week 1

Question 1

3 steps of the diagnostic process

Answer 1

1. hypothesis
2. information gathering
3. integration and interpretation

Question 2

diagnostic process
a) obtain some information from patient

Answer 2

-history taking
-patient-centered interviewing

Question 3

diagnostic process
b) consider what might be going on and what information you still need in order to take action

Answer 3

-illness scripts
-differential diagnosis
-probability
-evidence
-testing thresholds
-treatment thresholds

Question 4

diagnostic process
c) get this information

Answer 4

-history-taking
-patient-centered interviewing
-physical exams

Question 5

diagnostic process 4 parts

Answer 5

a) obtain some information from patient
b) consider what might be going on and what information you still need in order to take action
c) get this information
d) take appropriate action

Question 6

diagnostic process
d) take appropriate action

Answer 6

-testing thresholds
-treatment thresholds
-probability
-evidence

Question 7

history taking

Answer 7

-questions asked of a patient
-high diagnostic value and relatively inexpensive and harmless
-includes items such as different aspects of the patients presenting concerns as well as their current medications, past personal medical history, family history, social history (occupation, diet, relationships etc)
-information from the history is often charted as subjective notes

Question 8

patient centered interviewing

Answer 8

-method that focuses on patients’ ideas and feelings (especially fears) about their illness, as well as the impact their condition has on their functioning and their expectations
-people dont just seek help for symptoms; context matters
-you will be a more effective clinician if you understand the personal and emotional context of a patient concerns
–> not just diagnostically; allowing a patient to tell their story is therapeutic

Question 9

symptom

Answer 9

a manifestation of disease reported by the patient

Question 10

physical exams

Answer 10

-inspection, auscultation (listening), percussion, palpation and other maneuvers to gather further information
-information from physical exams is often charted as objective notes

Question 11

sign

Answer 11

a manifestation of disease that the clinician perceives

Question 12

sign vs symptom

Answer 12

sing: a manifestation of disease that the clinician perceives

symptom: a manifestation of disease reported by the patient

Question 13

objective vs subjective note

Answer 13

-information from physical exams is often charted as objective notes
-information from the history taking is often charted as subjective notes

Question 14

differential diagnosis

Answer 14

• a list of conditions that are candidates for explaining the patients concerns
  -ones first thought about what condition the patient has is subject to bias and, especially for beginners, too often wrong

Question 15

premature closure

Answer 15

failing to consider reasonable alternatives after an initial diagnosis is made

Question 16

illness scripts

Answer 16

-in expert clinicians, clinically-relevant memory is accessed in patterns termed “illness scripts”
–> knowledge recalled as illness scripts has a relatively consistent structure, which includes predisposing conditions, clinical features, and mechanism of the illness
-we are encouraging explicitly creating illness scripts as follows:
–>disease illness scripts to learn and compare and contrast conditions
–> patient illness scripts, to facilitate differential diagnosis

Question 17

disease illness script vs patient illness script

Answer 17

–>disease illness scripts to learn and compare and contrast conditions
–> patient illness scripts, to facilitate differential diagnosis

Question 18

probability

Answer 18

-need to consider how likely different conditions are in order to make decisions about what to do
-need to update estimates of probability as more information is obtained

Question 19

evidence

Answer 19

-information that helps you update your estimate of probabiltiies
-gathered from the patient history, physical exam and further testing
-the value of a piece of evidence is well-represented by a likelihood ratio (LR)
-how one should update one’s estimate of the probability can be calculated using the relevant likelihood ratio, though this is rarely done in practice

Question 20

testing and treatment thresholds

Answer 20

-you will never achieve 100% certainty that patient does or does not have a condition
-you therefore have to decide when to stop gathering more information
-thresholds are probabilities beyond which one will take certain actions and/or stop gathering information
–> like a diagnostic “finish line”

Question 21

what play important roles in the diagnostic process

Answer 21

history taking, patient entered interviewing, physical exams, illness scripts, differential diagnosis, probability, evidence, and testing and treatment thresholds

Question 22

what does the diagnostic process involve

Answer 22

gathering and interpreting information, and (re-)considering different hypothesis in light of this information