wow
Schemas
By Alex Rosiejka and Colin Steck
go!
Learning Objectives
- Define a schema and traditional frameworks
- Compare schema-based reasoning with traditional approaches, identifying when one may be superior
- Practice a schema with asssitance
- Apply schema principles to create your own for a chief complaint
Let's Do It
Understanding Schemas vs. Differentials
A cognitive framework or concept that helps organize and interpret information
A schema is a mental framework that organizes knowledge about anatomy and physiology, helping clinicians think systematically about the body’s structures and functions.
What is a schema?
What's the Difference?
Differentials are helpful for can't miss diagnoses (such as the deadly causes of chest pain)
The Good
A differential diagnosis lists possible conditions based on symptoms
Differentials focus on memorization and can easily allow you to miss things, especially on more unique presentations
The Bad
"Wait, what about VINDICATE ?"
The VINDICATE mnemonic is too inflexible. Remember trying to think of random conditions that fit into the Congenital category?
No
Yes
Chief Complaint
Start with a chief complaint
So how do I build one?
Identify life threats
It is helpful to identify life threats to keep in mind as you proceed
Identify major systems/mechanisms
List the systems that can cause those complaints
Let's break it down
"Click on each ⊕to learn more "
Sequence the structures
Put each system, or parts of system, in anatomical/phisiological order
Reason pathology and anatomy
Think of what can go wrong in each system
Let's do one together!
Chest Pain
(Organ)
Chest Pain
Let's start with the heart!
Identify what can cause pain in this cardiovascular circuit
Chest Pain
Aorta
Left Heart
Lungs
Right Heart
Body
Coronary Arteries
- Pulmonary Embolism
- Aortic Dissection - Aortic Stenosis
- Tamponade - Angina - Myocarditis - Cardiomyopathy
- Acute Coronary Syndrome
Chest Pain
Okay, that was the hardest part. Now, let's think of what else is in the chest region!
Chest Pain
What other structures are on this chest X-Ray?
Chest Pain
Think of what could cause the chief complaint in each of the organs/structures you just identified in the chest region. Check your answers by clicking on each system
Mediastinum
Skeletal
Esophagus
Skin
Diaphragm
Lungs
GI
Let's do one more together!
Dyspnea
(Organ)
Dyspnea
Let's start with the lungs!
Identify where things can go wrong in this pulmonary circuit
Dyspnea
Lungs
Blood
Heart
Airways
Body
-Bronchiectasis -Alveolar hemorrhage -Alveolar fluids (blood, water, pus) -Epiglottits
- PE - Pleural effusion -Pneumthorax - ILD - Vasculitis
- Myocarditis -Heart Block -Pericarditis - ACS - Valvulopathy - Heart Failure - Tamponade -Constrictive
- Anemia - Acidosis - Thyrotoxicosis
Dyspnea
Good! Again, let's think of what else is in the lung region!
What other structures are on this chest X-Ray?
Dyspnea
Think of what could cause the chief complaint in each of the organs/structures you just identified in the lung region. Check your answers by clicking on each system
Diaphragm
Structural
Your turn
(Don't worry, I can help!)
Altered Mental Status
Now that we have done some together, it is time for you to do one! Here's the steps:
- Think of the organ that comes to mind with AMS
- Think about how that organ works
- Write down your ideas
- Advance to the next slide to check your answers
Altered Mental Status
Hopefully, you identified that the main organ is the brain. Can you identify the 4 general ways that the brain can be altered?
Altered Mental Status
A helpful tool is to remember the mnemonic M.I.S.T. for AMS
Altered Mental Status
Now, just list all of the things you can think of that might alter the brain in each category!
Altered Mental Status
Click on each box to check your answers
- Metabolic
- BMP
- Organ Dysfunction
- Hepatic Encephalopathy
- ACS
- Hypercapnic Encephalopathy
- Thyroid
- Cortisol
- Others
- B12
- Urinary Retention
- Constipation
- Toxin
- Anti-cholinergic
- Opiates
- Alcohol withdrawl
- Benzo withdrawl
- Methanol
- Infections
- CNS
- Non-CNS
- Pneumonia
- Urinary Tract Infection
- Structural
- Subdural Hemorrhage
- Malignancy
- Ischemic Stroke
- Hydrocephalus
Recommendation: Do this process with as many chief complaints as you can think of
Yay, you did it!
If you want to learn more, please feel free to think of other chief complaints, walk through your thought proccess (SCHEMA) , and check your answer with this great resource
https://clinicalproblemsolving.com/reasoning-content/
- Cammarata M, Dhaliwal G. Diagnostic Schemas: Form and Function. J Gen Intern Med. 2023 Feb;38(2):513-516. doi: 10.1007/s11606-022-07935-1. Epub 2022 Nov 14. PMID: 36376638; PMCID: PMC9905354.
- https://clinicalproblemsolving.com/dx-schema-chest-pain/
- https://clinicalproblemsolving.com/%20dx-schema-dyspnea/
- https://youtu.be/NvAMA9xK_ik?si=FtZX8DKxKqPflDES
References
- Esophageal Rupture
(I don't believe you.) C'mon, play along...
