Lecture 7 - Differential Dx and Rehab

Question 1

Define differential diagnosis

Answer 1

The distinguishing of a disease or condition from others presenting similar symptoms.

Question 2

What is differential diagnosis used for?

Answer 2

Is used to differentiate between one or more conditions, diseases or injuries

Question 3

Why is differential diagnosis important?

Answer 3

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

Question 4

How do we achieve a differential diagnosis?

Answer 4

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

Question 5

How do we perform a differential diagnosis?

Answer 5

Clinician must have a working knowledge of pathology and the process of tissue healing

Question 6

Differential Dx - red flags (Pain)

Answer 6

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

Question 7

Differential Dx - red flags (Swelling)

Answer 7

Swelling w/o trauma
Enlarged or swollen lymph nodes
Several joints swollen or painful with insidious onset

Question 8

Differential Dx - Red flags (Genitourinary)

Answer 8

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

Question 9

Differential Dx - Red flag (Gastrointestinal Tract)

Answer 9

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

Question 10

Differential Dx - Red flags (general health)

Answer 10

Fever
with back, shoulder, hip, SI, groin pain of unknown origin is serious

Fatigue

Depression

Weakness with an insidious onset

Question 11

Differential Dx - Red flags (Day or night sweats)

Answer 11

Autonomic Nervous System problem

Menopausal symptom

Hormonal imbalances

Question 12

what components make up the CNS?

Answer 12

Brain

Spinal Cord

Question 13

What are the two divisions of the PNS? Describe them.

Answer 13

Somatic NS

• Coordinating body movement
• Regulates activities that are under conscious control

Autonomic NS

• Maintains homeostatis
• Sympathetic Division
• Parasympathetic Division
• Enteric (GI System)

Question 14

Describe the divisions of the ANS

Answer 14

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

Question 15

Differential Dx - Red Flags (Tingling and numbness)

Answer 15

Neurogenic origin

Circulatory origin

Question 16

Differential Dx - Red Flags (Headaches)

Answer 16

Hepatitis
Brain tumors
Lyme Disease
Bull’s eye rash
Muscle Tension
Vascular

Question 17

Differential Dx - Red Flags (Emergency Referral)

Answer 17

Cardiac Signs
Anaphylactic Shock
Bowel / bladder / incontinence 
Saddle area problem
Diabetic 
Mental confusion

Question 18

Differential Dx - Red Flags (General Referral Women)

Answer 18

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

Question 19

Differential Dx - Red Flags (Cancer)

Answer 19

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

Question 20

Differential Dx - Red Flags (Infection)

Answer 20

Infection of the intervertebral disc post Sx

Inflamed joint with abrasion near by

Inflammation that will not settle down

Discharge from the area

Question 21

Assesment and interpretation: Suspicious symptoms during history

Answer 21

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