8/9/2019 Making a Diagnosis

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6

Making

a

diagnosIs

ection Discussing

a

diagnosis

You will hear an extract In

which

a doctor

interviews

a 59-year-old office

I.-.

I@

worker

.

As

you

li

sten,

note

the

patient

s present

complaint

SURN ME

NiUJi FIRST NAMES o r ~

AGE

5

SEX

(VI

MARITAL STATUS

Y\

OCCUPATION

Offiu vJaN u

PRESENT COMPLAINT

Complete Tasks

2,

3 and 4 before you check your answers in the Key.

Listen to the

ext

ract again and

write down

several possible diagnoses

for

this patient. You

will

be

given further information on him later.

Complete Tasks 3 and 4 before you

check your

answers in the Key.

6

8/9/2019 Making a Diagnosis

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Here are the doctor s findings on examination

IE

General

Condition

c-J

f 3< 4

o

ENT

AS

81

16O/'1SVS

l

KO

i ~

H.5

Aor ,1

Iejl hMporoJ polpoblt

GIS

GlJS

CNS

No AUk

shffAe.sS. fUNk A .

NWt ~ O J ' S

1\ 1

Wifj, AD poiA.

Look back at the possible diagnoses you listed in Task 2 Order them so

that the most

likely

diagnosis is first and

the

least likely last Exclude any

which now seem

very

unlikely

Which investigations

would

you check lor this pat ient? Write them here

IN

VESTIGATIONS

Complete Task 4 belore you check you r answers in the

Key

_

1 The results

01

some investigations for this pcltienl are given on

p

75

How

do these findings affect your diagnosis? Write your final diagnosis here

DIAGNOSIS

8/9/2019 Making a Diagnosis

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H

Note these expres.. ons

u::;ed beltveen doctors

in discllssing a diagnosis.

es

o

Cerla n

is

must

can't

definitely not

exclude

rule out

Fairly cel1aifl

seems

probably

likely

unlikely

Uflcertwn

might

could

may

possibly

a possibility

The li stening ex

tract

in

Tasks 1 and 2

provides

littl

e

in f

orma

ti

on

on

wl lkh t

base

our

diagnosis.

We are still

unce

rtain

.

We

can sa)':

- TIle patient

might

have cervical spo ndylosis.

- Cervical spondy losis is a

possibility.

The

findings on examina

ti

on

provide more

evidence. Some diagnoses

become

more li k

ely

while

others

become

less

li k

ely. We can say:

e

seems

to have temporal arteritis.

-

TIleratient.

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ST

AG

E B

Pregnancy test is negative. Chest X-ray IS normal. Pulse is normal. The liver is

not enlarged.

2 Both ankles, the lett elbow and the right wrist are s'NOllen and painful. The

history shows no ingestion of

drugs. Bone marrow IS normal.

J

I he spleen is palpable and there is a maculopapular -ash all over.

4 The pain is associated with dietary indiscretion. Murp1Y S sign is positive. There

is mild jaundice.

5 The patient e)(hibits cutaneous calcinosis and has

di ff iculty

in breathing.

Do not look ahead until

yo

u have con sidered a

dia

gnosis for each pat ient.

SI:AGE C

I Five day fecal fat colle

ct

ion

is

15 mmoi/i. Jejunal blo:Jsy

is

normal. Lab slick

urinary protein test shows p

ro

tein ++. Serum tot

al

protein

is

40 l

2 The rash is on the buttocks and extensor surfaces of the arms and legs.

3

WBC shows lymphocytes ++ . Monospot is positive.

4 Lab tests show alkaline phosphatase 16 units/I.

USS

shows

a

non

functioning gall bladder.

S

The patient s face

is

pinched.

ection Explaining a diagnosis

Look back al Task I

in

Unit 3. p. 28. In that extract a doct

or

was examin ing

a patient , Mr Jameson, su ffer ing from leg and back pain. An M

Rl

scan of

the lumbar spine confi

rm

ed that

th

e patient had a prolapsed

intervertebra

l d isc. Think abou t how

yo

u would ex plain this diagnosis to

the patient. Wr ite down the poin ts you would include in your explanation.

List the pOi nts in the best order. For example:

I how serious the problem is

Yo

u

wi

ll h

ea

r th e doctor ex

plainin

g the diagnosis

to

the

>u

ti

ent. As

yo

u

li sten, note th e po

int

s

cove

red and the order in

which

they are dealt

wit

h.

Th en compare th is w

ith

you r ow n li st In Task 6.

When explaining a

di

agnosis, a pal ient wou ld expect you 10 answer

Ihe fo llowing question

s:

1

3

4

What s the cause of my problem?

How

se

rious

is

it?

What are you going to do about it?

What are the chances of a full recovery?

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In Unit 7. we will deal w ith qu

es

tions 3 and 4. Here we will look at some of

the language used

to

answer

quest

ions

I

and 2

In explanations It is

important to

use straightfor ward. non-speciali sl

language with

only

such detail as is

importan

t for the patient 's

understanding of the

probl

em. he language of

thp

textbooks you may

have studied Is clearly unsui table for patie

nt

explanation. Compare

this

ext ract with the recorded explanation in Task 7

Herniation of part of a lumbar intervertebral disc is a co mmon

cause of combined back pain and sciatica ... Pa

rt of

the

gelatinous nucleus pulposus protrudes through a rent

in th

e

annulus fibrosus at its weakest part, which is postero-Iateral ... If

it is large, the protrusion herniates through the posterior liga ment

and may impinge up

on an

issuing nerve

to

cause sciatic pain.

J. C.

Adams, Ou/line

of

Orrllopof'ri

ics

10th ed.

(E

dinburgh: C

hurl.:h llJ

l ivings tone, 1986). p. 21 7.)

Y

ou

c

an

make sure

your

explan

ation

s are eas

il

y

under

s

tood by

avoid ing

medical termino logy where poss

ib l

e and defining the terms you use in a

simple way.

Note how the doctor describes a disc:

- The disc is a lill e pad ofgristle which li

es

between the bones in your spine.

Write

simp

le explanations for pati e

nt

s of these terms. Co

mpar

e

your

explanations

with

those

uf othe

r s

tu

dent

s.

I the

pancreas

2 the thyroid

3 flbrOlds

4 emphysema

5

arrhythmia

6 bone marrow

7 the prostate gland

8 gastro-oesophageaJ reflux

Explanations often invo lve describing causes nd effects. Look at

these examples:

ause

bend the

kn ee

straighten

it

Effec/

the tension is

taken

o

ff th

e nerve

the nerve

goes

taut

We can link a cause and an effect like this:

- fw bend tile knee. the tension

is

taken off the erne.

-

f

w

straighten it the nerve

goes

Jaul.

Nute

thai

both

th

e cause and effect are in the present tense because

we are describing some

thin

g

whic

h is

ge

nerally

true.

'

'

m

x

u

'

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