skeletal

Question 1

alkaline phosphatase is what

Answer 1

enzyme measured in blood

Question 2

where is AP present in greatest concentrations

Answer 2

bone, live, and bile duct lining cells

Question 3

what is AP ordered for

Answer 3

to help differentiate a liver problem from bone sources

Question 4

what is ALP1 or ALP A

Answer 4

enzyme largely from liver

If elevated look at liver etiology

if other liver fx tests elevated, problem is likely with liver

Question 5

what is ALP2 or ALP B

Answer 5

enzyme mostly from bone

if elevated look for bone etiology

if liver tests are normal, elevation likely with bone, further testing needed

Question 6

ap is used for what

Answer 6

to point out growth abnormalities such as metastatic bone disease to bone, Paget’s disease, and arthritis (particularly RA)

elevation is not dx

Question 7

what lab is AP included in

Answer 7

CMP

Question 8

in addition to giving info for sources of problems, ap can be used for what

Answer 8

follow course of disease

Question 9

bone scan is what

Answer 9

nuclear scan done after injection of radioactive material into circulation

uses technicium 99

TC 99 is incorporated into bone depending on metabolic activity of bone- uptake is uniform, but will increase around areas of tumor metastases, fx, and other pathological conditions

Question 10

what do bone scans look like with tumors

Answer 10

bone formation is stimulated around tumors

Question 11

what will show metastases first, bone scan or xray

Answer 11

bone scan

Question 12

when to order bone scan

Answer 12

1. detect metastases
2. detect small fx that don’t show up on regular xray
3. part of w/u for pt with CA to stage disease and to determine best tx
4. for pt with c/o pain in extremity, hx of trauma when regular xray negative for fx

Question 13

white color on xray

Answer 13

structures with more calcium block passage eof xrays and show as white or nearly white

Question 14

darker color on xray

Answer 14

soft tissues are darker

air and blood are black or darker gray depending on intensity of xray

Question 15

bone and joint xray

Answer 15

ordered after trauma including falls to determine presence of fx

used to aid in dx of various kinds of arthritis

Question 16

OA findings on bone and joint xray

Answer 16

spurring, loss of intra-articular joint space, swelling, remodeling of peri-articular joint areas, and evidence of synovial fluid

Question 17

bone and joint xray after trauma

Answer 17

after trauma initial xray may show no overt fx

pt may return with pain and inability to bear wt fully and repeat xray may show fx that did not appear on initial xray

Question 18

reason why bone and joint xray did not show fx initally

Answer 18

it can take several days for edema to develop along fx line that will make fx observable on xray

Question 19

indications for bone xray

Answer 19

1. hx of trauma
2. pain
3. arthritis (acute and chronic)
4. masses which seem attached to bone
5. when osteomyelitis is suspected

Question 20

what is spinal xray

Answer 20

regular or plain films of spine taken from different views- AP, lateral, oblique

order what part of spine you want to xray

Question 21

spinal xray dx what

Answer 21

1. dx fx
2. spurring (perhaps indicating protruding disc)
3. vertebral collapse
4. osteoporosis
5. kyphosis
6. scoliosis
7. bone metastases

Question 22

what is most common indication for spinal x-ray and then what

Answer 22

pain

followed by trauma involving spine

Question 23

what kind of imaging from w/u for pt newly dx with CA

Answer 23

sometimes plain films of spine

but tc99 bone scan are superior for this purpose

Question 24

how accurate are spinal x-ray

Answer 24

accuracy of films depends on the finding

if plain film shows vertebral fx after trauma, further testing is probably not indicated

if plain film of spine shows spurring of vertebral bodies, this is non-specific finding and MRI may be needed to determine protruding disc

great when they confirm NP impression

Question 25

what are the 3 general areas usually examined when ordering spinal x-ray

Answer 25

1. cervical
2. lumbar
3. lumbo-sacral

Question 26

most common reason to order spine x-ray

Answer 26

pain- acute or chronic

following trauma

Question 27

what is uric acid

Answer 27

by product of breakdown of purines- 1 of building blocks of DNA, RNA, and some proteins

Question 28

elevated uric acid indicates what

Answer 28

risk for gout

risk for kidney stones

pts with genetic predisposition or bc of dietary factors r/t excessive ingestion of meat and/or etoh

Question 29

do you need clinical eval with gout

Answer 29

yes, uric acid level does not replace clinical eval

normal uric acid levels are common during attack

Question 30

other factors that can lead to acute gout

Answer 30

1. meds- like HCTZ
2. diet
3. sudden wt loss
4. trauma, including surgery

Question 31

expected findings on x-ray for osteoarthritis

Answer 31

hands, spine, and large joints are involved with spurring, narrowing of intra-articular space, subchondral cysts

on hand dx-rays- PIP (Bouchard’s nodes) and DIP (Heberden’s nodes)

Question 32

foods that can contribute to high uric acid

Answer 32

foods high in purines like meat (esp liver), fish, poultry, red wine, beer, and to lesser extent some vegetables and grains (asparagus, cauliflower, spinach, mushrooms green peas, lentils), oatmeal, and wheat germ