Intro to Differential Diagnosis Flashcards
*Describe the diagnosis processes
1) Pattern recognition
2) Hypothetico deductive
- Hypothesis generation
3) Algorithm
4) Exhaustive
5) Logical reasoning
*Components of illness scripts
- Pathophysiology: what causes the disease
- Epidemiology: who commonly gets this disease
- Time course: how long it’s been going on
- Symptoms & signs
- Diagnosis: results of testing
- Treatment: how would you treat this disease
*Differences between diagnosis informed care and medical screening
Diagnosis: uses directed questions & focused physical examination tests in a hypothesis-driven manner
Medical Screening: general systems review with the goal to assess for risk factors that may impact patients’ overall well-being
*Classification system of red flag screening
I = suggests serious pathology outside of MSK disorder, possible immediate intervention by a specialist
II =further patient questioning & adoption of selected examination methods
III = common, require further physical examination, likely to alter treatment
*Procedures to improve diagnostic accuracy (possible causes)
- TIM VaDeTuCoNe
- Trauma
- Inflammation: aseptic or septic
- Metabolic condition
- Vascular: arterial, venous, or lymphatic
- Degenerative
- Tumor: malignant primary, malignant metastatic, or benign
- Congenital
- Neurogenic/Psychogenic
Examples of a medical diagnosis
- stroke
- fracture
- foot pain
Examples of a PT diagnosis
- impaired gait
- generalized weakness
- decreased force production
- impaired AROM
- pain
- decreased strength
What is a diagnosis
- Process + product of a clinical investigation related to the pathology underlying a patient/client’s signs & symptoms resulting in a label
- investigation + label = diagnosis
What are some goals of a diagnosis
- (Primary) determine whether PT services are indicated for the patient’s condition
- identify the target disorder
Diagnosis limitations
- cause of condition may not be determined
- label may not be descriptive
- specificity of labeling depends on information & experience
4 possible options for is the suspected diagnosis within scope of practice
- Emergency referral: as a guide, on the same day
- Urgent referral: as a guide, within 5 days
- Watchful waiting: close surveillance while undergoing tx as required while allowing time to pass before medical intervention “treat and refer”, safety netting
- Appropriate referral: diagnosis is within scope of practice, evaluate and treat
Define safety netting
- management strategy used for people who may present with possible serious pathology
- strategies should include advice on which signs & symptoms to look out for, which action to take, & the time frame within which that action needs to be taken
*Describe performing diagnosis informed care
- PT interprets the diagnosis to determine appropriate intervention & prognosis
- MUST prioritize the most important aspects of disablement to address in pain
- most interventions have an indirect effect on pathology
- requires PT to determine cause/effect between pathology & functioning
Limitations of diagnosis informed care
- the label alone is insufficient to guide PTs
- most PT referrals indicate: shoulder, knee, hip, back pain
- essentialist approach relates to mechanism
- “treat the patient, not the diagnosis!”
Define essentialism
- treatment of the cause/source is more effective than treating individual signs & symptoms
- mechanism is not always directly responsible for impairment in functioning
