Bates Chapter 2 Flashcards | Quizlet

Bates Chapter 2

9/27/16, 10:08 PM

28 terms by Cristina_Hall

7 Steps of Clinical Reasoning

1. Identify abnormal findings

2. Localize findings anatomically
3. Interpret the findings in terms of
probable processes
4. Make hypotheses about the nature of
the patient's problem
5. Test your hypotheses
6. Establish a working diagnosis
7. Develop a plan agreeable to the patient

1. Identify abnormal findings

make a list of signs and symptoms found

during exam (objective and subjective),
and include any labs.

2. Localize findings anatomically

pinpoint the body part or system that the

symptom is associated with. Be as specific
as possible.

3. Interpret findings in terms of probable

processes

after finding WHERE the symptoms are

coming from, try to figure out how they
started (i.e. head ache from trauma)

4. Make hypotheses about the nature of

the patient's problem

draw on all knowledge and use evidence

based decision making.

5. Test your hypotheses

by getting a deeper hx, additional exams,

lab studies or x rays. Extra steps may not
be necessary if dx seems clear cut.

6. Establish a working diagnosis

establish a definition of the problem at the

highest level of explicitness and certainty
that the data allow. Could be general such
as tension headache, cause unknown or
something more specific.

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7. Develop a plan agreeable to the patient

help the patient come up with a solution

they can work with. Specify steps that are
needed next, which range from getting
more tests to confirm a diagnosis to
arranging family meetings, changing
medicines, etc. Make sure the patient is an
active participant in the plan.

Gravida, Parity, Miscarriages, Living (G, P,

M, L)

# of times pregnant, # of times carried to

viable gestational age, miscarriages, living
children. In chart displayed with just the
number separated by -.

Pack-years

# of packs smoked per day x years

smoking
ex: 2 packs x 10 years = 20 pack years

Problem List

Summarizes the patient's problems for the

front of the oce or for the chart. The
most active and serious problems are
listed first along with their date of onset.
This helps to remember to check certain
problems on follow up visits. Can also list
severe allergies to medication. Do not list
minor concerns that don't require
attention (ex: canker sores)

Reliability

Indicates how dependably repeated

measurements of the same relatively
stable phenomenon will give the same
result, also known as precision. May be
measured for one observer or more than
one observer.
How often do you get the same result?

Validity

Indicates how closely a given observation

agrees with the true state of aairs, or the
best possible measure of reality. Ex: BP
measurement by mercury based BP cus
are less valid than intra-arterial pressure
tracings.

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Sensitivity

Identifies the proportion of people who

test positive in a group of people known
to have a certain condition. When the test
is negative in people with the disease this
is a false negative. Good tests have
sensitivities of >90%, and when are
negative help rule out disease because
they are rarely wrong.
SnNout: when the Sensitivity of a
symptom or sign is high, a Negative
response rules OUT the target disorder.

Specificity

Identifies the proportion of people who

test negative in a group of people to be
without a given disease or condition, or
the proportion of people that are true
negatives. When the test is positive for
someone without the disease, it is a false
positive. Opposite of sensitivity.
SpPin: when the SPecificity is high, a
Positive test result rules IN the target
disorder.

Positive Predictive Value

the probability of disease in the patient

with a positive (abnormal) test, or the
proportion of true positives out of the
total population with the disease.
Ex: in a group of women with palpable
breast nodules in a cancer screening
program, the proportion with confirmed
breast cancer constitutes the PPV for
using palpable breast nodules for dx
breast cancer.

Negative Predictive Value

the probability of not having the condition

or disease when the test is negative.
Ex: in a group of women with palpable
breast nodules, the proportion without
confirmed breast cancer constitutes the
NPV.

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Predictive Value

9/27/16, 10:08 PM

Indicates how well a given symptom, sign,

or test result predicts the presence or
absence of a disease.
PPV + NPV = 100%

A 62 y/o school principle with a history of

COPD presents to the ER foe evaluation
of shortness of breath. You notice that his
lips, oral mucosa, and tongue are blue.
You diagnose a COPD exacerbation. The
discoloration of his lips, oral mucosa, and
tongue is referred to as:

Central cyanosis

Central Cyanosis

Occurs due to a ventilatory or circulatory

problem that leads to poor oxygenation in
the lungs when arterial O2 sat drops
below 85

Peripheral Cyanosis

Blue tint in fingers or extremities due to

inadequate circulation. The blood
reaching the extremities is not oxygen rich
and when viewed through the skin a
combination of factors can lead to a blue
color. Cna be observed in the absence of
heart or lung failures.

A 30 y/o janitor presents to your clinic for

evaluation of increasing weight. He drinks
a fifth of vodka daily. He has used IV drugs
in the past but is now clean. His sclerae
and skin have a yellowish tinge. He has a
large abdominal girth. You diagnose him
with liver disfunction. What is the
discoloration of his skin called?

Jaundice

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A 72 y/o retired secretary is brought to the

clinic by her daughter. The daughter is
concerned because her mother seems to
be more confused; she has gained more
weight, but her appetite has decreased,
and she seems to be more swollen in
general. You obtain blood tests and
diagnose her with profound
hypothyroidism. on examination of the
skin, you would expect it to feel:

Cool

A 42 y/o receptionist presents to your

oce for evaluation of multiple moles
(nevi). She used to sunbathe a lot when
she was younger and went to tanning
salons regularly until 2 years ago. You are
educating her about melanoma. When
evaluating a mole,m all of the following
characteristics are important to note
except:

Diameter smaller than 6 mm

A 52 y/o oce worker presents to your

oce for evaluation of a bump on his face.
It appeared 1 month ago and is growing.
He denies fever, chills, or itching. Physical
examination reveals a .4 cm nodule with a
depressed ceter and a firm elevated
border that is flesh colored. Based on this
information what is your most likely
diagnosis?

Basal cell carcinoma

Basal Cell Carcinoma

Initially translucent nodule, spreads,

leaves a depressed center with a firm
elevated border.

Squamous Cell Carcinoma

May develop in conjunction with an actinic

keratosis, firm, red.

Spider Angioma

Fiery red, central body surrounded by

erythema and radiating legs.

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