First Chief’s case of the season is over and done. The focus was on clinical reasoning and going through the steps of creating an appropriate problem representation, that leads to a differential diagnosis, which then triggers illness scripts.
Clinical Reasoning Tips to take away:
- Problem Representation- Create an effective “1-liner” about the patient and their story
- Salient features- i.e. fever, rash, lab abnormalities
- Temporal relation of conditions
- Illness Scripts- mental summary of a provider’s knowledge of a disease
- Predisposing conditions
- Pathophysiological insult
- Clinical consequences
Example from Chief’s Case (Malaria):
- 29 year old pregnant female, recently traveled to Sudan, presents with ~1 week of fever, shortness of breath, epigastric pain, found to have elevated total bilirubin, metabolic acidosis, anemia and thrombocytopenia.
- Pathophysiology- plasmodium infection, transmitted by mosquitos, going to liver and then invading RBCs
- Epidemiology- endemic areas (Sub-Saharan Africa and Southeast Asia), increased infection for young children, immunocompromised, pregnant women.
- Time Course- days to weeks, can lie dormant (P. vivax or P. ovale) for months in liver
- Salient symptoms/signs- fever, chills, nausea/vomiting/diarrhea, abdominal pain, tachycardia, tachypnea, headache
- Diagnostics- anemia, thrombocytopenia, LFT abnormalities, U/S with hepatosplenomegaly. Thick/thin smear (x3 to completely rule out).
- Treatment- depends on resistance pattern and pregnancy status. Will need definitive treatment for dormant liver parasites.
Thank you for the expert opinion from Drs. Dan Mueller and Bizath Taqui!