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PI > Medical > Flashcards

Medical Flashcards

1
Q

Five pillars of a case

A

1 policy limits
2 liability
3 property damage or scene photos with premis case
4 MRI results
5 prior medical history

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2
Q

Spinal anatomy
Bones in total

A
  1. 7 cervical
  2. 12 thoracic
  3. 5 lumbar
  4. 5 sacrum
  5. 5 coccyx
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3
Q

Tyes of abnormal discs

A

Bulge
Herniation (focal) focal means it takes up less than 25% of the space
Herniation with sequestration- floating around in spinal cavity
Extruded disk- blown out disc

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4
Q

Herniation (focal) focal means

A

it takes up less than 25% of the space

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5
Q

Herniation with sequestration

A

floating around in spinal cavity

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6
Q

Two parts of a disc

A

: annulus and nucleus

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7
Q

Extruded disk

A

blown out disc

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8
Q

3 structures in neck, 2 in back

A

Spinal cord, nerve root, Thecal sac (surrounds cord):

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9
Q

Doctors don’t do surgery for …

A

…for pain, alone
-Prevent a ticking time bomb
-They do surgery for Neuropathic and neurogenic issues: cord/ nerve
-Maybe for pain if it is chronic for more than a year alone

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10
Q

Nerves are ______, Spinal cord injuries cause __________

A

Nerves are sensory, spinal cord are motor function issues
So if shooting pain: Nerve impingement or touching

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11
Q

Nerve pain could be __________ (2 things)

A
  1. DISC HAS COME OUT & HITTIN THE NERVE
  2. CHEMICAL IRRITATION: RECENT TRAUMA TO THE AREA SO THERE’S A CHEMICAL REACTION HAPPENING DUE TO THE BODY SENDING PROTEINS TO THE AREA AS THE BODY’S WAY OF HEALING ITSELF.
    WHY DO I BRING THAT UP??? . . . PLANT THE SEED DAY 1 . . . LIKELY TO
    CERVICAL SPINE DERMATOMES
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12
Q

Stenosis

A

disc pushes on the nerve
A good word for us, game one

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13
Q

Spurling test

A

doc trying to create a stenotic issue, to determine, determine where pain radiates too

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14
Q

Hoffmans Sign test

A

for cervical herniated disc
Flicking middle finger, looking for an involuntary response in pointer finger

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15
Q

Myelopathy

A

Spinal cord compression
A nervous system disorder that can permanently affect the spinal cord. It causes a loss of sensation, loss of function, and pain or discomfort.

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16
Q

Lumbar radiculopathy

A

Sciatica AKA
inflammation of the nerve root in the lower back, pain and irritation in back and down the legs, involves sciatic nerve

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17
Q

Why have surgery for nerve pain

A

squeezing finger analogy, blood comes back into finger, but not if it is for a long time: like a garden hose, cut the supply for the nerve root off. A year or more, when we go into decompress it, wont be able to get the blood supply back

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18
Q

Lumbar pathology physical exam findings

A

positive straight leg raise test

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19
Q

Buzz words in MRI

A

Flattening
Hitting
Contacting
Abutting
Touching

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20
Q

Most surgeons don’t mess with …

A

the c2 c3 because too close to the brain stem

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21
Q

Edema

A

fluid, inflammation, Means a recent trauma or injury, especially if within the same month as accident

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22
Q

migrates

A

moving, maybe a sequestration

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23
Q

Neural foraminal stenosis

A

tells you which side the pain will go, nerves, radiologist is saying the canal is narrowed and is now pushing on the nerve.
A condition, narrowing in parts of spine cause compression of spinal nerves. most cases don’t cause symptoms, but can. Rest to surgery are the options

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24
Q

Mass effect

A

term used to describe the effect of a growing mass that results in secondary pathological effects by pushing on or displacing surrounding tissue. Mass effect can occur in any part of the body where a lesion grows and compresses adjacent structures, such as the brain, muscles, abdomen, or pelvis. Mass effect can cause symptoms such as pain, swelling, neurological deficits, or organ dysfunction.
brain: when something is pushing on something, brain is being squeezed bc blood fills up

