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Block 3: Neuro > Clin Lab: Neuro Diagnostics > Flashcards

Clin Lab: Neuro Diagnostics Flashcards

1
Q

CT head Indications

A
  • AMS
  • Stroke-like symptoms
  • Trauma to brain/spine
  • Suspected subarachnoid hemorrhage (SAH)
  • Recurrent headache/migraine
  • Seizures
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2
Q

When to do a non-contrast CT head?

A
  • Initial scan for stroke
  • Suspected bleed
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3
Q

When to do a CT head w/ IV contrast?

A
  • Suspected abscess or tumor
  • Suspected MS
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4
Q

How will a normal brain look on CT head - non-contrast?
Bone
Pineal gland/choroid plexi
CSF
Air
Gray matter
White matte

A
  • Bone = bright white
  • Pineal gland & choroid plexi – bright white
  • CSF – dark
  • Air – dark
  • Gray matter – lighter gray
  • White matter – darker gray
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5
Q

What color is bone on MRI?

A

darker (not bright white)

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6
Q

Abnormal findings on non-contrast CT head

A
  • Midline shift
  • Blood
  • Mass
  • Edema
  • Atrophy
  • Lesions
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7
Q

Fresh blood on CT is…

A

bright

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8
Q

Clotted (chronic) blood on CT is…

A

dark

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9
Q

CTA of head/neck Indications

A

Evaluate vasculature of the head/neck
- Embolus/thrombosis
- Dissection
- Malformation (AVMs)
- Stenosis

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10
Q

CTA head/neck procedure

A
  • Similar to CT head w/ IV contrast
  • Timing b/t contrast injection & taking the images is different
  • Enhances vessels
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11
Q

What is the imaging modality of choice for the brain in many circumstances except the ER?

A

MRI

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12
Q

Indications for an MRI brain

A
  • Suspected infx
  • Suspected mass/lesion
  • Neurologic deficits
  • Seizures
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13
Q

Normal MRI brain T1:
Gray matter
White matter
CSF = dark
Timing

A
  • Gray matter = gray
  • White matter = lighter gray
  • CSF = dark
  • Short time
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14
Q

Normal MRI brain T2:
Gray matter
White matter
CSF
Timing

A

Gray matter = light gray
White matter = darker gray
CSF = bright
Long time

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15
Q

Describe a flair MRI brain

A
  • T2 weighted
  • Decreases signal of CSF
  • Sensitive for Edema
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16
Q

Describe a diffusion weighted MRI brain

A
  • Rate of water diffusion
  • Increased in areas of pathology (bright)
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17
Q

Indications for CT spine

A
  • Acute trauma of spine
  • Evaluation when MRI contraindicated
  • Chronic back pain
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18
Q

Indications of CT spine non-contrast

A

Evaluate for fracture

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19
Q

Indications of CT spine w/ IV contrast (into vasculature)

A
  • Suspected abscess or tumor
  • Suspected MS
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20
Q

Indications for CT myelogram (into CSF)

A
  • back pain or localized neurologic signs suggesting spinal canal narrowing (spinal stenosis)
  • suspected tumors (cord, meningeal, etc), encroaching on the canal
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21
Q

Indications of MRI spine

A
  • Back pain
  • Bilateral neurologic deficits
  • Incontinence
  • Suspected infx
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22
Q

Indications for a Octreotide Scan

A
  • ID & localize neuroendocrine primary & metastatic tumors
  • Indicated in pts w/ known neuroendocrine tumors
  • Used preop to direct the surgeon to primary & metastatic tumors (especially in the abdo)
  • Used to monitor therapy
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68
Q

Contraindications of electronystagmography (ENG)

A

Pacemaker

69
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74
Q

Risk Factors

A

homocysteine
- elevated levels assoc w/ incr risk of AD

75
Q

Supportive tests for neurodegenerative dz/Alz

A
  • MRI
  • PET scan w/ amyloid imaging
76
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79
Q

Stroke symptoms can be caused by

A
  • ischemia (blocked flow of blood)
    OR
  • bleeding (intracranial hemorrhage)
80
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81
Q

What other imaging should for ischemic stroke / TIA?

A
  • CTA head & neck
  • MRI brain
  • MRA head/neck
82
Q

Why do a CTA head & neck for ischemic stroke/TIA?

