NSG 550/ NSG550 Exam 3 V1 – Diagnostic Reasoning for Nurse Practitioners Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 550/ NSG550 Exam 3 V1 – Diagnostic Reasoning for Nurse Practitioners Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A MRI: What does it visualize? Anatomy including 3 main structural divisions: Cerebrum Brainstem Cerebellum MRI: What does the MRI Identify? Benign and malignant neoplasms, edema, and herniation What should be use to identify benign and malignant neoplasms, edema, and herniation MRI What is the most accurate test to identify herniated vertebral discs? MRI MRA: What does it stand for? Magnetic resonance angiography What does an MRA visualize? Aterial blood flow. Intracranial aneurysms What if a patient cannot have an MRA, but needs one? A carotid ultrasound can be used. Carotid artery duplex scan: What is it used for? To identify occlusive disease in the carotid artery or its branches. For what types of patients is a carotid artery duplex scan recommended? Patients with CVA, PVD, and neurologic symptoms What are considered neurological problems? TIA Hemiparesis Paresthesia Dizziness Syncope Acute Speech Deficits Acute Visual Deficits Carotid Bruit What kind of test is an MRA? angiography What kind of test is an MRI? imaging What kind of test is a carotid artery duplex scan? Ultrasound What kind of test is a CT of brain? Xray When is a CT of brain indicated? When CNS disease is indicated What can a CT of brain diagnose? Brain tumors, infarction, bleeding, hematomas What can you use to diagnose crain tumors, infarction, bleeding, hematomas? CT of brain What test should be the initial test to obtain when a stroke is suspected? Non-contrast CT What kind of test is a Myelography? Xray What does a myelography do? Provides radiographic visualization of the subarachnoid space of the spinal canal. What structures can be seen with a Myelography? Cord, nerves roots, surrounding meninges When is a myelography indicated? Severe back pain or localized neurologic signs that suggest narrowing of the spinal canal. Herniated lumbar discs, tumors, cysts. What test would you use to identify herniated lumbar discs, tumors, cysts. Myelography Skull Xray: What is it used for? Evaluation of trauma or disease Skull Xray: What structures does it visualize? bones of skull, nasal sinuses, CNS calcifications, metastatic tumors, and child's abnormal head size. Spinal Xray: What is it used for? Evaluation of neck/back pain, arthritic changes, DDD, spondylolisthesis, fractures, scoliosis. Spinal Xray: What does the spinal xray not evaluate? Discs or soft structures. Spinal Xray: How will a muscle spasm show? As straightening of normal lordosis Spinal Xray: When is a spinal xray not indicated? In uncomplicated back pain Acetylcholine Receptor Antibody Test: What is this test used for? To diagnose acquired myasthenia gravis and monitor pt response to immunosuppressive therapy. Myasthenia Gravis: What is it and what causes it? Autoimmune disease caused by antibodies that block or destroy receptors for Acetylcholine. Myasthenia Gravis: s/sx Muscle Weakness and Fatigue Cholinesterase test: What does it identify? Patients with PChE deficiency before anesthesia or those who may have been exposed to phosphate poisoning. Cholinesterase test: What does it identify on amniotic fluid? Neural tube defects Electrodiagnostic (EEG): What is it? Graphical record of brain wave activity obtained through electrodes placed on scalp and forehead. Electrodiagnostic (EEG): What does it identify? Seizure, tumors, infarcts, brain death (coma). EEG: What kind of test is it? electrodiagnostic Caloric Study: What kind of test is it? electrodiagnostic Caloric Study: What is this test used for? To evaluate function of CN VIII (Vestibulocochlear). Part of a complete neuro exam Caloric Study: What can it identify? Disease in temporal portion of the cerebrum Abnormalities of the vestibular system, brainstem, and cerebellum. Electromyography (EMG): What is it? Records strength of muscle contraction as a result of electrical stimulation. Electromyography: What can it identify? Differentiate primary muscle diseases from primary neurologic pathologic conditions. Nerve conduction study: What does if identify? Peripheral nerve injury in pts with localized or diffuse weakness, muscle atrophy, dysesthesia, paresthesia, and