Clinical Reasoning Flashcards
What is clinical reasoning?
when a patient presents with a constellation of symptoms and you develop differential diagnoses from them
What is the syndromic approach?
Identifying consistent groups of signs and symptoms and providing treatment that will deal with the majority, or most serious organisms responsible
- Which etiologies are life threatening and/or locally common and/or easily treatable?
Good syndromic medicine requires intimate knowledge of what?
- Epidemiology of disease
- What is common or rare? - Knowledge of diagnostic resources
- What is easy to diagnosis? - Knowledge of treatment resources
- What can I easily treat?
Why is syndromic medicine practicied?
- Limited diagnostic resources mean specific diagnoses are rarely made
- Limited treatment resources mean some diagnoses are more or less ”useful”
- If you wait for a diagnosis, it might be too late
Downfalls of syndromic approach?
it can miss a lot of things!! These are algorithms, designed for less-skilled HCWs
Steps in clinical reasoning in a consultation of an undifferentiated patient?
- from when you hear the symptoms you should come up with the differential diagnosis from the start
- Group the conditions in the differential diagnosis into categories
- Determine which of these diagnoses are life-threatening
- i.e. RED FLAGS - Ask questions to rule out the life threatening diagnoses
- Ask relevant questions that will help you determine the most likely diagnosis i.e. focused history
- rule out each differential diagnosis - Apply physical exam maneuvers that are relevant in this case
- focused exam - Investigations needed i.e. focused investigations
- to rule out red flags
- to confirm or refute the diagnosis
Mnemonic for grouping differential diagnoses?
VINDICATE
Vascular
Infectious
Neoplasm
Drug
Iatrogenic/Idiopathic
Congenital
Autoimmune
Trauma
Electrolyte/Metabolic
NB: Don’t forget primary vs secondary
