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Clinical Reasoning Corner: Likelihood Ratios

The Clinical Problem Solvers

Objectives Define likelihood ratios and their utility in diagnostic reasoning Identify how likelihood ratios alter the probability of a diagnosis Apply likelihood ratios in clinical reasoning What are likelihood ratios and how do they work? A LR > 1 increases the probability of a specific diagnosis.

Clinic 52
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Subclavian Steal Syndrome

Vascular Physician

Type I – Antegrade vertebral flow is reduced Type II – Antegrade flow during diastolic phase and retrograde flow during systolic phase Type III – Permanent retrograde vertebral flow Diagnosis Diagnosis can be made using imaging such as duplex ultrasound of the subclavian and vertebral arteries.

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Leriche Syndrome

Vascular Physician

Patients with arterial blockage may have no symptoms. However, the most common symptoms for patients with Leriche Syndrome include hip, thigh, and buttock claudication which may be on both sides. Treatment is patient-specific and based on age, health, and severity. An ABI less than 0.9 What are the symptoms?

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Common Myths about Varicose Veins

Vascular Physician

For proper diagnosis, a vascular specialist will complete a comprehensive evaluation that includes an ultrasound to detect varicose veins, evaluate blood flow and determine the efficiency of vein valves. Keeping your blood circulating with regular exercise or physical activity may alleviate some pain. Multiple sessions may be required.

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PEMPix 2024 Online Case #1: Mission: SPACE

PEMBlog

PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. At that visit, his physical exam was normal. The patient has had improving activity and energy since his fall and initial ED evaluation 2 weeks prior. What’s the Diagnosis? No CN II-XII deficits noted.

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Prevention of Dementia: Kristine Yaffe

GeriPal

A lot of these are more vascular risk factors: hypertension, certainly; diabetes; obesity. Physical activity is a big one. But there are some things that we really think we can modify: the vascular risk factors, sleep, physical activity, maybe cognitive activity, and what kind of bang for the buck could we get?

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Under Pressure: Hypertensive Emergencies in the Pediatric Emergency Department

PEMBlog

All kids with hypertensive emergency need ICU-level care. Upon entering the room, you find the patients nurse at the bedside already in mid-conversation with the patients parent. However, the presence of end-organ damage is the defining feature of a hypertensive emergency, rather than the absolute blood pressure value alone.