neurologic pain. Nerve conduction study: What does it help differentiate? Primary peripheral nerve disease from muscular injury Electronystagmography (ENG): What sx indicate this test? Vertigo Unilateral deafness Electronystagmography (ENG): What does if differentiate? Differentiates between organic and psychogenic sx. Differentiates between peripheral and central pathologies. Evoked potential studies: When is it indicated? Suspected sensory deficit but unable to indicate recognition of a stimulus. Monitor natural progression or treatment of deteriorating neurologic diseases like MS Evoked potential studies: For which pts is it indicated? infants comatose pts noncommunicative pts malingering pts Lumbar puncture (fluid study): What does it evaluate? Examines CSF. This includes: blood, bacteria, malignant cells, glucose, and protein. Lumbar puncture (fluid study): What does it diagnose? Primary or metastatic brain or spinal cord neoplasm Cerebral hemorrhage Meningitis Encephalitis Autoimmune disease Demyelinating disease Lumbar puncture (fluid study): How can it be used therapeutically? Decrease ICP Administer anesthetics Therapeutic agents Amyloid beta protein precursor, soluble, and Tau: What kind of test is it? Fluid study Amyloid beta protein precursor, soluble, and Tau: What does this test do? Helps to diagnose Alzheimer's disease and senile dementia. Amyloid beta protein precursor, soluble, and Tau: What symptoms indicate this test? Progressive dementia and confusion Tilt-table testing: What kind of study is this? Manometric study Tilt-table testing: What is it? Provocative test to diagnose vasopressor and vasovagal syncope. Tilt-table testing: What is this test performed with? EP study Tilt-table testing: What does it look like if positive? Pt will demonstrate symptomatic hypotension and syncope within a few minutes of being tilted upright by approximately 60-90 degrees. Brain Scan: What kind of test is it? Nuclear Brain Scan: What is it? Image of the brain taken after injection of radioactive isotopes into the circulation. Brain Scan: What does it diagnose? Cerebral brain death. Identifies tumor, infarct, and infection involving cortex Is a brain scan as useful as a CT, MRI, or PET scan? No. What kind of brain scan is used to support diagnosis of cerebral brain death? Nuclear cerebral flow brain scan What kind of brain scan helps to diagnose Parkinson's? SPECT What does an Ethanol test evaluate? Alcohol impaired driving and overdose What is the intervertebral foramen? A foramen between 2 spinal vertebrae. What do cervical, thoracic, and lumbar vertebrae all have in common? They all have intervertebral foramina Where do spinal nerves pass? Through the foramen from spinal cord out to the rest of the body. What is Foraminal Stenosis? narrowing of tightening of the openings between bones in the spine. What happens when the foramen in the spine close in? The nerve root passing through them can be pinched. What can a pinched nerve lead to? Radiculopathy What is Radiculopathy? Pain, numbness, and weakness in the part of the body the nerve serves. Which test can you see Foramen? MRI of the cervical and lumbar spine. Where will you not see foramen? MRI of the brain Mammogram: What does it measure? Breast density. Mammogram: What kind of test is it? XRAY BIRADS: What is it? Categories of mammogram findings BIRADS: 0 abnormality noted, more imaging recommended BIRADS: 1 negative BIRADS: 2 benign findings noted BIRADS: 3 probably benign breast findings Short-term f/u suggested BIRADS: 4 suspicious findings, further evaluation is indicated. BIRADS: 5 known breast cancer Acid phosphatase: What is it used for? To document rape cases. Acid phosphatase: What was it formerly used for? To diagnose prostate cancer. Acid phosphatase: What can it detect? Bone mets useful for prostate cancer Paget's disease hyper parathyroid disease w/ skeletal muscle involvement. CA 19-9, 132: Which cancers are associated? Colon Stomach Bile duct CA 19-9, 132: What can elevated levels mean? Advanced cancer in pancreas. Gallstones Pancreatitis Cirrhosis Cholecystitis. CA 19-9, 132: What is it? Tumor marker to diagnose cancer and evaluate response to treatment. CA 15-3 and CA 27-29: What are they? Tumor markers for breast cancer. Which marker is most specific to breast cancer? CA 27-29 CA 125, 134: What