Tests and Diagnostics

Question 1

Glasgow Coma Scale

Answer 1

• Scale - 3-15
• 8 or less - coma
• Eye - 1 to 4
• Verbal - 1 to 5
• Motor - 1 to 6

Question 2

Hearing Tests

Answer 2

• Normal 0-15 db
• Rinne’s Test
• Weber’s Test

Question 3

Vision Tests

Answer 3

• Snellen Chart

Question 4

Tuberculosis Mantoux Test (PPD)

Answer 4

• Intradermal injection
• Read in 48-72 hours
• Positive results
  
  • >5 mm induration in immunosuppressed
  • >10 mm induration in high-risk patients
  • >15 mm induration in normal populations
• Confirmed w/ CXR

Question 5

Pyelogram

Answer 5

• Visualizes urinary tract
• Used to diagnose urinary disorders
• Prior to procedure
  
  • Bowel enema
• IV contrast given
  
  • pts screened for iodine allergy
• X-ray
• Increase fluid after procedure
• Contraindicated w/ patients with decreased renal function
  
  • → contrast media toxic

Question 6

MRI

Answer 6

• Detects variations of soft tissues
• No metal objects
• No pacemakers
• Contrast is non-iodine
• Safe during pregnancy
• Long procedure
  
  • → Antianxiety medications

Question 7

Oral Glucose Challenge Test

Answer 7

• Fasting state 8-12 hours prior
• 3 days prior of carbs and 1500 calories/day
• 75 g of glucose consumed
  
  • Baseline
    
    • Normal <100
  • 30 and 60 minutes
    
    • Normal <200
  • 120 minutes
    
    • Normal <140

Question 8

Lumbar Puncture

Answer 8

• Empty bladder before the procedure
• Patient in side-lying position
  
  • Prone position acceptable if side-lying position impossible
• Needle inserted between 3rd and 4th lumbar vertebrae
• After procedure
  
  • Supine position
  • Spinal headache
  • Encourage patient to drink plenty of fluids
• Contraindicated
  
  • Increased ICP
  • Infection at puncture site

Question 9

Total Knee Replacement

Answer 9

• Indications
  
  • Joint pain
  • Impaired mobility
• After surgery
  
  • Compression dressing to immobilize knee
  • Frequent neurovascular assessment
    
    • Q2-4 hours
  • Avoid squatting, kneeling, twisting for at least 6 weeks
  • Early ambulation
  • VTE prophylaxis
  • Limit flexion positions for 2 weeks

Question 10

Liver Biopsy

Answer 10

• Diagnosis of liver disease
• Types
  
  • Incisional (open)
    
    • OR w/general anesthetics
  • Needle biopsy (closed)
    
    • Local anesthetics
    • Supine position w right arm over their head
    • Exhale fully and not breathe during insertion of the needle
• Considerations
  
  • coagulation status
  • Blood type in case of hemorrhaging
  • Pt remains in a right-side lying position for 2 hours after the procedure
  • Flat position for 12-14 hours after to prevent bleeding
  • Post-biopsy monitoring
    
    • pneumothorax
    • bile peritonitis
    • shock due to hemorrhage