Special Studies And Diagnostic Considerations Flashcards by max eriksen

Increased red blood cell count might be found in?

Polycythemia
Poisoning
Dehydration
Severe diarrhea

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A decreased red blood cell count might be found when?

Anemias
Neoplasm of the bone
Lupus

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When might total white blood cell count shifts occur?

During infection

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When might erythrocyte sedimentation rate be increased?

Infections
Necrotic processes
Neoplasms

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When would alkaline phosphatase be increased?

Prostatic tumors

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When might serum protein levels be decreased?

Starvation
Malabsorption
Edema
Diarrhea
Liver disease

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When might serum protein levels be increased?

Multiple myeloma
Rheumatoid arthritis
Lupus
Chronic infection

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When might you find HLA-B-27 antigen?

Individuals with rheumatoid disease as with ankylosing spondylitis

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When are orthopedic tests positive?

When the test causes the patient’s symptoms to increase or decrease as expected

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Orthopedic tests are based on the function of what structures?

Joint
Muscle
Nerve

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What is the result if an orthopedic test causes different pain or symptomatology other than what was expected?

While it may still be significant it is not considered positive

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Interpretation and analysis of orthopedic examination procedures depends not only on the reliability and validity of such measures but also on the?

Sensitivity and specificity of the “signs” elicited by the test procedures

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what might plain film help identify?

abnormalities in the growth plate 
bony misalignment
certain types of stress injuries 
dislocations
degenrative disease
fractures
loss of integrity of the osseous structures and joint space
metastatic disease
metabolic disease
soft tissue injury
some types of primary tumors

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when are plain x-rays NOT recommended for routine evaluations of acute low back pain?

within the first month unless red flags are noted on clinical examination

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what are some red flags to recommend plain X-rays of the lumbar spine to rule out fractures?

recent significant trauma (any age)
recent mild trauma (patient over 50)
history of prolonged steroid use, osteoporosis or a patient over 70

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plain X-rays in combination of CBC and ESR would be helpful in ruling out a tumor when what red flags are present?

Prior cancer or recent infection
Unexplained weight loss
Prolonged steroid use
Low back pain worse with rest
IV drug abuse
Fever over 100F

PUP LIFe 4 ever

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what lumbar view would detect unilateral or bilateral spondylolysis?

oblique view… HOWever oblique views approximately double total radiation exposure, compared to standard views

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what is a potential harm of taking a oblique lumbar view?

oblique views double radiation exposure compared to standard views which is equivalent to female gonadal radiation exposure of daily chest xrays for 6, 16 or 96 year olds. So be sure they are justified!

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what are plain X-rays not effective for diagnosing?

spinal stenosis
herniated disc
lumbar nerve root impingement
ruling out cancer or infection

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What is the method of X-ray that examines a single layer of tissue and blurs the tissue above and below the tissue being examined by moving the x-ray tube in one direction while the film is moved in the other direction, patient is motionless

Tomography

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what is injection of water-soluble imaging material directly into the nucleus pulposus of the disc?

discography

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what type of information is recorded during a discography?

amount of dye accepted
pressure needed to inject material
configuration of the opaque material
reproduction of patient’s pain

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what are the two diagnostic objectives of a discography?

evaluate radiographic leak (extent of disc damage)

characterize the pain response (compares to typical pain)

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what patient response is required by many investigators to indicate an abnormal discography?

a painful response that reproduces the patient’s usual pain

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what are some potential complications of discography?

disc and disc space infections disc herniation following disc infections signicant amount of ionizing radiation exposure (1.5-4.0 rads when studying 2-3 discs)

what is the main reason for doing a discography?

to determine the levels at which spinal fusion will be successful in patients with persistant low back pain (due to discogenic disease)

what evidence is there behind using discography?

- LIMITED evidence that it can help select patients that would benefit from spinal fusion. - There is NO evidence that is helpful in patients with acute low back problems but it will help pay for a ferrari enzo!

the use of discography or CT discography to diagnose herniated discs appears to offer?

no significant advantage over other imaging methods

what is the single most valuable function of CT?

provide the geography and characteristic, of tissue structures within solid organs

what is a CT scan helpful in finding?

central canal and lateral recess stenosis facet disease fracture intervertebral disc protrusions or herniations metabolic bone disease