is it? Tumor marker for ovarian cancer Carcinoembryonic Antigen (CEA) Determine extent of disease and prognosis in patients with cancer (GI or breast) Mean Inhibitory Concentration (MIC) average concentration of the drug that inhibits the growth of an organism. What is the Bethesda system used for? For reporting cervical and vaginal cytologic diagnosis. What is the purpose of the Bethesda system? To minimize discrepancies in result reporting and create standardized framework for reporting results. What is the Bethesda system? List of terms that are universal to lab systems for reporting Pap results. Bethesda system: What is the most common abnormality found? Cervical dysplasia Bethesda system: ASC-H: Atypical squamous cells of undetermined significance- cannot exclude HSIL Pap results are borderline but may be more serious. Bethesda system: ASCUS- Atypical squamous cells of undetermined significance Pap results are borderline, between normal and abnormal. Bethesda system: LSIL- low grade squamous intraepithelial cells Cell changes on your cervix are more serious. Bethesda system: HSIL: high grade squamous intraepithelial cells Cell changes on cervix are more serious Bethesda system: ASC-US: Atypical squamous cells of undetermined significance abnormal cells seen on pap. Not a diagnosis. Condition is not cancerous. May be inflammation and LSIL. What does atypical glandular cells on the cervix indicate? Cancer or Pre-cancer What usually causes atypical glandular cells on the cervix? HPV What should be done after finding atypical glandular cells on the cervix? A biopsy to determine is cells are cancerous Colposcopy: What is examined? An illuminated, magnified view of the cervix, vagina, and vulva. Colposcopy: What may be detected? Pre-malignant and malignant lesions. Biopsies can also be performed. Colposcopy: What is used during this test? A colposcope Chlamydial and gonorrheal testing: What samples can be used to conduct these tests? Endocervical Urethral Vaginal Pharyngeal Rectal Urine Fetal biophysical profile (BPP): What is this test used for? Measures baby's movement and muscle tone in utero. Measures HR accelerations with movement and the amount of amniotic fluid. HCG: What are types of HCG tests? Qualitative beta HCG and Quantitative HCG HCG: What is the qualitative beta HCG? Rapid pregnancy test HCG: Why are quantitative HCG tests used? More accurate Used in high-risk pregnancies To monitor patients with HCG secreting tumors Cervical Biopsy: What is it used for? Identifies and treats premalignant and superficial malignant lesions on the cervix When is a cervical biopsy indicated? When Pap smear reveals epithelial cell abnormality or Pelvic exam reveals possible neoplastic abnormality. What types of biopsies are included in a cervical biopsy? Punch biopsy Endocervical biopsy LEEP Cone biopsy DEXA Scan: What kind of test is this scan? Xray DEXA Scan: What is it used for? Determine bone mineral content and to diagnose osteoporosis. DEXA Scan: How is it performed? Specialized X-ray that uses 2 different energies so bones surrounded by soft tissue can be penetrated. DEXA scan: Who should get this can most importantly routinely, and often often? Post-menopausal women; Every 2 years What is the most sensitive test to determine iron deficiency anemia? Ferritin Ferritin: What is this test for? Indicate iron store in the body Ferritin: What can decreased levels indicate? Decreased iron stores associated with iron deficiency anemia. Ferritin: What can increased levels indicate? Hemochromatosis Hemosiderosis Iron Poisoning Recent iron transfusion Vitamin B12 folate deficiency Myelodysplastic syndrome malignancy What other tests are useful in classifying anemia? MCV, MCH, MCHC, RDW What deficiencies are macrocytic anemia? Folate and B12 What deficiencies are microcytic anemia? Iron, Thalassemia Macrocytic anemia: Relationship to MCV Increased MCV Microcytic anemia: Relationship to MCV Decreased MCV What blood tests are decreased in anemia? RDW MCH Iron-deficiency anemia: What causes anemia other than low iron? blood loss, dietary deficiency, iron absorption problems, ESRD, chronic inflammation. Iron-deficiency anemia: Symptoms pallor, fatigue, cold hands/feet, swollen/sore tongue, cracks at sides of mouth/lips, brittle nails, pica, h/a, SOB, and weakness. Iron-deficiency anemia: Diagnostic