Task 1.2: How to Analyze the Test Results and Revise the Differential Diagnosis

Now that you have some of the test results in hand, use the step-by-step instructions that follow to analyze the results, draw conclusions and incorporate this information into your differential diagnosis.

Getting Started

1. Go to the email sent to you by Dr. Campbell, and download the attachments. You will need the following throughout the task:
   • Test Results for Ella Cruz - These files contain the results of some of the tests that were ordered for the patient. (Some test results take longer; keep this in mind if you don't see a result you are waiting for.)
     
     
   • Your earlier draft of the Differential Diagnosis.
     
     
2. Carefully review the email from Dr. Campbell to become familiar with the goals of this task.
   
   
3. Organize your team to do the work.
   • If you need a refresher on getting organized, refer back to the step-by-step in Task 1.
     
• Work with your teammates to create a quick list of the questions that you have about how physicians read and interpret test results and revise their differential diagnoses. As before, these questions may help you in formulating your thoughts as you begin this task.
  
4. Read about the methods physicians use to evaluate test results and refine the differential diagnosis.
   • As you read, take notes on any material you find that answers the questions you raised with your team (above) or that may help you to move forward with the task.
   • Reread section 4 of the Diagnosis and Treatment Process document: Test each diagnosis to confirm or disconfirm it. This section explains how a physician revises the differential diagnosis as test results arrive.
     

Revising the Differential Diagnosis

1. Return to the test results sent to you by Dr. Campbell and evaluate them.
• Look at each test result and analyze how it affects each diagnosis in your differential.
  • In the case of the chest x-ray Dr. Campbell attached, it is always important to review the radiology results where possible rather than relying on anyone else's assessment. It may be of interest or value to review the chest x-ray for your own information.
    
    
• Be sure to prioritize your analysis in the same order you prioritized your differential; in other words, review the first diagnosis first.
  
  
• Remember, one test may be more accurate in detecting some diagnoses than others. For each test used to uncover information about a diagnosis, you need to find out:
  • Does a negative result on this test usually rule out this diagnosis with near-certainty?
    
    
  • Can abnormal results sometimes be difficult to see?
    
    
  • Does this test require time to pass before it will show an accurate result?
    
    
• Use the Diagnosis and Treatment Archive (DATA) in the Resources link (above) as needed for additional information.
  
  
2. Move systematically through the Differential Diagnosis document, making changes where they are needed due to the test results. It is recommended that you keep the version you had in the previous task intact, and save this version under a new name. You are not only required to submit it under a new name, but it may help you to review how your thinking has evolved over what could be multiple iterations of this process.

1. Rule out any diagnoses that are no longer viable based on the current test results.
   
   
2. If a test result is negative but not completely reliable, you may keep the relevant diagnosis on the differential but change its ranking by moving it lower on the list.
   
   
3. Support your conclusions with evidence from the tests and your own deductive reasoning. Discuss any factors that you think should be given more or less weight in this decision.
   
   
3. Next, decide whether you need to change the ranking of those diagnoses which were not investigated further through testing. Ask yourself:
   • Does the current evidence for (or against) this diagnosis still justify its ranking in the differential?
     
     
   • In light of other diagnoses that may have changed in likelihood based on test results, has the relative likelihood of this particular diagnosis changed as well? If so, is it more or less likely than it was before?
     
     
4. Check to make sure you have reviewed all of the diagnoses in your differential.
   

Review and submit your work.

1. Review your work.
   
   
   • Did you do a thorough analysis of all the test results and revise the differential diagnosis based on this analysis?
     
     
   • Did you take into consideration the reliability of the test results when determining how to revise your differential?
     
     
   • Did you work with your teammates to come to a conclusion about how the diagnoses have changed?
     
2. Submit your work.
   
   
   • Review the checklist located in the Submit Your Work section of this task to ensure completion of the task before submitting your deliverables to your mentor.
     
     
   • Please note: Only one set of deliverables need to be submitted per team. Any additional notes not captured in that set of deliverables should be retained by the team members for possible use in future tasks.

Diagnosis and Treatment Archive (DATA) - Mystery Case

Diagnosis and Treatment Process
This document describes the process that health care professionals typically use to diagnose and treat their patients.