BIOE221. Session 8. The Clinical Approach. Bioscience Department. Endeavour College of Natural Health endeavour.edu.au

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1 BIOE221 Session 8 The Clinical Approach Bioscience Department

2 The Clinical Approach Session objectives Understand common symptomatology and how to assess them. Demonstrate use of the Clinical Management Pentagon to plan and approach clinical cases. Identify appropriate physical examinations to assess signs, symptoms and refine the differential diagnosis.

3 Common Symptomatology Common symptoms are non-specific to a particular disease, and are often associated with a wide variety of conditions affecting different systems. Common symptoms must be thoroughly assessed to facilitate development and refinement of the differential diagnosis.

4 Common Symptomatology Pain Headache Nausea & Vomiting Cough Breathlessness Diarrhoea Constipation Weight change Fatigue & Lethargy Fever Skin rashes Chest pain

5 Considerations when assessing common symptomatology Location: Where is it occurring? Onset: When did it start? Duration: How long has it been occurring? Severity: How bad is it? Causation: What makes it worse/better? Pain: Assess using PQRST Patient history & current presentation

6 Differential Diagnosis Distinguishing between 2 or more conditions with similar symptoms by systematically comparing the signs and symptoms. Through physical examination you begin to refine the differential to arrive at the most likely diagnosis, or, refer the patient for further testing.

7 Acute or Chronic When determining if a patients presentation is acute or chronic, you must consider the presenting symptoms, not just the time factor. Example: If a patient has a chronic history of asthma, but presents with recent onset of increased episodes of breathlessness and wheezing, this would be an acute change.

8 Acute or Chronic 4 Ways Acute Chronic Acute Chronic Acute/Acute A true acute presentation e.g. cold or flu Chronic/Acute A chronic condition with an acute exacerbation e.g. RA flare up Acute/Chronic An acute condition progressing towards chronicity e.g. Viral infection > CFS Chronic/Chronic A true chronic presentation e.g. Dysmenorrhea R/t endometriosis

9 Clinical Management Pentagon (Thakkar, 2017)

10 Using the Clinical Management Pentagon in Clinical Examination Observe & Ask: Case history & presentation Find & Generate: What systems are affected? Is it acute or chronic? Define symptom profile. Analyse & Interpret: Develop differential diagnosis

11 Using the Clinical Management Pentagon in Clinical Examination Investigate & Reflect: Select physical examinations & consider expected findings Synthesize & Apply: What have the findings shown? Refine differential diagnosis to decide on the most likely diagnosis. Organize, Manage & Communicate: Develop ongoing approach, Treat or refer?, Communicate to client and other health professionals.

12 Activity 1 (15 minutes) Consider the following case presentation: 8 year old girl Recent cold infection for 1 week Minor residual cough: nonproductive Feeling of pressure and loss of hearing in right ear Some moderate pain (4/10) Temperature = 38.2 o C History of recurrent upper respiratory tract infections Then answer these questions: Is it acute or chronic? What systems have been affected? What is the differential diagnosis? What physical examinations would you need to perform? What do you expect to find from these exams? What would be the most likely diagnosis? Treat or refer?

13 Case Study History & Presentation 52 yr old man presents with persistent dry cough for the last 3 months following a chest infection resulting in pneumonia for which he was prescribed antibiotics. He appears to be overweight, and has audible breath sounds on light exertion. He has a history of tonsillitis as a child, as well as mild asthma persisting into adulthood, which has eased since he quit smoking 5 years ago. Examination Results Vital Signs: Temp = 37.2 o C Pulse = 92 reg & weak Resp = 18br/min with effort BP = 155/85 Appearance: Pale and tired. Dark circles under eyes. Stiff in body movements. Appears a little unkept. Anthropometrics: BMI = 30.5kg/m 2

14 Case Study Instructions Use the pentagon and work in small groups to analyse the case study and plan your clinical examination approach. (20 minutes)

15 References Thakkar, M. (2017). Handout clinical management pentagon [class handout]. Department of Biosciences, Endeavour College of Natural Health, Australia. Retrieved from pdf/documents/bios222 SN01_Handout- ClinicalManagementPentagon.pdf

16 COMMONWEALTH OF AUSTRALIA Copyright Regulations 1969 WARNING This material has been reproduced and communicated to you by or on behalf of the Endeavour College of Natural Health pursuant to Part VB of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice.

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