tests CBC serum iron level serum ferritin level reticulocyte count Iron-deficiency anemia: tests to r/o underlying causes renal function panel CMP thyroid studies vit b12 level EKG tests for GI bleed Iron-deficiency anemia: What are tests done for GI bleed? colonoscopy upper endoscopy fecal occult blood testing Iron-deficiency anemia: Treatment depends on cause and severity. Oral supplements IV iron Dietary modifications Blood transfusion If GI bleed= treat promptly What are the different type of WBCs? Neutrophils Lymphocytes Monocytes Eosinophils Basophils What tests are routine for bacterial infections? Neutrophil left shift WBC count What does a neutrophil "shift to the left" on a CBC w/ diff indicate? immature leukocytes neutrophil band cells inflammation bacterial infection What does a LARGE neutrophil "shift to the left" on a CBC w/ diff indicate? Severe infection What can a CBC diagnose? Infection Anemia Leukemia Blood Disorder Platelet Disorder Hemoglobin: What does this test measure Total hemoglobin in the blood. Rapid measure of direct RBC count. Hemoglobin: What do increased levels indicate? Hemochromatosis Hemoglobin: What do decreased levels indicate? Anemia Haptoglobin: What does it detect? Intravascular destruction of RBCs Hematocrit: What does it meaure? indirect measure of RBCs What is the level of Hematocrit's relationship to Hemoglobin? Hematocrit is usually 3x the hemoglobin value. When in hematocrit often measured? Pts with ongoing bleeding. Activated partial thromboplastin time (aPTT): When/Why is it used? To assess intrinsic system and the common pathway of clot formation. To monitor heparin therapy Antithrombin activity and antigen assay: Why is it used? Used to evaluate pts suspected of having hypercoagulable states. Helps identify the cause of heparin resistance in pts. Detects how much antithrombin protein your body has made. Antithrombin activity and antigen assay: What does it identify when ordered together? Identify Type 1 or Type 2 antithrombin deficiency What is ordered for unexplained blood clots? Antithrombin activity and antigen assay Direct Coombs Test: Why is this test performed? To identify immune hemolysis or to investigate hemolytic transfusions reactions. Indirect Coombs test: What is it used for? To detect antibodies against RBCs in the serum. Indirect Coombs test: What is it most commonly used for? screening potential blood recipients. D-Dimer: What is it used for? To identify intravascular clotting Erythropoietin: EPO: What it is used for? To assist in differentiating the cause of anemia and polycythemia. Factor-V-Leiden: What it is used for? To diagnose V-Leiden thrombophilia Internationalized Normal Ration: (INR): What is it used for? Used to measure how quickly blood forms a clot compared with normal clotting time. Platelet count: What it is used for? Counting number of platelets per cubic millimeters of blood. Platelet count: When to perform? For patients that develop: Petechiae, Spontaneous bleeding, Increasing heavy menses, Thrombocytopenia Prothrombin Time: (PT): What does it do? Evaluates the adequacy of the extrinsic system and common pathway in the clotting mechanism. Bence Jones Protein: What is it? A special protein found in the blood and urine. Indicative of Multiple Myeloma Antibiotic use and wound culture interpretation: When is it indicated? When a wound or soft tissue has signs of infection, persistent fever in post op patients, or spontaneous drainage from wound or soft tissue. Antibiotic use and wound culture interpretation: When should you perform a wound culture? Before initiation of antibiotic therapy Antibiotic use and wound culture interpretation: When are wound culture results available? Preliminary report in 24 hours. Gram stain available in 10 minutes. Wound Culture and Sensitivity: When is it indicated? When a wound or soft tissue has s/s of infection Wound Culture and Sensitivity: What are the s/sx of infection? Redness, Warmth, Swelling, Pain If a wound has s/sx of infection, what tests should you obtain? Culture and sensitivity w/ gram stain, culture, and susceptibility. Wound Culture and Sensitivity: Why is an antimicrobial susceptibility beneficial? For provides to determine appropriate AB therapy. What is MIC? Average concentration of the drug that inhibits the growth or an organism. What is Minimum