Patient assessment and clinical reasoning
Patient assessment and clinical reasoning
This domain tests hypothesis-driven assessment and defensible clinical reasoning. Expect questions on subjective and objective examination, red flags, differential diagnosis, the ICF framework, outcome measures, baseline function and when to stop and refer.
Core rules
- Start with the patient’s story, goals and irritability, then choose tests that can change your hypothesis.
- Screen for red flags before provocation: trauma, unexplained weight loss, night pain, fever, bladder or bowel changes, progressive neurological deficit, cancer history.
- Use the ICF to separate body structure and function, activity, participation and environmental or personal factors.
- Record baseline measures you can repeat: pain, range, strength, function, gait, balance or patient-reported outcome.
- Reassess after intervention. If findings do not fit, revise the hypothesis rather than repeating the same technique.
Worked example
A 62-year-old reports sudden mid-thoracic pain, night sweats and unintentional weight loss. You do not proceed to thoracic mobilisation. You screen systems, note the red flags, and arrange urgent medical review. Your reasoning is that the probability of serious pathology is low but the consequence is high, so the safe action is referral, not treatment. You document the red flags and advice.
Traps
- Anchoring on an early diagnosis and ignoring contrary findings.
- Treating imaging findings as the whole diagnosis.
- Missing red flags because the patient seems “musculoskeletal”.
- Recording only impairments and not function or participation.