Time Stamps

  • 2:05 Part 1 Case
  • 7:07 Framing bias
  • 11:48 Data-driving reasoning
  • 12:38 Hypothesis-driven approach
  • 16:08 Periodic paralysis syndromes
  • 17:26 Representativeness heuristic
  • 20:51 Part 2 Case
  • 31:36 Pivot Points
  • 35:55 Diagnosis
  • 37:20 Take aways

Show Notes

  • A clinician employing “data-driven reasoning” (“working forwards”) starts with raw clinical data and tries to arrange them into meaningful patterns to build hypotheses about the patient’s illness.
  • A clinician employing “hypothesis-driven reasoning” (“working backwards”) starts with a clinical problem, generates a series of hypotheses about the patient’s illness, then tests each of these against the available clinical data.
  • Patients with hypokalemic periodic paralysis syndromes suffer episodic weakness due to massive intracellular shifts of potassium, often triggered by periods of stress or exercise; they can be entirely asymptomatic between episodes.
  • The representativeness heuristic is a mental shortcut in which a clinician judges the probability of a diagnosis based on the similarity of the patient to the clinician’s mental picture (i.e. stereotype) of that diagnosis.
  • Base-rate neglect refers to the tendency of clinicians to rely on information specific to a case (e.g. using the representativeness heuristic) to judge the likelihood of a given diagnosis, while ignoring the actual prevalence of that diagnosis.
  • It is not uncommon for patients with Sjogren’s syndrome to develop renal manifestations of their disease; this can take the form of subclinical lab abnormalities, nephrogenic diabetes insipidus, progressive renal insufficiency, and chronic tubular or interstitial nephritis, with or without renal tubular acidosis.
  • The combination of hypokalemia and non-anion gap metabolic acidosis is a diagnostically meaningful pattern, characteristic of two disease processes: diarrhea and renal tubular acidosis.


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