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| Diagnostic Testing and Procedures- Back to the Basics Series |
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by Bob Blumm, MA, PA-C, DFAAPA - March 4, 2011
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As new PAs and NPs are confronted by patients with disease and major health problems it is necessary to know the appropriate tests that can provide important clinical information leading to diagnosis and treatment plans. Although all advance practice clinicians have seen this information somewhere in their training, part of the purpose of going through Back to the Basics, is to serve the professions by bringing them through the “time machine” to the basics of medical care. This should never be perceived as an insult to your intelligence but as reminders of pearls that can make a difference in the most important person---the patient.
Arteriogram (Angiogram) This test consists of a series of imaging studies that focus upon the vascular system with the utilization of contrast media. Creatine and BUN are important tests to perform before utilizing contrast materials as well as prior allergic experiences, type and general allergy history to create suspicion of possible triggers. These all require a “history” which is why physical examination including in-depth history must remain a cornerstone to our approach to the patient. With the addition of digital subtractive angiography, bony structures can be removed from the studies, adding to clarity. Utilization of this test can be to R/O problems such as abdominal aortic aneurysm by performing abdominal aortogram. This is a useful test in aging populations when carotid arteriogram can reveal the vascular mapping necessary to relieve a stenosis or plaque buildup in the carotid artery. Renal angiography can provide much needed information on patients with acute renal failure. For our patients who demonstrate signs and symptoms of claudication, lower extremity arteriography is the test of choice.
Arthrogram- This test can provide valuable pre-operative or diagnostic information to the orthopedist and requires injection of contrast medium into a joint cavity which allows visualization of the specific joint. One of the best examples would be an Arthrogram of the knee.
Barium Enema- We all will encounter patients with high grade motility problems which can have a large differential diagnosis. This x-ray study of the colon involving injection of barium into the colon allows for visualization of tumors, polyps and diverticula and can differentiate between Crohn’s disease versus a colonic tumor. This test is an excellent adjunct to colonoscopy which is invasive and allows real time visualization of the entire colon.
Bone densitometry: This is an accurate means of measuring bone mass and differentiating between osteopenia and osteoporoses thusly predicting risk of fractures in small and large bones as well as the vertebrae. There is an increase in this disease process and creates a need for medication for life, with its own risks and the prevention of complications and disability from fractures.
We are just starting this interesting review and will hope to add this information weekly so that all NPs and PAs will be up to date in the imaging studies that are available to diagnose their patients. This can serve to drive the motivated clinician to return to their medical training textbooks or to pick up additional up to date focused books on this subject. I would suggest for many of my colleagues a new text (2009) published by CCI entitles “Assisting in Surgery: Patient Centered Care.” Authors are Jane C. Rothrock, PhD, RN, CNOR, FAAN and Patricia C. Siefert, RN, MSN, CNOR, CRNFA, FAAN. These two individuals became close friends as we served together in various capacities during my five years as AAPA Liaison the American College of Surgeons. I am a contributing author in this text which would serve as the best reference source available today on surgical first assisting for PAs and NPs as well as all other members of the surgical team.
 Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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