PC716 EXAM 3 – QUESTIONS AND ANSWERS
You are considering the hypothesis of sleep apnea. The Malampati score is 3/4. This
piece of data is which of the following? - Answers :Significant positive.
Numerical results from any screening tool, based only upon subjective data, is
documented where in the SOAP Note? - Answers :Labs and diagnostics.
The hypothesis is mononucleosis, the presence of sore throat, headache and fever are
considered to be which of the following? - Answers :Significant positives.
The hypothesis is mononucleosis, the absence of a runny nose, head congestion and
sinus pressure is what kind of data? - Answers :Significant negative.
The hypothesis is mononucleosis, the absence of nausea and vomiting, a child in the
household with strep and age 58 is considered to be what kind of data? - Answers
:Confounding.
The root cause of most diagnostic errors occurs during the. - Answers :History and
physical exam.
One little puppy lying on a bed. Mom says "roll over" He falls onto the floor. Dad puts
him on the bed and says "roll over" The puppy rolls over but now straddles between the
night stand and the bed. Sister comes in, puts the puppy on the bed and says "roll over"
The puppy does so and gets tangled in the quilt. This is an example of which of the
following? - Answers :Poor interrater reliability.
The puppy lands on the floor six times on the night stand twice and gets tangled in the
quilt twice. Mom, dad and sister believe that this landing on the floor that many times
was just a happy accident. In order to adjust for the possibility that this happened by
chance alone, they decide to apply which of the following? - Answers :Kappa statistic.
One little puppy lying on the bed. He rolls over and falls off landing on his feet. His mom
picks him up and puts him back on the bed. The puppy rolls over and lands on his feet
again. Mom repeats this sixth time and each time the puppy lands on the floor. This is
an example of? - Answers :Good intra rater reliability.
McGee sets the Kappa for identification of a liver greater than 9 centimeter using
percussion to have a Kappa of 0.11. This may be interpreted as meaning which of the
following? Two or more clinicians will. - Answers :Have slight agreement on the
presence of a liver greater than 9 centimeters by percussion. (on the same patient
under the same circumstances)
Clinician A is seeing a patient for a comprehensive annual physical exam. The patient
has no medical problems and no specific complaints or concerns. As part of the exams,
DTRs are performed. The clinician checks patients patellar reflexes and notes 1+ reflex
, on the left knee and 4+ reflex on the right. The next step for the clinician is to do which
of the following? - Answers :Repeat patellar reflexes again, keeping technique
consistent on both the right and the left knee.
You and your classmate are waiting on the preceptor to talk about Bettys physical
exam. You both know that the preceptor is going to ask you about positives, negatives
and confounders for each hypothesis. Your classmate turns to you and asks "How do
you know? The difference between a confounder and a significant negative?" - Answers
:Both are the absence (no, not, non, negative) of subjective or objective data. However,
negative support the hypothesis and confounders argue against the hypothesis.
At the end of the physical exam, your preceptor heard Betty say she was thirsty and
urinating more. The preceptor thinks that maybe diabetes was a hypothesis that needed
to be considered. The preceptor asks you if Polyurea and polydipsia are risk factors for
diabetes. And why do you think that? - Answers :Polyuria and polydipsia are NOT risk
factors for type 2 diabetes. They are symptoms of having diabetes. Risk factors are
items that increase risk but do not cause or a result of the diagnosis. For diabetes
Betty's risk factors are age and obesity.
Your preceptor asks you now that the physical exam is complete how do you think
through the objective data to make a diagnosis (Assessment)? - Answers :You consider
one hypothesis at a time and think through the data. Asking are there more PROS
(positives and negatives) vs CONS (confounders). Also paying attention to any LRs or
levels of evidence as those pieces of data have more weight. Then make a decision,
where does the weight of the data, in support or against the hypothesis. Sometimes the
data is pretty evenly divided you make sure that you have gathered all the right data, did
I sort the data correctly, but then you have to start thinking across hypotheses. This may
require that we definitively rule out another (depression and hypothyroidism) so no
matter where the data is weighted good clinical judgement requires us to keep it and
move forward.
Your classmates heard in the Workshop that data can do "double duty", meaning it can
be in one bucket for one hypothesis and be in a different bucket for another hypothesis.
Can you give them an example of how one piece of data supported one hypothesis and
argued against another? - Answers :There are so many examples of data doing double
duty. Look at any piece of data in the confounder bucket. I bet you can find it in the
positive or negative bucket for another hypothesis. Example) Neck Circumference
16.5cm. For the hypothesis of OSA that is a positive but a confounder for all other
hypothesis. Example) No periorbital edema. For the hypothesis of Hypothyroidism you
will find it in the confounder bucket but the significant negative bucket for all the other
hypothesis.
Your preceptor wants to know what section (S/O/A/P) you are DOCUMENTING these
pieces of data.
