With the patient’s constellation of signs and symptoms, it was obvious to me that this was a classic presentation of ‘I have no idea what this is.’
Diagnosis is not the end, but the beginning of practice.
A diagnostic criteria for SLE is to fulfill at least four of the following eleven letters that make up the mnemonic “SOAP BRAIN MD”:
That is a lot of ground to cover. Are you sure it is not lupus, House?
In our problem-based learning tutorial groups, we get a chance to work through cases that are relevant to our weekly objectives. We go through the symptoms, a differential diagnosis, and come up as a group what sort of tests that we think would be appropriate to order while the tutor guides us along to a rationale for why we want to do certain things.
We also get an opportunity to learn about all the tests that are done for certain conditions through our lectures that cover some treatments or clinical pearls of how a diagnosis is made. Both of these components kind of allow us a chance to think of ways to diagnosis a patient. Of course, these scenarios are sometimes very ideal and designed as such to allow us to every avenue. The best opportunities to really get a handle and solidify the skill will come next year, when we transition to a clinical teaching environment.