[chapter 1] diagnostic tests

Diagnostic tests for various autoimmune conditions

• Increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

• Positive Rheumatoid factor (RF) antibodies

• Positive anti-nuclear antibody (ANA)

Diagnostic tests for rheumatoid arthritis (RA)

• Tests used for various autoimmune conditions plus

• A positive anti-citrullinated peptide antibody (ACPA)

Diagnostic tests for Systemic Lupus Erythematosus (SLE)

• Tests used for various autoimmune conditions plus

• A positive anti-dsDNA antibodies

Diagnostic tests for multiple sclerosis (MS)

Magnetic resonance imaging (MRI)

Diagnostic tests for anemia

Decreased Hgb/Hct/RBCs

Diagnostic tests for microcytic anemia or iron deficiency

decreased MCV

Diagnostic tests for macrocytic anemia, B12 or folate deficiency

increased MCV (>100 FL), Schilling test

Diagnostic tests for venous thromboembolism

D-dimer test (marker for fibrinolysis)

Diagnostic tests for DVT (deep vein thrombosis)

• Ultrasound (US)

• Venography

• MRI

Diagnostic tests for pulmonary embolism (PE)

Pulmonary Computed Tomographic Angiography (CTA)

Diagnostic tests for stroke prevention

CHA₂DS₂-VAS

CHA2DS2-VAS

• Congestive heart failure

• Hypertension

• Age > 75

• Diabetes

• Stroke

• Vascular disease

• Age (65-74)

• Sex

Diagnostic tests for Heparin-induced thrombocytopenia (HIT)

• An unexplained decrease in platelets (> 50% drop from baseline) 5-14 days after starting heparin

• Positive antibodies based on a heparin-PF4 enzyme-linked immunosorbent assay (ELISA) test and/or

• Serotonin release assay (SRA)

Diagnostic tests for acute coronary syndrome (ACS)

• Electrocardiogram (ECG or EKG)

• Cardiac enzymes

  • Creatine kinase muscle/brain (CK-MB)

  • Troponin I and T

Diagnostic tests for arrhythmias

• ECG (or EKG)

• Holter monitor (a portable ECG device)

• Heart rate (HR)

Diagnostic tests for a cerebrovascular accident such as CVA or a stroke

• Computed tomography (CT)

• MRI

Diagnostic tests for chronic heart failure

• Echocardiogram (Echo)

• Increased B-type natriuretic peptide (BNP)

• Increase N-terminal proBNP (NT-proBNP)

Diagnostic tests for stable angina

• Cardiac stress test

• Angiography

Diagnostic tests for dyslipidemia

• Increased TC, Non-HDL, LDL, TGs

• Coronary artery calcium (CAC)

  • A non-invasive CT scan of the heart that measures calcium-containing plaque

Diagnostic tests for hypertension

• Increased systolic/diastolic blood pressure

Diagnostic tests for Hypertensive Emergencies

• BP > 180/120 mmHg with acute target organ damage

Diagnostic tests for Hypertensive Urgencies

• BP > 180/120 mmHg without acute target organ damage

When to use the 10-year ASCVD risk tool

• No past history of ACS/IHD, Stroke or PAD

Diagnostic tests for diabetes and prediabetes

• Fasting plasma glucose (FPG)

• Oral glucose tolerance test (OGTT)

• Hemoglobin A1C (A1C)

Diagnostic tests for hyperthyroidism

• ↓ TSH, ↑ FT4

Diagnostic tests for hypothyroidism

• ↑ TSH, ↓ FT4

Diagnostic tests for ovulation

• Luteinizing hormone (LH)

• Peak value provides optimal timing for intercourse to become pregnant

Diagnostic tests for pregnancy

• Positive human chorionic gonadotropin (hCG)

  • Urine sample (outpatient test kit)

  • Blood

Diagnostic tests for Bacterial Vaginitis

• Clear, white or gray vaginal discharge

• Fishy odor

• pH > 4.5

• Little or no pain

Diagnostic tests for

• White, thicker vaginal discharge, pruritus

Diagnostic tests for Trichomoniasis

• Yellow, green frothy, foul-smelling vaginal discharge

• pH > 4.5

• Soreness and pain with intercourse

Diagnostic tests for Peptic Ulcer Disease (PUD)

• Upper gastrointestinal endoscopy (mouth to small intestine)

Difference between Duodenal Ulcers and Gastric Ulcers (PUDs)

• Duodenal Ulcers

  • Pain 2-3 hours after eating (without food in stomach)

  • Pain relief with food/antacids

• Gastric Ulcers:

  • Pain right after eating (with food in stomach)

  • Little/no pain relief with food/antacids

Diagnostic tests for GERD

• Esophageal pH monitoring

• Endoscopy

Diagnostic tests for H. pylori

• Urea breath test (UBT)

• Fecal antigen test

Diagnostic tests for Inflammatory Dowel Diseases: Ulcerative Colitis, Crohn’s Disease, and both.

• Ulcerative Colitis

  • Affects the colon and rectum

  • Sigmoidoscopy

• Crohn’s Disease:

  • Affects more of the GI tract

  • Endoscopy

• For both:

  • Colonoscopy

  • Biopsy

  • CT

  • MRI

Diagnostic tests for Bronchospastic Disease

• Spirometry

What are the three main variables used for bronchospastic disase analyses

• FEV1: how much air can be forcefully exhaled in one second

• FVC: the maximum amount of air that can be forcefully exhaled

• FEV1/FVC: the percentage of total air capacity (“vital capacity”) that can be forcefully exhaled in one second

Diagnostic tests for asthma

• FVC, FEV1 and peak expiratory flow rate (PEFR)

• Allergic asthma: skin test (to detect an allergen)

Diagnostic tests for COPD

• Post-Bronchodilator FEV1/FVC < 0.

