NSG555 / NSG 555 Exam 3: Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | (Latest 2026/2027 Update) All Modules Covered | 100% Correct | Grade A - Wilkes

NSG555 / NSG 555 Exam 3: Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | (Latest 2026/2027 Update) All Modules Covered | 100% Correct | Grade A - Wilkes Narcan: Drug Class? Potent Opioid antagonist Narcan: Indication Opiate overdose What med should be routinely prescribed for all patients with an opioid use disorder? Narcan What type of half life does Narcan have? A short half-life Methadone: Other name for Methadone? Dolophine Methadone: Drug Class Long acting full opioid receptor agonist at mu receptor. How many times can you use Methadone daily? 1 time Where can you usually get Methadone? Federally licensed substance abuse treatment programs Methadone: What is the precaution to taking this med? QTC prolongation cardiac abnormalities What are the other names for Buprenorphine? Buprenex Soblocade What is the name for Buprenorphine/Naloxone Combo? Suboxone What is the drug class of Buprenorphine? Partial Opioid receptor agonist/ opioid antagonist How does Buprenorphine work? Decreases cravings What is the precaution with buprenorphine / Suboxone? Can precipitate withdrawal if used too soon after a full opioid agonist. Why can buprenorphine/suboxone precipitate withdrawal if used too soon after a full opioid agonist? It will displace any residual opioids from mu receptors. What preparation of suboxone is safer? Sublingual What do you need to prescribe suboxone in outpatient settings? A Waiver What can be used to manage pain in a patient with opioid use disorder and comorbid pain? Suboxone What forms is suboxone available? Buccal film Sublingual film Sublingual tab What forms is buprenorphine available? Sublingual tab Subdermal implant SQ injection Naltrexone: Drug Class Competitive opioid receptor antagonist Naltrexone: When can it precipitate withdrawal? If used within 7 days of heroin use In what forms is Naltrexone available? Orally or monthly depot injection. Naltrexone: Indications Treatment of choice for highly motivated patients for ETOH and Opioid use disorders. Naltrexone: Precaution Risk for LFT elevation What is the available po form on Naltrexone? Revia What is the available IM form on Naltrexone? Vivitrol What can inappropriate use of opioids indicate? A patient's pain is uncontrolled What are symptoms of Opioid Intoxication? Miosis Hypotension Bradycardia Low RR Unconsciousness What is miosis? constriction of the pupil What is the treatment for opioid intoxication? Naloxone (Narcan) What are symptoms of opioid withdrawal? Anxiety Lacrimation Muscle ache abdominal cramps diarrhea seizures What is the treatment for opioid withdrawal? Buprenorphine/ Naloxone (Suboxone) Clonidine Bentyl Buprenorphine: When administered for detoxification and not maintenance, what is it more effective for? Suppressing and controlling symptoms of withdrawal as the taper nears completion when compared with methadone. What are the symptoms of cocaine intoxication? Auditory hallucinations Agitation Violent Behavior Hypertension Tachycardia Muscle Twitching What is the treatment for cocaine intoxication? Lorazepam How does antabuse work in cocaine use disorder? It increases the synaptic dopamine in the brain reward circuit and acts as an agonist treatment in the setting of cocaine use disorder. What medications are used for cocaine-induced chest pain and myocardial infarction? Nitrogylcerin Aspirin 3 multiple choice options What medications should not be used for cocaine-induced chest pain and myocardial infarction? Metroprolol 3 multiple choice options What are the contraindications of beta blockers? Patients with cocaine induced chest pain Why are betablockers contraindicated for cocaine induced chest pain? Further lowers coronary blood flow thereby worsening ischemia. Alcohol use disorder: Symptoms of Intoxication Impaired fine motor control Impaired judgement and coordination Ataxic gait and poor balance Lethargy Difficulty sitting upright Difficulty with memory Nausea/Vomitting Coma Respiratory Depression Death What level of alcohol induces coma? 300mg.dL and over What are the symptoms of mild alcohol withdrawal? Insomnia Irritability Hand tremor What are the symptoms of moderate alcohol withdrawal? Autonomic hyperactivity Fever What is autonomic hyperactivity? Diaphoresis