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What is the difference between a sign and symptom?

A sign is an objective indication of a medical fact whereas a symptom is a subjective feeling related by the patient.

What defines 'Differential Diagnosis'?

All possible diagnoses related to patient's signs and symptoms.

True or false: Diagnostic errors are mostly associated with common diseases rather than rare ones.

True.

What is the correct order for clinical reasoning?

Identify, Frame, Organize, Limit, Explore, Rank, Test your leading Hypotheses, Re-rank, Test.

What does a sensitivity of 20% in a duplex ultrasound test for DVT mean?

It means that duplex ultrasound is not really a useful test for identifying DVT.

What is used to help identify an unrecognized disease or risk factor in a seemingly well person?

Screening.

When is screening for a disease worthwhile?

When the test is of high quality, the burden of disease is sufficient to warrant screening, and there is evidence that screening reduces morbidity and mortality.

What do we call the most likely diagnosis based on prevalence, demographics, risk factors, symptoms, and signs?

Leading hypothesis.

True or False: If the specificity of a laboratory test for disease A is 80%, it means that 20% of persons who do not have disease A will show a positive result.

True.

What is a patient's principal diagnosis related to?

Most related to the patient's chief complaint.

What are examples of pivotal points in framing a differential diagnosis?

Bilateral/Generalized versus Unilateral, Limb versus Localized, Old versus new set of symptoms, triggering event.

True or False: Treatment Threshold is the probability below which the diagnosis is so likely you would treat the patient without further testing.

False.

True or False: Test Threshold is the probability below which the diagnosis is so unlikely it is excluded without further testing.

True.

When are diagnostic tests necessary?

When the pretest probability of disease is in the 'middle' (above the test threshold and below the treatment threshold).

What is the potential primary diagnosis for a 30-year-old reporting chest pain, heartburn, and pre-prandial stomach pain?

Gastritis, GERD, bleeding ulcer.

What is the potential secondary (must not miss) diagnosis for a 30-year-old reporting chest pain, heartburn, and pre-prandial stomach pain?

Heart attack (myocardial infarction), angina pectoris.

What are diagnostic criteria?

Specific combinations of signs, symptoms, and test results that the clinician uses to attempt to determine the correct diagnosis.

True or False: All diagnostic criteria must be met in order to confirm a diagnosis.

False.

What is the intended purpose of medical algorithms?

They are intended to improve and standardize decisions made in the delivery of medical care.

Which of the following is NOT a cause for a diagnostic error? (A) Inadequate history and physical examination by clinicians (B) Patient's adverse reaction to a prescribed medication (C) Failure to order appropriate tests (D) Failure to properly interpret tests.

Patient's adverse reaction to a prescribed medication.

What imaging technique is based on the ability of X-rays to penetrate tissues and organs differently according to tissue density?

Radiography.

As X-rays pass through body tissues, what happens to the X-rays that reach the film?

Fewer reach the film and the image appears whiter.

True or False: Patients with osteoporosis have less calcium in their bones, and the bones appear gray and porous on X-ray.

True.

True or False: X-rays can easily penetrate air, so areas filled with air or gas appear black or very dark on X-ray films.

True.

What is Computerized Tomography (CT scanning)?

Computers re-create a 3-dimensional, cross-sectional view of body structures after obtaining x-ray information from the entire circumference of the body.

What is fluoroscopy?

An X-ray procedure where the radiologist can visualize body organs and observe their motion.

What are potential risks for radiation exposure?

Somatic, genetic, and fetal.

What can a chest X-ray identify?

Tumors of the lung, inflammation of the lung, COPD, pneumothorax, fractures of vertebrae or thorax, infection of the lung, heart size, diaphragmatic hernia.

What was the first use of CT scanning?

For the evaluation of the brain.

What do these CT-scans demonstrate?

Aortic calcification and pericarditis.

What technique allows for calcified atheromatous plaques on coronary vessels to be seen and quantified?

Coronary CT Angiography.

What is ultrasonography?

A diagnostic technique in which high-frequency sound waves are directed at internal structures and a record is made of the wave pulses as they are reflected back through the tissues.

What do sound waves transmit well through and not well through?

Transmit well through fluid but not well through air, bone, or contrast medium.

What technique is used to determine whether a lump or other abnormality is fluid-filled or a solid tumor?

Ultrasonography.

What technique is used to evaluate pregnancy and placental status?

Ultrasonography.

What technique determines direction and velocity of blood flow in the heart?

Color flow doppler imaging.

What happens in MRI?

Hydrogen atoms in tissues containing water are excited and emit radio frequencies that are detected by a receiving coil.

What structures do not generate MRI signals and appear black?

Bone and air.

What is nuclear scanning?

A procedure where a radiopharmaceutical is injected into the patient and concentrates in a targeted organ, emitting gamma rays.

What is PET scanning?

A technique in which radiolabeled chemicals are taken up to a greater extent by cells that have higher metabolism.

How do PET images indicate less or more metabolic function?

Red areas represent more metabolically active regions due to absorption of radiolabeled glucose.

What is endoscopy?

A general term referring to the inspection of the internal organs and cavities.

What is arthroscopy?

Endoscopy of joints.

What is bronchoscopy?

Endoscopy of the larynx, trachea, bronchi, and alveoli.

What is esophagogastroduodenoscopy?

Endoscopy of the esophagus, stomach, and duodenum.

What is colonoscopy?

Endoscopy of the rectum and colon.

What is colposcopy?

Endoscopy of the vagina and cervix.

What is cystoscopy?

Endoscopy of the urethra, bladder, ureters, and prostate.

What is hysteroscopy?

Endoscopy of the uterus.

What is laparoscopy?

Endoscopy of the abdominal cavity.

What are potential complications of endoscopy?

Perforation of organ or cavity, persistent bleeding from a biopsy site, respiratory depression as a result of oversedation, infection, and transient bacteremia.

What technique allows endoscopic visualization of joint interior?

Arthroscopy.

What procedure is performed for a suspicious Pap test?

Colposcopy.

What procedure is most likely performed for occult blood in stool?

Colonoscopy.