← Differential Diagnosis class notes
Differential Diagnosis: Three Screening Cases
Decide what changes the plan and how urgently to act. These examples are educational rather than a patient diagnosis or formal triage protocol.
Case 1: Shoulder symptoms with exertional chest pressure
During a shoulder evaluation, a patient develops new exertional chest pressure with nausea and unusual shortness of breath. Should the therapist finish the musculoskeletal special tests first?
Reveal the reasoning
No. Stop routine examination and initiate the local emergency response. Concerning acute cardiac symptoms can radiate to shoulder or upper body; do not label them a shoulder impairment because of the appointment reason.
Case 2: New bladder symptoms and saddle sensory change
A patient with back and leg pain reports new difficulty passing urine and numbness in the saddle region. Can a negative isolated special test reassure the patient?
Reveal the reasoning
No. These are concerning cauda equina features requiring immediate assessment through the local emergency pathway. A single negative provocative or bedside finding cannot safely exclude this possibility.
Case 3: Burning thoracic pain followed by a rash
A patient has unilateral burning chest-wall pain, followed days later by a localized vesicular skin eruption. Is this a routine rib-mobility problem?
Reveal the reasoning
A dermatomal eruption with neuropathic pain warrants medical assessment for possible herpes zoster and appropriate infection-control precautions. A PT should not independently assign a definitive rash diagnosis from the photograph or pattern alone.
References for urgent patterns: AHA heart attack warnings and NICE neurological referral guidance. For actual emergencies use local emergency services and established clinical pathways.
