Medical Screening and Differential Diagnosis

What is the purpose of the medical screen?

decides whether a pt referral is warranted, confirm or rule out the need for PT intervention, screen red flags, aids in clinical decision making, should be ongoing throughout PT

What is the important steps for the PT eval?

1. History/Review of Systems

2. physical exam

3. diagnosis

What is the difference between medical screening and screening for referral?

medical screening is method for detectign disease of body dysfunction before an individual would normally seek medical care, usually given to individuals that do not have current symptoms but may be at risk for adverse health outcomes and screening for referral is determining whether an individual has a condition that can be addressed by a PT intervention or whether the conditions requires physician or other healthcare progressional eval

what are some reasons to screen?

direct access pts, quicker and sicker pt case, previously obtained prescription, medical specialization, disease progression, pt client disclosure, and presence of one or more yellow flags

what is the differential diagnosis?

purpose is to differentiate between one condition vs another, rule out disease and conditions that appear MSK, part of the PTs scope of practice, helps PTs recognize areas beyond the PT scope of practice, and IDs clients that need referral to another provider

What is the difference between the medical diagnosis and the physical therapy diagnosis?

the med diagnosis is the recognition of disease or pathological conditions, more focused on the molecular level, the PT diagnosis is focused on the movement system and the whole person w

what are the steps in PT diagnosis?

examination, evaluation, diagnosis, prognosis, intervention, and outcomes

what is the difference between the examination and eval?

exam in collecting the information, and eval is the whole process in which there is assessment or judgement of the collected data

what does a PT diagnosis cover?

emphasis places on specific human movement impairments, activity limitations, and participation restrictions

what are the potential pathways by the physical therapist?

referral/consulation (no treatment, referral may be non urgent or immediate/urgent) or diagnose and treat, or both

What are PT screening tools used for?

ID chief and secondary problems, ID info inconsistent with the presenting complaint, ID non contributing info, generate working hypothesis, determine whether referral or consult is indicated

what is at minimum included in the screening exam?

taking vital signs, use symptoms not pain during screening, look for red flag histories, signs, and symptoms, and medication review, ask open ended questions

what is evidence based practice?

A process that integrates the best available research, clinical expertise, and patient values to make informed healthcare decisions (can use CPGs along with expertise and pt preferences)

what are yellow flags?

cautionary or warning symptoms that signals the need to slow down and consider the need for further screening, can use outcome measure as a screening tool: optimal screening for prediction of referral and outcome for yellow flags (OSPRO-YF)

what are red flags?

stop and evaluate symptoms that require immediate attention, either further screening or referral (features of a pt’s med hx and exam features associated with high risk of serious disorders (infection, inflammation, cancer, fracture), can use a screening tool (optimal screening for prediction of referral and outcome review of symptoms or OSPRO-ROS)

what are constitutional symptoms?

constellation of signs and symptoms present when the pt is experiencing a systemic illness

what are 3 key factors that lead to screening?

side effects of medications (might be most common source), comorbidities (depression, diabetes, incontinence, obesity, chemical dependency, hypertension, osteoporosis, and deconditioning), visceral pain mechanisms

review of symptoms vs systems review

systems review is a brief/limited exam o fthe anatomic/physiologic status of the CV/pulm, integ, MSK, and neuromuscular systems whereas the ROS is more general and assesses things like fatigue, malaise, weakness, chills/sweats/fever, weight loss/gain, nausea, paresthesia/numbness, dizziness and lightheadedness, change in mentation/cognition abilities

what are the guidelines for immediate medical attention?

• angina like symptoms that last 20 mins or includes symptoms of nausea, vomiting, or profuse sweating

• incontinence

• anaphylatic shock

• symptoms of inadequate ventilation

• confused/lethargic, or change in mental status new onset

• positive tests for appendicitis or peritoneum inflammation

• worsening intermittent claudication

• throbbing chest, back, or abdominal pain that increases with exertion

• changes in lymph nodes, detection of palpable fixed or irregular mass in breast, axilla, or elsewhere

what are the general physician referral guidelines?

unknown cause, lack of significant NMS signs and symptoms, lack of progress with PT intervention, constitutional or associated signs and symptoms developed, significant past med hx unknown to physician, change in health status lasting longer than 7-10 days beyond the expected time period, pt with jaundice that has not been diagnosed

what is primary prevention?

stopping procesess that lead to the disease and illness and other conditions through edu, reduction in risk factors and general health promotion

what is secondary prevention?

intervening to detect and treat diseases early, aiming to reduce severity and improve outcomes by using screening and early diagnosis.

what is tertiary prevention?

Aimed at reducing the impact of long-term illness or disability through rehabilitation and support, focusing on improving quality of life and minimizing complications.

what is the PTs role in disease prevention?

has a role in all levels of prevention (1,2,3) as well as promoting health and wellness, educating patients, and facilitating lifestyle changes.