Tachycardia HTN What are the symptoms of severe alcohol withdrawal? Seizures Hallucinations Delirium Tremens What are the symptoms of general (mild, moderate, and severe) alcohol withdrawal? Anxiety Anorexia Nausea/ Vomiting Psychomotor agitation What tool is used to monitor alcohol withdrawal? CIWA Clinical Institute Withdrawal Assessment What areas are assessed in CIWA protocol? Nausea/Vomiting Tremor Paroxysmal sweats Anxiety Agitation Tactile disturbances Auditory disturbances Visual disturbances Headaches Orientation CIWA Scoring: Mild 10 CIWA Scoring: Moderate 10-15 CIWA Scoring: Severe 15+ What are the first line treatments for ETOH? Naltrexone Acamprosate Naltrexone: How does is work in alcohol use disorder Reduces cravings/desire What forms are Naltrexone available for alcohol use disorder? PO Monthly injection (Vivitrol) Implant When will Naltrexone precipitate withdrawal in alcohol use disorder? In patients with physical opioid dependence. What is another name for Acamprosate? Campral How does Acamprosate work? Modulates glutamate transmission Decreases craving for Alcohol What does Acamprosate treat, in first-line use? Maintaining abstinence after detox. Can Acamprosate be used in pts with liver disease? Yes. It is not metabolized by the liver and not impacted by ETOH use. Acamprostate: Contraindications Severe renal disease What med is used 2nd line for alcohol use disorder? Disulfiram What is the other name for Disulfiram? Antabuse How does Disulfiram work? Blocks enzyme in the liver. Which enzyme in the liver does Disulfiram block? Aldehyde dehydrogenase What reaction is observed if a pt takes Disulfiram and drinks alcohol at the same time? Aversion Reaction What are the symptoms of the aversion reaction in patients that take Disulfiram and alcohol at the same time? Flushing Headaches N/V Palpitations SOB Vertigo Hypotension How long does the pt have to be alcohol free to administer antabuse? 12 hours Antabuse: Patient education: What does the pt using antabuse have to avoid and for how long after discontinuation? Anything that contains alcohol or 2 weeks What are some products that contain alcohol? Vinegar Aftershave Perfumes Mouthwash Cough medicine Antabuse/Disulfiram: Contraindications Severe cardiac disease Pregnancy Psychosis Bupropion/ Wellbutrin in ETOH: Precautions Increases risk of withdrawal seizures in ETOH patients What is the treatment for Alcohol use disorder? Benzos Thiamine, folic acid, MVT Fluid and electrolyte balance Alcohol Use Disorder: Why are benzos used? To keep pt calm and lightly sedated Alcohol Use Disorder: Benzos: MOA Enhance GABA effects on brain Alcohol Use Disorder: What meds are used in mild withdrawal? Tegretol Valproic acid Gabapentin Alcohol Use Disorder: Why use thiamine, folic acid, and MVT? For nutritional deficiencies Alcohol Use Disorder: What is Thiamine used for? To prevent or treat Wernicke's encephalopathy What causes Wernicke's encephalopathy? -thiamine [vitamin B1] deficiency Tobacco Use Disorder: Treatment Varenicline Bupropion Nicotine replacement therapy (NRT) What is the brand name for Varenicline? Chantix What is the brand name for Bupriopion? Zyban Which med is most appropriate for tobacco cessation? Varenicline Varenicline: How does it work? Mimics action on Nicotine Reduces rewarding aspects Prevents withdrawal symptoms Bupropion: How does it work? Inhibits reuptake of dopamine and norepinephrine Reduces cravings and withdrawal symptoms Nicotine Replacement Therapy: What forms is it available? Transdermal patch Gum Lozenge Nasal Spray Inhaler Nicotine patch: What do you need to watch for with use? Vivid dreams Sleep disruptions What are the leading causes of death in patients with serious mental illness? Heart Disease Cancer Cerebrovascular Disease Respiratory Disease What is the significance of the leading causes of death for patients with serious mental illness? Can all be linked to smoking What methods are used for smoking cessation advice? 