Specialty PA Protocol & Differential Diagnosis Assistant
Structure differential diagnoses and apply specialty protocols for complex patient cases
What You Can Do
You can rapidly structure differential diagnoses ranked by clinical probability, apply specialty-specific diagnostic protocols to atypical presentations, and generate clear clinical reasoning documentation that bridges patient presentation to evidence-based decision paths. This skill helps you systematize complex cases where multiple etiologies are plausible, ensuring diagnostic rigor, protocol compliance, and time-sensitive decision justification across cardiology, orthopedics, psychiatry, emergency medicine, oncology, gastroenterology, and other specialty settings.
Features
applies relevant institutional and evidence-based protocols (ACR imaging guidelines, AHA/ACC cardiac protocols, ACOG obstetric protocols, etc.) to your clinical specialty
systematically lists and ranks differential diagnoses by clinical probability with supporting clinical features and red flags
structures reasoning when clinical presentation deviates from typical protocol pathways, with clear justification for protocol modifications
generates structured notes suitable for attending physician review and EHR documentation with explicit reasoning chains
applies specialty-specific risk stratification tools (e.g., HEART score for chest pain, Ottawa rules for orthopedic injury, suicide risk assessment scales)
recommends diagnostic testing sequence (labs, imaging, procedures) prioritized by protocol and clinical urgency
handles cases spanning multiple organ systems by clearly identifying primary specialty domain and coordinating systems considerations
Example Output
Example 1: Cardiology PA – Atypical Chest Pain
Case: 58-year-old with 3 days substernal chest pain, negative troponins × 2, nonspecific EKG changes, history of GERD and anxiety.
Differential Diagnosis (ranked by probability):
- Acute Coronary Syndrome (ACS) – intermediate risk by HEART score (5/10); continued troponin surveillance + stress testing indicated
- Pulmonary Embolism – low pretest probability but dyspnea present; D-dimer warranted
- Esophageal spasm – positional component, response to antacids
- Anxiety-related chest pain – documented history but cannot exclude ACS
Protocol Application: Per ACC/AHA guidelines, patient meets criteria for serial troponin protocol with stress imaging. Admit for observation and stress test in AM.
Example 2: Orthopedic PA – Complex Knee Pain
Case: 42-year-old with acute knee swelling, mild fever (101.2°F), recent intra-articular injection.
Red Flag Assessment: Fever + joint swelling post-injection = rule out septic arthritis (joint aspiration/culture indicated STAT)
Diagnostic Pathway:
- STAT knee aspiration with cell count, culture, Gram stain, crystal analysis
- Pending results: hold physical therapy, consider empiric antibiotics if clinical concern high
- Imaging: MRI only after infection ruled out (ACR guidelines)
Clinical Reasoning: Septic arthritis risk outweighs mechanical workup; infection must be excluded before advanced imaging.
What's Included
- SKILL.md: Complete system prompt for specialty PA protocol and differential diagnosis workflows
- Specialty Protocol Templates: Evidence-based protocol frameworks for cardiology, orthopedics, psychiatry, emergency medicine, oncology, and gastroenterology cases
- Differential Diagnosis Ranking Checklist: Structured format for systematically listing, ranking, and justifying differential diagnoses by clinical probability
- Clinical Reasoning Documentation Framework: Template for peer-review-ready documentation including case summary, differential ranking, protocol application, and recommended diagnostic pathway
- Red Flag Assessment Toolkit: Quick-reference guides for identifying urgent findings requiring immediate protocol escalation or consultation
Who It's For
- Physician Assistants in specialty practice (cardiology, orthopedics, psychiatry, emergency medicine, oncology, gastroenterology, pulmonology)
- PA students and residents requiring structured clinical reasoning frameworks for complex cases
- Clinical educators and PA program directors teaching differential diagnosis and protocol application
- Hospitalist PAs managing undifferentiated presentations requiring rapid risk stratification
- Urgent care and emergency medicine PAs working up complex presentations with multiple specialty considerations
Best For
- Working up atypical or complex presentations that deviate from straightforward diagnostic pathways
- Applying specialty-specific protocols (ACC/AHA, ACR, ACOG, etc.) to real-world patient cases
- Ranking and justifying differential diagnoses for peer review and attending physician consultation
- Generating clinical reasoning documentation suitable for EHR entry and medical records
- Rapid risk stratification in time-sensitive cases requiring protocol-based decision justification
- Managing cases spanning multiple organ systems with competing diagnostic considerations
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