1. A1c (no result available at visit) - Answers :Plan: diagnostics.
You are considering the hypothesis of sleep apnea. The Malampati score is 3/4. This
piece of data is which of the following? - Answers :Significant positive.
Numerical results from any screening tool, based only upon subjective data, is
documented where in the SOAP Note? - Answers :Labs and diagnostics.
The hypothesis is mononucleosis, the presence of sore throat, headache and fever are
considered to be which of the following? - Answers :Significant positives.
The hypothesis is mononucleosis, the absence of a runny nose, head congestion and
sinus pressure is what kind of data? - Answers :Significant negative.
The hypothesis is mononucleosis, the absence of nausea and vomiting, a child in the
household with strep and age 58 is considered to be what kind of data? - Answers
:Confounding.
The root cause of most diagnostic errors occurs during the. - Answers :History and
physical exam.
One little puppy lying on a bed. Mom says "roll over" He falls onto the floor. Dad puts
him on the bed and says "roll over" The puppy rolls over but now straddles between the
night stand and the bed. Sister comes in, puts the puppy on the bed and says "roll over"
The puppy does so and gets tangled in the quilt. This is an example of which of the
following? - Answers :Poor interrater reliability.
The puppy lands on the floor six times on the night stand twice and gets tangled in the
quilt twice. Mom, dad and sister believe that this landing on the floor that many times
was just a happy accident. In order to adjust for the possibility that this happened by
chance alone, they decide to apply which of the following? - Answers :Kappa statistic.
One little puppy lying on the bed. He rolls over and falls off landing on his feet. His mom
picks him up and puts him back on the bed. The puppy rolls over and lands on his feet
again. Mom repeats this sixth time and each time the puppy lands on the floor. This is
an example of? - Answers :Good intra rater reliability.
McGee sets the Kappa for identification of a liver greater than 9 centimeter using
percussion to have a Kappa of 0.11. This may be interpreted as meaning which of the
following? Two or more clinicians will. - Answers :Have slight agreement on the
presence of a liver greater than 9 centimeters by percussion. (on the same patient
under the same circumstances)
Clinician A is seeing a patient for a comprehensive annual physical exam. The patient
has no medical problems and no specific complaints or concerns. As part of the exams,
DTRs are performed. The clinician checks patients patellar reflexes and notes 1+ reflex
, on the left knee and 4+ reflex on the right. The next step for the clinician is to do which
of the following? - Answers :Repeat patellar reflexes again, keeping technique
consistent on both the right and the left knee.
You and your classmate are waiting on the preceptor to talk about Bettys physical
exam. You both know that the preceptor is going to ask you about positives, negatives
and confounders for each hypothesis. Your classmate turns to you and asks "How do
you know? The difference between a confounder and a significant negative?" - Answers
:Both are the absence (no, not, non, negative) of subjective or objective data. However,
negative support the hypothesis and confounders argue against the hypothesis.
At the end of the physical exam, your preceptor heard Betty say she was thirsty and
urinating more. The preceptor thinks that maybe diabetes was a hypothesis that needed
to be considered. The preceptor asks you if Polyurea and polydipsia are risk factors for
diabetes. And why do you think that? - Answers :Polyuria and polydipsia are NOT risk
factors for type 2 diabetes. They are symptoms of having diabetes. Risk factors are
items that increase risk but do not cause or a result of the diagnosis. For diabetes
Betty's risk factors are age and obesity.
Your preceptor asks you now that the physical exam is complete how do you think
through the objective data to make a diagnosis (Assessment)? - Answers :You consider
one hypothesis at a time and think through the data. Asking are there more PROS
(positives and negatives) vs CONS (confounders). Also paying attention to any LRs or
levels of evidence as those pieces of data have more weight. Then make a decision,
where does the weight of the data, in support or against the hypothesis. Sometimes the
data is pretty evenly divided you make sure that you have gathered all the right data, did
I sort the data correctly, but then you have to start thinking across hypotheses. This may
require that we definitively rule out another (depression and hypothyroidism) so no
matter where the data is weighted good clinical judgement requires us to keep it and
move forward.
Your classmates heard in the Workshop that data can do "double duty", meaning it can
be in one bucket for one hypothesis and be in a different bucket for another hypothesis.
Can you give them an example of how one piece of data supported one hypothesis and
argued against another? - Answers :There are so many examples of data doing double
duty. Look at any piece of data in the confounder bucket. I bet you can find it in the
positive or negative bucket for another hypothesis. Example) Neck Circumference
16.5cm. For the hypothesis of OSA that is a positive but a confounder for all other
hypothesis. Example) No periorbital edema. For the hypothesis of Hypothyroidism you
will find it in the confounder bucket but the significant negative bucket for all the other
hypothesis.
Your preceptor wants to know what section (S/O/A/P) you are DOCUMENTING these
pieces of data.
1. A1c (no result available at visit) - Answers :Plan: diagnostics.
