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Differential Diagnosis > Introduction to the screening process > Flashcards

Introduction to the screening process Flashcards

1
Q

Three factors that create a need for screening

A
  1. Side-effects of medications
  2. Comorbidities
  3. Visceral pain mechanisms
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2
Q

If medical diagnosis is delayed, correct diagnosis is made when…

A
  1. The patient does not get better with PT interventions
  2. Patient gets better, THEN worse
  3. Other signs and symptoms eventually develop
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3
Q

Quickly, what are the reasons for screening??

DQSMDSSP

(Do question “sound medical doctor” S&S predictors)

A
  1. Direct access
  2. Quicker and sicker patient/client base
  3. Signed prescription without direct MD contact
  4. Medical specializations
  5. Disease Progression
  6. Patient disclosure
  7. Symptoms not previously reported because of forgetfulness, fear, or embarrassment
  8. Presence of one or more yellow or red flags
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4
Q

What is meant by “quicker and sicker?”

A

QUICKER–healthcare system we live in is trying to move patients in and out of hospital or follow up care facilities as quickly as possible.
It is important to be vigilant as a PT and not become complacent; always be looking for yellow and red flags during this short period of time you are with the patient

SICKER–The “American lifestyle” contributes heavily to the predisposition of our patients to have more than one condition taking place at once. It is important to constantly be identifying areas of possible concern in patients who may fit the mold of a certain condition that they did not come in to see you for

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5
Q

What is meant by “natural history?”

A

Medicine has changes immensely in a short period of time. People who have been diagnosed with certain conditions or diseases are living longer lives.
There are certain symptoms that you must be aware of that could occur secondarily from the chronic disease such as chronic pain, changes or limitations in ambulation and endurance, increased fatigue, etc.

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6
Q

What is a yellow flag?

A

Cautionary or warning symptom that give the practitioner pause. Screening may need to be considered

Require further investigation (screening, inquisition)

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7
Q

What is a red flag?

A

Features of a patient’s history and clinical examination that are thought to be associated with high risk of a serious disease process such as infection, inflammation, fracture, or cancer

Require immediate action (referral)

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8
Q

What are red flags associated with PAST MEDICAL HISTORY (Personal or family)?

CIRRHH

A

Personal/family history of CANCER

INFECTION within the last 6 weeks followed by:

  • Neurologic symptoms 1-3 weeks after
  • Joint pain
  • Back pain

RECURRENT COLD/FLU

RECENT TRAUMA

HISTORY OF IMMUNOSUPPRESSION

HISTORY OF INJECTION DRUG USE

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9
Q

What are red flags associated with RISK FACTORS?

STAGE BASE DOO

A 
SUBSTANCE ABUSE
TOBACCO USE
AGE
GENDER
EXPOSURE TO RADIATION

BMI
ALCOHOL USE/ABUSE
SEDENTARY LIFESTYLE
ETHNICITY/RACE

DOMESTIC VIOLENCE
OOPHERECTOMY/HYSTERECTOMY
OCCUPATION

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10
Q

What are red flags associated with CLINICAL PRESENTATION?

A

Unknown cause

Sxs unrelieved after PT intervention

Sxs get worse after PT intervention

Sxs get better, then worse

Significant weight loss (10% BW in 10-21 days)

Gradual, progressive, or cyclical sx presentation

Sxs unrelieved by rest or a change in position

Change of position, heat application, or rest no longer relieve sxs

Sxs out of proportion with what is typically seen in a condition

Sxs last longer that what is typically seen in a condition

Unable to alter sxs during examination

Sxs do not fit expected mechanical or NMS pattern

No pattern of sxs

A growing mass

Post-menopaual vaginal bleeding

Bilateral sxs:

  • Edema
  • Numbness
  • Skin pigment changes
  • Clubbing
  • Nail bed changes
  • Skin rash

Changes in muscle tone/ROM for individuals with neurologic conditions

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11
Q

What are red flags associated with PAIN PATTERN?

BFINCWTPCF

(Before finding immense negative changes within true pain, care fully)

A

Back/shoulder pain

Full and painless ROM accompanied with pain at rest

Inconsistent pain when compared with emotional/psychological overlay
Screening tests for emotional overlay negative

Night pain

Constant and intense pain (ARE YOU HAVING PAIN RIGHT NOW?)

Worsening pain with activity relieved by rest (area of interest being inactive)

Throbbing (vascular), knife-like, boring, or deep aching

Poorly localized pain

“Comes and goes”

Food intake or medications change MSK pain sxs

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12
Q

What are red flags associated with ASSOCIATED SIGNS AND SYMPTOMS?

