Task 1.3: How to Analyze the Test Results and Revise the Differential Diagnosis

Once again, using the new set of test results you have received from Dr. Campbell, 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 2 for Ella Cruz - These files contain the results of the tests that were ordered for the patient
     
     
   • 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. Review Ella’s test results.
   • 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.
     
     
   • As before, the attached MRI has been evaluated by the Radiology department and Dr. Campbell, but it is of value to you to become familiar with the tools of the trade. Take a look at the MRI and see how it looks to you. A normal MRI can be found for comparison in the Resources link (above).
     
4. 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.
     

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.
  
  
• Be sure to prioritize your analysis the same way you prioritized your differential.
  
  
• 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 abnormal result?
    
    
• Use 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. Again, it is recommended that you keep the earlier version of the differential for history tracking purposes. You may even choose to return to prior versions at this point to reorient yourself to the thought process you have had during these multiple iterations of diagnosis and testing.

1. Rule out any diagnoses that are no longer viable based on the current test results.
   
   
2. 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.
   

Meeting to Exchange Feedback

1. Meet with your cohort to discuss your findings and ideas. Your mentor will assign your team one or more diagnoses at the beginning of the meeting. Your team will present your key ideas and lead the discussion of those diagnoses.
   • For tips on working with a team, go to the General Skills Resources link (in the left menu) under "Teamwork.
     
     
   • Jot down notes to record what you gain from the discussion. Write any answers you found to the questions you and your teammates posed in the beginning of this task. You may also note down any questions you still have about analyzing tests and making a diagnosis.
     
     
2. After incorporating any feedback you may have received during the discussion, submit your work to your mentor. Be sure to save all of your work, regardless of whether you submit it to the mentor.
   

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.

Normal MRI
This is an example of a normal head MRI, and can be used for comparison to others.