what are some of the things best imaged by an MRI?

``` Cerebral edema CNS disease intervertebral disc protrusion (herniation) Intracranial disease Metastatic bone disease Meniscal tear Reveal early stages of DDD Spinal cord tumors Spinal stenosis Soft tissue tumor ```

what type of imaging involves an X-Ray taken after the introduction of a Radio Opaque substance into the spinal subarachnoid space (Metrizamide)?

Myelography

what is a water soluble contrast medium that is rapidly absorbed into general circulation and used in myelography ?

Metrizamide

in the presence of red flags suggesting cauda equina syndrome or progressive major motor weakness what imaging procedures are recommended?

CT MRI Myelography CT Myelography

CT, MRI, Myelography, or CT Myelography and/or consultation with an appropriate specialist is recommended when clinical finding suggest what?

Fracture Infection Tumor Space-occupying lesion

in a pateint with acute low back problems who have had a prior surgery what imaging method is recommended to distinguish disc herniation from scar tissue?

MRI with contrast

what procedure is better for imaging bone?

what procedure is better for imaging Neural tissue, Bone marrow, and for diagnosing tumor or infection?

MRI

Claustrophobia would be a problem for which type of imaging?

MRI

what procedures might be a problem for Obese patients?

CT and MRI scanners have a maximum table weight, extremely heavy person may need myelography

presence of internal metallic objects such as implanted medical devices, metallic surgical clips, or metallic objects or fragments in the eye can be a major problem for what imaging method?

MRI sometimes CT

what two methods have a higher risk of complications CT myelography, CT, MRI, Myelography?

CT myelography and Myelography have a higher risk of complications than MRI and CT

after one month of acute low back pain symptoms what two things would make imaging appropriate?

1) when surgery is being considered for a detectable loss of neurological function 2) further evaluate possibly serious spinal pathology in the presence of red flags

what is type of imaging involves a radiographic record after introduction of opaque contrast material into a joint?

Arthrogram. out dated as MRI arthrography has taken over

when is a bone scan recommended?

to evaluate acute low back pain when spinal tumor, infection, or occult fracture is suspected from RED FLAGS

when is a bone scan contraindicated?

during pregnancy as the radionuclide may be found in the breast milk

what is the diagnostic objective of a bone scan?

a radioactive compound adheres to metabolically active bone to detect; -occult fractures -infections -bony metastasis of the spine differentiate these things from benign pathology such as degenerative changes

what is a diagnostic technique which involves the use of an ultrasound generator and receiver that displays echoes on an oscilloscope?

ultrasound

when is an ultrasound used?

evaluation and location of space occupying soft tissue masses (also known as a fetus..)kidding thats not in the book)

what is the procedure of choice for the location of some vascular venous occlusions?

doppler ultrasound

what is the study of muscle activity arising from muscles and associated with muscle activity?

EMG (electromyography)

What reading/test is detected by needle electrodes which have been inserted into skeletal muscle. the electrical activity may be displayed on a cathode ray oscilloscope and heard on the loud speaker

EMG

when does a muscle show no action potential?

surprisingly, at REST...

when a muscle is contracting and generating an action potential what is its antagonist muscle doing?

relaxes and gives NO action potential

what information can be obtained by an electromyography?

the electrical activity; - evoked in the muscle by insertion and movement of the needle - resting muscle with the needle undistributed - motor unit during voluntary contractions

NCVs (nerve conduction velocities) are utilized to evaluate the?

conductivity of a nerve from the point of stimulation to the muscle

what is the normal nerve conduction rate of the ulnar and medial nerves? common peroneal nerve?

50-60 m/s in Ulnar and medial | 45-50 m/s in common peroneal

what is the frequent nerve conduction velocity in a neuropathy?

below 40 M/S

Dysfunction of the spinal cord is known as?

myelopathy

Dysfunction of a spinal nerve root is known as?

Radiculopathy

Dysfunction of a peripheral nerve distal to the nerve root is known as?

Neuropathy

Muscle abnormalities are known as?

Muscle abnormalities

what is a needle electromyography used for?

used to assess acute and chronic nerve root dysfunction, myelopathy, and myopathy

what is the H reflex used for?

measure sensory conduction through nerve roots, used to assess cervical and lumbar neuropathies

what is a test measuring motor conduction through nerve roots, used to assess proximal neuropathies?

F wave response

what test is used to assess acute and chronic recruitment patterns during static and dynamic pass using surface electrodes instead of needle insertion?

surface EMG

what is the purpose of sensory evoked potentials?

used to assess sensory neurons in peripheral and spinal cord pathways

what study is used to assess acute and chronic peripheral entrapment neuropathies that may mimic radiation?

nerve conduction study

EMG and H reflex tests appeared to be useful to?

1) document presence or absence of radiculopathy or neuropathy as the cause of the symptoms in the lower extremities 2) provide more information on specific nerve roots that may be compromised 3) help differentiate between acute and chronic nerve root dysfunction

what is the optimal time for needle EMG testing?

after the patient has had lower limb symptoms for at least 3-4 weeks. test results are not reliable before this time.

sensory evoked potentials appear to be useful in diagnosing?

spinal stenosis and spinal cord myelopathy

F wave tests and surface EMG are not considered effective methods of assessing what?

low back problems

what are the three reasons to use primary evoked potential?

1) specific in location and is noted where pathways from a particular sense organ end 2) map specific cortical sensory areas 3) visual evoked potentials and auditory evoked potentials are performed routinely

what is an electroencephalgraphy?

the study of the electrical activity of the brain

when is an EEG useful?

providing information about organic diseases of the brain. Focal changes may aid in the localization of cerebral damage

what information does an angiography provide?

demonstrating intercranial aneurysms vascular disorders hematomas tumors

thermography involves measuring?

small temperature differences between sides of the body

how can thermography help detect pathologies?

since the body has symmetry, evaluating patterns on infrared thermographic images of the body, upper and lower extremities, one can locate possible underlying pathologies