A

Recent report of confusion (often reported by family)

Presence of constitutional symptoms, unusual vitals

Proximal muscle weakness associated with change in DTRs

Joint pain with skin rashes and/or nodules

Cluster of S&S observed during review of systems that characterizes a particular organ system

Unusual menstrual cycle/sxs

ASK! ANY OTHER SXS OR PROBLEMS THAT MAY NOT SEEM RELATED TO CURRENT PROBLEM?

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13
Q

What is primary prevention?

A

Stopping the process that leads to the development of some disease in the first place

FOCUS IS ON TRUE PREVENTION OF DISEASE

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14
Q

What is secondary prevention?

A

Regular screening for early detection of diseases or conditions

FOCUS IS ON IMPROVING OUTCOMES OF DISEASES

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15
Q

What is tertiary prevention?

A

Provides ways to limit the extent of disability while improving function in patients with chronic or terminal diagnoses

FOCUS IS ON MANAGING DISEASE PROGRESSION

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16
Q

What are constitutional symptoms?

A

Fever

Diaphoresis (unexplained sweating)

Sweats (occurring at any time, night or day)

Nausea

Vomiting

Diarrhea

Pallor

Dizziness/Syncope (fainting)

Fatigue

Weight-loss

17
Q

What does the Goodman screening referral method entail?

A

Past medical history

Personal and family history

Risk factor assessment

Clinical presentation

Associated signs and symptoms of systemic diseases

Review of systems

18
Q

What is a sign?

A

Observable findings detected by the therapist upon objective examination

Signs can be seen, heard, smelled, measured, photographed, shown to someone else, or documented in some way

19
Q

What is a symptom?

A

Reported indications of disease which are perceived by the patient but cannot be observed by someone else

“Numbness, tingling, or creeping,” sensations are examples

20
Q

What should you ask your patients instead of: “How are you today?”

A

“Are you better, the same, or worse today?”

“What can you do today that you could not do yesterday/last week/last month?”

21
Q

What questions can the therapist ask to identify the presence of associated signs and symptoms?

A

“Are there any symptoms of any kind anywhere else in your body that we have not talked about yet?”

ALTERNATIVELY:

“Are there any symptoms or problems anywhere else in your body that may not be related to your current problem?”

22
Q

What is the difference between a SYSTEMS REVIEW and a REVIEW OF SYSTEMS?

A

SYSTEMS REVIEW–brief and limited view of the anatomic and physiologic status of the cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular systems as well as the patient’s ability to communicate

REVIEW OF SYSTEMS–Therapist is actively searching for any characteristics of systemic disease; it is a useful tool recognizing clusters of associated signs and symptoms and the possible need for medical referral

23
Q

What are scenarios in which immediate medical referral are advised?

A

Anginal pain not relieved in 20 minutes with reduced activity/administration of nitroglycerin; angina at rest

Angina pain accompanied by nausea, vomiting, profuse sweating

Bowel/bladder incontinence and/or saddle anesthesia (cauda equina syndrome); cervical spine pain with incontinence

Anaphylactic shock

Inadequate ventillation/CO2 retention

Diabetic patient is confused or lethargic/changes in mental function

Positive McBurney’s point (Appendicitis); rebound tenderness (inflamed peritoneum)

Sudden worsening of claudication (thromboembolism)

Throbbing chest, back, or abdominal pain that increases with exertion accompanied by sensation of heartbeat when lying down which is palpable (aneurism)

Changes in size, shape, tenderness, or consistency of lymph nodes; detection of palpable, fixed, irregular mass in the breast, axilla, or elsewhere especially in cases of previous cancer history

24
Q

In the context of screening for referral, what is the primary purpose of a diagnosis?

A

To guide the plan of care and intervention strategies

25
Q

True or false? Direct access is the only reason PTs must screen for systemic disease

A

FALSE

26
Q

A patient gives you a written prescription from a MD, chiropractor, or dentist. What is the first screening question to ask?

A

“Did the MD (chiropractor, dentist) examine you?”

27
Q

When does screening for medical diseases take place?

A

Throughout the episode of care

28
Q

PTs are qualified to make human movement system diagnosis regarding primary neuromusculoskeletal conditions, but, we must do so in accordance with…

A

State practice acts

29
Q

When does medical referrral for a problem outside the scope of PT practice take place?

A

No apparent movement dysfunction exists

No causative factors can be identified

Findings are not consistent with neuromuscular or musculoskeletal dysfunction

Patient presents with suspicious red flag-type symptoms

30
Q

True or False? PT evaluation and intervention may be a part of the MD’s differential diagnosis

A

TRUE

31
Q

What is the major difference between a yellow- and a red-flag symptom?

A

Yellow–requires further investigation (screening)

Red–requires practitioner to seriously consider referral within the context of the patient’s complete examination

32
Q

What are the major decision-making tools used in the screening process?

A

Past medical history

Risk factor assessment

Clinical presentation

Associated signs and symptoms of systemic diseases

Systems review vs Review of systems

Differential Diagnosis (5 decks)

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