Lecture 7 - Differential Dx and Rehab Flashcards
Define differential diagnosis
The distinguishing of a disease or condition from others presenting similar symptoms.
What is differential diagnosis used for?
Is used to differentiate between one or more conditions, diseases or injuries
Why is differential diagnosis important?
Effective treatment requires specificity and accuracy in diagnosis
Achieved through:
-Comparison and contrasting of patient’s S and S
-What is the difference b/w a sign and a symptom?
-Sign = Objective = AT
-Symptom = Subjective = Patient
How do we achieve a differential diagnosis?
May involve a combo of: Clinical diagnosis -Based on signs and symptoms Physical diagnosis -Based on physical examination Pathological diagnosis -Microscopic Provocative diagnosis -Induce the S/S Laboratory diagnosis -Diagnostic imaging
How do we perform a differential diagnosis?
Clinician must have a working knowledge of pathology and the process of tissue healing
Differential Dx - red flags (Pain)
Pain: Diffuse Not altered by movement Intensifies with ↑s in intrathecal pressure Intensifies with ↑ intra-abdominal pressure Pain that is altered after eating Pain at rest Psychological factors Bone pain Pain that ↑s with exertion
Differential Dx - red flags (Swelling)
Swelling w/o trauma
Enlarged or swollen lymph nodes
Several joints swollen or painful with insidious onset
Differential Dx - Red flags (Genitourinary)
Any abnormal urinary constituents : Blood -urinary tract infection kidney contusion Color -dark can indicate liver problems Amount -small amounts -lower urinary tract obstruction Proteinuria -sign of renal impairment Frequency/excessive urination -diabetes -cystitis -prostatitis Incontinence -urological problem -gynecological problem -psychological problem -neurological problem
Differential Dx - Red flag (Gastrointestinal Tract)
Dramatic wt loss : cancer diabetes hypothyroidism hyperthyroidism depression anorexia
Changes in appetite :
depression
hypothyroidism
hyperthyroidism
Diarrhea:
ulcerative colitis
IBS
Constipation: neurogenic muscular mechanical drug diet
Differential Dx - Red flags (general health)
Fever
with back, shoulder, hip, SI, groin pain of unknown origin is serious
Fatigue
Depression
Weakness with an insidious onset
Differential Dx - Red flags (Day or night sweats)
Autonomic Nervous System problem
Menopausal symptom
Hormonal imbalances
what components make up the CNS?
Brain
Spinal Cord
What are the two divisions of the PNS? Describe them.
Somatic NS
- Coordinating body movement
- Regulates activities that are under conscious control
Autonomic NS
- Maintains homeostatis
- Sympathetic Division
- Parasympathetic Division
- Enteric (GI System)
Describe the divisions of the ANS
Sympathetic NS
Responds to impending danger or stress
Fight or flight
Increase HR, BP, adrenaline
Parasympathetic NS
Rest and relax
Constriction of pupils, slowing of heart, blood vessel dilation, stimulation of digestive and GI systems
Enteric NS (AKA Intrinsic NS) Manage every aspect of digestion Esophagus to stomach, small intestine and colon
Differential Dx - Red Flags (Tingling and numbness)
Neurogenic origin
Circulatory origin
Differential Dx - Red Flags (Headaches)
Hepatitis Brain tumors Lyme Disease Bull’s eye rash Muscle Tension Vascular
Differential Dx - Red Flags (Emergency Referral)
Cardiac Signs Anaphylactic Shock Bowel / bladder / incontinence Saddle area problem Diabetic Mental confusion
Differential Dx - Red Flags (General Referral Women)
Low back, hip, pelvis, groin, or SI symptoms with insidious onset or constitutional symptoms
Symptoms with menses
Chest, breast, axillary or shoulder pain without cause or with a medical history of cancer
Self or family
Bone pain on weight bearing pain that lasts longer than one week, worse at night
Differential Dx - Red Flags (Cancer)
Any patient with Hx of cancer complaining of vague MSK pain should be referred to rule out metastasis
Especially in the age group of 50-75
Prostate, colon
lumbar
sacral pain
Lung, breast
cervical
thoracic pain
There will be other S&S
malaise
wt loss
chronic area dysfunction
Differential Dx - Red Flags (Infection)
Infection of the intervertebral disc post Sx
Inflamed joint with abrasion near by
Inflammation that will not settle down
Discharge from the area
Assesment and interpretation: Suspicious symptoms during history
Insidious onset Multiple joint problems -RA -Lupus -Gout Fever, chills, nausea, wt loss Change in normal body function -Bowel or Bladder Night pain or pain at rest Pain getting worse without cause Pain does not change with movement Symptoms can not be reproduced -Functional or special tests
