Red Flags/Differential Diagnosis

Question 1

Identify Red Flags based off:

Answer 1

patient/family medical history
medical screening questionnaire
systems review (Y/N questions)

Question 2

Red flags help determine:

Answer 2

if patient appropriate for PT

• w/ consult
• w/out consult
• not appropriate (med consult or 911)

Question 3

What is a red flag?

Answer 3

sign or symptom found during patient history, systems review, or test and measures-> indicates physician referall

sign= observed or measured
symptom= patient reports

Question 4

Red flags may indicate:

Answer 4

• non-neuromusck problem
• serious NMS prob
• systemic disease
• serious pathology
• further exam by other health care necessary

Question 5

Initial Systems review/questionnaire

Answer 5

ask general yes/no questions about health and if theyre being treated by physician for anything

ask for:
weight loss, fatigue, remors, rash, sleeping, falls, etc.

Question 6

Muskoloskeletal pain (comparing vs. systemic)

Answer 6

Decreases w/ cessation of activity
Lessens at night
increases with mechanical stress
continuous or intermittent

ex: sleeping pain goes away if you move

Question 7

Systemic Pain (comparing vs. muskoloskel)

Answer 7

reduced by pressure
disturbs sleep
not aggravated by mechanical stress
constant or in waves

ex: no matter what position sleeping youre in pain

Question 8

Visceral referred pain

Answer 8

from internal organs or heart- trunk or abdomen
NOT well localized - diffuse
referred to site where organ was located in fetal development

Question 9

Concerning PMH

Answer 9

• cancer
• recent (6wks) infection followed by neuro sympts 1-3 wks later, joint pain, or back pain
• recurrent colds/flu in pattern
• trauma
• minor trauma in old ppl w/ ostopenia
• immunosuppresion (HIV, steroids)
• injection drug use

Question 10

Initial Potential Red Flag info

Answer 10

unknown etiology
gradual/progressive/cyclical symptoms
unrelieved pain w/ rest or change
out of proportion of injury, beyond time frame
PT cant alter symptoms
unrelieved by PT

Question 11

Fatigue

Answer 11

RF: tiredness interferes with person’s ability to carry out daily activities >2-4 wks

Question 12

Fever, Chills, Sweats

Answer 12

Infections, cancers, CT disorders (ex: Rhematoid arhtiris)

RF: unknown origin
>99.5-101
present 2-3 wks
no MD consult

Question 13

Weight loss

Answer 13

How much, over what time frame, other symptoms?

RF: 5-10% w/out change diet/excercise
10-15 lb wt loss/gain in 2 weeks

Question 14

Nausea and Vomiting

Answer 14

How often/long? Other symptoms? W/out nausea?
Organ disease, metastatic cancer, adverse drug reaction

RF: unknown origin and MD not away
progessively worse

Question 15

Change in mentation

Answer 15

New onset or worsening? Long/short term memory? Quick or slow come one?
Delirium, dementia, head injury, adverse drug, infection

Question 16

Follow up questions to abnormal signs and symptoms

Answer 16

When did it start?
Do you know why?
Has it changed?
Other unnusual symptoms associated?
Physician aware?

Question 17

Cancer RFs

Answer 17

persistant pain at night
constant pain
unexplained weight loss
loss of apetite
unusual lumps, growths, mass
unwarranted fatigue

Question 18

Neurological RFs

Answer 18

hearing changes
frequent/severe headahces w/ no injury history
swalling/speech probems
balance, coordination, falling
vision
fainting/drop attacks
sudden weakness

Question 19

Cardiovascular RFs

Answer 19

short breath
dizzy
pain/heavy chest
pulsate pain in body
constant/severe pain lower leg or arm
discoloered/painful feet
swelling w/ no injury history

Question 20

GI RFs

Answer 20

nausea vomiting
bladder function prob
menstrual irregs
abdominal pain
heardburn/indigestion

Question 21

Signs/Symptoms requiring IMMEDIATE medical regerall

Answer 21

angina > 20 mins; w/ nausea, sweating
bowel/bladder incontinence/saddle anesthesia
inadequate ventilation
diabetes and confused
McBurney’s positive or rebound tenderness
tenderness or claudication
throbbing chest/abdom pain increased with exerstion

Question 22

What is differential diagnosis

Answer 22

Process and end result of exam and eval

PT organizes clusters, syndromes to determine prognosis, plan of care, and interventions

identify source/cause of prob and provide label
ex: tendon, bone, joint, nerve, etc.

Question 23

3 types of Clinical Diagnosis

Answer 23

1. Pattern recognition
   instant realizeation that patient conforms to pattern of disease
2. History and physical exam
   consideration of all hypotheses of potential etiology
3. Hypothetico-deductive method
   indentify early cues; formulate short list of potential diagnoses

Question 24

Contractile vs. Inert. vs. Nerual

Answer 24

contractile- muscle
inert- lig, bone, cartilage
neural- nerve