Podcast
Questions and Answers
What is considered the gold standard for diagnosing ACL tears?
What is considered the gold standard for diagnosing ACL tears?
Which imaging modality is primarily used for initial screening of suspected spinal fractures?
Which imaging modality is primarily used for initial screening of suspected spinal fractures?
Which symptom is characteristic of Cauda Equina Syndrome?
Which symptom is characteristic of Cauda Equina Syndrome?
Which of the following red flag symptoms does NOT indicate potential malignancy in back pain?
Which of the following red flag symptoms does NOT indicate potential malignancy in back pain?
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What imaging is recommended for further evaluation of cord compression and Cauda Equina Syndrome?
What imaging is recommended for further evaluation of cord compression and Cauda Equina Syndrome?
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Which clinical diagnostic tests are superior to MRI for ACL tears in terms of cost and efficiency?
Which clinical diagnostic tests are superior to MRI for ACL tears in terms of cost and efficiency?
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Which symptom is NOT a red flag for back pain indicating the need for immediate investigation?
Which symptom is NOT a red flag for back pain indicating the need for immediate investigation?
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What imaging technique is less precise than MRI but can be used for detecting ankle ligamentous injuries?
What imaging technique is less precise than MRI but can be used for detecting ankle ligamentous injuries?
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Which symptom could be indicative of a spinal epidural abscess?
Which symptom could be indicative of a spinal epidural abscess?
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What is the primary recommended lab study to evaluate for systemic etiology of acute pain and limping?
What is the primary recommended lab study to evaluate for systemic etiology of acute pain and limping?
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What is a significant subjective indicator that might suggest a spinal infection?
What is a significant subjective indicator that might suggest a spinal infection?
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Which sign is NOT typically associated with the diagnosis of a vertebral compression fracture?
Which sign is NOT typically associated with the diagnosis of a vertebral compression fracture?
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In the differential diagnosis of mechanical low back pain, which condition is characterized by pain worsening with lumbar extension activities?
In the differential diagnosis of mechanical low back pain, which condition is characterized by pain worsening with lumbar extension activities?
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What finding would most likely indicate a high risk for malignancy in a patient with back pain?
What finding would most likely indicate a high risk for malignancy in a patient with back pain?
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Which of the following is an objective finding that could support a diagnosis of lumbar spondylosis?
Which of the following is an objective finding that could support a diagnosis of lumbar spondylosis?
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What is a common misdiagnosis for a patient presenting with pain, paresthesia, and possibly sensory changes in the lower extremities due to disk herniation?
What is a common misdiagnosis for a patient presenting with pain, paresthesia, and possibly sensory changes in the lower extremities due to disk herniation?
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Which of the following is NOT typically a red flag for back pain?
Which of the following is NOT typically a red flag for back pain?
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Which characteristic pain pattern is commonly associated with spondylolisthesis?
Which characteristic pain pattern is commonly associated with spondylolisthesis?
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Which vital sign or lab result would most likely indicate a spinal infection in a child?
Which vital sign or lab result would most likely indicate a spinal infection in a child?
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If a patient presents with pain relieved by rest and restricted range of motion, which condition is most likely ruled out?
If a patient presents with pain relieved by rest and restricted range of motion, which condition is most likely ruled out?
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What is an appropriate key lab assessment for a patient experiencing cardiac arrhythmias due to electrolyte imbalances?
What is an appropriate key lab assessment for a patient experiencing cardiac arrhythmias due to electrolyte imbalances?
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Which diagnostic test is best performed within 24 hours of an unprovoked seizure to detect epileptic form activity?
Which diagnostic test is best performed within 24 hours of an unprovoked seizure to detect epileptic form activity?
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When evaluating a patient for Cauda Equina Syndrome, which of the following symptoms would be a significant red flag?
When evaluating a patient for Cauda Equina Syndrome, which of the following symptoms would be a significant red flag?
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The Ottawa Ankle Rules indicate that an X-ray is necessary for which of the following conditions?
The Ottawa Ankle Rules indicate that an X-ray is necessary for which of the following conditions?
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Which of the following findings would suggest a central etiology during a spontaneous dizziness assessment?
Which of the following findings would suggest a central etiology during a spontaneous dizziness assessment?
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Which medication might contribute to seizures when evaluating patient history?
Which medication might contribute to seizures when evaluating patient history?
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What symptom would be a potential indication for a lumbar puncture in a patient with altered mental status?
What symptom would be a potential indication for a lumbar puncture in a patient with altered mental status?
