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Problem Iden fica on
-Informa on Gathering
-Informa on Integra on and Interpreta on
-Working Diagnosis
Involved in Problem Iden fica on
-Clinical History
-Pa ent Interview
-Physical Exam
-Diagnos c Tes ng
-Referral/Consulta on
The Diagnos c Process
- pa ent experienced a health problem
- Pa ent engages with health care system
- Informa on gathering
- (problem iden fica on)
- Info integra on and interpreta on
- Working diagnosis
- Communica on of the diagnosis
- Treatment
- Outcomes
Five W's to improve Diagnosis
- What: labs studies and diagnos c test
- Who: pa ent popula on
- Why: ra onale for ordering tests
- When: Acuity level
- Where: loca on of body part and/ or loca on of test centers
What to consider when ordering labs and diagnos c tests?
,- Benefits
- Adverse effects
- Cost
- Risk of morbidity and mortality
- Follow up
- Poten al discomfort
Accuracy
True Value
Precision
Reproducibility
Sensi vity
ability to detect disease
% of pa ents with the disease and test posi ve
Specificity
ability to detect absense of disease
% of pa ents without the disease and a nega ve test
Likelihood Ra o
How likely for a pa ent to have the disease or condi on
Complete Blood Count with Differen als
* White Blood Cell
• Hemoglobin
• Hematocrit
• Platelet Count
• Red Blood Cell
• Mean Corpuscular Volume (MCV)
• Mean Corpuscular Hemoglobin(MCH)
• Mean Corpuscular Hemoglobin
Concentra on (MCHC)
• Red Cell Distribu on Width (RDW)
Coagula on Studies
, * Platelet Count
• Prothrombin Time (PT)
• Par al Thromboplas n Time(PTT)
• Interna onal Normalized Ra o (INR)
Other labs to consider:
• Factor V
• Fibrinogen level
BMP
• Sodium (Na)
• Potassium (K)
• Chloride (Cl)
• Bicarbonate (HC03)
• Blood Urea Nitrogen (BUN)
• Crea nine
Liver Func on Tests (LFT)
Comprehensive Metabolic Panel CMP
Glucose
Electrolytes
- Calcium
- Sodium
- Potassium
- CO2
- Chloride
Proteins
- Albumin
- Total Protein
Kidney
- BUN
- Crea nine
Liver
- ALP