5 A's ABC method / Ask and Act What are the 5A's? 1. Ask for smoking status 2. Advise to Quit 3. Assess motivation to quit 4. Assist by providing evidence-based treatment 5. Arrange Follow-up What is the ABC method for smoking cessation? Ask Brief advice Cessation support What should every smoker receive? An offer for treatment regardless of motivation to treat status What can all substance use disorders lead to? Sexual dysfunction For what is Gabapentin used for in people with substance use disorders? Treatment for insomnia What are the benefits of Gabapentin? Helps with anxiety No sedative effects No metabolized by liver Does not lower seizure threshold No blood monitoring Geriatric Psychopharmacology: What should you consider if a TCA is indicated? Nortriptyline Geriatric Psychopharmacology: Why should you consider Nortriptyline if a TCA is indicated? Fewer anticholinergic side effects Geriatric Psychopharmacology: What medication should you consider for patients with MDD and insomnia and decreased appetite. Remeron Geriatric Psychopharmacology: When should you consider Remeron? When MDD patient is geriatric and has symptoms of insomnia and decreased appetite. Geriatric Psychopharmacology: How is Methylphenidate used? In low doses to adjunct antidepressants for patients with severe depression or psychomotor retardation. Geriatric Psychopharmacology: What should always be a consideration for the geriatric population and medications/ treatments Polypharmacy Geriatric Psychopharmacology: What is delirium in the geriatric population? A reversible medical emergency Geriatric Psychopharmacology: What is the percentage of mortality? 40% 3 multiple choice options Geriatric Psychopharmacology: Where is delirium most common? In ICU and post-op Geriatric Psychopharmacology: How long does it take for delirium to develop? Hours to days. Geriatric Psychopharmacology: What stage is it considered when the delirium develops in hours to days? Acute What are the subtypes of delirium? Hyperactive, Hypoactive, Mixed What are the symptoms of Hyperactive delirium? Agitation Restlessness Hyperalertness What are the symptoms of Hypoactive delirium? Lethargic Slowed Apethetic What are the symptoms of mixed delirium? Cycles between hyperactive and hypoactive What are the causes of delirium? D = Drugs E = Electrolyte L = Low oxygen sat I = Infection R = Reduced sensory input I = Intracranial (Strokes) U = Urinary retention M = Myocardial What is the treatment for delirium? Symptom treatment 1:1 sitter What is the treatment for delirium induced agitation and psychotic symptoms? Haldol Atypical antipsychotics What is Dementia? Group of disorders characterized by gradual development of cognitive deficits Irreversible What is the difference between dementia and delirium? Dementia is irreversible while delirium is reversible 3 multiple choice options What are the types of dementia? Alzheimer's Disease (AD) Vascular Disease Lewy Body Disease (LBD) Frontotemporal degeneration (FTD) HIV infection Huntington's Disease (HD) What is the most common type of dementia? Alzheimer's disease (AD) What is the second most common type of dementia? Vascular disease Alzheimer's disease: What is Alzheimer's Disease? Most common form of dementia that has a gradual progressive decline Alzheimer's disease: What does it affect? Memory Learning Language Alzheimer's disease: What are the symptoms? Aphasia Apraxia Agnosia What is Aphasia? Difficulty with speech What is Apraxia? Inability to perform previously learned tasks What is Agnosia? Inability to recognize an object Alzheimer's disease: What is the etiology? Accumulation of beta-amyloid plaques and intraneuronal tau proteins tangles. Alzheimer's disease: What is the treatment? Cholinesterase inhibitors NMDA receptor antagonists What is Vascular Disease? Cognitive decline secondary to large vessel strokes Vascular Disease: Risk Factors HTN DM Smoking Obesity HLD A-fib Advanced Age Lewy Body Disease: What are the symptoms? Waxing and Waning Cognitive Decline Visual hallucinations of animals and small people Parkinsonism Lewy Body Disease: What does EPS start to develop? At least 1 year after cognitive decline Lewy Body Disease: What is the etiology? Lewy bodies and Lewy neurites in brain (primarily basal ganglia) Lewy Body Disease: Treatment Cholinesterase inhibitors Seroquel and Clozaril (low doses/ short term) Levodopa/ Carbidopa Melatonin and/or Clonazepam (REM sleep disorder) Lewy Body Disease: What is the precaution to treatment? High sensitivity to antipsychotics. Lewy Body Disease: How does high sensitivity to antipsychotics present? Exacerbation of parkinsonism Confusion Autonomic dysfunction Frontotemporal Degeneration: What is the cause of dementia with this condition? Atrophy of the frontal and temporal lobes Frontotemporal Degeneration: Is this condition genetic? 