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How to Prioritize a Differential Diagnosis

You have been asked to prioritize the differential diagnosis for Nick Herren and explain the reasoning for your prioritization. First, review the details of the case. Using the Research Notes Template, record any relevant signs, symptoms, risk factors and observations about Nick’s case. Next, research the diagnoses included in Dr. Wood’s differential. Compare the diagnoses with the signs, symptoms, and risk factors to see if any seem to particularly match Nick’s situation, and capture your notes in the template. Then, using the Diagnostic Report Template (provided by Dr. Wood), you and your team should write and submit a prioritized differential diagnosis including your rationale for the prioritization.

The steps below will walk you through this process.

Get Organized

1. Review the email from Dr. Wood to make sure you understand the task. It may be helpful to print the email and highlight the important points.


2. Download the attachments from the email that Dr. Wood sent. You will be referring to these materials as you complete several upcoming tasks, so make them easy to access.


3. Meet with your team and decide how you will complete your work.


4. Contact your mentor with any questions about your team assignment.

Review the Case

1. Familiarize yourself with the details of Nick Herren’s case.
   
   • Watch the case background video provided by Police Investigator, Tom Diaz.
   
   
   • Review Nick Herren’s patient chart from the Highland Hospital ICU.
   
   
2. As you review the case, note any signs, symptoms, and risk factors that may relate to Nick’s cause of death and record them in the Clinical Findings & Risk Factors table at the beginning of the Research Notes Template.

   You will not need to submit your Research Notes, but each team member should work from a separate template and keep his/her own notes. Your teammates may each notice different facts that are relevant to the case, so be sure to share your findings as you go.

Refer to Step 1 of the Diagnostic Process document (in Resources) which describes how to determine all relevant indicators of a medical problem, including signs, symptoms, and risk factors. Note: While the Diagnosis Process document is similar to the Diagnosis & Treatment Process from other rotations, it is different is important ways. Refer to this version as you work through the Medical Detective rotation.

The term “diagnosis” is commonly used in the context of determining the cause of a living patient’s illness. However, “diagnosis” can also refer to a hypothesis about the conditions that resulted in a patient’s death.

Consider the following:

• Did Nick Herren have any previous illnesses (acute or chronic) or injuries that may relate to his cause of death?


• Did friends or family members notice any relevant, recent changes in Nick’s behavior patterns?


• Was Nick taking any medications or other substances that could have contributed to his death?


• Did Nick have any known inherited conditions?


• Did Nick’s recent medical history (i.e., 2-3 days prior to his collapse) indicate any illness or medical problems?

Match Signs & Symptoms to the Possible Diagnoses

The Diagnostic Research Table in your Research Notes Template lists Dr. Wood’s preliminary differential diagnosis. Use the Diagnostic Research Table to capture your notes on each of the diagnoses and the decedent’s corresponding clinical findings and risk factors. The steps below will walk you through the process of organizing your research using the Diagnostic Research Table.

1. Research each diagnosis and its corresponding signs, symptoms, and risk factors using the Resources available. Take notes and fill in the table as you learn about each diagnosis.


2. Record the decedent’s signs, symptoms, and risk factors that match each diagnosis. Confirm that the signs and symptoms of each diagnosis describe what Nick Herren experienced.


3. Continue filling in the table until you have recorded all of the clinical findings and risk factors that are relevant to the case and matched them to the appropriate diagnoses.

Prioritize the Differential Diagnosis

Prioritize the list of possible diagnoses for your report to Dr. Wood. Follow the instructions in the Diagnostic Report Template that you downloaded earlier from Dr. Wood’s email.

Use your Research Notes Template as needed. Remember, this includes Dr. Wood’s differential diagnosis for the most likely causes of death as well as your notes about each diagnosis and Nick’s corresponding clinical findings and risk factors.

Refer again to the Diagnostic Process document in the Resources, paying particular attention to Step 3 “Prioritize your differential”.

Continue to use the links in Resources as needed. They may be particularly useful in determining the likelihood of each diagnosis.

For additional help, you may also r eview the Tips and Traps by clicking the link at the top of this page. Carefully read each suggestion and make sure you are on the right track. For writing help, refer to the General Skills Resources link in the left menu.

 

Review Your Work.

Refer to your completed Diagnostic Report template.

1. Did you prioritize the differential diagnosis from the most to the least likely?


2. Did you provide a clear and thorough explanation for your prioritization?

 

Submit Your Work.

1. Make sure all team members sign off on the completed deliverable.


2. Review the checklist located in the Submit your work section of this task and submit your work to your mentor.

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• Even if there are no initial signs or symptoms for a particular diagnosis, do not rule it out as a possible diagnosis. (For example, in some cases death may be the first symptom of cardiac problem.) Some diagnoses can only be determined during the autopsy phase when you can see the inner workings of the body and review test results.
  