A
  • Allows possible visualization of clot
  • Possible tx options depending on location
83
Q

Why do a MRA brain for ischemic stroke/TIA?

A
  • More sensitive for edema assoc. w/ stroke than CT
  • If unable to do MRI, repeat CT head in 48 hrs to visualize area of stroke
84
Q

Why do a MRA head/neck for ischemic stroke/TIA?

A

if CTA head/neck not done already

85
Q

What other imaging should be done to work up the possible causes of the stroke?

A

Echo
- Afib, plaques, clots

86
Q

Dx tests/labs for AMS - confusion/coma

A
  • ABG / EKG / CXR / ua / CBC / CMP / lactic acid / glucose
  • Blood alcohol level
  • Toxicology screen
  • Serum osmolality and osmol gap
  • Ketones
  • Salicylate level
87
Q

Blood Alcohol Concentration level
> 50mg/dL (0.5%) effects

A

impairment begins

88
Q

Blood Alcohol Concentration level > 80mg/dL (0.08%) effects

A
  • flushing
  • slower reflexes
  • impaired visual acuity
89
Q

Blood Alcohol Concentration >100mg/dL (0.1%)

A
  • CNS depression
  • hypotension (rare, but important in trauma)
90
Q

Drugs screened on a tox screen?

A
  • opioids
  • benzo
  • methamphetamine
  • marijuana
91
Q

Toxicology screen Interpretation:

A
  • (-) test doesn’t rule out some drugs (ie fentanyl)
  • (+) test
    Some tests may be (+) for days after use
    (+) test doesn’t necessarily indicate that is the cause of AMS
92
Q

Free water in the blood is ___ related to its osmolality.

A

inversely

93
Q

What is a normal osmolality?

A

285 - 295

94
Q

What the 3 most important solutes in the blood that predict calculated osmolality?

A
  • Na+, glucose, BUN
95
Q

Calculated Osmolality equation

A

(2 X Na) + Glu/18 + BUN/2.8

96
Q

What is a normal calculated osmolality?

A

10 mOsm/L

97
Q

What things can cause a high osmol gap (>10 mOsm)?

A
  • Ethylene glycol
  • Toluene
  • Methanol, Isopropanol, Ethanol
98
Q

What crystals are seen in ethylene glycol?

A

Ca++ oxalate crystals

99
Q

What acid/base disorder occurs w/ methanol, Isopropanol, or Ethanol?

A

metabolic acidosis w/ HAGMA w/ high osmol gap

100
Q

Immediate S/S of Salicylate OD

A
  • Tinnitus
  • lethargy
  • confusion
  • restlessness
  • fever in moderate overdoses
101
Q

Eventual S/S of Salicylate OD

A
  • hyperreflexia
  • seizures
  • hallucinations
  • stupor
  • coma in severe overdoses
102
Q

What should be done if you suspect a salicylate level?

A
  • Tests should be performed immediately & at about 4 hrs after suspected ingestion
  • Call Poison control
103
Q

What are ketones assoc. with?

A

DKA or starvation ketoacidosis
–> HAGMA

104
Q

What yields ketoacids?

A

fatty acid catabolism

105
Q

Testing for ketones?

A

beta-hydroxybutyrate

106
Q

CNS tumors imaging

A
  • MRI w/ contrast
  • CT w/ contrast
  • PET scan
  • CT myelogram
  • CT chest/abd/pelvis w/ contrast
107
Q

What will CSF analysis show in CNS tumors?

A
  • incr PRO
  • normal cells
108
Q

Describe PNS tumors

A

Sympathetic nervous system ganglion tumors

109
Q

Types of PNS tumors

A
  • Paragangliomas
  • Pheochromocytomas
  • Neuroblastomas
110
Q

What is released in from PNS - sympathetic nervous system ganglion tumors?

A

catecholamines
- will be elevated

111
Q

Catecholamine testing

A

24 hr urine collection

112
Q

What is measured in catecholamine testing?

A
  • dopamine
  • epi/norepi
  • homovanillic acid (HMA)
  • metanephrine
  • normetaphrine
  • vanillylmandelic acid (VMA)

Block 3: Neuro (10 decks)

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