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Case  Analysis  Tool  Worksheet

Student's  Name: Case  ID:

I.  Epidemiology/Patient  Profile

II.  Prioritized  Cues  from  Hx  and  PE.  (Do  not  include  lab,  x-­‐ray,  or  other  diagnostic  test  results  here.)
•  Tier  1:  The  cues  (may  be  positive  or  negative)  that  contribute  most  to  the  diagnosis  of  the  active  problem.  
•  Tier  2:  These  are  cues  of  intermediate  importance  (list  only  positive  cues).
•  Tier  3:  Of  least  importance  (list  only  positive  cues).

Tier  1   Tier  2 Tier  3

III.  Problem  Statement

IV.  Differential  Diagnosis

Based  on  what  you  have  learned  from  the  history  and  physical  examination,  list  up  to  3  diagnoses  that  might  explain  this  patient’s  complaint(s).  
List  your  most  likely  diagnosis  first,  followed  by  two  other  reasonable  possibilities.  For  some  cases,  fewer  than  3  diagnoses  will  be  appropriate.  
Then,  enter  the  positive  or  negative  findings  from  the  history  and  the  physical  examination  that  support  each  diagnosis.    

Leading  dx:

History  Finding(s) Physical  Exam  Finding(s)

Alternative  dx:

History  Finding(s) Physical  Exam  Finding(s)

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Alternative  dx:

History  Finding(s) Physical  Exam  Finding(s)

V.  Explanation  of  Diagnostic  Plan  (including  tests,  labs,  imaging  studies,  etc.)  and  Treatment  Plan  in  prioritized  order:

Diagnostic  Plan Rationale

Treatment  Plan Rationale

I  have  adhered  to  the  honor  system:  

Student's  signature