How to Take a History—Anatomy

OK, now, we have:

Identified our chief complaint
Generated a list of syndromes which could contain the chief complaint
Asked questions to rule in/rule out these syndromes

We need now to figure out WHERE the problem is. For each syndrome, there is at least one anatomical region where a lesion can cause the syndrome.

But there may be more. Therefore, especially when there are more than one chief complaints, it behooves you to identify possible anatomical locations where lesions can cause each syndrome. In essence, you make a table up, either in your head or on paper, and try to fit the syndromes together with the locations.

Using Occam's Razor (this is anatomy, after all...), you look for the location where ONE lesion can cause the most syndromes you are eliciting.

There, brave explorer, you plant your flag.

To exemplify this step, consider a patient with paraparesis, bilateral leg weakness. Stop now and get a pencil and paper (I know, shockingly outdated technology, but humor me). Hey, I said stop and do it! This computer has eyes (oh my God, I knew it all along...cf. the conspiracy pages on the net...).

OK. Got a list written down? Honest? Now, to look at: MY LIST

We shall now consider a variety of PATHOLOGICAL entities appearing at various anatomical locations to explain the clinical syndromes you have elicited.

Yes, another layer to the cake...