By D. Iomar. Concordia College, Austin Texas.

This is the single most important question in differentiating axial from radicular pain celexa 20mg low price. Whereas radicular pain in the neck may sometimes present as dull or aching, axial and referred pain patterns are never lancinating, electric, or radiating. This question is important for two reasons: first, if your patient’s pain has lasted less than 3 months (acute pain), it is much more likely to resolve on its own. Second, patients with axial neck pain and a his- tory of a motor vehicle accident immediately precipitating their symptoms have up to an 80% chance of their pain resulting from a diseased Z-joint. Patients with axial neck pain (with or without a referral pain pattern) and a history of neck trauma other than a motor vehicle accident precipitating their symptoms also have an increased probability of Z-joint disease causing their pain. A history of trauma precipitating acute (or chronic) neck pain necessitates ruling out the possibility of a fracture with X-ray and/or computed tomography evaluation in most cases. Most patients with Z-joint disease can recall some history of trauma (even if it was 60 years ago and did not immediately precipitate their symptoms). Patients with radicular symptoms caused by a herniated disc may be more likely to have worsening symptoms with neck flexion (which increases intradiscal pressure). Patients with radicular symptoms caused by foraminal stenosis may be more likely to have increased symptoms with neck oblique extension (such as looking back over the shoulder) because this position increases pressure on the foramen. Patients with Z-joint disease may have increased pain with neck extension because this position increases pressure on the Z-joints. This question is most helpful for deciding which imaging studies (if any) to order and how to treat your patient. If the answer to any of these questions is “yes,” then you should consider an underlying infection or malignancy. Progressive neurological injury is an indication for surgery and the patient should have spinal cord compromise ruled out. Physical Exam Having completed the history portion of your exam, you have deter- mined whether or not your patient has symptoms of axial neck pain or radicular, and you have begun to narrow your differential diagnosis. To help differentiate C7 from T1, have the patient laterally rotate the head as you simultaneously palpate the spinous processes of C7 and T1. C7 will move slightly with lateral rotation but T1 is fixed and will not rotate.

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Liver generic 20mg celexa overnight delivery, enlarged Qualified yes Explanation: If the liver is acutely enlarged, participation should be avoided because of risk of rupture. If the liver is chronically enlarged, individual assessment is needed before collision, contact, or limited-contact sports are played. Malignant neoplasm Qualified yes Explanation: Athlete needs individual assessment. Musculoskeletal disorders Qualified yes Explanation: Athlete needs individual assessment. Neurologic disorders History of serious head or spine trauma, severe or repeated concussions, or crainotomy (Sallis, 1996; Smith and Qualified yes Laskowski, 1998). Explanation: Athlete needs individual assessment for collision, contact, or limited-contact sports and also for noncontact sports if deficits in judgment or cognition are present. Research supports a conservative approach to management of concussion (Sallis, 1996; Smith and Laskowski, 1998). Seizure disorder, well-controlled Yes Explanation: Risk of seizure during participation is minimal Seizure disorder, poorly controlled Qualified yes Explanation: Athlete needs individual assessment for collision, contact, or limited-contact sports. The following noncontact sports should be avoided: archery, riflery, swimming, weight or power lifting, strength training, or sports involving heights. In these sports, occurrence of a seizure may pose a risk to self or others. Obesity Qualified yes Explanation: Because of the risk of heat illness, obese persons need careful acclimatization and hydration. Organ transplant recipient Qualified yes Explanation: Athlete needs individual assessment.

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In all circumstances discount celexa 20 mg amex, ultrasound is the imaging modality of choice for primary investigations. Jaundice Neonatal jaundice may result from a variety of physiological and metabolic causes, most of which can be successfully treated medically without the need for imaging. Prolonged neonatal jaundice (>7–10 days) is a common indication for urgent ultrasound imaging of the neonatal liver, primarily to exclude biliary atresia9 (partial or complete congenital interruption of the common bile duct12). Catheters, lines and tubes Many neonatal radiographic examinations are undertaken to assess the position of lines and catheters prior to their medical use and it is important that radiog- raphers are able to identify incorrectly positioned catheters and bring these find- ings to the attention of their radiological and medical colleagues. Endotracheal tube Endotracheal intubation is necessary for mechanical ventilation, and accurate positioning of the endotracheal tube within the trachea is essential if effective ventilation is to be achieved and respiratory obstruction avoided. The distal tip of the tube should be positioned at the level of the second thoracic vertebra, approximately 1 – 2cm above the carina2. It is important, when undertaking plain film radiography to assess the position of the endotracheal tube, that the baby’s head is in its natural position (i. Umbilical arterial catheter Catheterisation of the umbilical artery provides a secure access for the invasive monitoring of blood and the infusion of fluids. On entry at the umbilicus the arterial catheter should initially run caudally towards the pelvis before entering 116 Paediatric Radiography Fig. Note the tip is at the level of T5 resulting in collapse of the left lung. A cor- rectly positioned umbilical arterial catheter should lie in the lower aorta (below vertebra L3) or above the diaphragm (higher than ver- tebra T12) in order to avoid the renal arteries as they exit from the aorta. Plain film radiography to assess the position of the arterial catheter should include both the chest and abdomen in order to demonstrate its entire length. Umbilical venous catheter When correctly positioned, the umbilical venous catheter should be seen running cranially from the umbilicus along the umbilical vein, the ductus venosus and the inferior vena cava to lie with its tip within the right atrium of the heart (Fig. It is used primarily to deliver drugs and fluids and to monitor central venous pressures. Plain film radiography to assess the position of the catheter should include the chest and upper abdomen (from the level of the umbili- cus) to ensure that the entire length of the catheter is visualised.

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