PURPOSE: The purpose of this assignment is for the student to develop skill in systematic case presentation and further development of an evidence - based diagnostic reasoning process. The diagnostic...

PURPOSE:
The purpose of this assignment is for the student to develop skill in systematic case presentation and further development of an evidence - based diagnostic reasoning process. The diagnostic reasoning process recommended is outlined in the first three chapters of the course textbook, Bates’ guide to physical examination and history taking (11th ed).
Select ONE of the following presenting complaints (PC): Either a client with –
Shortness of breath
or
Chest pain
or
Abdominal pain
or
Headache

or
Ear pain, sore throat or other common presentation in primary care
There is benefit from choosing a patient or client with a fairly straight forward complaint for purposes of being able to clearly articulate the clinical decision making process.

Use this presenting complaint as the focus for your assignment. If the above complaints do not apply to your clinical area please discuss with your lecturer.
METHOD:
General appearance / presenting complaint/ history of presenting complaint / past history / family history / personal and social history. The clinical skills checklist in this folder will guide you on the history that needs to be included.
• Discuss the data you have gathered for your client and link where relevant to the evidence. (this section will probably be lighter with literature/evidence than other area’s of the assignment)
Three early diagnostic considerations
• Discuss three of the more likely early diagnostic considerations for your presenting complaint and discuss aspects of the history and general appearance that would help support or refute these considerations
 Physical examination
• Discuss the physical examination that has been performed on your client with rationale and links to the literature. The clinical skills checklist will guide you in the systematic approach to follow for the clinical exam but the required depth will be obtained from a clinical exam text book e.g. Bates.
Differential diagnoses
• Discuss your three early diagnostic considerations and now link the data from the physical exam that would help support or refute these considerations
Diagnostic tests
• Select three diagnostic tests that would help rule in or out your earlier diagnostic considerations, use evidence to support the selection of these tests
Diagnostic reasoning and formulation of a diagnostic decision
• Select two of your diagnostic considerations and using the literature explain how the general appearance, history, physical examination and diagnostic tests would support or refute these two possible diagnoses