 |
|
|
|
|||||||||||||||||||||
|
||||||||||||||||||||||||
 |
||||||||||||||||||||||||
|
|
|
|
|
|
 |
|||||
|
brilliantbaby.com the website that can help you have a happy, smarter child. |
|||||
|
In making a diagnosis, a clinician depends heavily on probability. A clinician, after taking a clinical history, are usually not 100% sure of what a patient has. What clinicians do when making a diagnosis is rely on the most likely disease given the set of symptoms and signs gathered from the clinical history and physical examination. Example: A seven year old boy, with fever of 102 F, sore throat for 3 days, who is alert, without difficulty breathing, and has big, red tonsils with white spots (exudate), and reddish rashes at the upper chest, has a good chance of having Strep throat. Some clinicians will not do a Strep test and prescribe an antibiotic. In this situation, the clinician made a diagnosis based on the high probability of Strep throat based on the symptoms and physical findings. The child could very well have Viral infection. Example: A five year old girl has been coughing for 3 weeks. She has no fever, runny nose, vomiting, diarrhea, rashes, belly pain, headache, and chest pain. The cough is more at night and after running, exercise, or laughing. In the past 6 months she has been diagnosed to have bronchitis and was given antibiotics. The mother has asthma and the father has allergies. Both parents are smoker. Her physical examination was normal. Given the history of 3 weeks of coughing without a fever plus the previous bronchitis, a clinician will consider asthma as the most probable disease of the girl. However, this girl might have allergy, foreign body in the lungs or other causes of prolonged coughing. Example: A nine year old boy has itchy rashes at the legs and arms. He played in the woods with poison ivy. The boy was seen by their physician and within a minute of the interview and a look at the rashes, a diagnosis of “Contact allergy from poison ivy” was made. The typical appearance of the rashes and the history of playing in an area with poison ivy, puts the probability of “contact allergy” top in the list of diseases to be considered. The estimate of the likelihood of a disease before any test is done, depends heavily on the probability of the disease given a set of signs and symptoms. Fortunately, most clinicians has a good grasp of the common illnesses and how it manifest in their community. Leo Leonidas, MD, FAAP
|
|||||