40% Frontotemporal Degeneration: What are the symptoms of this condition? Disinhibition (verbal, physical, sexual) Difficulty with speech and comprehension Frontotemporal Degeneration: What is Kluver-Bucy Syndrome? Hypersexual Hyperorality Frontotemporal Degeneration: What is the treatment for this condition? Symptom focused SSRI to help with disinhibition Frontotemporal Degeneration: What helps with disinhibition? SSRI What are the cholinesterase inhibitors that are used to treat dementia? Donepezil (Aricept) Galantimine (Razadyne) Rivastigmine (Exelon) What is the other name for Donepezil? Aricept What is the other name for Galantimine? Razadyne What is the other name for Rivastigmine? Exelon Donepezil: By how much does it slow clinical deterioration? 6-12 months Donepezil: What is it used for? Mild-to-moderate NCD Donepezil: How many times a day is it dosed? Once daily Donepezil: When is it not effective? In severe, end-stage disease Donepezil: After what symptom should meds be stopped? Nausea/ Vomiting. Donepezil: What are the side effects? Diarrhea Weight loss Abnormal dreams Insomnia Dizziness Galantimine: How many times a day is this dosed? Twice daily Galantimine: What are the side effects? GI side effects Galantimine: What is this med used for? Mild to moderate NCD Rivastigmine: How many times a day is this med dosed? Twice daily Rivastigmine: What is this med used for? Mild-to-moderate AD & Parkinson's Disease Dementia Rivastigmine: What form of this med is best? Transdermal patch Rivastigmine: Why is the transdermal patch the best form? Used daily with fewer side effects Rivastigmine: What is the disadvantage of this medication? High GI side effects. Which medication for dementia has the highest risk for GI side effects? Rivastigmine What medications are used for mood symptoms with dementia? SSRIs What can be done for aggression, agitation, and psychosis? Atypical antipsychotics What are examples of atypical antipsychotics used for agitation, aggression, and psychosis? Zyprexa Seroquel Risperdal Haldol Other can atypical antipsychotics, what meds can be used for mood symptoms? Benzos, but for a short time. Memantine: Drug class MNDA receptor antagonist What is the other name of Memantine? Namenda Memantine: What is the med used for? Moderate to severe dementia Memantine: What are the benefits if choosing this med? Fewer side effects than Cholinesterase inhibitors Memantine: How does this med work? Promotes synaptic plasticity Can NDMAs and Cholinesterase inhibitors be used together? Yes. What meds is Namzric a combo of? Mamantine and Donepezil What is serious side effect of Namzric? Hallucinations Geriatrics: How to anticholinergic side effects effect the brain? Drowsiness Dizziness Confusion Hallucinations Geriatrics: How to anticholinergic side effects effect the eyes? Blurred vision Dry eyes Geriatrics: How to anticholinergic side effects effect the mouth? Dry eyes Geriatrics: How to anticholinergic side effects effect the heart? Tachycardia Geriatrics: How to anticholinergic side effects effect the bowel? Constipation Geriatrics: How to anticholinergic side effects effect the bladder? Urine retention Geriatrics: How to anticholinergic side effects effect the skin? Skin flushing Unable to sweat Overheating Pediatrics: Intellectual Disability Disorder Impaired cognitive and adaptive/social functioning Pediatrics: Intellectual Disability Disorder: Symptoms Deficits of intellectual and adaptive functioning Pediatrics: Intellectual Disability Disorder: What are examples of deficits in intellectual functioning? Reasoning, problem solving, planning, abstract thinking, judgement, and learning. Pediatrics: Intellectual Disability Disorder: What are examples of deficits in adaptive functioning? Communication Social Participation Independent living Pediatrics: Intellectual Disability Disorder: What types of severity are there? Mild Moderate Severe Profound Pediatrics: Intellectual Disability Disorder: Causes Genetic Prenatal Perinatal Postnatal Pediatrics: Intellectual Disability Disorder: What are the genetic causes? Down Syndrome Pediatrics: Intellectual Disability Disorder: What are the prenatal causes? Rubella Herpes Simplex Pediatrics: Intellectual Disability Disorder: What are the perinatal causes? Anoxia Prematurity Birth Trauma Pediatrics: