Provisional: one diagnosis you believe is most likely- “the working diagnosis”

Differentials: 2-4 diagnoses very common in general – typical or atypical presentation

Also consider:

• Red Flags: Any diagnoses which are rapidly fatal if untreated
• Any diagnoses specifically suggested by standout features of any patient’s history e.g. unusual hobbies, recent travel etc

use the following frameworks to think of differentials

VINDICATE

V – Vascular I – Infectious N – Neoplastic D – Degenerative I – Iatrogenic/intoxication C – Congenital A – Autoimmune T – Traumatic E – Endocrine/metabolic

PROMPT

Probability – what is the most likely and common diagnoses?

Red flags – what ‘clues’ do you need to uncover to exclude or include a serious diagnosis?

Often missed – Don’t forget things like pregnancy, drugs, allergies, constipation, menopause).

Masquerades – depression, drugs, diabetes, anaemia, thyroid, UTI, spinal

Patient wants to Tell you something (fear, embarrassment?)