  
• When considering the likelihood of a particular diagnosis, think about how common the diagnosis is based on the decedent’s age, race, gender as well as his/her personal medical history.

• Sometimes it is difficult to prioritize diagnoses in a precise numerical order (e.g., 1-10). For example, one diagnosis could be equally as likely (or unlikely) as another, in which case you can group these together and rank that on the same level. If you take this approach when prioritizing your differential diagnosis, be sure to explain your rationale for such groupings.
  
  
• Keep in mind that there are often contributing factors that may not be the actual cause of death, but that make a given diagnosis more likely to be the cause of death. For example, for a smoker who dies of lung cancer smoking cigarettes is a contributing factor that puts him/her at an increased risk for lung cancer .
  
  
• Signs and symptoms are often common problems that may or may not be serious (e.g., headache, fatigue). They are rarely unique to a particular diagnosis, which can make it difficult to definitively rule a diagnosis in or out.
  

 

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When referring to a Wikipedia resource, note that while Wikipedia is a valuable resource, unlike some other websites anyone can contribute to or modify the site (whether they're knowledgeable about the topic or not). As a result, the site is subject to constant change by questionable sources. Be sure to cross-check information on Wikipedia with other reputable sites to ensure accuracy.

Medical Process

Diagnostic Process - Describes the process that health care professionals typically use to determine, or diagnose, the cause of death.

Brain-related Diagnoses

Aneurysm - A comprehensive overview of brain aneurisms including causes, symptoms, and diagnosis.

Risk factors increasing chances of aneurysm

Aneurysm overview with illustrations – Answers to common questions about cerebral aneurysms.

Animated description of brain aneurysms – This narrated animation shows you how brain aneurysms develop and rupture.

Arteriovenus malformation (AVM) - A comprehensive overview of AVM including causes, symptoms, and diagnosis.

Risk factors increasing chances of AVM

Illustrated overview of AVM

Stroke - A comprehensive overview of stroke including causes, symptoms, and diagnosis.

Risk factors increasing chances of stroke - A description of the factors that increase your chances of having a stroke.

Illustrations of the brain and how it is affected by stroke.

The blood vessels of the brain and how they are affected by stroke.

Warning Signs of Stroke - includes videos of doctors discussing stroke in depth.

Stroke Statistics – Facts and statistics about strokes in the United States , Canada , and the world.

Subarachnoid hemorrhage - An illustrated description of subarachnoid hemmorhage including causes, and risk factors. (Note: Though this source presents subarachnoid hemmorhage within a discussion of stroke, it is not typically classified as a type of stroke.)

Tumor - A comprehensive overview of brain tumors including causes, symptoms, and diagnosis.

Head injuries - An overview of concussions including causes, symptoms, and diagnosis.

Concussion - A comprehensive overview of concussions including causes, symptoms, and diagnosis.

Concussion overview – A brief description of concussion including illustrations of the brain impacting the skull.

Risk factors increasing chances of concussion – A brief description of the conditions that increase the likelihood of concussion.

Heart-related Diagnoses

Congenital heart disease - A comprehensive overview of congenital heart disease including causes, symptoms, and diagnosis.

Risk factors increasing chances of congenital heart disease

Heart arrhythmia – supraventricular tachycardia – A comprehensive overview of heart rhythm disorders including causes, symptoms, diagnosis, and risk factors.

Diagnosing arrhythmias – Describes the tests used and the challenges of evaluating heart arrhythmias.

Heart attack due to atherosclerosis - A comprehensive overview of atherosclerosis including causes, symptoms, and diagnosis. (Read all 4 pages.)

Risk factors increasing chances of heart attack - A description of the factors that increase your chances of having a heart attack.

Hypertrophic cardiomyopathy (HCM) - A comprehensive overview of hypertrophic cardiomyopathy including causes, symptoms, and diagnosis.

Risk factors increasing chances of hypertrophic cardiomyopathy - A description of the factors that increase your chances of having HCM.

Myocarditis - A comprehensive overview of myocarditis including causes, risk factors, symptoms, and diagnosis.

Lung-related Diagnoses

Pulmonary embolism (blood clot in lung) - A comprehensive overview of deep vein thrombosis and pulmonary embolisms including risk factors, causes, symptoms, and diagnosis.

Risk factors increasing chances of a pulmonary embolism - A list of risk factors mentioned for Pulmonary embolism in various sources.

Drug use

Abuse of stimulants – An overview of stimulant addiction and abuse including effects on the brain and body.

Energy drinks – Article exploring the effects of highly caffeinated energy drinks.

Teen drug abuse – An overview of teen drug abuse including types of drugs, statistics, risk factors, symptoms, and diagnosis.

 

 

Ask the Experts

What are initial possibilities that could explain the cause of death when a young, otherwise healthy person dies suddenly?

What role do family and friends play in death investigations?