Illness Script

Clinical reasoning is a key decision-making

skill that allows you to interpret and process a
patient’s history, examination and other
clinical information in order to diagnose and
treat their presenting condition.

The Manchester Clinical Reasoning model is

an effective tool that helps you to develop
this skill. By working through each domain of
the model, the illness script allows you to
differentiate between different conditions that
have similar presenting symptoms.
Furthermore, linking the pathophysiology
(“how”) to the symptoms will allow you to
better understand how they are associated
with the history and examination findings.

How to use the Illness Script effectively:

 For each condition in the case, compare
and contrast each domain in the Clinical
Reasoning model
 Think about the key characteristics and
differences between each condition that
allows you to discriminate between them
 Think about how results from common
investigations such as blood tests and
plain-film radiographs will differ, and
what the gold-standard investigation will
be
 Finally, summarise each condition by
working down the grid to consolidate
your learning. Use the scripts for unseen
cases, such as those in TCD

Illness script v2.0 (Sept 2024) 1

 Illness Script

Week 2: Subacute Breathlessness

Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
EPIDEMIOLOGY
Who?
Who gets this
disease?
Epidemiology,
risk factors and
circumstances

Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
CLINICAL
PRESENTATION
What?
What are the
classic
symptoms and
signs?

Time
Course
Hyperacute/
Week 2: Subacute Breathlessness Illness script v2.0 (Sept 2024)
2
 Illness Script
Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
acute/ subacute/
chronic
Constant or
episodic

Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
Why?
Which questions
are helpful in the
history to pull out
this information?
What signs will
you be looking for
in the
examination?

Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
PATHOPHYSIOL
OGY
How?
Biomedical cause;
derangements in
Week 2: Subacute Breathlessness Illness script v2.0 (Sept 2024)
3
 Illness Script
Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
anatomy,
physiology etc

Red Flags?
What are the red
flag symptoms
you need to ask
about for patients
with this
presenting
symptom?

Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
Investigatio
ns &
Results
What
investigations do
you want to do
including bloods,
and radiology?

Gold
Standard
Week 2: Subacute Breathlessness Illness script v2.0 (Sept 2024)
4
 Illness Script
Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
Investigatio
n
What
investigation(s)
will be most
useful to you to
diagnose this
condition?

Community
Exacerbation of Exacerbation of
Acquired Arrythmia / AF
COPD Asthma
Pneumonia
Managem
ent
Think lifestyle
advice, as well as
medical
management
where
appropriate

Week 2: Subacute Breathlessness Illness script v2.0 (Sept 2024)

5