Intellectual Disability Disorder: What are the postnatal causes? Malnutrition Toxin exposure Trauma Pediatrics: Intellectual Disability Disorder: Treatment Behavioral Therapy Pediatrics: Intellectual Disability Disorder: What are the precautions? Pts may not be able to self-report drug-related problems. Pediatrics: ADHD: First line pharmacological treatment? Stimulants Pediatrics: ADHD: How do stimulants help? Increase DA in PFC Increase DA in the nucleus accumbens and reward circuitry. Pediatrics: ADHD: What is the treatment for ADHD? Medications and educational and behavioral interventions Pediatrics: ADHD: Which stimulants are used for first line pharmacological treatment? Methylphenidate Compounds Dextroamphetamine Mixed amphetamine salts Ritalin Concerta Adderall Pediatrics: ADHD: Which stimulants are schedule II? Ritalin Concerta Adderall Pediatrics: ADHD: What is the 2nd line treatment? Alpha-2 agonists Pediatrics: ADHD: What medications are alpha 2-agnonits? Clonidine Guanfacine Pediatrics: ADHD: What do you need to monitor when giving stimulants? Height Weight BP CBC w/ Diff Pediatrics: ADHD: How often do we need to monitor height, weight, bp, and cbc w/ diff for patients using stimulants? Quarterly Pediatrics: ADHD: Why do we need to monitor height and weight quarterly? Risk of growth restriction Is it necessary to obtain EKG prior to initiating a stimulant? Not for a healthy individual Pediatrics: ADHD: Should stimulants be in the prescription monitoring program? Yes. Pediatrics: ADHD: What is the relationship between growth and stimulants? Evidence of growth suppression in not clear. Resolves in mid-adolescence. Pediatrics: ADHD: What should you do about a twice administered stimulant that parents request to soley administer? Consider the extended release version. Pediatrics: ADHD: What medications are used for ADHD that are not stimulants? Atomoxetine (Strattera) Bupropion (Wellbutrin) Alpha 2 adrenergic agonist (Clonidine, Guanfacine) Pediatrics: ADHD: When should you consider a non-stimulant for ADHD? When stimulants aren't working well to control sx. When stimulants are causing alot of side effects Substance abuse hx A contraindicated comorbidity As an adjunct to stimulants in therapy. Pediatrics: Autism: What is Autism? Characterized by impairments in social communication/ interaction and restrictive, repetitive behaviors/interests. Pediatrics: Autism: What is the ratio of autism between male and female? 4:1 Pediatrics: Autism: What age is autism diagnosed/recognize? 12-24 months Pediatrics: Autism: Treatment Approach Early intervention, behavioral therapy, psychoeducation, meds. Pediatrics: Autism: What meds are used for disruptive behaviors, aggression, and irritability. Alpha-2 agonists Low dose atypical antipsychotics Pediatrics: Autism: Which alpha-2 agonists are used for disruptive behaviors, aggression, and irritability. Clonidine Guanfacine Pediatrics: Autism: Which atypical antipsychotics are used for disruptive behaviors, aggression, and irritability. Risperidone Abilify Pediatrics: Autism: Which meds are used for sleep? Melatonin Pediatrics: Autism: Which meds are used for sleep and anxiety? Remeron Pediatrics: Autism: Risperidone and Abilify: Indications Autism associated irritability, aggression, temper tantrums, self-injurious behaviors, and mood lability. Pediatrics: Autism: Risperidone: Age Range 5+ to 18 (weight based) Pediatrics: Autism: Aripiprazole: Age Range 6-17 years Most antidepressants cause sexual problems, except...... Bupropion (Wellbutrin) Mirtazapine (Remeron) SSRI: Sexual side effects Desire/ Libido Frequency of sex Arousal (Lubrication) Orgasm (Difficulty orgasming) SSRI: Sexual Side Effects: Management Watchful waiting, if persistent Decrease the dose of SSRI, but within therapeutic range If an SSRI will cause sexual side effects, which meds should it be switched to? Bupropion Phosphodiesterase-5 inhibitor If a woman with a distressing sexual problem wants a medication to help, and she tried all nonpharmacologic treatments, what med is first choice? Bupropion What is premature ejaculation? Recurrent pattern of ejaculation during sex within 1 minute and before individual wishes it. What is the treatment of premature ejaculation? Prolong time from SSRI and TCAs stimulation to orgasm. Fluoxetine, Paroxetine What pharmacological regimen can be an effective and safe