Differential Diagnosis

and Clinical Decision Making

Screening

It is a method for detecting disease or

body dysfunction before an
individual would normally seek
medical care.
Screening for referral

 Therapist’s responsibility

 Cost effective

 Treat specifically

 Identifysign and symptoms of systemic disease…shoulder

and back pain

 Cancer is major part of medical screening

Reason for Medical Disease
Screening
Direct access

Quicker & sicker

Signed prescription

Medical specialization

Progression of time & disease

Patient /client disclosure

Presence of one or more yellow or red flags

Yellow or Red Flags
A yellow flag is a cautionary or warning
symptom that signals " slow down" and
think about the need for screening.

A red-flag symptom requires immediate

attention , either to pursue further
screening questions and/or tests , or to
make an appropriate referral .
 RED FLAGS
Factors that require immediate medical attention
- Blood in sputum
- LOC or altered mental status
- Neurological deficit not explained by monoradiculopathy
- Numbness or Parasthesia in the perianal region (aka
saddle anesthesia)
- Pathological changes in bowel and bladder
- Patterns of symptoms not compatible with mechanical
pain (on physical exam)
- Progressive neurological deficit
- Pulsatile abdominal mass
 Yellow Flags

Depression
Anxiety
Malingering/Non-Organic Pain
Past Medical History

Personal or family history of cancer

Recent (last 6 weeks) infection
Recent history of trauma such as motor
vehicle accident or fall (fracture; any age) or
minor trauma in older adult with
osteopenia/osteoporosis
History of immunosuppression (e.g., steroids,
organ transplant, HIV)
History of injection drug use (infection
 Clinical Presentation
No known cause/insidious onset
Cyclical presentation: Better/worse/better
Weight loss/gain within 10-21days
Unrelieved by rest/positional change
Unrelieved by PT intervention
Persist longer than expected
Growing mass
Unable to alter symptoms during
examination
Cont…
Postmenopausal vaginal bleeding
Bilateral symptoms:
◦ Edema
◦ Numbness/tingling
◦ Clubbing
◦ Skin rash
Change in muscle tone or ROM for individuals
with neurological symptoms (CP, SCI, TBI,
MS)
Pain pattern
Back or shoulder pain
Pain with full and painless ROM
Night pain
Constant and intense
Poorly localized
Vascular/ neurological/ musculoskeletal/
emotional
Associated Signs and
Symptoms
Recent report of confusion (or
increased confusion
Presence of constitutional symptoms
Proximal muscle weakness
Joint pain with skin rashes, nodules
Physical Therapist Role in
Disease Prevention
 Primary Prevention:
Stopping the processes) that lead to the development of diseases),
illness(es), and other pathologic health conditions through
education, risk-factor reduction, and general health promotion

 Secondary Prevention:
Early detection of disease(es), illnesses), and other pathologic
health conditions through regular screening; this does not prevent
the condition but may decrease duration and/or severity of
disease and thereby improve the outcome, including improved
quality of life

 Tertiary Prevention:
Providing ways to limit the degree of disability while improving
function in patients/clients with chronic and/or irreversible
diseases
 DIAGNOSIS BY THE
PHYSICAL THERAPIST
It is the policy of the (APTA) that PT shall
establish a diagnosis for each patient.
PTs use diagnostic labels that i d e n tify the
impact of a condition on function at the level
of the system (especially the movement
system) and the level of the whole person.
The PT is qualified to make a diagnosis
regarding primary NMS conditions though
we must do so in accordance with the state
practice act.
How do you dignose your
patients?
Clinical Decision Making/ Clinical
Reasoning process
It is a process by which a health care
provider take objective data acquired
from an actual patient and integrate it
with factual knowledge from text
books and medical literature to either
make a diagnosis or develop a
treatment plan.
Clinical Reasoning process
It is not a simple skill
Interpretation of subjective data
Evaluation of the accuracy and validity of
data.
Synchronize individual pieces of data into
higher order groups
Determination of the relevance of
scientific literature for a specific clinical
situation.
Clinical Reasoning process
Criticalevaluation of the arguments for
and against the diagnosis.
Application of biostatistics
Integration of different types of
knowledge into a complete decision
making process
Guide to physical therapy practice
Difference b/w medical and
physical therapy diagnosis
Medical diagnosis
Based on the pathologic or pathophysiologic
state at the cellular level.

Physical therapy diagnosis

Based on Model of disablement : impairment
,functional limitation or disability.
Diagnosis

A label encompassing a cluster of sign

& symptoms commonly associated
with a disorder or syndrome or
category of impairment ,functional
limitation or disability.
A list of possible diagnosis which may explain
the patient’s presentation
It should include those diagnosis in which either
its likelihood is high enough or the danger if it
should be missed is high enough, in order to
warrant immediate testing to investigate that
specific diagnosis
It may include additional diagnoses whose
likelihood is low enough to not warrants
immediate testing, but which have not been
completely ruled out
It is prioritized in descending order of
likelihood.
Differential diagnosis

A process of identifying all of the possible

diagnoses that could be connected to the signs,
symptoms, and lab findings, and then ruling
out diagnoses until a final determination can
be made.

List of diaganosis
THANKS