Question

1. Jeff Smith, a 15-year-old boy, has been referred to an orthopedic specialist because he has an elevated ALP. Discuss the implication of an elevated ALP. Review the range of diseases indicated by an elevated ALP. Evaluate Jeff Smith's situation and describe why he is seeing an orthopedic physician.

2. You are reviewing the record of Russ Walker, a 58-year-old man with a family history of heart disease. He has just been admitted to the hospital with chest pain. Dr. Rupert Wilbert, a cardiologist, has noted and ordered a thallium stress test for Mr. Walker. Why do you think Dr. Wilbert chose this particular test? What is involved with this study? If Mr. Walker cannot complete the treadmill portion of the test, what effect will that have on the test results?

Answer 1

1. In the case of elevated levels of ALP, Jeff Smith referred to an orthopedic specialist as this increased levels indicates Osteosarcoma.  Osteosarcoma (also called osteogenic sarcoma) is the most common type of cancer that starts in the bones. The cancer cells in these tumors look like early forms of bone cells that normally help make new bone tissue. Increased alkaline phosphate indicate pulmonary metastasis of the condition which infact leads to death.

2. A thallium stress test is a nuclear imaging test that shows how well blood flows into your heart while you're exercising or at rest. This test is also called a cardiac or nuclear stress test.It is done in stages:

An intravenous (IV) line started.

• A radioactive substance, such as thallium or sestamibi, will be injected into one of the veins.
• Lie down and wait for between 15 and 45 minutes.
• A special camera will scan the heart and create pictures to show how the substance has traveled through blood and into the heart.

Most people will then walk on a treadmill (or pedal on an exercise machine).

• After the treadmill starts moving slowly, he will be asked to walk (or pedal) faster and on an incline.
• If he is not able to exercise, hr may be given a medicine called a vasodilator. This drug widens (dilates) your heart arteries.
• In other cases, he may get a medicine (dobutamine) that will make his heart beat faster and harder, similar to when exercise.

blood pressure and heart rhythm (ECG) will be watched throughout the test.

When his heart is working as hard as it can, a radioactive substance is again injected into one of the veins.

• wait for 15 to 45 minutes.
• Again, the special camera will scan the heart and create pictures.
• He may be allowed to get up from the table or chair and have a snack or drink.

The provider will compare the 1st and 2nd set of pictures using a computer.