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Which method is effective in assessing dizziness triggered by specific movements?
Which method is effective in assessing dizziness triggered by specific movements?
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Which laboratory finding is associated with hyperkalemia?
Which laboratory finding is associated with hyperkalemia?
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What should be done during the physical examination for suspected seizures?
What should be done during the physical examination for suspected seizures?
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Study Notes
Diagnostic Workup for Breast Conditions
- Clinical imaging evaluates masses and other breast abnormalities, guiding biopsies.
- Ultrasound is more sensitive than mammograms but less specific, more expensive, and has a higher false positive rate.
- Tissue sampling is performed if suspicious findings are detected during evaluation, regardless of findings at other stages, due to the imperfect sensitivity and specificity of clinical breast exams (CBE) and imaging.
- Women over 40 should have a mammogram followed by an ultrasound; women aged 30-39 should err on the side of caution by having both a mammogram and ultrasound.
- Women under 30 should have an ultrasound or MRI (if family history present).
- MRI is not routinely recommended unless there is follow-up on biopsy-proven cancer or some other indication.
- The GAIL model is a calculator tool for assessing a woman's 5-year breast cancer risk using personal medical history, reproductive history, and first-degree relative history.
Concerning Signs of Breast Cancer
- Nipple discharge, inversion or discoloration.
- Skin changes, asymmetry, or skin changes.
- Documentation of mass should include location, size, shape, consistency, tenderness, mobility, and retraction/dimpling.
- Common breast cancers include: ductal/lobular carcinoma (painless lump, typically irregular and fixed), inflammatory breast cancer (redness, swelling, no mass, aggressive), and Paget disease (crusty nipple, areola itching, steroid resistant).
- Other common breast findings include: fibrocystic changes (cyclical cysts with menses), fibroadenoma (firm, mobile, round, painless), fat necrosis (post-injury), intraductal papillomas (nipple discharge), duct ectasia (benign discharge), galactorrhea (unrelated to childbearing), and mastitis (infection, swelling, tenderness, redness).
- Fibroadenoma- firm, mobile, painless, smooth borders.
- Breast cyst- fluid-filled sacs, benign, more common in 40s, painless or tender.
- Fibrocystic changes- benign, typically bilateral.
- Lipoma or other benign soft tissue mass- soft, mobile, not too well-defined.
- Screening guidelines are provided for average-risk women.
Exam 1
- Anchoring bias occurs when a clinician over-relies on the first piece of information received.
- Screening tests are used in asymptomatic patients to detect diseases early.
- Diseases contributing to harm when thinking about diagnostic error include vascular, infection, and cancer.
- Epidemiology is the study of disease distribution in populations.
- When assessing a new patient, knowing the differential diagnosis(es) relies on patient history and physical examination (both data points).
- Diagnostic testing criteria includes sensitivity which measures true positive results among all positive cases.
- A high value test is appropriate when testing a 68-year-old male patient who is up to date on colonoscopies.
- Imaging to evaluate soft tissues includes MRI.
- Ultrasound is the first line diagnostic for a 25-year-old patient with a palpable breast mass.
- Diagnostic mammogram is prioritized (step one) if a 45-year-old woman has a palpable breast mass.
- Thyroid function can be evaluated with a TSH test.
- To evaluate an unexplained lymphadenopathy, complete blood count is the first diagnostic step.
Additional Details
- Imaging studies include X-ray, CT scan, MRI and ultrasound.
- Possible screening tests: Colonoscopy, Cervical (HPV), CT Scan, and Mammogram.
Medical History
- Hypertension, hyperlipidemia, tobacco use disorder.
- Symptoms are a persistent and worsening cough, shortness of breath (especially with exertion), and occasional white sputum.
Physical Examination
- Vital signs: BP 135/85 mmHg, HR 90 bpm, RR 22 breaths/min, O2 saturation 92% on room air.
Specific Findings
- Lung exam: bilateral wheezing, decreased breath sounds at the bases, no dullness to percussion.
- Cardiac exam: regular rhythm, no murmurs.
- Other findings: mildly enlarged lymph nodes in the cervical region.
- Differential diagnoses from different organ systems or mechanisms (pathophysiology) are recommended.
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Description
This quiz explores the various methods used in the diagnostic workup of breast conditions, including imaging techniques like mammograms and ultrasounds, as well as the importance of tissue sampling. It emphasizes guidelines for different age groups and introduces tools like the GAIL model for assessing breast cancer risk. Test your understanding of these critical diagnostic practices.
