NURS 752 Exam 3 (Final) questions with
answers
Big 3 Category- Top Misdiagnosis - ANSWER: ➡ stroke, sepsis, lung cancer
#1 cause of malpractice - ANSWER: ➡ Misdiagnosis
What helps form hypotheses and create your diagnostic reasoning? - ANSWER: ➡ Epidemiology
Clinical diagnosis requires - ANSWER: ➡ info from pt (subjective) 75%
use that info with ur knowledge of understanding disease + PE is 15%
Likelihood Ratios - ANSWER: ➡ Weights that help you understand how much a physical sign
argues for or against a diagnosis
Possible weights of 0 to infinity
>1 means increased probability of disease
<1 means decreased probability of disease
Specificity - ANSWER: ➡ Proportion of patients without the diagnosis who have the physical sign
(e.g., positive finding)
ex: me for celiac disease
,Sensitivity - ANSWER: ➡ Proportion of patients without the diagnosis who lack the physical sign
(i.e., have a negative result)
Likelihood Ratio Definition - ANSWER: ➡ probability of finding in pts with disease / probability of
same finding in pts without disease
2 approaches to clinical decision-making Metacognition (thinking about thinking) - ANSWER: ➡
Intuitive vs Analytical
Experts vs. Novices - ANSWER: ➡ experts gather less data, but better data, organize better = shorter
time to make accurate diagnosis
what makes a good clinical diagnostician? asking right questions
Article: Diagnostic Excellence and Patient Safety - Strategies and Opportunities - ANSWER: ➡ PC-
cancer screening (colonoscopy 10 years, FOBT 2 years = survival rate up)
ED- sepsis (more deaths than some cancers) good improvements but more needed
Inpatient- PE (over tested but under diagnosed) better with clinical decision tools and plasma d-
dimer measurement
Article: Big 3 diagnostic errors and serious misdiagnoses related harms are - ANSWER: ➡ · 5
vascular events: stroke, MI, venous thromboembolism, aortic aneurysm/dissection, arterial
thromboembolism
· 5 infections: sepsis, meningitis/encephalitis, spinal abscess, pneumonia, endocarditis
· 5 cancers- lung, breast, colorectal, prostate, melanoma
Video: Catherine Lucey- Good clinical diagnosticians: - ANSWER: ➡ o Efficiently obtain enough
information from patient to make initial differential diagnosis
o Search memory/resources to identify possible causes of patient's symptoms
,o Prioritize the likelihood that a possible disease explains patient's concerns
o Use tests (carefully) to evaluate their assessments have to be careful and know and get correct
proper information because some tests are harmful, expensive, wasteful, timely
o Always continue to analyze the success of their diagnoses to improve accuracy going forward
Video: Catherine Lucey- experts: - ANSWER: ➡ reorganize their knowledge in a relational way- S&S
to syndromes to disease
ACL Article: - ANSWER: ➡ common knee injury in athletes
clinical diagnostic tests and MRI are 2 methods of evaluating ACL injuries
evidence supports clinical diagnostic tests, faster, sooner, cheaper too
gold standard: diagnostic arthroscopy
Screening tests - ANSWER: ➡ to detect asymptomatic and early stage disease
should be highly sen/spec to pick up most cases of true disease and avoid false positives
targeted toward pop with higher disease prevalence (high positive predictive value)
safe, cost effective
should screen for diseases in which early identification and treatment have been demonstrated to
improve clinical outcomes
HIV - ANSWER: ➡ Grade A- ages 15-65
, Cervical Cancer - ANSWER: ➡ Grade A- ages 21-65
21-29 cervical cytology every 3 years
30-65 cervival cytology every 3 years and HIV every 5 years
Colorectal Cancer - ANSWER: ➡ 45-75
45-49 grade B
50-75 grade A
HTN - ANSWER: ➡ adults 18 and older without known HTN: grade A- office BP
Ovarian Cancer - ANSWER: ➡ Asymptomatic women- against- grade D
High value screening tips - ANSWER: ➡ screen less
dont screen if living less than 10 yrs
discuss potential downstreams before initial
use higher treshold for positive result
understand basic test characteristics and limitations as well as pts goals/values
Role of diagnostic testing - ANSWER: ➡ to reduce uncertainty regarding a specific patient diagnosis
