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CMS100- Foundations of clinical medicine > Test 1- Lecture 1-5 > Flashcards

Test 1- Lecture 1-5 Flashcards

1
Q

a naturopathic Dr just obtained some initial info from a px about her main concern, what is the next step

A

consider what information is still needed

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2
Q

If a practitioner is seeking to obtain valuable medical information while exposing the patient to minimal harm, discomfort or inconvenience, what aspect of the diagnostic process will they engage in?

A

history taking

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3
Q

In what section of a medical chart would we be most likely to include information about symptoms?

A

subjective

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4
Q

What term is used to describe a mental summary of a practitioner’s knowledge of a disease?

A

illness script

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5
Q

What single attribute of a test will best help a practitioner determine its value as evidence as it relates to a particular condition?

A

likelihood ratio (LR)

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6
Q

of total cases within a given time period within a specific population AKA how common a Cx is in a certain population

A

prevalence

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7
Q

diagnostic process wheel contains what 3 factors

A
  1. hypothesis
  2. gathering
  3. interpret info
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8
Q

Hx taking
pt-centered interview

A

step 1 of the diagnostic process diagram: obtain info from px

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9
Q

factors when considering what might be going on with the px and what info you still need in order to take action

A

illness scripts, DDx, probability, evidence, testing thresholds, treatment thresholds (could be px education, diagnostic imaging etc.)

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10
Q

Hx taking
pt centered interview
PE

A

step 2 of the diagnostic process diagram: get this information

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11
Q

purpose of px-centered interview

A

focus on C/C, feelings, fears, impact, expectations

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12
Q

manifestation of disease found by the clinician and charted in the OBJECTIVES

A

signs

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13
Q

DDx

A

list of potential Cx associated with the px concenrs

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14
Q

premature closure

A

failure to consider all possibilities after the initial diagnosis is made and could lead to misdiagnosis
- px often assume their first thoughts of Cx is always correct ( subject to bias

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15
Q

ways memory is assessed, clinically-relevant memories where knowledge is recalled including: predisposing Cx, who’s more vulnerable

A

illness scripts

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16
Q

when are illness scripts used?

A

to describe summary of practitioner’s knowledge of disease or to compare/ contrast Cx

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17
Q

probability

A

the likelihood of different Cx presented in order to make the right decisions of what to do next

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18
Q

Evidence using likelihood ratios

A

infos that helps update your estimate of probabilities from evidence

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19
Q

how do you gather evidence to increase LR

A

History taking for pre test

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20
Q

when do you use LR

A

to estimate one’s probability of a Cx

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21
Q

threshold

A

probabilities beyond a point you stop gathering info, but never 100% certainty

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22
Q

parts of an illness script

A
  1. Disease
  2. epidemiology
  3. timing
  4. S/S
  5. Mechanism: pathophysiological
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23
Q

demographic, age, sex, ethnicity, SES, predispositions, exposures, social, FHx

A

Epidemiology

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24
Q

time course (3)

A
  1. duration: hyper acute (same day), acute (few days), subacute, chronic
  2. persistence/ pattern: constant, stable, progressive
  3. episodic: waxing (increasing in intensity over time), waning (decreasing in intensity overtime or becomes more mild), intermittent (comes and goes)
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25
Q

syndromes

A

collection of S/S grouped in a medical Cx with recognizable patterns

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26
Q

between 2-3 diseases, organized chart

A

comparing and contrasting illness scripts

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27
Q

px illness script vs disease illness script

A

what is happening with the px vs the disease illness script where the ND transcribes in medical terminology and compares/ contrasts potential Cx
- representation of px concerns matching to a disease illness script

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28
Q

when comparing disease illness scripts, which of the following should you do?

A

create a table with illness scripts in adjacent columns/ rows

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29
Q

allows for the possibility that the initial beliefs about the diagnosis were incorrect

A

DDx

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30
Q

A process at which clinicians think about the possible causes of the px S/S before making a final diagnosis after obtaining information from the px→ compare the information to one’s understanding of different conditions to generate multiple hypothesis that could answer the S/S

A

DDx

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31
Q

what is one problem that people may fail to consider after arriving at an initial guess of a Cx

A

involve considering that you might have been wrong

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32
Q

process of DDX

A

obtain px info, create problem representation and px illness script, compare px illness script to a # of disease illness scripts

33
Q

what often occurs for beginners in terms of errors

A

higher % of missing a serious diagnosis
the first guess is often wrong because the most common Cx are not usually the most serious

34
Q

availability heuristic

A

“jumping the gun” a type of cognitive error–> a person would use an initial guess from info that comes quickly & easily that could worsen diagnostic performance

35
Q

Possibilism

A

a type of error when you make a list of all possibilities, but the list could be too long, unnecessary testings with no use of probability

36
Q

2 types of errors

A
  1. availability heuristic
  2. possibilism
37
Q

prediction based on available medical info, the expected outcome for person’s health & Cx, the healthcare provider will predict what will happen, if its going to improve or get worse

A

prognosis

38
Q

philosophically; what Cx have the best benefit to harm ratio if treated
healthcare providers make decisions about px care, need to consider what research is most effective and practical for improving px’x health

A

pragmatism

39
Q

what is the difference between pragmatism and prognosis

A

pragmatism is a philosophical approach that guides decision-making based on practically and real-world consequences, whereas prognosis is a medical term that describes the predicted outcome of px’s medical condition

40
Q

how is pragmatism and prognosis related

A

the pragmatic approach to healthcare decision-making could involve considering the prognosis as one of the factors when determining the most practical and effective course of action for the px

41
Q

the steps for DDx illness scripts

A
  1. make a problem list, list everything found from case study
  2. processed problem list of what’s key factors
  3. Px illness script (epidemiology, timing, syndrome statement, other history)
  4. other history
  5. DDX- Final Cut with the epidemiology, timing, syndrome, mechanism
42
Q

what is measured as likelihood ratios (Lrs)

A

the strength of evidence that is measured

43
Q

what does LR represent

A

numerical value of information from a test

44
Q

LR=1 indicates what

A

are useless ( don’t change probability)

45
Q

LR> 1, to infinity indicates what?