- Infection (Pneumonia) - Pneumothorax - Pleuritis
- Mediastinitis
- Myasthenia - Guillian Barre - ALS
- Rib Fracture - Costochondritis
- Zoster
- GERD - Peptic Ulcer
"Wait, does Multiple Sclerosis fall under Degenerative or Autoimmune?"
Clinical schemas promote flexible, anatomically grounded thinking. This approach enhances clinical reasoning by focusing on physiological relationships and anatomical landmarks, leading to more precise and effective diagnoses. Schemas foster a comprehensive understanding, reducing errors caused by overly rigid methods.
- Scoliosis -Obesity -Flail Chest
- Diaphragmatic Hernia
Schemas
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Transcript
wow
Schemas
By Alex Rosiejka and Colin Steck
go!
Learning Objectives
Let's Do It
Understanding Schemas vs. Differentials
A cognitive framework or concept that helps organize and interpret information
A schema is a mental framework that organizes knowledge about anatomy and physiology, helping clinicians think systematically about the body’s structures and functions.
What is a schema?
What's the Difference?
Differentials are helpful for can't miss diagnoses (such as the deadly causes of chest pain)
The Good
A differential diagnosis lists possible conditions based on symptoms
Differentials focus on memorization and can easily allow you to miss things, especially on more unique presentations
The Bad
"Wait, what about VINDICATE ?"
The VINDICATE mnemonic is too inflexible. Remember trying to think of random conditions that fit into the Congenital category?
No
Yes
Chief Complaint
Start with a chief complaint
So how do I build one?
Identify life threats
It is helpful to identify life threats to keep in mind as you proceed
Identify major systems/mechanisms
List the systems that can cause those complaints
Let's break it down
"Click on each ⊕to learn more "
Sequence the structures
Put each system, or parts of system, in anatomical/phisiological order
Reason pathology and anatomy
Think of what can go wrong in each system
Let's do one together!
Chest Pain
(Organ)
Chest Pain
Let's start with the heart!
Identify what can cause pain in this cardiovascular circuit
Chest Pain
Aorta
Left Heart
Lungs
Right Heart
Body
Coronary Arteries
- Pulmonary Embolism
- Aortic Dissection - Aortic Stenosis
- Tamponade - Angina - Myocarditis - Cardiomyopathy
- Acute Coronary Syndrome
Chest Pain
Okay, that was the hardest part. Now, let's think of what else is in the chest region!
Chest Pain
What other structures are on this chest X-Ray?
Chest Pain
Think of what could cause the chief complaint in each of the organs/structures you just identified in the chest region. Check your answers by clicking on each system
Mediastinum
Skeletal
Esophagus
Skin
Diaphragm
Lungs
GI
Let's do one more together!
Dyspnea
(Organ)
Dyspnea
Let's start with the lungs!
Identify where things can go wrong in this pulmonary circuit
Dyspnea
Lungs
Blood
Heart
Airways
Body
-Bronchiectasis -Alveolar hemorrhage -Alveolar fluids (blood, water, pus) -Epiglottits
- PE - Pleural effusion -Pneumthorax - ILD - Vasculitis
- Myocarditis -Heart Block -Pericarditis - ACS - Valvulopathy - Heart Failure - Tamponade -Constrictive
- Anemia - Acidosis - Thyrotoxicosis
Dyspnea
Good! Again, let's think of what else is in the lung region!
What other structures are on this chest X-Ray?
Dyspnea
Think of what could cause the chief complaint in each of the organs/structures you just identified in the lung region. Check your answers by clicking on each system
Diaphragm
Structural
Your turn
(Don't worry, I can help!)
Altered Mental Status
Now that we have done some together, it is time for you to do one! Here's the steps:
Altered Mental Status
Hopefully, you identified that the main organ is the brain. Can you identify the 4 general ways that the brain can be altered?
Altered Mental Status
A helpful tool is to remember the mnemonic M.I.S.T. for AMS
Altered Mental Status
Now, just list all of the things you can think of that might alter the brain in each category!
Altered Mental Status
Click on each box to check your answers
Recommendation: Do this process with as many chief complaints as you can think of
Yay, you did it!
If you want to learn more, please feel free to think of other chief complaints, walk through your thought proccess (SCHEMA) , and check your answer with this great resource
https://clinicalproblemsolving.com/reasoning-content/
References
- Esophageal Rupture
(I don't believe you.) C'mon, play along...
- Infection (Pneumonia) - Pneumothorax - Pleuritis
- Mediastinitis
- Myasthenia - Guillian Barre - ALS
- Rib Fracture - Costochondritis
- Zoster
- GERD - Peptic Ulcer
"Wait, does Multiple Sclerosis fall under Degenerative or Autoimmune?"
Clinical schemas promote flexible, anatomically grounded thinking. This approach enhances clinical reasoning by focusing on physiological relationships and anatomical landmarks, leading to more precise and effective diagnoses. Schemas foster a comprehensive understanding, reducing errors caused by overly rigid methods.
- Scoliosis -Obesity -Flail Chest
- Diaphragmatic Hernia