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25
Q

2 types of views MRI

A

sagittal (side view) and axial view top view down

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26
Q

Degenerative changes

A

does not mean it is preexisting, just means changes in neck consistent with age

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27
Q

Osteophytes:

A

bone spurs

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28
Q

Spinal cord compression injuries

A

motor skills, balance, dropping stuff, bladder issues, finger gets stuck in a position, (hand stuck claw—cusp of paralysis)

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29
Q

MRI stage

A

Conservative Chiro and PT has provided either no relief or only temporary. It is time for surgical and pain mgmt.
Should be scheduled for a consultation with a surgeon or pain mgmt. specialist within a week of the MRI
-don’t let time pass allows client to minimize injury

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30
Q

trigger point injections

A

oTrigger point injections- muscular, muscle spasms, typically for extremities
When use:
* Build quick value for elderly or unwilling to treat clients
* Lower policy limits (10K or less)
* Client needs to understand that this is strictly muscular and will not address neural compression component of spine injuries

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31
Q

PRP stem cell injections

A

(platelete rich plasma)
 Similar to trigger point, won’t build much value to case
 Can be very expensive even tho do not substantially drive up case value in adjusters eyes

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32
Q

Facet joints

A

are paired structures at the back of each vertebra (spinal column bones). The facet joints, like other joints in the body, form a working motion unit that allows movement between two vertebrae

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33
Q

Facet mediated pain

A

 Result of damaged capsule in the facet joint
 MRI will not sho the damaged torn capsule as it is too small
 But MRI will show edema/fluid near the facet joint, indicative of recent trauma
 So when adjuster says no bulge or herniation on the MRI. Tell them the are correct…because disk disruption has nothing to do with facet mediated pain symptomology – pain on extension and pain reduction on flexion which unloads the facet join

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34
Q

 FACET INJECTIONS

A
  • Trying to hit the generally area of the facet joint. Diagnostic and therapeutic at the same time. Trying to determine which joint hurts
    o Pain relief tells physician located damaged area
  • Should result in 1-2 weeks of relief
  • Client needs to understand this is likely only temporary
  • This injection along with prior chiro pt treatment and MRI should result in tender of a 10K policy
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35
Q

MEDIAL BRANCH BLOCK (FACET)

A
  • More focal than facet injection
  • Focused n getting pain relief at the correct location of the affected nerve
  • Provides day or two of relief
  • Usually used to pinpoint the spot of the Rhizotomy or ablation
  • Facet injection with medial branch block and reco for subseq radiofrequency ablation could/should result in tender of policies up to 30K
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36
Q

Rhizotomy/ radiofrequency ablation

A

AKA: neurotomy/ biacuplasty (adjusters wont call this a surgery)
 Obliterates the nerve
 3 ways
* Can be performed chemically, by heating the nerve or freezing the nerve
 Only temporary as the nerve will likely regenerate and the procedure may need to be performed again
 Procedure should be performed on policies 25k or greater and less than 100K
 100K policy, only consider rhizotomy first if the client refused to do anything more invasive, but 25-50 could be good
 Be mindful on 100k policies where this is reco along with a separate surgery
* Ask the client willing to have surgery then why would we do the Rhizotomy first?

37
Q

2 types of Epidural Steroid Injections

A

 2 types: interlaminar (cord compression) and transforminal (nerve compression)

38
Q

Epidural steroid injections

A

 Both lumbar and cervical levels
 Diff than facet inj or MBBs bc addressing pain caused by disc disruption as opposed to facet joing pain, seerate part of the anatomy
 May provide up to 6 mos relief
 One ESI should result in tender of $10k policy, two ESIs possibly coupled with surg reco, should result in tender of policies up to 25-30K
 2 ESIs along with a surgical reco and or RFA performed should result in $50k policy
 Multiple ESIs along with RFA and surg reco may tender 100k, but again b mindful when client is willing to have the surgery

39
Q

What about pain meds?

