General brief overview, history present illness, review of systems, past medical history, family history, social history, physical exam, reviewing of current diagnostic testing, assessment, and plan. Part of the comprehensive clinical reasoning skills includes gathering pertinent information and data, recognizing key features, creating the problem representation, adopting a framework in which to process the data and then applying the data required to that framework to come up with an appropriate differential diagnosis. When looking at the differential diagnosis then deciding what further data you need to rule in or rule out the diagnosis. At the same time being aware of any of potentially red flag symptoms or differential diagnosis that if you miss can have potentially disastrous outcomes for the patient. Hanging especially close attention to being able to rule the red flag differential diagnosis out or in. Once the practitioner has the differential diagnosis list and has identified the red flag or must not miss diagnoses they must look at what testing could rule in or rule out that differential. One diagnostic test that might be helpful in this case would be a chest x-ray because the data

CLINICAL REASONING 4 suggests the differential diagnosis that includes pleurisy or aortic dissection. The chest x-ray for a patient with pleurisy would come back normal but with aortic dissection should show in an enlargement on the medial sternal part of the heart. If the enlargement was noticed by radiology