General Medicine Lecture 3 Problem-Based Medicine

Front 1

What are 7 types of diagnosis?

Back 1

1) Differential
2) Tentative
-working
3) Presumptive
4) Etiological (agent)
5) Anatomic
6) Open (have no idea)
7) Undetermined

Front 2

What are 4 methods to reaching a diagnosis?

Back 2

1) Pattern recognition
2) Hypothetic-deductive reasoning
-algorithm
3) Exhaustive method
4) Problem-oriented

Front 3

What is an example of a condition that can be diagnosed via pattern recognition?

Back 3

Endocrine alopecia- Cushing's
-more you see it the recognize it, problem is won't recognize if never seen before

Front 4

What is the method hypothetic-deductive reasoning?

Back 4

Think of as a path that you follow with your thinking and is guided by diagnostic work ups

Front 5

What is the exhaustive method of diagnosis?

Back 5

Go back and exam the patient over and over again and rule everything out- look at everything you can think of and hopefully find something
-Time is a huge issue here

Front 6

Problem-oriented diagnostics is a subcategory of the _______ method.

Back 6

Exhaustive method

Front 7

What is the problem-oriented diagnostic method?

Back 7

-Expanded by hypothetic-deductive method: sequence of reasoning from one exam to the next
-Rigid sequence: have to take 1 step after the next and forces you to think and explain
-with experiences tart to skip steps
-problems pursued independently

Front 8

When is problem-oriented diagnostics used?

Back 8

With teaching: reasoning is apparent bc everything is in order and eases communication

Front 9

What does the initial database of the problem-oriented method of diagnostics include?

Back 9

1) Detailed history
-everything
-ask same question in different ways
2) Complete physical exam

Front 10

When listing the problems (part of problem-oriented diagnostic approach) what does the problem consist of?

Back 10

Everything that concerns:
-Patient
-Client
-Veterinarian

Front 11

At what level should a problem-list be constructed?

Back 11

At the level they're understood
e.g. abdominal distention VS abdominal mass VS neoplasia VS carcinoma

Front 12

What are 3 components to describing a problem?

Back 12

1) Chronicity (duration)
2) Character (describe)
3) Concern (severity, frequency)

Front 13

Is anorexia, weight loss and lethargy good clinical signs to pivot the problem off of when trying to reach a diagnosis using the problem-oriented strategy?

Back 13

No, because they're not specific to any disease
-want to make it specific to an organ or body system

Front 14

What are the different ways to sub-group your differential diagnoses?

Back 14

-where? e.g. abdominal mass
-what? e.g. pleural fluid
-DAMNIT

Front 15

What does the D in DAMNIT stand for?

Back 15

Degeneration

Front 16

What does the A in DAMNIT mean?

Back 16

Anomaly

Front 17

What 3 things does the M in DAMNIT stand for?

Back 17

1) Metabolic
2) Mechanical
3) Motor

Front 18

What does the N in DAMNIT stand for?

Back 18

Neoplasia, nutritional

Front 19

What 6 things does the I in DAMNIT stand for?

Back 19

1) Idiopathic
2) Iatrogenic
3) Inflammatory
4) infectious
5) immune mediated
6) Infarct (vascular)

Front 20

What 3 things does the T in DAMNIT stand for?

Back 20

1) Trauma
2) Toxins
3) Temperature

Front 21

If you were to use the scheme DAMN IT VP, what does the VP stand for?

Back 21

V: vascular
P: physical, physiological, pharmacological

Front 22

You should rank your differentials according to what 5 things?

Back 22

1) Age
2) Breed
3) Season
4) Gender
5) Chronicity

Front 23

How should you formulate a diagnostic plan?

Back 23

Rule-in or Rule-out
Prioritize
-most likely disease
-tests that split the differentials in half
-Good tests
-Non-invasive & cheap first

Front 24

What are the 7 steps to a problem-oriented approach to diagnostics?

Back 24

1) Obtain initial database
2) List problems
3) List differentials
4) Rank differentials
5) Formulate diagnostic plan
6) Formulate therapeutic plan
7) Update 2-6 as get results back

Front 25

Where is the master problem list located in your records?

Back 25

Front of medical record (index or table of contents)
-All problems should be listed

Front 26

When recording a problem, what aspects should be included?

Back 26

Sign, physiological abnormality, physical finding, laboratory abnormality
-number, date, problem, date of resolution or refinement

Front 27

What makes a problem on the problem list a major problem?

Back 27

Life-threatening
Life-altering

Front 28

What defines a minor problem?

Back 28

Acute, self-limiting, temporary

Front 29

When do you keep progress notes on an animal in your records?

Back 29

Hospitalized patients
-narrative progress of each problem
-Problems are numbered, dated and titled
-info entered chronologically

Front 30

What does SOAPP stand for?

Back 30

S: Subjective information
O: Objective data
A: Assessment
P: Plans (diagnostic & therapeutic)
P: Pain

Front 31

What are 4 examples of subjective information?

Back 31

1) History
2) Observations
3) Complaints
4) Activity

Front 32

What are 3 examples of objective data?

Back 32

1) Physical exam
2) Laboratory results
3) Other tests (that get to a number or give yes or no answer like a SNAP test)

Front 33

What are 3 examples of assessment (SOAPP)?

Back 33

1) Diagnosis
2) ID of the problem based on SO
3) Prognosis

Front 34

What is included in the plan (SOAPP)?

Back 34

1) Diagnostic plan
-Further diagnostic procedures
-List of rule-outs at the time
2) Therapeutic plan
-Plans for treatment
-Treatment actually performed including drug, dosages, length of therapy, goals of therapy

Front 35

What are the two components of pain (SOAPP)?

Back 35

Assess (SOA)
Treat
-planned therapy
-Therapy employed

Front 36

When do you utilize the SOAPP method?

Back 36

In the hospital