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Respond individually to the 2 following posts.
1.Making accurate diagnosis is very important and the construction of a differential diagnosis list is crucial in order to provide the best quality treatment for our patients. According to Rhoads & Penick (2017) determining the differential diagnosis is the process of distinguishing one disease from another that presents with similar symptoms. To my understanding, it all starts from the chief complaint of the patient, history and social history and physical assessment. The provider then forms a differential diagnosis list from the most common to the most serious. Keeping an open mind and exploring all possibilities is important (Chandler, 2018). Subjective information is crucial as well such as onset of chief complaint, location, radiation, aggravating and alleviating factors and even the effects on daily life. Diagnostic testing is also important in determining correct diagnosis if already not defined with the previous steps. An example I can provide is the chief complaint of “rectal pain” from a 35 year old hispanic male with a medical history of hypertension, obesity, smoker, sedentary lifestyle and frequent constipation. Differential diagnosis could include: anal abscess, genital warts, tumors, colorectal cancer and inflammatory bowel disease. Physical assessment that included digital rectal exam and visual inspection confirms a diagnosis of external hemorrhoids. The need to reevaluate patient overtime is crucial in order to reformulate new diagnostic possibilities as new signs and symptoms present.
Chandler, B. (2018). Hemorrhoids differential diagnosis, what else could it be. Adler Micromed. https://www.adlermicromed.com/hemorrhoids-differential-diagnosis/
Rhoads, J., Penick, J. (2017) Formulating a differential diagnosis for the advanced practice provider. 2nd edition. Springer Publishing Company.
2. Formulating differential diagnosis’ is a common way of distilling subjective and objective data into a singular diagnosis. Essentially creating a list of potential pathologies that are congruent to the data at hand, and slowly eliminating them one-by-one to come to the right conclusion, is the process of differential diagnosis (Rhoads & Penick, 2017). Several ways of developing the differential list exist, these methods are typically used in concert with one another to utilize the pros and cons of each method to best guide future clinical decisions.
The first method is basing differential diagnosis purely off history and physical exam and the practitioner’s own knowledge of pathophysiology and clinical judgment to formulate the differential list. This method can develop a robust differential list; however, the lack of laboratory data, imaging, and other diagnostic testing can create a differential list that could be missing the actual diagnosis. The data provided by the test mentioned above can be crucial in formulating diagnosis. A good example in this case would be lacking laboratory data in the setting of pheochromocytoma.
In contrast to the above example, a differential list could be based purely on laboratory data. The downside to this method it’s a bit of a “tunnel vision” effect. One must utilize history and physical exam in concert with laboratory data to better formulate the differential list. Coster et al. do a good job of outlining this method in differentiating between bacterial and viral infections. The authors outline that a history and physical exam may suggest a bacterial infection with a viral infection on the differential list. In early and acute stages of infection it may be difficult to differentiate between bacterial and viral infections, the authors found that trending the acute phase reactant, CRP, can help determine the actual diagnosis (Coster et al., 2019).
Lastly a differential list can be based heavily from imaging. Imaging is very important in the differential diagnostic process, and provides crucial data to many different diagnoses, however one must be cautious to avoid overdiagnosis. Cook and Décary do a good job of explaining this phenomenon, incidental findings on imaging like “lumbar degeneration” may never have caused a problem for a specific patient, and the addition of the diagnosis to their list may lead to no positive outcomes for the patient (Cook & Décary, 2020).
As highlighted above all these methods have pros and cons that can be balanced when all three methods are used in concert. The practitioner’s knowledge and clinical judgment coupled with these three methods are the best and most well-rounded approach to differential diagnosis.
Cook, C. E., & Décary, S. (2020). Higher order thinking about differential diagnosis. Brazilian Journal of Physical Therapy, 24(1), 1–7. https://doi.org/10.1016/j.bjpt.2019.01.010
Coster, D., Wasserman, A., Fisher, E., Rogowski, O., Zeltser, D., Shapira, I., Bernstein, D., Meilik, A., Raykhshtat, E., Halpern, P., Berliner, S., Shenhar-Tsarfaty, S., & Shamir, R. (2019). Using the kinetics of c-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections. Infection, 48(2), 241–248. https://doi.org/10.1007/s15010-019-01383-6
Rhoads, J., & Penick, J. C. (Eds.). (2017). Formulating a differential diagnosis for the advanced practice provider. Springer Publishing Company. https://doi.org/10.1891/9780826152237
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