 Step-By-Step Guide
Tips and Traps
Resources
Step-By-Step Guide
How to Analyze the Test Results and Choose a Working Diagnosis
Now that you have 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. It will be your job to determine the final diagnosis for this patient.
Getting Started
- Get prepared to do your work in this task.
- Go to the email sent to you by Dr. Mendoza, and download the attachments. You will need the following throughout the task:
- Test Results for Jenny Anderson - These files contain the results of the tests that were ordered for the patient.
- You will also want to return to your earlier draft of the Differential Diagnosis to revisit what you have listed there and ultimately come up with your working diagnosis for Jenny Anderson.
- Carefully review the email from Dr. Mendoza to become familiar with the goals of this task.
- Review Jenny Anderson’s x-rays.
- 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.
- Briefly, the key pieces to looking at an x-ray are to compare what is normal to what you have in front of you, both in terms of the shapes of the bones and the spaces between them. Specifically:
- Examine each bone for any evidence of fracture or deformity. Have your anatomical resources available to compare with Jenny’s x-ray so that you have a baseline understanding of how the bones should look.
- Examine the spaces between the bones for any abnormal shifts/gaps.
To view some normal x-rays to compare with Jenny’s, and also to learn more about how to read an x-ray, see the Resources (above), particularly links contained within DATA.
- 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 the first diagnosis to confirm or disconfirm it. This section explains how a physician revises the differential diagnosis as test results arrive.
- For additional guidelines that physicians follow during this step of the diagnosis and treatment process, see Tips and Traps (above).
- Organize your team to do the critique.
• If you need a refresher on getting organized, refer back to the step-by-step in Task 1.
Revising the Differential Diagnosis
To help you determine how to revise the Differential Diagnosis, follow the steps below.
- Return to the x-rays taken of Jenny Anderson’s foot and ankle (attached to the email from Dr. Mendoza), and evaluate them.
- What do these x-rays tell you? Compare Jenny’s x-rays with examples of x-rays showing each diagnosis in other patients. Examples of positive x-rays for each diagnosis are accessible by clicking on the Resources link (above).
- Move systematically through the differential diagnosis document, making changes where they are needed due to the test results. It may help you to keep track of the changes you are making by using the “bold” or “highlight” functions in text.
- Be sure to rule out any diagnoses that are no longer viable based on the current test results.
- Remember, one test may be more accurate in detecting some diagnoses than others. You will need to do some research using DATA (Diagnosis and Treatment Archive) in Resources (above) and also consult the relevant Ask the Expert videos. 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?
- Be sure to 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.
- 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?
- Check to make sure you have reviewed all of the diagnoses in your differential.
Meeting to Exchange Feedback
- 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 meeting to exchange feedback, see Tips and Traps (above).
- 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.
- 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.
Tips and Traps
For Tips and Traps regarding selecting a working diagnosis, refer to Case 1: Tennis Twist, Task 4.
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