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Old 06-19-2011
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Question Right Knee pain and bone scan picture

A 61-year-old man visits his physician with complaints of right knee pain. The pain is constant and does not seem worsened or alleviated with activity. Over-the-counter nonsteroidal anti-inflammatory drugs do not help. He has tried ice and heat, neither of which help. On examination, there is no crepitation or joint swelling. A bone scan was performed 1 month ago for a study at the University’s new radiology center (see figure). Which of the following tests is the most appropriate next step in management?

Right Knee pain and bone scan picture-bonescan.jpg
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Answer Choices
A. Acid phosphatase
B. Alkaline phosphatase
C. Magnetic resonance imaging of the lesions
D. Prostate-specific antigen to evaluate for prostate cancer
E. Rheumatoid factor
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Old 06-19-2011
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i don t know..there are findings not only at the r knee...metasasis,Paget?
Mri or psa?
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Old 06-19-2011
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Would love to know the explanation to this one..Great question
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Old 06-20-2011
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Option B (Alkaline phosphatase) is correct. Alkaline phosphatase measures bony activity and is high in Pagetís disease.

Option A (Acid phosphatase) is incorrect. Alkaline phosphatase measures bony activity and is high in Pagetís disease.

Option C (Magnetic resonance imaging of the lesions) is incorrect. Magnetic resonance imaging offers no further diagnostic assistance and is quite costly. Plain radiographs may be more helpful.

Option D (Prostate-specific antigen to evaluate for prostate cancer) is incorrect. This uptake pattern shows a lot of bony involvement, not like the lesions seen with metastasis.

Option E (Rheumatoid factor) is incorrect. The arthritis in the knee is most likely from underlying Pagetís disease and not arthritis. The patientís presentation is not at all consistent with rheumatoid arthritis.

High-yield Hit 1
Diagnostic Evaluation
Paget's disease is most often diagnosed using a combination of biochemical markers of bone turnover and radiologic abnormalities. Biochemical markers of bone formation (such as serum alkaline phosphatase) and bone resorption (such as urinary hydroxyproline) are usually increased in patients with active disease. Serum bone-specific alkaline phosphatase, urinary deoxypyridinoline, and cross-linked N-telopeptides of type I collagen may be more sensitive markers for assessing disease in patients with low levels of disease activity. Serum osteocalcin, another marker of bone formation, is often in the normal range and is not a clinically useful marker of disease activity. For most patients with Paget's disease, serum total alkaline phosphatase is an adequate indicator of disease activity.
A bone scan at the time of diagnosis is the most useful test to define the location and extent of lesions (see Fig. 76-2). Radiographs of the affected areas confirm the presence of Paget's disease and are useful for evaluating complications and local disease progression (see Fig. 76-1). The radiologic abnormalities seen on standard radiographs may reflect one of the three distinctive stages of pagetic lesions. The earliest lesions are osteolytic lesions, which are often observed as osteoporosis circumscripta in the skull (Fig. 76-1A) or as an advancing "blade of grass" in long bones (Fig. 76-1B). Cortical thickening, coarse trabecular markings, and both lytic and sclerotic lesions in the same bone (Fig. 76-1C) characterize the second stage of the disease. In the final stage, sclerotic lesions are primarily observed and are often associated with an increase in bone width (Fig. 76-1D). Bone biopsy is rarely needed to diagnose Paget's disease and should be avoided in weight-bearing areas.
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Old 11-29-2011
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Default Magneto-therapy research

I found interesting topic about it.It can to recover if you break your bones and so on.Many studies proved it and many doctors told that it is quite good.Well I don't know exactly is it good or not.Have somebody tried it?
Oops forget about article here it ( http://magneto-therapy.eu )
Help please
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