Clinical Reasoning and Differential Diagnosis, Evaluate Your Skills
By Josep Pastor
Clinical Reasoning and Differential Diagnosis, Evaluate Your Skills. After explaining how clinical reasoning can be applied to identify a patient’s problems, focus on the most relevant issue, and determine its causes, this book describes complex case studies from a physiological and diagnostic perspective. Readers will be asked to answer a series of questions in order to assess their knowledge and acquire the necessary skills for properly establishing a diagnosis.
Table of Contents
1. HOW TO PERFORM DIFFERENTIAL DIAGNOSIS
What is clinical reasoning?
Intuitive clinical reasoning based on the identification of patterns
Clinical reasoning based on laboratory tests
Clinical reasoning based on the identification of problems
Steps of problem-based clinical reasoning
2. CLINICAL REASONING IN A CASE OF
FEVER/HYPERTHERMIA
CLINICAL CASE: Fever/hyperthermia
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
Individualise the diagnostic plan
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Urinary tract infections
What is bacteriuria? Is it synonymous with a urinary infection?
Can any bacteria isolated from the urinary tract produce clinical signs of a UTI?
What is the best way to identify a bacterial urinary infection?
How do we treat urinary infections?
•Uncomplicated urinary tract infections
•Complicated urinary tract infections
Are there any alternatives to prevent infections?
•Cranberry supplements
•D-mannose
•Methenamine salts
•Antibiotics as prophylaxis
Recommended reading
3. CLINICAL REASONING IN A CASE OF
POLYURIA/POLYDIPSIA
CLINICAL CASE: Polyuria/polydipsia
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
Individualise the diagnostic plan
•What is the approach with such a patient?
•Which diagnostic tests are required?
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Central diabetes insipidus (CDI)
What is central diabetes insipidus?
What causes central diabetes insipidus?
Which clinical signs warn about this process?
What are the common laboratory findings?
Which diagnostic tests can be used to confirm a suspicion of CDI?
•Modified water deprivation test
•Desmopressin response test
What treatment options are available?
What’s the correct follow-up for an animal with CDI?
Recommended reading
4. CLINICAL REASONING IN THE CASE OF URINARY
DISORDER
CLINICAL CASE: Urinary disorder
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
Individualise the diagnostic plan
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Ectopic ureter
What causes ectopic ureter?
What is the most significant clinical sign in ectopic ureter?
What is the best method for ruling out or confirming a clinical suspicion of ectopic
ureter?
What is the treatment of choice for ectopic ureters?
Recommended reading
5. CLINICAL REASONING IN A CASE OF
REGURGITATION/DYSPHAGIA
CLINICAL CASE: Regurgitation/dysphagia
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
Individualise the diagnostic plan
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Cricopharyngeal dysphagia
What is cricopharyngeal dysphagia?
What are the clinical signs of cricopharyngeal dysphagia?
What causes this disorder?
How is cricopharyngeal dysphagia diagnosed?
Are electromyograms and biopsies essential for the diagnostic process?
What is the best treatment for cricopharyngeal achalasia?
Recommended reading
6. CLINICAL REASONING IN A CASE OF DIARRHOEA
CLINICAL CASE: Diarrhoea
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
•Is the breed prone to any gastrointestinal diseases?
•Is it acute or chronic diarrhoea?
•Is it large intestine or small intestine diarrhoea?
•Do we need more diagnostic tests? Which ones?
Individualise the diagnostic plan
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Feline inflammatory bowel disease
What is chronic inflammatory bowel disease (IBD)?
How are intestinal microbiota involved in IBD?
Is IBD associated with other diseases?
Is it possible to measure the degree of IBD involvement?
Which tests are recommended for a cat with suspected IBD?
Which imaging tests provide the most information in cats with IBD?
Is intestinal lymph node cytology helpful in the diagnosis of IBD?
What is the best type of biopsy in animals with suspected IBD?
Recommended reading
7. CLINICAL REASONING IN A CASE OF JAUNDICE
CLINICAL CASE: Jaundice
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
Individualise the diagnostic plan
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Canine hepatic lymphoma
Can there be an exclusively hepatic lymphoma?
If a multicentric lymphoma can affect the liver, how can it be distinguished from a
primary hepatic lymphoma?
Which phenotype usually affects the liver in dogs?
Is it easy to identify hepatic lymphoma with diagnostic imaging?
Do multicentric lymphomas and hepatic lymphomas have the same prognosis?
Recommended reading
8. CLINICAL REASONING IN A CASE OF RESPIRATORY
DISTRESS
CLINICAL CASE: Respiratory distress
Reasoning applied to the case
Identifying the animal’s problems
Prioritise the problems
Structuring and organising the problem (differential diagnosis)
•How can we detect the presence of respiratory distress?
•What causes respiratory distress?
Individualise the diagnostic plan
•What is the approach with such a patient?
•What is most likely in S ’s case?
•Which additional tests should be considered?
Establish a definitive diagnosis or reassess the differential diagnosis
Final treatment plan and evolution
Brief review of… Pulmonary parasitosis in cats
Which lung parasites are important in cats?
Is it possible to differentiate between them or other lung diseases based on clinical
signs?
Which other parasites can cause cough?
How are they transmitted?
What changes are revealed by chest X-rays?
Which are the best diagnostic techniques for detecting lung diseases caused by
parasites?
Recommended reading
