NURS 752 Exam 3 Questions with 100%
Correct Answers
Big 3 Category- Top Misdiagnosis
stroke, sepsis, lung cancer
#1 cause of malpractice
Misdiagnosis
What helps form hypotheses and create your diagnostic reasoning?
Epidemiology
Clinical diagnosis requires
info from pt (subjective) 75%
use that info with ur knowledge of understanding disease + PE is 15%
Likelihood Ratios
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
,Proportion of patients without the diagnosis who have the physical sign (e.g., positive
finding)
ex: me for celiac disease
Sensitivity
Proportion of patients without the diagnosis who lack the physical sign (i.e., have a negative
result)
Likelihood Ratio Definition
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)
Intuitive vs Analytical
Experts vs. Novices
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
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
· 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:
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:
reorganize their knowledge in a relational way- S&S to syndromes to disease
ACL Article:
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
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
Grade A- ages 15-65
Cervical Cancer
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
Correct Answers
Big 3 Category- Top Misdiagnosis
stroke, sepsis, lung cancer
#1 cause of malpractice
Misdiagnosis
What helps form hypotheses and create your diagnostic reasoning?
Epidemiology
Clinical diagnosis requires
info from pt (subjective) 75%
use that info with ur knowledge of understanding disease + PE is 15%
Likelihood Ratios
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
,Proportion of patients without the diagnosis who have the physical sign (e.g., positive
finding)
ex: me for celiac disease
Sensitivity
Proportion of patients without the diagnosis who lack the physical sign (i.e., have a negative
result)
Likelihood Ratio Definition
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)
Intuitive vs Analytical
Experts vs. Novices
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
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
· 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:
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:
reorganize their knowledge in a relational way- S&S to syndromes to disease
ACL Article:
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
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
Grade A- ages 15-65
Cervical Cancer
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
