Differential Diagnosis Reasoning - National Physical Therapy Examination NPTE

1. What finding best differentiates angina from musculoskeletal chest wall pain in exertional symptoms?

   Angina: exertional pressure relieved by rest and not reproducible by palpation. Angina stems from myocardial ischemia during exertion, easing with rest and not triggered by palpation, unlike musculoskeletal pain's local tenderness.

2. Which pattern best differentiates peripheral polyneuropathy from radiculopathy?

   Polyneuropathy: symmetric stocking-glove sensory loss with distal weakness. Polyneuropathy causes length-dependent, symmetric distal deficits from axonal damage, contrasting radiculopathy's segmental, asymmetric involvement.

3. What ROM pattern most strongly indicates shoulder impingement rather than frozen shoulder?

   Near-normal passive ROM with painful arc during active elevation. Impingement causes pain during active elevation from subacromial compression, but passive motion remains intact, unlike the global restrictions in frozen shoulder.

4. Which finding best differentiates inflammatory arthritis from osteoarthritis in joint pain and stiffness?

   Inflammatory: morning stiffness lasting more than $60$ minutes with warmth/swelling. Inflammatory arthritis involves synovial inflammation, causing prolonged morning stiffness and joint warmth, unlike OA's mechanical wear with brief stiffness.

5. Which sign best differentiates ACL rupture from meniscal tear after a twisting injury?

   ACL: immediate swelling/hemarthrosis within $0$–$2$ hours. ACL rupture causes rapid intra-articular bleeding from vascular disruption, unlike meniscal tears which produce delayed effusion.

6. What finding differentiates knee OA pain from L$3$–L$4$ radiculopathy presenting as anterior knee pain?

   Radiculopathy: dermatomal sensory changes and diminished patellar reflex. Radiculopathy follows nerve root patterns with sensory and reflex changes, unlike localized joint pain in knee OA without neurological deficits.

7. Which clinical sign best differentiates cellulitis from DVT in a swollen, painful calf?

   DVT: unilateral swelling with pitting edema and risk factors (recent immobility). DVT presents with venous thrombosis signs like pitting edema and risk factors, distinguishing it from cellulitis's infectious warmth and erythema.

8. What finding most strongly supports vascular claudication over lumbar stenosis?

   Pain is dose-dependent with walking and not relieved by spinal flexion. Vascular claudication arises from ischemia during exertion, persisting regardless of spinal position, distinguishing it from neurogenic relief in flexion.

9. Which finding best differentiates Achilles tendinopathy from acute Achilles rupture?

   Rupture: positive Thompson test with loss of plantarflexion. Achilles rupture results in complete tendon discontinuity, yielding a positive Thompson test, unlike tendinopathy which maintains weak plantarflexion.

10. What key sign differentiates BPPV from vestibular neuritis in acute vertigo?

    BPPV: positional vertigo with latency and fatigability on Dix-Hallpike. BPPV exhibits delayed onset and fatiguing vertigo during positional testing, contrasting with the constant vertigo in vestibular neuritis.

11. What single feature best differentiates spinal cord myelopathy from peripheral neuropathy?

    Myelopathy: upper motor neuron signs (hyperreflexia, Babinski, clonus). Myelopathy affects the spinal cord, producing upper motor neuron signs like hyperreflexia, unlike peripheral neuropathy's lower motor neuron pattern.

12. What key feature differentiates plantar fasciitis from tarsal tunnel syndrome?

    Tarsal tunnel: paresthesia/burning with positive Tinel at tarsal tunnel. Tarsal tunnel syndrome involves tibial nerve compression, eliciting paresthesia via Tinel sign, unlike plantar fasciitis's localized heel pain without neural signs.

13. Which symptom most strongly differentiates meniscal tear from patellofemoral pain syndrome?

    Meniscal tear: mechanical locking or catching with joint line tenderness. Meniscal tears cause mechanical symptoms from torn fragments interfering with motion, contrasting with patellofemoral pain's tracking issues without locking.

14. Which clinical feature best differentiates TIA from benign positional vertigo when dizziness is reported?

    TIA: focal neurologic deficit (aphasia, unilateral weakness, visual loss). TIA involves transient cerebral ischemia, causing focal neurological deficits, unlike positional vertigo's peripheral vestibular origin without focality.

15. What single feature best differentiates carpal tunnel syndrome from C$6$ radiculopathy?

    Thenar weakness with nocturnal paresthesia in digits $1$–$3$ (median nerve). Carpal tunnel involves median nerve compression at the wrist, causing thenar atrophy and nocturnal symptoms confined to the first three digits, sparing C6 dermatome.

16. Which presentation most strongly differentiates cauda equina syndrome from lumbar radiculopathy?

    Saddle anesthesia with new urinary retention or overflow incontinence. Cauda equina syndrome compresses multiple roots, causing bilateral saddle symptoms and bladder dysfunction, beyond single-root radiculopathy.

17. Which sign differentiates cerebellar ataxia from sensory ataxia due to neuropathy?

    Sensory ataxia worsens markedly with eyes closed (positive Romberg). Sensory ataxia relies on proprioception, worsening without visual input, unlike cerebellar ataxia which persists regardless of visual cues.

18. Which finding differentiates neurogenic claudication from vascular claudication?

    Neurogenic: symptoms improve with lumbar flexion (shopping cart sign). Neurogenic claudication from spinal stenosis relieves with flexion due to increased canal space, unlike vascular claudication which is unaffected by posture.

19. Which exam finding best differentiates hip OA from lumbar spine referred pain?

    Hip OA: limited hip IR and flexion with groin pain reproduction. Hip OA limits internal rotation and flexion due to joint degeneration, reproducing groin pain, whereas lumbar referral lacks these specific restrictions.

20. What finding best differentiates compartment syndrome from DVT after lower-leg trauma?

    Compartment syndrome: pain out of proportion and pain with passive stretch. Compartment syndrome involves fascial pressure causing severe pain disproportionate to injury, exacerbated by stretch, unlike DVT's vascular swelling.

21. Which test finding most strongly suggests cervical radiculopathy rather than peripheral nerve entrapment?

    Positive Spurling test reproducing dermatomal symptoms. Spurling test compresses the cervical nerve root, reproducing radicular pain in a dermatomal pattern, unlike peripheral entrapments which lack this response.

22. Which feature best differentiates heart failure dyspnea from deconditioning during activity?

    Heart failure: orthopnea or paroxysmal nocturnal dyspnea with edema. Heart failure dyspnea results from pulmonary congestion, worsening in supine positions with edema, unlike deconditioning's exertional fatigue without these signs.

23. Which symptom cluster best differentiates pulmonary embolism from pneumonia in acute dyspnea?

    PE: sudden dyspnea with pleuritic pain and tachycardia, often minimal fever. Pulmonary embolism causes acute embolic obstruction, leading to dyspnea and pleuritic pain with tachycardia, differing from pneumonia's infectious fever and consolidation.

24. Which feature best differentiates rotator cuff tear from adhesive capsulitis?

    Adhesive capsulitis: global loss of passive ROM with capsular pattern. Adhesive capsulitis restricts passive motion in a capsular pattern due to glenohumeral fibrosis, unlike rotator cuff tears which preserve passive range.

Study these flashcards