Diagnostic Reasoning

Question 1

Question: What is Clinical Reasoning?

Answer 1

Answer: Clinical reasoning involves reviewing the person’s data/records, listening to the patient’s story, completing a physical examination, considering epidemiology, local/regional disease patterns, deciding on diagnostic tests and imaging, deciding on therapeutic management, and providing advice, prescriptions, or consultations.

Question 2

Question: How does Clinical Reasoning begin?

Answer 2

Answer: Clinical Reasoning begins with the application of current knowledge, such as epidemiology. It is further facilitated through the acquisition of new knowledge, data collection (e.g., History of Present Illness), and the implementation of diagnostic reasoning processes and principles.

Question 3

Question: What are some key components of History of Present Illness (HPI)?

Answer 3

Answer: In HPI, you obtain demographic information, vital signs, and perform symptom analysis. Various data collection strategies like OPQRSTU and BOLDCAARTS help gather relevant information.

Question 4

Question: What is the Hypothetical-Deductive Reasoning approach in Clinical Reasoning?

Answer 4

Answer: Hypothetical-Deductive Reasoning works from general to specific, developing hypotheses to explain clinical problems and applying collected information to test these hypotheses. It involves generating a list of differential diagnoses based on the collected data.

Question 5

Question: What are the three main considerations in Clinical Reasoning approaches?

Answer 5

Answer: Clinical Reasoning involves probabilistic, prognostic, and pragmatic approaches. These consider the likelihood of disorders, their prognosis if untreated, and their responsiveness to treatment, respectively.

Question 6

Question: How is a diagnosis/hypothesis formulated and tested in Clinical Reasoning?

Answer 6

Answer: A diagnosis or hypothesis is formulated and tested by analyzing the data, refining hypotheses through cause-effect analysis, and assessing their adequacy in explaining all clinical findings. Evidence-based medicine and pathophysiologic principles play a role in this process.

Question 7

Question: What are some common strategies for collecting information during Clinical Reasoning?

Answer 7

Answer: Strategies like OPQRSTU, BOLDCAARTS, VITAMINS-C, I-VINDICATE, and “Skin In” approach help collect relevant information to consider a wide range of problems and avoid early closure on incorrect diagnoses.

Question 8

Question: What are some habits that support good Clinical Judgment and Diagnostic Reasoning?

Answer 8

Answer: Effective clinical reasoning involves using a systematic approach, reviewing multiple body systems, generating many hypotheses, considering and ruling out life-threatening or function-threatening problems, avoiding early anchoring and premature closure, and including illness/injury prevention and health promotion in assessments.

Question 9

History of Present Illness
Collecting Information -
OPQRSTU

Answer 9

O - onset
* P - provoking / palliating factors
* Q - quality (one word) / quantity (0-10)
* R - region / radiation
* S - symptoms associated
* T - timing / treatments tried
* U - understanding – what do they think?

Question 10

History of Present Illness
Collecting Information - BOLDCAARTS

Answer 10

B - had it
before?
O - onset
L - location
D - duration
C -characteristics
A - aggravating
factors
A - associated
symptoms
R - relieving
factors
T - treatment
tried or timing
S - severity

Question 11

‘VITAMINS-C’ Approach for the
Etiology or Cause of Symptoms

Answer 11

V - vascular
I - infectious
T - traumatic
A -autoimmune/allergic
M - metabolic
I -idiopathic/iatrogenic
N - neoplastic
S - substance abuse
and psychiatric
C - congenital
This approach may
help you generate a
list of differential
diagnoses…

Question 12

I-VINDICATE Another Approach for the
Etiology or Cause of Symptoms

Answer 12

I - iatrogenic
V - vascular
I - infectious,
inflammatory
N - neoplastic
D -degenerative
I - idiopathic
C - congenital
A -autoimmune
T - trauma /
toxins
E - endocrine
(metabolic)

Question 13

Skin In’ Approach for the Basis of a Symptom

Answer 13

Consider the problem from the ‘skin in’.
* As an example, a patient presents with chest
pain. Consider the possible causes of chest
pain, beginning at the skin, and visualize all
the structures that could be affected:
* Skin – herpes zoster
* MSK – muscle strain
* Lung – pneumonia, pneumothorax,
PE
* GI – esophagitis, reflux, hernia
* Cardiac – pericarditis, angina, MI
* This approach could help to consider the
wide range of problems and to avoid ‘early
closure’ on the incorrect diagnosis