A

increases the probability

46
Q

LR<1 indicates (fractions or decimals down to 0)

A

decreases the probability

47
Q

how much the evidence changes your mind depends on the strength of evidence

A

but the change in probability isn’t linear

48
Q

pre-test probability

A

likelihood a person has a particular condition/ disease BEFORE a diagnostic test is preformed, an estimate of how likely that px has that condition based on their Sx, Hx, risk factors

49
Q

if you’re initial probability is closer to 0% or 100% what is most likely to happen?

A

it would be more difficult to change your mind

50
Q

how much more likely a person WITH a medical condition will test positive compared to a person without a condition
- higher LR+ = strong indication that a person has a condition
- how probability of disease shifts when the finding is present

A

positive LR (LR+)

51
Q

how much more less likely it is for a person with a medical condition to have a negative test compared to a person without the condition
- a lower LR- means that a negative test is a good indicator that the condition is not present

A

negative LR (LR-)

52
Q

probability

A

how likely something is to happen, not possible to reach 100%

53
Q

define biases

A

not a personal shortcoming, but a human trait that people use “common representatives” to make judgements

54
Q

how do people use their biases to make judgements?

A

assessing how closely something/someone matches their perceived ideologies/stereotypes, probabilities or likelihoods based on similarities of perceived ideas

55
Q

the degree to something is representative or similar to a stereotype, “ must be this because it fits the stereotype”

A

bias automatic assessment of representativeness

56
Q

pre-test probability

A

best estimate of a disease probability before doing any diagnostic testing

57
Q

post testing probability

A

from the pre-test probability with diagnostic tools to calculate post-testing probability

58
Q

best reference class

A

set of patients that reflects the px in a population.

59
Q

prevalence

A

epidemiological measure portion of the population that has the condition RIGHT NOW

60
Q

what is the difference of prevalence and incidence

A

prevalence: portion of the population that currently has the condition without a. timeline

incidence: rate of new cases of a condition developing in a population over a defined period

61
Q

what are the pros of prevalence

A

easy to research, can specify subpopulations, more accurate estimates, take into account the presenting Sx to provide more accurate initial judgement of potential Cx

62
Q

what are the cons of prevalence

A

underestimate if something people may frequently seek attention for, which in database may increase the prevalence OR does not accurately reflect acute conditions bc research is uncommon

63
Q

base rate neglect

A

aka base rate fallacy: cognitive error when people focus too much on specific information ( ex: results of diagnostic test) and underestimate the broader context of “ base rate”

64
Q

what can occur if a person neglects base rate?

A

erroneous (incorrect) conclusions bc it disregards the overall likelihood of a probability of Cx
- ex” hearing about a rare disease that has very severe Sx, “google self diagnosis” and causes misdiagnosis

65
Q

what are 3 types of cognitive biases

A
  1. anchoring bias
  2. confirmation bias
  3. base rate neglect
66
Q

cognitive bias where people rely heavily on first piece of information “anchoring” to make decisions/ estimations

A

ANCHORING BIAS

-ex: if a seller sets a high price for a used car it can influence the buyer’s perception of the cars value, making them more likely to agree to a higher price than they may have, anchoring their judgement without rationally thinking it through

67
Q

confirmation bias

A

seek, interpret info that confirms pre-existing beliefs/ hypotheses while ignoring or downplaying info that contradicts them
-ex: someone strongly believes in a particular political ideology may only pay attention to news sources that align with their beliefs, while dismissing opposing perspectives

68
Q

what is room for improvement concept and how does it relate to biases

A

overestimates the probability of a diagnosis

stemming from 3 biases: base rate neglect. anchoring bias, confirmation bias

69
Q

what s the consequence of overestimation

A

overuse of medication, excessive procedures, corrupt shared decision making with patient.

70
Q

what should you NOT use to for probabilities

A
  1. incidence in the population
  2. lifetime prevalence: chances of developing the disease overestimated, not general representation of the population
  • use epidemiology instead
71
Q

which if the following would make for the best reference class for use in estimating pretest probability?

A

research on the eventual diagnosis group that is similar to the. symptoms that the px seems to be presenting

72
Q

Double counting evidence

A

findings are closely correlated or included in each other’s findings
Ex: increased patellar reflex and increased ankle jerk reflex

73
Q

px who have the disease (numerator), the probability that the test will be positive

A

Sensitivity- TRUE POSITIVE

LR+ : (ex: probability that you would see certain evidence if your hypothesis were true)

74
Q

in px, who don’t have the disease, probability that your test will be negative

A

specificity - TRUE NEGATIVE

(if you were to see the same evidence if your hypothesis was false)

75
Q

PPV: positive predictive value

A

probability that disease is PRESENT given the test was POSITIVE

76
Q

PPV: negative predictive value

A

probability that disease is ABSENT given that the test was NEGATIVE

77
Q

pathgnomonic

A

high LR+, not necessarily sensitive but highly specific

78
Q

sine qua non

A

findings if absent strongly decreases the probability of a condition (Low LR- close to 0)

CMS100- Foundations of clinical medicine (1 decks)

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