Session 7 The Clinical Approach Bioscience Department · The Clinical Approach Bioscience...

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BIOE221

Session 7

The Clinical Approach

Bioscience Department


The Clinical ApproachSession 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.


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.


Common Symptomatology

• Pain

• Headache

• Nausea & Vomiting

• Cough

• Breathlessness

• Diarrhoea

• Constipation

• Weight change

• Fatigue & Lethargy

• Fever

• Skin rashes

• Chest pain


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


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.


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.


Acute or Chronic – 4 Ways

Acute Chronic

Acute Acute/AcuteA true acute presentation

e.g. cold or flu

Acute/ChronicAn acute condition

progressing towards chronicity

e.g. Viral infection > CFS

Chronic Chronic/AcuteA chronic condition with an

acute exacerbatione.g. RA flare up

Chronic/ChronicA true chronic presentation

e.g. Dysmenorrhea R/tendometriosis


Clinical Management Pentagon

(Thakkar, 2017)


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


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.


Activity 1 (15 minutes)Consider the following

case presentation:

• 8 year old girl

• Recent cold infection for 1

week

• Minor residual cough: non-

productive

• Feeling of pressure and loss of

hearing in right ear

• Some moderate pain (4/10)

• Temperature = 38.2oC

• 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?


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 = 37.2oC

• 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/m2


Case Study Instructions

Use the pentagon and

work in small groups to

analyse the case study

and plan your clinical

examination approach.

(20 minutes)


ReferencesThakkar, M. (2017). Handout clinical management pentagon [class

handout]. Department of Biosciences, Endeavour College of Natural Health, Australia. Retrieved from https://source.endeavourlearninggroup.com.au/coursematerial/pdf/Documents/BIOS222__SN01_Handout-ClinicalManagementPentagon.pdf

https://source.endeavourlearninggroup.com.au/coursematerial/pdf/Documents/BIOS222__SN01_Handout-ClinicalManagementPentagon.pdf


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