treatment? Taking Clomipramine 15mg - 30mg about 2 hours before intercourse. What medication is used to treat premature ejaculation? Phosphodieterase-5 inhibitor What Phosphodieterase-5 inhibitors are used for premature ejaculation? Sildenafil (Viagra) Tadalafil (Cialis) How should you take Sildenafil for premature ejaculation? Take 30 minutes to 4 hours before sexual activity How should you take Tadalafil for premature ejaculation? Take 30-60 minutes before sexual activity What should be avoided with the use of Phosphodieterase-5 inhibitor? Concomitant use with nitrates. Why should nitrates be avoided with Viagra? It can cause an unsafe drop in blood pressure. What are examples of nitrates that should be avoided with Cialis? Nitroglycerine Isosorbide Dinitrate Amyl nitrate "poppers" What patients should be handled with caution while using Phosphodieterase-5 inhibitors. Patients taking alpha-adrenergic blockers Erectile dysfunction risk factors Hypogonadism Diabetes Hypertension Dyslipidemia Tobacco Vasoconstriction Atherosclerosis Thrombosis Increased Autonomic Activity What are the 3 groups of personality disorders? Cluster A Cluster B Cluster C Personality Disorders: What familial association is Cluster A? Psychotic Disorders Personality Disorders: What familial association is Cluster B? Mood Disorders Personality Disorders: What familial association is Cluster C? Anxiety Disorders Personality Disorders: What is the appearance of Cluster A personalities? Eccentric, peculiar, withdrawn Personality Disorders: What is the appearance of Cluster B personalities? Emotional, dramatic, inconsistent Personality Disorders: What is the appearance of Cluster C personalities? Anxious or Fearful Types of personalities in Cluster A? Schizoid Schizotypal Paranoid Types of personalities in Cluster B? Antisocial Borderline Histrionic Narcissistic Types of personalities in Cluster C? Avoidant Dependent Obsessive-compulsive Personality Disorders: Characteristic Very difficult to treat Patients don't acknowledge help Chronic and life long Meds have limited usefulness except for comorbidities. Personality Disorders: Borderline: Overview Fear of abandonment Aggression Impulsive Repeated SI attempts/gestures/self-mutilation Splitting Personality Disorders: Borderline: Treatments Gold Standard = DBT Pharmacotherapy as adjunct to psychotherapy Personality Disorders: Borderline: What meds can be used? Mood stabilizers Low dose antipsychotic meds Personality Disorders: Borderline: Why are meds used? For mood swings Lability Personality Disorders: Borderline: Which meds should be avoided? Benzodiazepines Personality Disorders: Antisocial: Characteristics Failure to conform to social norms Deceitful, manipulative for personal gain Reckless, irritable Lack remorse Personality Disorders: Antisocial: Where does this begin? Begins as conduct disorder in childhood Personality Disorders: Antisocial: Treatment Treat symptoms Psychotherapy is ineffective Personality Disorders: Antisocial: What symptoms can you treat? Anxiety Depression Aggression Personality Disorders: Antisocial: What caution do you need to take when treating symptoms? Caution d/t high comorbidity with substance use disorders. What is first-line treatment for personality disorders? Psychotherapy What can be used to adjunct psychotherapy in personality disorders? Medication for symptoms What meds should you avoid prescribing to patients with personality disorders? Meds that can be fatal in overdose Meds that can induce physiological dependence and tolerance. Which meds can be fatal in overdose? TCAs Which meds can induce tolerance and dependence? Benzos Personality Disorders: Should meds be changed each time there is a crisis or change in mood symptoms? No. Changes can happen suddenly and remit just as quickly. Personality Disorders: Targeted Symptom Domains? Cognitive and perceptual disturbances Impulsivity or behavioral dyscontrol Affective dysregulation Personality Disorders: How are antidepressants and mood stabilizers dosed? The same as for MDD and BPD Personality Disorders: How are antipsychotics dosed? At a lower dosing range compared to dosing for schizophrenia. Personality Disorders: Antipsychotics examples? Abilify, Risperdal, Seroquel Personality Disorders: Antidepressants and mood stabilizers examples? Lithium Lamictal 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.