Introduction Class and Illness Scripts (Class 1&2)

Question 1

List the three steps of the diagnostic process

Answer 1

1. hypothesis
2. information gathering
3. integration and interpretation

Question 2

a manifestation of disease reported by the patient

Answer 2

a symptom
corresponds with history-taking

Question 3

• Information from the history is often charted as _________ notes

Answer 3

subjective

Question 4

Method that focuses on patients’ ideas and feelings (especially fears) about their illness, as well as the impact their condition has on their functioning and their expectations

Answer 4

patient-centred interviewing

Question 5

Inspection, auscultation (listening), percussion, palpation and other maneuvers to gather further information

Answer 5

Physical Exams

Question 6

manifestation of a disease that the clinician perceives

Answer 6

a sign
- corresponds with physical exam

Question 7

Information from physical exams is often charted as _______ notes

Answer 7

objective

Question 8

A list of conditions that are candidates for explaining the patient’s concerns

Answer 8

Differential Diagnosis

Question 9

failing to consider reasonable alternatives after an initial diagnosis is made

Answer 9

premature closure

Question 10

In expert clinicians, clinically-relevant memory is accessed in patterns termed

Answer 10

illness scripts

Question 11

______ scripts to learn and to compare and contrast conditions

Answer 11

Disease illness

Question 12

______ scripts, to facilitate differential diagnosis

Answer 12

Patient illness

Question 13

Need to consider how likely different conditions are in order to make decisions about what to do
- people don’t seem to do this well without training

Answer 13

Probability

Question 14

• Information that helps you update your estimate of probabilities
• Gathered from the patient history, physical exam and further testing

Answer 14

Evidence

Question 15

The value of a piece of evidence is well-represented by a ________

Answer 15

likelihood ratio (LR)

Question 16

________ are probabilities beyond which one will take certain actions and/or stop gathering information
- Like a diagnostic “finish line”

Answer 16

Thresholds

Question 17

The ___________________ involves gathering and interpreting information, and (re-)considering different hypotheses in light of this information

Answer 17

diagnostic process

Question 18

Components of a disease illness script

Answer 18

1. epidemiology
2. time course
3. clinical presentation (signs, symptoms)
4. mechanisms/pathophysiology

Question 19

epidemiology (3)

Answer 19

demographics: age, sex, race/ethnicity, socioeconomic status
risk factors: pre-existing conditions
exposures: travel, occupational, medication, hobbies, sexual, drugs, close contacts

Question 20

time course

Answer 20

duration: hyperacute, acute, subacute, chronic
persistence/pattern
constant: stable progressive
episodic: waxing and waning, intermittent

Question 21

Clinical Presentation

Answer 21

The most important signs and symptoms

Question 22

What constitutes a high-quality disease illness script (2)

Answer 22

1. it uses medical terminology and categories
2. it will change over time with experience and research

Question 23

How do you process a disease illness script?

Answer 23

Problem Representation
- create a problem list
- process the list
- emphasize the most valuable evidence and de-emphasize less important valuable evidence
- abstract the patient’s concerns into medical language
- finalize the problem representation in a way that it can be compared with disease illness script

Question 24

A concise representation of the patient’s concern that allows matching with a disease illness script

Answer 24

Patient Illness Scripts

Question 25

what are the components of a patient illness script?

Answer 25

1. epidemiology
2. time course
3. clinical presentation (syndrome statement)
4. other important medical history

Question 26

Clinical Presentation

Answer 26

Focus on most important signs and symptoms

Question 27

what do you exclude in the clinical presentation section of a patient illness script?

Answer 27

• Elements already mentioned in previous sections
• Findings of little relevance
• Past medical history that is unconnected to the chief complaint
• Previous diagnosis (unless they were clearly correct)

Question 28

Steps from symptoms to a possible diagnosis

Answer 28

1. make a patient illness script
2. make a simple problem list
3. make a processed problem with medical terminology
4. make a patient illness script
5. use disease illness scripts to make a differential diagnosis