A

o Fine for doc to prescribe but builds little to no value in case
o Be weary of client whose primary concern is Rx pain meds and dismisses other treatment options
o Adjusters will try toallege pill seeking, secondary gain motivation. Even on cases with great PD and no priors, where client had surgery, but continuously fills pain med scripts
 Doc is concerned with how much medication person is consuming
 Don’t want to paint the wrong picture in the eyes of the carrier, should scale this pain meds use back
 Don’t be afraid to discuss optics of this with clients

40
Q

Disc decompression or laser/micro discectomy

A

SURGICAL OPTION
 Minimally invasive
 Can be stuck into disk and suction, so it brings back the bulge
 Suction, laser, heat ablation, cut a piece off, leave the disc, but get the compression off root or cord
 Lumbar or vervical
 Minimal cost, but still a surgery
 Case value range from 150K to 250k
 Client needs to understand that following this procedure, they will need to likely lead to a very sedentary lifestyle (especially for lumbar) as the disc is still in a weakened state and could easily herniate again and or collapse, necessitating further. More invasive surgery
 Might not be for them if very active

41
Q

Laminectomy

A

SURGICAL OPTION
 Typically along with micro discectomy
 Removes bone from spine
 Lumbar mainly, but can cervical
 Remove a portion or all of the lamina bone to create space for the compressed cord o nerve to shift backwards to relieve pressure
 More invasive than decompression or laser discectomy, but less invasive than full discectomy and fusion
 Value of 150k-300k depending on how many levels
 Can do this with a 100k policy
 Client needs to be careful in the future to ensure that disc does not herniate wors/ again or collapse

42
Q

Ask adjusters: does damage to the disc itself cause pain?

A

Yes is the answer, can cause localized pain at the disc. If he is saying the disc doesn’t touch the cord or only touches the sac
 Adjusters will say there is degeneration all over the place. Yeah but there is an annular tear, so recent trauma, if it was old it would be calcified over the top of it
 You wouldn’t see the tear if it was old

43
Q

Anterior Cervical Discectomy and Fusion

A

ACDF
SURGICAL OPTION
 Goes through the front of the neck move voice box out of way, remove the disc itself
 Allograft is placed in between vertebrae, can come from the hip so two surgeries at once
 Provides stability and eliminates pressure on cord caused by disc disruption
 Goals is to get the two bones to become one big bone, eliminates 20% range of motion in neck…but if two done then eliminate 40% of range of motion
 Who knows what will happen if we wait another 6 months
 Seen up to four level fusions completed
 1- level ACDF typical valued at 350K, 2 level 500K, 3 level 600K+++
 If a surgeon is willing to do a 2 level on a 100k policy, get it done
* Ask them what they are going to want back on their bill
 Bone allograft from ither cadaver or harvested from client’s hip will be utilized
 Say to adjuster, if he says preexisting, degenerative: who is waiting around to do this, today is the day I am going to have this accident so I can have massive surgery so I can get 30K
 No one is doing this if they don’t need it
 In litigation, this is what is coming. I will be the one standing in front of the jury and asking this question: he is faking it? Who would sign up for this. This is being done bc needed

44
Q

Spondylolisthesis

A

A spinal disorder in which one vertebra (spinal bone) slips onto the vertebra below it. This causes pain in lower back or legs.

Urgent medical attention is usually recommended by healthcare providers

Certain types can be dangerous or life threatening

45
Q

TOTAL DISC REPLACEMENT/ disc arthroplasty

A

SURGICAL OPTION
 Cut channels into bone and place implant into where the disc used to be
 Sames as ACDF, but not fusion, so range of motion is not drastically reduced
 Limited in number of levels, typically anything over two levels, would likely involve a fusion and TDR combination for stability
 Similar values as fusions, but easier for client to consider in light of range of motion preservation
 Implants are pricey so be cognizant of hard costs of procedure before performing multi level TDR procedure on a 100K policy

46
Q

Anterior lumbar interbody fusion

A

ALIF
SURGICAL OPTION
o Much more invasive than the posterior procedure
o Required when re-alignment of the vertebrae is necessary prior to fusion
o Likely requires a vascular sugeon to assist due to movement of the vessels and organs
o Didn’t need to happen, adjuster: so it was two doctors that put their license on the line for this?
 I will ask the jury the same question
o Value of 350-500k for one level, 500-750k for multiple levels
o Benefits of lumbar fusion is stability and less worry regarding the future for the client following successful procedure
 What type of a lifestyle do you wantto lead? Wouldn’t you rather have the peace of mind of only one surg procedure instead of the risk of many later
 At least a 250K policy for this unless doc is willing to take pennies on the dollar

