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Differential Diagnosis for Physical Therapy: Introduction: Summary
• Edema - accumulation of fluid in the interstitial spaces ○ Measurable by Pitting Scale • Nail deviations ○ Clubbing – oxygen deficit (COPD) ○ Beau's lines – Immune response
■ Herpes Zoster (shingles) – caused by varicella zoster virus (VZV) – Maybe seen years after primary infection of chicken pox – Affects one cranial nerve or dermatome on one side of body Neuromuscular Screening and Assessment Tools 6 major areas to assess: 1. Mental/Cognitive status ○ Mini-mental state examination (MMSE) - 30-point questionnaire used to assess cognition ■ Commonly used to screen for Dementia/Alzheimer’s ■ >25/30 is effectively normal (intact) ■ Below this, scores can indicate: – Mild (21-24 points) – Moderate (10-20 points) – Severe (≤9 points) ■ MDC: 5 point change ○ Montreal Cognitive Assessment (MOCA)- Rapid screen of cognitive abilities designed to detect mild cognitive dysfunction ■ 26/30 or higher – N ■ MCD/MCID: Not established 2. Cranial nerves: this assessment falls under the BSF area of the ICF model ○ Watch for asymmetry. The following is a summary of the cranial nerves and their
○ Paronychia – inflammation ○ Splinter hemorrhages - clots ○ Spoon nails – anemia
• Contact Dermatitis – (localized) exposure to allergen or direct chemical (i.e., metals, cosmetics, soaps, plants) ○ Sensitivity occurs on first exposure then with subsequent exposures rash may appear ○ Location of lesions may lead to id of allergen • Hives – uticaria –systemic--results from Type I hypersensitivity caused by ingested substances (fruit, shellfish, drugs) • Psoriasis – chronic inflammatory d/o of unknown origin with familial tendency • Discoid Lupus Erythematosus (DLE) – seen more commonly in women (30-40y/o) due to abnormal immune reaction ○ Butterfly pattern over nose and cheeks seen ○ Red plaques with brown scales • Skin Infections ○ Bacterial infections – common maybe primary or secondary ■ Cellulitis – infection of dermis and subcutaneous tissue arising secondary from injury, or ulcer – Staphylococcus aureus or Streptococcus – Seen in lower trunk, LE’s ■ Boils – S. Aureus i nfection - begins at
respective functioning ■ I (Olfactory) - Smell ■ II (Optic) - Visual acuity, visual fields and ocular fundi ■ II,III (Optic/Oculomotor) - Pupillary reactions ■ III,IV,VI (Oculomotor, Trochlear, Abducens) - Extra-ocular movements, including opening of the eyes ■ V (Trigeminal) - Facial sensation, movements of the jaw, and corneal reflexes ■ VII (Facial) - Facial movements and gustation ■ VIII (Acoustic) - Hearing and balance
hair follicle and spreads to dermis – Spread of infection if squeezed
○ Viral Infections ■ Herpes Simplex (cold sores)
– Type I (HSV-1) - most common cause of cold sores/fever blisters – Type II - most common cause of genital herpes
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