Special Studies And Diagnostic Considerations Flashcards
Increased red blood cell count might be found in?
Polycythemia
Poisoning
Dehydration
Severe diarrhea
A decreased red blood cell count might be found when?
Anemias
Neoplasm of the bone
Lupus
When might total white blood cell count shifts occur?
During infection
When might erythrocyte sedimentation rate be increased?
Infections
Necrotic processes
Neoplasms
When would alkaline phosphatase be increased?
Prostatic tumors
When might serum protein levels be decreased?
Starvation Malabsorption Edema Diarrhea Liver disease
When might serum protein levels be increased?
Multiple myeloma
Rheumatoid arthritis
Lupus
Chronic infection
When might you find HLA-B-27 antigen?
Individuals with rheumatoid disease as with ankylosing spondylitis
When are orthopedic tests positive?
When the test causes the patient’s symptoms to increase or decrease as expected
Orthopedic tests are based on the function of what structures?
Joint
Muscle
Nerve
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
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
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
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
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
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
what lumbar view would detect unilateral or bilateral spondylolysis?
oblique view… HOWever oblique views approximately double total radiation exposure, compared to standard views
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!
what are plain X-rays not effective for diagnosing?
spinal stenosis
herniated disc
lumbar nerve root impingement
ruling out cancer or infection
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
what is injection of water-soluble imaging material directly into the nucleus pulposus of the disc?
discography
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
what are the two diagnostic objectives of a discography?
evaluate radiographic leak (extent of disc damage)
characterize the pain response (compares to typical pain)
what patient response is required by many investigators to indicate an abnormal discography?
a painful response that reproduces the patient’s usual pain
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?
CT
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
