Differential Diagnosis

Question 1

What is a differential diagnosis?

Answer 1

a process wherein a doctor differentiates between two or more conditions that could be behind a person’s symptoms.
The goal: to create a final diagnosis, or a list of three possible diagnoses

Question 2

SOAP note format : differential diagnosis

Answer 2

S: OLD CAARTS/FED TACOS
O:Vitals/PE
A: 1. Chief Complaint
A. First differential – likely
B. Second differential – less likely
C. Third Differential – least likely
2.Somatic dysfunction  chronic past medical history diagnoses  relevant family history or diagnosis for which a patient requires counseling

Question 3

5 Osteopathic Models

Answer 3

◦Biomechanical
◦Neurologic
◦Respiratory-Circulatory
◦Metabolic-Energetic-Immune
◦Biopsychosocial/Behavioral

Question 4

VINDICATE mnemonic

Answer 4

◦Vascular
◦Inflammatory
◦Neoplastic
◦Degenerative/Deficiency
◦Idiopathic/Intoxication
◦Congenital
◦Autoimmune/Allergic
◦Traumatic
◦Endocrine

Question 5

Ex of Biomechanical complaints

Answer 5

◦Somatic Dysfunction
◦Inflammation (Joint/muscle)

think: ◦Achy ◦Point tenderness ◦Activity related

Question 6

Ex of Neurologic complaints

Answer 6

◦Nerve impingement
◦Nerve inflammation

think: ◦Numb/tingling/burning ◦Radiating

Question 7

Ex of Resp/Circ complaints

Answer 7

◦Ischemia

think: ◦Claudication

Question 8

Ex of Met/Ene/Imm complaints

Answer 8

◦GI dysfunction
◦GU dysfunction
◦Inflammation

think: ◦Cramping/intermittent (visceral) ◦Constant (infection)

Question 9

Ex of Behavioral complaints

Answer 9

◦Psychosomatic
◦Postural

think: ◦Worse when stressed/depressed/anxious

Question 10

Case 1
◦A 26-year-old presents to the office complaining of low back pain. Patient states that it started two days ago while lifting heavy boxes. The pain is sharp and shooting. It is constant at 7/10, and radiates to the left great toe. Ibuprofen has helped minimally. Coughing, straining for bowel movement, and lifting has made it worse. The patient notices weakness in the left lower extremity as well. ◦Differential Diagnosis?

Answer 10

1. Lumbar radiculopathy – L5
2. Sprain/Strain – unlikely
3. Fracture – unlikely
4. Somatic dysfunction: lumbar, lower extremity

Question 11

Case 2
◦A 27-year-old presents to the office complaining of low back pain for the past week. Pain began while raking leaves. Patient notes pain generally in the low back region. The pain is achy, and constant, getting slightly better since the onset. Patient states there is no radiation of the pain. Ibuprofen, rest, and hot packs makes it better; certain movements make it worse. At worst, the pain is 5/10. It is better in the morning and gets worse throughout the day. ◦Differential Diagnosis?

Answer 11

1. Lumbar strain – likely
2. Scoliosis – unlikely
3. Ankylosing spondylitis - unlikely
4. Somatic dysfunction - lumbar

Question 12

Case 3
◦A 22-year-old female presents to the office complaining of low back pain that has been going on for several years. No inciting factor is noted. Patient notes pain in the thoracolumbar junction region and sacral region. Patient states there sometimes radiation into upper legs bilaterally. The pain is achy, cramping, and intermittent, worse on some days, better on others. Patient states the pain is worse around her menstrual cycle, but can occur at any time. Patient relates that stress seems to make it worse. Ibuprofen helps. At worst, the pain is 7/10, some days there is no pain at all.◦Differential Diagnosis?

Answer 12

1. Endometriosis – most likely
2. Menstrual - likely
3. Sprain/strain – unlikely
4. Somatic dysfunction: thoracic, lumbar, sacral