or reject)
Implementation (use and seek additional evidence)
Confirmation (continue?)

Question 20

Innovators -> Early adopters -> Early majority -> Late majority -> laggards. What change theory are these types of adopters a part of?

Answer 20

Roger’s Theory of diffusion and innovation

Question 21

What things predict the rate of adoption according to Roger’s?

Answer 21

Relative advantage
Compatability
Complexity
Trialability
Observability

Question 22

What model of change does smoking cessation follow?

Answer 22

Transtheoretical model of change:
Pre-contemplation
Contemplation
Preparation
Action
Maintenance.

Question 23

Change is a _____ process - not ______

Answer 23

Dynamic

Linear.

Question 24

T/F: Climate change has a huge impact on human health

Answer 24

True

Question 25

Top 5 risk behaviors that cause many chronic diseases?

Answer 25

Tobacco use
Second hand smoke
Poor nutrition
Lack of physical activity
Excessive alcohol use.

Question 26

Healthy People 2030
8 global outcome measures
355 measurable public health objectives
23 high priority core objectives

Question 27

What are some examples up UPstream factors?
Is addressing social, individual needs and screening examples of upstream?

Answer 27

Community Impact - laws, policies, regulations to support health for all people and improve community conditions.

No these are midstream

Question 28

Examples of Primary, secondary and tertiary levels of prevention

Answer 28

Primary: before the disease occurs (seatbelt, vaccinations)
Secondary: reduce impact of disease or injury that already occurred (mammogram to detect breast cancer EARLY, diet/exercise programs)
Tertiary: soften impact of ongoing illness (cardiac or stroke rehab)

Question 29

USPSTF: A, B, C, D and I

Answer 29

A - offer or provide this service - high certainty that net benefit is substantial
B - offer or provide this service - high certainty net benefit is moderate.
C - offer or provide this service for select patients depending on individual circumstances.
D - discourage use of this service - harms outweigh benefits
I - insufficient evidence. Patients should understand this uncertainty.

Question 30

USPSTF Colorectal screening in 50-75yo - Grade?
45-49?
>76?

Answer 30

A, B, C

Question 31

colorectal screening guidelines:

Answer 31

Annual FOB test, flex sig q5yrs, colonoscopy q10yrs, CT q5yrs or stool DNA every 3yrs.

Question 32

Review USPSTF guidelines and become familiar with usual recs,

Question 33

Review HEDIS and become familiar with usual Recs

Question 34

Difference between sensitivity and specificity; PPV and NPV - find a good resource! - check out 3 articles on Canvas