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  <head>
    <title>006-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Clinical reasoning, history and examination">
      <outline text="Safety and context first">
        <outline text="Is the patient unstable">
          <outline text="Airway, work of breathing, oxygenation"/>
          <outline text="Circulation, mental state, temperature"/>
          <outline text="Severe pain, active bleeding"/>
        </outline>
        <outline text="Primary survey runs alongside resuscitation"/>
        <outline text="Stabilisation and diagnosis proceed together"/>
        <outline text="Context changes probability">
          <outline text="Age, pregnancy, immune status"/>
          <outline text="Recent surgery, travel, occupation"/>
          <outline text="Medicines, devices, prior disease"/>
        </outline>
      </outline>
      <outline text="History of the presenting problem">
        <outline text="Open question first, then focused"/>
        <outline text="Onset, site, character, severity, radiation"/>
        <outline text="Timing, progression, precipitants, relievers"/>
        <outline text="Chronology is often diagnostic">
          <outline text="Sudden maximal: vascular, rupture, obstruction, arrhythmia, seizure, pneumothorax"/>
          <outline text="Episodic: intermittent obstruction, migraine, mediator release, exposure"/>
          <outline text="Progressive: structural disease, neurodegeneration, malignancy, organ failure"/>
        </outline>
        <outline text="Ideas, concerns and expectations"/>
        <outline text="Effect on sleep, work, mobility, self-care"/>
      </outline>
      <outline text="Background and medicines">
        <outline text="Severity, complications, control, not labels"/>
        <outline text="Family history: inherited disease, premature vascular events"/>
        <outline text="Social history: supports, occupation, substances, exposures"/>
        <outline text="Medication history">
          <outline text="Dose, route, timing, indication"/>
          <outline text="Adherence, benefit, adverse effects, recent changes"/>
          <outline text="Over-the-counter and complementary products"/>
        </outline>
        <outline text="Allergy: name the actual reaction"/>
        <outline text="Review of systems tests the differential, not everything"/>
      </outline>
      <outline text="Examination as hypothesis testing">
        <outline text="Consent, dignity, chaperone, infection control"/>
        <outline text="Observe before touching"/>
        <outline text="Vital signs read as a pattern, not single values"/>
        <outline text="Link every sign to anatomy and mechanism">
          <outline text="Raised jugular venous pressure depends on technique"/>
          <outline text="Crackles are not specific to one disease"/>
          <outline text="Separate weakness from pain, effort, fatigue"/>
        </outline>
        <outline text="Reliability varies: a sign shifts probability"/>
      </outline>
      <outline text="Problem representation">
        <outline text="Demographics, time course, key syndrome"/>
        <outline text="Major risk factors and discriminating findings"/>
        <outline text="Compression that keeps the inconvenient finding"/>
      </outline>
      <outline text="Differential by mechanism and anatomy">
        <outline text="Vascular, infective, inflammatory, neoplastic"/>
        <outline text="Degenerative, toxic, metabolic, endocrine"/>
        <outline text="Traumatic, obstructive, iatrogenic, congenital, functional"/>
        <outline text="Priority questions">
          <outline text="Most likely"/>
          <outline text="Most dangerous if missed"/>
          <outline text="Most treatable or time-sensitive"/>
        </outline>
      </outline>
      <outline text="Probability and diagnostic tests">
        <outline text="Pre-test probability from prevalence, setting, risk, findings"/>
        <outline text="Sensitivity: proportion with disease testing positive"/>
        <outline text="Specificity: proportion without disease testing negative"/>
        <outline text="Likelihood ratio shifts the odds"/>
        <outline text="Predictive value depends on prevalence">
          <outline text="Rare disease yields false positives in excess"/>
          <outline text="Very high probability survives a negative result"/>
        </outline>
        <outline text="Most informative near a decision threshold"/>
        <outline text="Reference interval is a distribution, not a boundary"/>
      </outline>
      <outline text="Cognitive error and calibration">
        <outline text="Anchoring and premature closure"/>
        <outline text="Confirmation bias and search satisfaction"/>
        <outline text="Base-rate neglect and framing"/>
        <outline text="Diagnostic pause">
          <outline text="What else could this be"/>
          <outline text="Which finding does not fit"/>
          <outline text="What evidence would change the plan"/>
        </outline>
        <outline text="Calibration: state residual probability, not exclusion"/>
        <outline text="Follow-up is a diagnostic tool"/>
      </outline>
      <outline text="Documentation and communication">
        <outline text="Source and reliability of information"/>
        <outline text="Relevant positives and negatives, uncertainty, plan"/>
        <outline text="Handover: situation, background, risk, recommendation"/>
        <outline text="Closed-loop communication on critical instructions"/>
        <outline text="Shared decision-making and decision-specific capacity"/>
      </outline>
    </outline>
  </body>
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