answers
Big 3 Category- Top Misdiagnosis - ANSWER: ➡ stroke, sepsis, lung cancer
#1 cause of malpractice - ANSWER: ➡ Misdiagnosis
What helps form hypotheses and create your diagnostic reasoning? - ANSWER: ➡ Epidemiology
Clinical diagnosis requires - ANSWER: ➡ info from pt (subjective) 75%
use that info with ur knowledge of understanding disease + PE is 15%
Likelihood Ratios - ANSWER: ➡ Weights that help you understand how much a physical sign
argues for or against a diagnosis
Possible weights of 0 to infinity
>1 means increased probability of disease
<1 means decreased probability of disease
Specificity - ANSWER: ➡ Proportion of patients without the diagnosis who have the physical sign
(e.g., positive finding)
ex: me for celiac disease
,Sensitivity - ANSWER: ➡ Proportion of patients without the diagnosis who lack the physical sign
(i.e., have a negative result)
Likelihood Ratio Definition - ANSWER: ➡ probability of finding in pts with disease / probability of
same finding in pts without disease
2 approaches to clinical decision-making Metacognition (thinking about thinking) - ANSWER: ➡
Intuitive vs Analytical
Experts vs. Novices - ANSWER: ➡ experts gather less data, but better data, organize better = shorter
time to make accurate diagnosis
what makes a good clinical diagnostician? asking right questions
Article: Diagnostic Excellence and Patient Safety - Strategies and Opportunities - ANSWER: ➡ PC-
cancer screening (colonoscopy 10 years, FOBT 2 years = survival rate up)
ED- sepsis (more deaths than some cancers) good improvements but more needed
Inpatient- PE (over tested but under diagnosed) better with clinical decision tools and plasma d-
dimer measurement
Article: Big 3 diagnostic errors and serious misdiagnoses related harms are - ANSWER: ➡ · 5
vascular events: stroke, MI, venous thromboembolism, aortic aneurysm/dissection, arterial
thromboembolism
· 5 infections: sepsis, meningitis/encephalitis, spinal abscess, pneumonia, endocarditis
· 5 cancers- lung, breast, colorectal, prostate, melanoma
Video: Catherine Lucey- Good clinical diagnosticians: - ANSWER: ➡ o Efficiently obtain enough
information from patient to make initial differential diagnosis
o Search memory/resources to identify possible causes of patient's symptoms
,o Prioritize the likelihood that a possible disease explains patient's concerns
o Use tests (carefully) to evaluate their assessments have to be careful and know and get correct
proper information because some tests are harmful, expensive, wasteful, timely
o Always continue to analyze the success of their diagnoses to improve accuracy going forward
Video: Catherine Lucey- experts: - ANSWER: ➡ reorganize their knowledge in a relational way- S&S
to syndromes to disease
ACL Article: - ANSWER: ➡ common knee injury in athletes
clinical diagnostic tests and MRI are 2 methods of evaluating ACL injuries
evidence supports clinical diagnostic tests, faster, sooner, cheaper too
gold standard: diagnostic arthroscopy
Screening tests - ANSWER: ➡ to detect asymptomatic and early stage disease
should be highly sen/spec to pick up most cases of true disease and avoid false positives
targeted toward pop with higher disease prevalence (high positive predictive value)
safe, cost effective
should screen for diseases in which early identification and treatment have been demonstrated to
improve clinical outcomes
HIV - ANSWER: ➡ Grade A- ages 15-65
, Cervical Cancer - ANSWER: ➡ Grade A- ages 21-65
21-29 cervical cytology every 3 years
30-65 cervival cytology every 3 years and HIV every 5 years
Colorectal Cancer - ANSWER: ➡ 45-75
45-49 grade B
50-75 grade A
HTN - ANSWER: ➡ adults 18 and older without known HTN: grade A- office BP
Ovarian Cancer - ANSWER: ➡ Asymptomatic women- against- grade D
High value screening tips - ANSWER: ➡ screen less
dont screen if living less than 10 yrs
discuss potential downstreams before initial
use higher treshold for positive result
understand basic test characteristics and limitations as well as pts goals/values
Role of diagnostic testing - ANSWER: ➡ to reduce uncertainty regarding a specific patient diagnosis
