Instructor: Mitch Heflin, MD
Chapter 16: Process of Diagnosis (optional)
Describe the “diagnostic process,” including pretest & posttest probability and test and treatment thresholds.
Define, calculate and demonstrate the use likelihood ratios.
Explain the advantage of using a likelihood ratio over its individual components, sensitivity and specificity.
An 80 year old retired textile worker comes to you for a routine follow-up visit. He has been generally healthy, although he smoked 1 pack per day of cigarettes until he quit 5 years ago and still drinks two mixed drinks every evening. He complains of fatigue and increased dyspnea on exertion. He denies chest pain, fever, chills, cough, orthopnea, PND or edema. He has noted occasional palpitations associated with these symptoms.
His clinical exam reveals that he has lost 5 lbs in the last 6 months. His BP is 130/80 with a regular HR of 92. His conjunctiva are pale, lungs clear, and heart sounds normal.
He has no edema, a normal abdominal exam, and a rectal exam reveals soft heme negative brown stool.
A CBC reveals a Hgb of 9.0 with a Hct of 30 (down from 13.5 and 39 at last visit).
- Read the article: Guyatt G, Patterson C, Ali M, et al. Diagnosis of Iron-Deficiency Anemia in the Elderly Am J Med 1990; 88:205-209.