47
Q

Posterior lumbar Fusion (In Situ Fusion)

A

SURGICAL OPTION
o Fusion cage
o Cut through ligament
o Less invasive with ALIF
o Less costly than ALIF, no vascular surgeon to pay
o Fusion provides stability and peace of mind for client
o Value for 1 level 350-400, 2 level 500-600k

48
Q

Kyphoplasty

A

SURGICAL OPTION
o Injecting cement into the vertibrae where a compression fracture is
o Time is of the essence
o Elderly clients:value added to case
o After four weeks likely wont be able to perform the procedure
o Bc the bonewill heal on its own but wont be good bc
o Two types: with an without balloon
o Drilling into bone, inject cement
o Don’t lose out on opp to add value

49
Q

PAINT MGMT SPECIALIST vs. SURGEON, factors to weigh

A

1 coverage!!!!
2 client’s appetite for treatment (doc reco surg…are you willing to undergo it?)(if the doc recos surgery, are you willing to have it? That is going to be a huge factor how much we can recover)
3 priors (preexisting can make them more vulnerable to injury, so can help, can make case easier)
4 client’s ability to receive treatment
5 MRI findings
6 when you are not sure send to a surgeon that also does pain mgmt.

50
Q

CLIENT MAKING SURGICAL DECISIONS
Factors to consider

A

1 coverage!!!
2 MRI findings in conjunction with symptoms reported
3 client’s lifestyle
4 client’s employment
5 client’s age (younger resistant to surgery) (older may not be willing to have surgery)
6 client my need to be reminded that they only get to do this once (cant settle case now and come back in five years to get more money)(hate to see you later on when this turns bad, we cant get you compensated for it) if a doc told you need surg, opposing attorney will argue why aren’t they following what the doc told them to do, if they did they wouldn’t have all this pain)

51
Q

Accurint

A

A program that is used as investigative technology that can expedite the identification of people, their assets, addresses, relatives, and business associates. It provides instant access to comprehensive database of public records that would normally take days to collect. This program can be expensive.

52
Q

Anteriolisthesis

A

a type of spondylolisthesis, which occurs when one of the spine’s vertebrae slips out of position. Anterolisthesis refers to anterior (forward) slippage of the vertebra. However, when a vertebra slips backward (posterior), doctors call the condition retrolisthesis

53
Q

Bodily Injury

A

BI
Bodily injury liability coverage helps pay for another person’s expenses if you injure them in a car accident. This type of coverage typically helps cover someone else’s medical bills.

54
Q

3rd party that deals with Medicare liens

A

Centers for Medicare & Medicaid Services
CMS

55
Q

Civil Remedy Notice

A

CRN
Used by parties that are beginning the process of filing suit against an insurer, when a party feels they have been damaged by specific acts of the insurer. Can be done on a BI claim.

56
Q

BI Tender

A

When the insurance carrier pays the full policy limits for Bodily Injury.

57
Q

CAD

A

computer aided dispatch

58
Q

CME

A

Compulsory Medical Exam
Done during the litigation process and is when the defendant hires an ortho, neuro, or another doctor to examine the plaintiff to determine if there was really an injury & it is permanent. Also helps rule out if the injury was caused by the accident or was an existing injury.

59
Q

CDR

A

crash data retrieval
Used to image the data stored in the EDR, i.e., downloading data. Data remains in the module and the CDR tool will image the data without changing the data stored within the EDR.
-Does the analysis on the EDR

60
Q

Declaration Page

A

Dec Page
On an insurance policy, it is a summary of essential policy information

61
Q

Dermatome Chart

A

Dermatome maps depict the sensory distribution of each dermatome across the body. Clinicians can assess cutaneous sensation with a dermatome map as a way to localise lesions within central nervous tissue, injury to specific spinal nerves, and to determine the extent of the injury.

62
Q

EDR

A

Event Data Recorder
A device installed in motor vehicles to record technical vehicle and occupant information for a brief period (usually in seconds), before, during, & after a crash.
-The “black box” unit in the car.
-Is what is analyzed when the CDR does the analysis.

