Differential Diagnosis Framework for Nurse Practitioners
Systematize differential diagnoses with SNAP-based clinical reasoning framework
What You Can Do
You can build comprehensive, defensible differential diagnoses for complex patient presentations by working with Claude to organize clinical thinking, identify missing information, and prioritize diagnostic testing. The framework uses modified SNAP methodology (Symptom → Narrow → Assess → Prioritize) combined with likelihood ratio thinking to move beyond pattern recognition to systematic evaluation. This helps you justify clinical decisions, strengthen documentation for chart audits, and manage diagnostic uncertainty in busy clinical settings.
Features
Symptom categorization, Narrowing by pathophysiology, Assessment of red flags, Prioritization by likelihood ratios
Systematic screening for life-threatening diagnoses requiring immediate action or referral
Quantify how clinical findings shift probability of diagnoses, moving beyond intuition
Identify missing history, physical exam findings, or testing needed to rule in/out key diagnoses
Build evidence-based testing sequences that balance diagnostic yield, cost, and patient safety
Ensures differential and workup recommendations fit NP independent and collaborative practice models
Generate clinical reasoning statements demonstrating systematic thinking for medical record and chart audits
Works across undifferentiated presentations (chest pain, abdominal pain, dyspnea, altered mental status)
Example Output
Example 1: Chest Pain Presentation
Patient: 52-year-old male with 3 hours substernal pressure, diaphoresis, left arm radiation
SNAP Analysis:
- Symptom: Acute substernal chest pain with typical ACS features
- Narrow: Cardiac (ACS, aortic dissection), pulmonary (PE), GI (GERD), MSK (unlikely given presentation)
- Assess Red Flags: ECG changes present? Hemodynamic instability? Hypoxia? → Determines emergent vs. urgent pathway
- Prioritize: (1) Troponin + serial ECG (highest pre-test probability for ACS), (2) Chest X-ray (PE, aortic pathology), (3) D-dimer if PE suspected
Diagnostic Gaps Identified: Need ECG interpretation, troponin baseline, vital sign trends over next 3 hours
Example 2: Chronic Abdominal Pain (Complex Case)
Patient: 38-year-old female with 6 months intermittent epigastric/RUQ pain, normal recent imaging
Differential by Likelihood:
- Functional dyspepsia (most common, normal imaging) — requires Rome IV criteria review
- Sphincter of Oddi dysfunction (consider if imaging normal) — controversial diagnosis, referral consideration
- Chronic pancreatitis (less likely without amylase elevation) — needs fecal elastase assessment
- Unrecognized GERD (redefined as extraesophageal) — trial PPI diagnostic approach
Diagnostic Gaps: Detailed symptom characterization (triggers, timing), medication review (NSAIDs?), alarm feature assessment, previous testing documentation
Recommended Workup Path: Establish diagnosis of exclusion first (repeat CBC, CMP, lipase if not recent) → Consider empiric PPI trial vs. gastroenterology referral based on alarm features and patient preference
What's Included
- SKILL.md instruction file: Complete framework with SNAP methodology, likelihood ratio approach, and red flag protocols
- SNAP Assessment Template: Structured worksheet for organizing symptoms, narrowing differentials, and identifying gaps
- Red Flag Screening Checklist: Quick reference for life-threatening diagnoses requiring immediate action across common presentations
- Diagnostic Workup Prioritization Matrix: Framework for sequencing testing by likelihood, yield, and cost-effectiveness
- Documentation Template: Clinical reasoning statements demonstrating systematic thinking for EMR and chart audit support
Who It's For
- Nurse Practitioners in primary care — managing undifferentiated complaints and complex chronic disease
- Acute care/urgent care NPs — triaging acute presentations with diagnostic uncertainty
- Specialty NPs (cardiology, gastroenterology, pulmonology, etc.) — complex cases outside subspecialty expertise
- NP residents and students — building systematic clinical reasoning during training
- NPs in medically underserved settings — managing complex patients with limited specialist access
Best For
- Undifferentiated acute presentations (chest pain, abdominal pain, dyspnea, altered mental status)
- Complex chronic disease with multiple comorbidities and atypical presentations
- Cases requiring documentation of systematic reasoning for chart audits or medical-legal review
- Diagnostic uncertainty when considering in-office management vs. specialist referral
- Building confidence in clinical reasoning before patient encounters or during new practice settings
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