Inhibitory Concentration? Lowest concentration of the drug that inhibits growth of an organism. Does acute uncomplicated low back pain warrant imaging? No. How long does back pain usually resolve? Within a month Why should you not order imaging for low back pain? It resolves quickly and XRAY and CT scans lead to unwarranted radiation exposure. Myelography: What is it? radiographic visualization of subarachnoid space of spinal canal. Myelography: When is it indicated? Severe back pain or findings suggestive of spinal canal narrowing. Tumors Stenosis Herniated disc Cyst Gamma-Glutamyl Transferase (GGT): What is it? A liver enzyme that is a biomarker for heavy alcohol use, or alcoholism What should a provider do if drug levels are elevated in the blood? Must assess for side effects and symptoms of toxicity What should a provider do if drug levels are low in the blood? Must decide if a dose increase is warranted, or if patient is noncompliant with treatment. What are common meds that need monitoring? Antibiotics, cardiac meds, anti-seizure drugs, rheumatologic/autoimmune meds, meds to treat BPD. Blood culture and sensitivity: What is it used for? To detect presence of bacteria in the blood. Identify infection, infestation, leukemia, and other diseases. Blood culture and sensitivity: How is it performed? 2 cultures are needed to be obtained from different sites. Drug screening: What does it identify? Metabolites of illegal drugs used Drug screening: What sample is most commonly used? Urine Drug screening: Which tests are better from the blood? Toxicology tests for drug overdose Poisoning Drug screening: Who uses drug screening? Employers Law enforcement agencies Genetic Testing: What is it used for? Identifies predisposition to disease Establish presence of disease Establish paternity Provide forensic evidence SARS viral testing: Uses Diagnose severe acute respiratory syndrome, caused by corona virus. SARS viral testing: Is it part of routine testing? No. Not conducted unless a cluster of cases develop. Skin Biopsy: Uses Test of inflamed skin or mucosa to evaluate and diagnose immunologically mediated dermatitis. Used to confirm histopathology of skin lesions. Toxicology: Uses evaluates drug abuse, overdose, or poisoning. Toxicology: On what sample is this test performed? Performed on blood WBC Scan: Uses Identify and localize occult inflammation or infection. Fever of unknown origin Suspected osteomyelitis IBS Determines if abnormal mass is infected West Nile Virus Testing: Indications When flu-like symptoms occur in an area which the virus exists. Sexual Assault Testing: Uses Used to obtain evidence of recent sexual assault, identify STIs, Sexual Assault Testing: After how long after assault is evidence minimal? 72 hours What is involved in sexual assault testing? Photographs of injuries Pregnancy Tests Clothes placed in a paper bag Prophylactic antimicrobial testing offered Hep B vaccine offered. In CVA: What test to do in first 24 hours? Non-contrast brain CT scan (not MRI, first). Low back pain: How long should it be for unresolved lower back pain before imaging? 6-8 weeks What is the difference between MRI and MRA? MRI = Magnetic Resonance Imaging. CANNOT give you any information on blood vessels, just structures and ventricles. MRA = Magnetic Resonance Angiography - Can look at the blood vessels .. should be ordered if there's a concern for an occlusion What is a mammography? -x-ray imaging of the breast tissue for early signs of cancer. It is the only way to detect microcalcifications What is BI-RADS? Breast Imaging Reporting and Data System -Includes breast density on every single report and summary of findings Bi-Rad System Grading 0-6 Stage 6; known malignancy/they already know they have breast cancer, they've already had a biopsy and are positive for breast cancer. The indication of the test would be to see if the patient is responding to treatment/progression to disease. Stage 5; highly suggestive of malignancy; get a follow-up biopsy Stage 4; suspicious; consider biopsy Stage 3; probably benign, short term f/u Stage 2; benign Stage 1; negative Stage 0; incomplete Other pertinent information in the Bi-RADS report -Patient information -imaging findings -universal discussion of findings/assessment so everyone can communicate to eachother (providers, radiologists, oncologists), -density