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  <head>
    <title>071-02 History, examination, diagnostic strategy, differential diagnosis, and common disease</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Primary-care diagnosis and common disease">
      <outline text="Consultation and hidden agenda">
        <outline text="Low prevalence, early atypical presentation"/>
        <outline text="Treat, test, observe, refer, or prevent"/>
        <outline text="Identify all concerns before the first in depth">
          <outline text="Safe symptom may precede real fear"/>
          <outline text="Ask hopes and worries to avoid late surprises"/>
        </outline>
        <outline text="Fresh history, not only the record"/>
        <outline text="Negotiate priorities when time is short">
          <outline text="Danger first, then patient priority, prevention"/>
          <outline text="Unresolved concerns get named follow-up"/>
        </outline>
      </outline>
      <outline text="Probability at low prevalence">
        <outline text="Pre-test probability from age, risk, setting"/>
        <outline text="Good tests yield false positives in low risk"/>
        <outline text="Thresholds: observe, test, or treat">
          <outline text="Lower when delay dangerous, treatment safe"/>
          <outline text="Higher when treatment harmful, diagnosis unsure"/>
        </outline>
        <outline text="Decision rules only in validated populations">
          <outline text="A score is evidence, not the decision-maker"/>
        </outline>
      </outline>
      <outline text="Selective but complete examination">
        <outline text="Observations when systemic illness possible"/>
        <outline text="Focused is not rushed">
          <outline text="Include systems for danger and alternatives"/>
        </outline>
        <outline text="Serial examination informs evolving illness"/>
        <outline text="Record meaningful negatives"/>
        <outline text="Telehealth limits: arrange in-person care"/>
        <outline text="Chaperone, consent, trauma-informed care">
          <outline text="Confidential enquiry despite support person"/>
        </outline>
      </outline>
      <outline text="Common chronic disease and secondary causes">
        <outline text="Hypertension: technique, repeats, home readings">
          <outline text="White-coat and masked patterns differ"/>
          <outline text="Young onset, resistance, hypokalaemia: secondary"/>
        </outline>
        <outline text="Diabetes: glucose or glycated haemoglobin">
          <outline text="Variants, anaemia, pregnancy distort the value"/>
          <outline text="Consider autoimmune or monogenic diabetes"/>
        </outline>
        <outline text="Lipids interpreted by absolute risk">
          <outline text="Very high LDL cholesterol suggests familial disease"/>
          <outline text="Severe triglycerides risk pancreatitis"/>
        </outline>
        <outline text="Chronic kidney disease needs persistence">
          <outline text="Do not mislabel acute change as chronic"/>
        </outline>
      </outline>
      <outline text="Respiratory and cardiovascular symptoms">
        <outline text="Chronic cough: broad causes, escalate alarms">
          <outline text="Normal chest imaging excludes not everything"/>
        </outline>
        <outline text="Asthma: show variable airflow limitation">
          <outline text="Normal spirometry does not exclude it"/>
          <outline text="Check inhaler technique before failure label"/>
        </outline>
        <outline text="Chest pain: coronary, embolic, aortic, other causes">
          <outline text="Atypical ischaemia, but physiology over stereotype"/>
        </outline>
        <outline text="Palpitations: correlate symptom with rhythm">
          <outline text="Normal resting trace misses intermittent arrhythmia"/>
          <outline text="Device matched to event frequency"/>
        </outline>
      </outline>
      <outline text="Pain and fatigue without polarisation">
        <outline text="Persistent pain has mixed contributors">
          <outline text="Imaging abnormalities common when asymptomatic"/>
          <outline text="Opioid escalation without function adds harm"/>
        </outline>
        <outline text="Fatigue: separate sleepiness, weakness, dyspnoea">
          <outline text="Revisit the model, do not expand panels"/>
        </outline>
        <outline text="Post-infectious symptoms">
          <outline text="Avoid forced graded activity if it worsens"/>
          <outline text="Pacing and tailored rehabilitation"/>
        </outline>
      </outline>
      <outline text="Cancer detection and safety-netting">
        <outline text="Alarm symptoms individually non-specific">
          <outline text="Combinations, duration, age, trajectory decide"/>
        </outline>
        <outline text="Negative screen is not diagnostic reassurance"/>
        <outline text="Referral states concern, negatives, urgency"/>
        <outline text="Safety-net: course, warnings, timeframe, return">
          <outline text="Assign responsibility for pending results"/>
          <outline text="Non-attendance triggers proportionate follow-up"/>
        </outline>
      </outline>
      <outline text="Mental health and substance use">
        <outline text="Diagnosis by pattern, not questionnaire alone"/>
        <outline text="Ask about mania before antidepressants"/>
        <outline text="Direct suicide enquiry does not create intent"/>
        <outline text="Non-judgemental alcohol and drug assessment">
          <outline text="Alcohol or benzodiazepine withdrawal dangerous"/>
          <outline text="Care without prior commitment to abstinence"/>
        </outline>
        <outline text="Breadth first, then selective depth"/>
      </outline>
    </outline>
  </body>
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