Differential Diagnosis Unit 1 Flashcards
What are key factors to consider the need for screening?
- Side effects of medications
–Muscle or joint pain - Comorbidites
–Diabetes, incontinence, hypertension, depression, etc. - Visceral Pain mechanisms
–Differs from neuro/musculoskeletal, but it may improve due to placebo effect - The patient/client does not get better with PT intervention
- The patient/client gets better then worse
- Other associated signs and symptoms eventually develop
What are Reasons for Screening?
- Direct Access: Therapist has primary responsibility or first contact
- Medical Specialization: Medical specialists may fail to recognize underlying systemic disease
- Disease progression: Early S/S are difficult to recognize, or symptoms may not be present initially
- Patient/client disclosure: client disclosure information previously unknown or undisclosed to the physician
- Client does not report symptoms or concerns to the physician
- Presence of one or more yellow or red flags
What does the screening process involve when identifying yellow or red flags?
- Getting the Pts. PMH
- Risk factors the Pt. has
- Clinical Presentation
- Pain Patterns
- Associated S/S
When screening for Yellow and Red Flags, what should stand out during the screening?
- Personal or Family Hx of cancer
- Recent (last 6 weeks) infection - recurrent FLU or colds
- Recent hx of trauma, such as MVA or fall, etc.
- History of immunosuppression (steroids, organ transplant, HIV)
When screening for Yellow and Red Flags, what are some risk factors we should look for?
- Substance use/abuse
- Tobacco use
- Age
- Gender
- Sedentary Lifestyle
- Domestic Violence
- Exposure to radiation
When screening for Yellow and Red Flags, what are some Clinical Presentations that should stand out?
- Unknown etiology, insidious onset
- Symptoms dont improve with PT, or they get worse
- Significant weight gain or loss without effort
- Gradual, progressive, cyclical presentation of symptoms
- Unrelieved by rest or change in position
- No discernible pattern of symptoms
- Growing mass
- A hematoma
When screening for Yellow and Red Flags, what are Pain Patterns that should stand out?
- Back or shoulder Pain
- Pain accompanied by a full and painless ROM
- Night Pain (constant and intense)
- Pain described as throbbing (vascular) knife-like, boring or deep aching; coming and going like spasms, colicky
- Pain that is poorly localized
When screening for Yellow and Red Flags, what are Associated Signs and Symptoms that we can see that should stand out?
- Recent report of confusion, usually its a family member who takes the therapist aside to report this
- Presence of constitutional symptoms (Fever, Nausea, Vomiting, Diarrhea, Pallor, Syncope, Sweats, Diaphoresis, etc.)
- Proximal muscle weakness, especially if accompanied by change in DTRs)
- Joint pain with skin rashes, nodules
- Unusual menstrual cycle/symptoms
What are the Guidelines for Physician Referral?
- Lack of significant neuro-muscular S/S
- Lack of expected progress with PT intervention
- Vital sign abnormalities / Early signs of cancer
- Cardiac and Pulmonary symptoms unknown to patient
- Abdominal pain, especially accompanied by constitutional symptoms
- Symptoms that seem out of proportion to the injury
What are the Guidelines for Immediate Medical Attention?
- Client with angina has nausea, vomiting, profuse sweating
- Client presents with bowel/bladder incontinence and/or saddle anesthesia secondary to cauda equina lesion
- Client is in anaphylactic shock
- Client with diabetes appears confused or lethargic or exhibits changes in mental function
- Client has (+) McBurney’s (Appendicitis)
- Sudden or worsening of intermittent claudication
How does a PT have Cultural Competence when interviewing a patient?
- Effective interviewing and communication require the clinician to possess an awareness and understand the uniqueness of each individual.
What are the 4 interviewing techniques?
- Open Ended Questions
- Closed Ended Questions
- Funnel Sequence Technique
- Paraphrasing Technique
When would you use Open-Ended Questions?
At the beginning of the interview (Patients may provide more information about them and the disease)
When would you use Closed-Ended Question?
These are used to characterize the symptoms more clearly (Yes or No Questions)
What is the Funnel Technique/Sequence?
Moving from the Open-Ended questions to the Closed-Ended Questions