of breast tissue -clinical correlations -summary of findings Importance of cervical screenings (like a papsmear) A papsmear is the brushing of the cervix that removes sell, sent off to detect cancer. -It is essential to make sure there is an adequate amount of sample to send off! (That's why we do a pap smear before the pelvic exam). Papsmear abnormalities Pap smear abnormalities refer to various types of cell changes in the cervix that may indicate the presence of HPV or precancerous conditions. examples of papsmear results are... -squamous cell abnormalities, -glandular abnormalities, -hpv, -ASC-US (atypical squamous cells of undetermined significance.. this is inconclusive and may require a coloscopy) -ASC-H (atypical squamous cells - cannot exclude high-grade / suggestive of cancer) -LSIL, (low grade squamous intraepithelial lesion) -HSL (high grade squamous intraepithelial lesion) What's your next step after an abnormal papsmear? Colposcopy What is a colposcopy? -An exam that looks at the cervix, vagina, and vulva through a magnifying device (colposcope). -Typically done if you have an abnormal pap smear (screening) or concern for HPV. It can be done at bedside. What is the Bethesda system? -The National Cancer Institute developed a standard system called the Bethesda System to classify and report cervical cytology (PAP). -it improves accuracy and consistency to guide follow up and treatment. Bethesda system findings The Bethesda system findings categorize different types of cells found in cervical samples, ranging from no abnormal cells to pre-cancerous and cancerous cells, helping to identify potential risks and guide further medical decisions. examples are... -NILM (negative for intraepithelial lesion or malignancy.. no abnormal cells are present) -ASC-US -ASC-H -LSIL -HSIL -AGC - atypical glandular cells (pre-cancerous cells) - cells that line the inside of the cervix - precancerous -AIS - adenocarcinoma in situ - abnormal glandular cells that are cancerous but not spread beyond site of origin -Invasive carcinoma - cancerous cells with invasion of surrounding tissue What is a DEXA scan? X-ray to measure bone density (risk of osteoporosis, fractures) If you are concerned about iron deficiency you need to... send off an iron panel. If you're worried about low iron levels, think of sending an iron panel as exploring a diagnosis - like investigating a crime scene to find clues about whether it's macrocytic anemia or microcytic anemia. What is included in an iron panel? -TIBC (total iron binding capacity) measures transferrin (protein that transports iron). -Transferrin saturation calculates the percentage of transferrin that is carrying iron -Iron Saturation Ferritin is NOT included in panel - this needs to be sent separately. If someone presents with vague fatigue symptoms, what labs should you consider? -evaluate for anemia -thyroid studies What is included in a CBC with differential CBC; WBC, hgb, hct, MCB, MCH, platelets. -your differential has to equal 100. If something is elevated, something else has to drop down/compensate. What can cause a left shift in our differential? Neutrophils, often referred to as "bandemia" A left shift in our differential, which refers to an increase in immature neutrophils called "bandemia," can be caused by infections or other inflammatory conditions. Interpreting antibiotic tables S: Sensitive (think of suitable), which means that the antibiotic will kill the pathogen R: resistant—will NOT kill the pathogen I: indeterminant, not the best choice What is a biophysical profile? A biophysical profile is like a comprehensive check-up for a baby before it is born, using ultrasound to assess its movement, muscle tone, breathing, and the amount of amniotic fluid. -Performed pre-delivery/antepartum What is a fetal stress test? When you're actively in labor and monitoring deceleration and contractions, making sure the baby and mom is handling the labor process well. Importance aspects of newborn metabolic screening test -heel stick -hearing screen and pulse ox (24-48 hours). Each state is different... The top 5 things found on screening are -PKU -glucose-6 phosphate dehydrogenase deficiency -congenital hypothyroidism -congenital adrenal hyperplasia -galactosemia -maple syrup urine disease, -cystic fibrosis -biotinidase deficiency. -ALL