Examination, Evaluation, and Diagnosis
What this domain tests
This domain tests clinical reasoning from history and systems review through tests, measures, and differential diagnosis. Items ask you to decide what to examine next, interpret a test result, identify red flags, and state a physical therapy diagnosis and prognosis.
Core rules
- Screen before you treat: vital signs, general appearance, medical history, and systems review. Red flags override a musculoskeletal plan.
- Reliability is consistency; validity is whether a test measures what it claims. A test can be reliable but invalid.
- Sensitivity: high sensitivity means a negative result helps rule out (SnNout). Specificity: high specificity means a positive result helps rule in (SpPin). Likelihood ratios above 10 or below 0.1 meaningfully change probability; a single special test rarely confirms a diagnosis.
- Use clusters and the whole clinical picture. Document baseline outcome measures so later change can be judged against the minimal clinically important difference (MCID).
- Diagnosis in physiotherapy describes movement dysfunction and tissue involvement, not only a medical label.
Worked example
A patient reports new low back pain with saddle anesthesia, urinary retention, and bilateral leg weakness. These are red flags for cauda equina syndrome. The correct action is urgent referral, not lumbar stabilization exercises. Reasoning: the cluster of bilateral neurological signs and bowel or bladder involvement raises the probability of a surgical emergency, so further musculoskeletal testing is inappropriate until medical evaluation occurs.
Traps
Ordering special tests before screening. Treating a positive test as a diagnosis. Ignoring symptom irritability. Comparing an outcome score with baseline without knowing the MCID.