63
Q

Herniation

A

Rupture or protrude through an abnormal body opening

64
Q

Impingement

A

Rubbing or pressure on tendon nerve etc.

65
Q

IME

A

Independent Medical Examination
Done during pre-litigation and it is when the client’s insurance company requires a [chiropractic?] exam & gives an opinion for if the client needs more treatment or if the treatment that has been done was necessary.

66
Q

ISO

A

Insurance Services Office, Inc.
Company that collects statistical data, provides rating information, develops standard policy forms, and files information with state regulators on behalf of insurance companies.
-Anytime an insurance company receives a claim for an individual, they will report it to this program. It helps them determine coverage for when the client applies for insurance.

67
Q

Letter of Protection

A

LOP
Letter sent by personal injury lawyer to client’s medical provider that guarantees them payment for medical services.

68
Q

Letter of Representation

A

LOR: Letter that the personal injury lawyer sends to all insurances involved in the case. It outlines that all correspondence for the client should be done through the injury lawyer for the remainder of the case.

69
Q

Liens

A

A charge on real or personal property for the satisfaction of some debt or duty.

70
Q

Medical Payments Coverage

A

MedPay
Part to an auto insurance policy; may help you pay you or your passengers’ medical expenses if you’re injured in a car accident, regardless of who caused the accident

71
Q

PRR

A

public records request
This request is usually sent to the police stations, investigating agency, or governmental agency to receive public records on the individuals involved in the case.

72
Q

Retrolisthesis

A

one of two types of spondylolisthesis: this one is a joint dysfunction that occurs when a single vertebra in the back slips backward along or underneath a disc. Retrolisthesis is the opposite of Anteriolisthesis, which occurs when a vertebra slips forward.

73
Q

Subrogation

A

Subro
Allows a third-party company (health insurance, PIP insurance) to get reimbursed for payments made to the doctors that treated our client.
-Payments on behalf of the client once case is settled.

74
Q

Tender

A

insurance co pays full policy limits

75
Q

Thecal Sac

A

The thecal sac or dural sac is the membranous sheath (theca) or tube of dura mater that surrounds the spinal cord and the cauda equina. The thecal sac contains the cerebrospinal fluid which provides nutrients and buoyancy to the spinal cord.

76
Q

Underinsured Motorist Coverage

A

UIM
Applies when the driver who caused the accident has liability insurance, but the limits aren’t high enough to cover the damages. In this case, the other’s driver’s insurance would pay first, and your UIM coverage would make up the difference in costs, up to the client’s limits.

77
Q

Uninsured Motorist Coverage

A

UM
Helps compensate the insured or another protected person (as a passenger) for damages caused by another motorist without insurance.

78
Q

Uninsured Motorist Subrogation

A

UM Subro
Allows car insurance company to get reimbursed for payments that were made with the UM coverage once the case is settled.

79
Q

radiculopathy

A

pinched nerve

80
Q

gadolinium

A

Gadolinium is a rare-earth metal that enhances the quality of MRI images by acting as a contrast agent

81
Q

Diffuse degenerative disc desiccation

A

a condition where the discs between your vertebrae lose their fluid and become dehydrated. This can cause stiffness, weakness, and pinched nerves in your back.

82
Q

anterior

A

near the front

83
Q

posterior

A

near the back

84
Q

paracentral

A

lying near the center or central part

85
Q

myelomalacia

A

a pathological term referring to the softening of the spinal cord. Possible causes of myelomalacia include cervical myelopathy, hemorrhagic infarction, or acute injury, such as that caused by intervertebral disc extrusion. Myelomalacia. MRI image shows spinal bleeding

86
Q

Syringomyelia

A

SYRINX
develops when cerebrospinal fluid, which usually flows around the outside of your brain and spinal cord, collects inside your spinal cord and forms a fluid-filled cyst (syrinx)

87
Q

focal disc protrusion

A

It describes a condition where damage to the disc causes it to protrude/bulge outwards or herniate, coming into contact with nearby spinal nerves as they exit the spinal canal, causing pain and discomfort

88
Q

Lumbarized

A

Lumbarization: when top of the sacrum (S1) can be separated from the sacrum and the lumbar spine appears to have 6 vertebrae, not 5

89
Q

paraspinal

A

The muscles surrounding and attaching to the spine

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