states test for PKU What is a human chorionic gonadotropin (hCG)? What are considerations of HCG? Human chorionic gonadotropin (hCG) is a hormone produced during pregnancy that helps maintain the pregnancy, and its levels can be measured to determine the health of the pregnancy or detect certain medical conditions. -Normal2 -Negative 5 -Indeterminate 5-25 -Positive 25 Any issues or complications with the pregnancy, you'll want to do a quantitative level as well. -A Positive hCG can also happen in the setting of hCG secreting tumor, gestational trophoblastic disease (GTD), nontrophoblastic neoplasm or pituitary source of hCG (cancer) What is the difference between a quantitative and qualitative HCG test? -QuaLitative HCG test is like a pregnancy test that tells you if you're pregnant or not. -QuaNtitative HCG test is like a pregnancy test that measures the level of HCG hormone in your body, allowing you to track the progress of your pregnancy and ensure there are no complications. Different ways to test for STI's (such as Chlamydia/Ghonnorhea, Trichomonas) -pelvic exam -urethral swab -urine -pharyngeal chlamydia or pharyngeal gonorrhea swab (if oral sex is indicated) -rectal swab (if anal sex is indicated) EEG -a test that measures electrical activity in the brain using electrodes attached to the scalp. -Test for subclinical seizures/indicated with epilepsy Findings of a lumbar puncture A lumbar puncture is like collecting a sample of cerebrospinal fluid (CSF) from your lower back to check for serious conditions such as.. -meningitis -Guillain-Barre syndrome -multiple sclerosis (MS) -cancer of the nervous system Symptoms that would warrant for an LP -headache -altered mental status -fever -+meningeal signs (high sensitivity and specificity for infection) -seizures -light sensitivity/double vision LP lab findings -Appearance - clear -Opening pressure - 10-20cmCSF -WBC - 0-5 cells 2PMN -Glucose - 60% of serum glucose -Protein - 45mg/dl -Culture and gram stain Carotid artery duplex US study of the carotid arteries, provides a range of occlusion not a specific number. -1-15% -16-49% -50-79% -80-99% -Complete occlusion -Asymptomatic patients with 70% stenosis would warrant some follow up. -Those with 50% and are symptomatic that warrants for a need surgical referral/evaluation CT with myelogram a special CT scan that looks at muscle function, innervation of the nerve, and disc vertebrae (like if someone comes in with back pain) -it is an option for people who can't get MRi's (like an implanted device) What does the american college of radiology recommend for a 24 year old with atraumatic back pain? No diagnostic - nothing Patient presents with AMS, what are some important tests to evaluate? -Always look for metabolic and infectious causes -BMP, CBC, urine culture and sensitivity, ammonia levels, thyroid levels, -b12 and folic acid -infections processes; syphillis or an RPR. What is a toxicology report? Toxicology is like investigating a crime scene to find evidence of drugs or medications in someone's body, just like checking for fingerprints or DNA to see if someone is telling the truth or not. Examples of things it can measure; -salicylate levels -Tylenol levels -anti-epileptic levels.. if someone comes in with seizures but claims they've been taking their meds, do a toxicology report to see if they're lying/noncompliant What is the most routine presenting symptom of herpes zoster/shingles? Pain and rash over dermatomal distribution / linear distrubition / zosterform unilateral (shouldn't cross over midline) What is a MIC (minimum inhibitory concentration)? The MIC is like the smallest amount of medicine/antibiotic needed to stop the growth and kill the bacteria.. (just like how a tiny drop of poison can take down a whole colony of ants). Differences in lumbar/cervical spine MRI vs. MRI of the brain MRI lumbar spine/cervical spine will provide detailed pictures of the bones, discs, nerves, and surrounding soft tissues in these specific areas. These details are specific to the lumbar and cervical spine regions and would not be included in an MRI focused on the brain. The brain MRI focuses on the brain's structures, including the cerebrum, cerebellum, and brainstem, and is used to evaluate conditions such as tumors, vascular abnormalities, or other neurological disorders in the brain.