• Eosinophils > 300 cells/uL indicate inflammation and better response to inhaled corticosteroids

Diagnostic tests for metabolic acidosis

• Arterial blood gas, measures pH, pCO2, HCO3

• ↓ pH, ↓ HCO3; compensation: respiratory alkalosis

Diagnostic tests for respiratory acidosis

• ↓ pH, ↑ pCO2; compensation: metabolic alkalosis

Diagnostic tests for metabolic alkalosis

• ↑ pH, ↑ HCO3; compensation respiratory acidosis

Diagnostic tests for respiratory alkalosis

• ↑ pH, ↓ pCO2; compensation metabolic acidosis

Diagnostic tests for anion gap metabolic acidosis

• Anion gap > 12 mEq/L

Diagnostic tests for general infections

• Fever (temperature > 100.4 F or 38 C)

• ↑ WBC count

• Left shift (↑ bands or immature neutrophils)

Diagnostic tests for C. difficile

• Positive C. difficile stool toxin

  • Enzyme immunoassay plus glutamate dehydrogenase (GDH) test

  • PCR

Diagnostic tests for HIV

• HIV antigen/antibody Immunoassay

• HIV-1/HIV-2 antibody differentiation immunoassay

• HIV RNA viral load

• Nucleic acid tesT

Diagnostic tests for Infectice Endocarditis

• Echo (to check for vegetation)

• Blood culture (to identify causative organism)

Diagnostic tests for Lyme Disease

• Round, red bullseye rash

• ELISA test

Diagnostic tests for Meningitis

• Lumbar puncture (LP), plus symptoms of severe headache

• Stiff neck

• Altered mental status

Diagnostic tests for Onychomycosis (Fungal Infection of Toenail or Fingernail)

• 20% KOH (potassium hydroxide) smear

Diagnostic tests for Lice (Pediculosis)

• Pruritus

• Visible lice on the scalp

• Nits (eggs) on hair shafts

Diagnostic tests for Pinworm (Vermicularis)

• Tape test (on skin adjacent to anus to check presence of eggs)

• Helminths (worms) in blood, feces or urine

Diagnostic tests for Pneumonia

• Chest X-ray showing infiltrates

• Consolidations or opacities

Diagnostic tests for Syphilis

• Positive nontreponemal assay [rapid plasma reagin (RPR)

• Venereal Diseases Research Laboratory (VDRL) blood test]

• Treponemal assay

Diagnostic tests for Toxoplasma gondii Encephalitis

• Toxoplasma IgM and IgG test

Diagnostic tests for Latent Tuberculosis (TB)

• Positive tuberculin skin test (TST)

  • AKA a purified protein derivative (PPD)

• Interferon-gamma release assay (IGRA) blood test

Diagnostic tests for Active Tuberculosis (TB)

• Positive sputum acid-fast bacilli (AFB) stain and culture

• Chest X-ray with cavitation

Diagnostic tests for Urinary Tract Infection (UTI)

• Urinalysis

  • Positive leukocyte esterase or WBC > 10 cells/mm3

  • Nitrities

  • Bacteria

• Urine culture

Diagnostic tests for breast cancer

• Mammogram

• Utrasound

• MRI

Diagnostic tests for cervical cancer

• Pap smear

• HPV test

Diagnostic tests for colon cancer

• Colonoscopy

• Sigmoidoscopy

• Double-contrast barium enema,

• CT colonography

• Stool DNA

• Fecal occult blood test (FOBT)

• Fecal immunochemical test

Diagnostic tests for lung cancer

• Chest CT

Diagnostic tests for skin cancer

• Skin biopsy

Diagnostic tests for prostate cancer

• Digital rectal exam (DRE)

• Prostate-specific antigen (PSA)

Diagnostic tests for general cancer

• Carcinoembryonic antigen (CEA)

  • Test marker in to identify cancer

• Positron emission tomo

Diagnostic tests for allergic reactions

• Skin prick (scratch) test (immediate)

• Immunoglobulin E (IgE) antibodies blood

Diagnostic tests for bleeding

• ↓ Hgb/Hct

• Visible blood or bruising

• Coffee ground emesis or dark/tarry stools (upper GI bleeding)

• Red blood in stool (lower GI bleeding or hemorrhoid)

Diagnostic tests for Cholestasis (Bile Duct Blockage)

• ↑ alkaline phosphatase (Alk Phos)

• ↑ total bilirubin (Tbili)

• ↑ gamma-glutamyltransferase (GGT)

Diagnostic tests for Cognitive Impairment (ex: Alzheimer’s)

• Mini-mental state exam (MMSE)

• Score < 24 indicates impairment

Diagnostic tests for Cystic Fibrosis

• Sweat tests

Diagnostic tests for glaucoma

• ↑ intraocular pressure (IOP)

• Visual field test (to identify optic nerve damage)

Diagnostic tests for gout

• ↑ uric acid (UA) level

Diagnostic tests for liver diseases

• Liver function tests (LFTs):

  • ↑ AST/ALT

  • ↑ Alk Phos

  • ↑ Tbill

  • ↑ lactate dehydrogenase (LDH)

Diagnostic tests for cirrhosis (chronic liver disease)

• ↑ PT/INR

• ↓ Albumin

Diagnostic tests for hepatic encephalopathy

• ↑ ammonia level (blood)

Diagnostic tests for movement disorders such as Parkinson’s

• Abnormal involuntary movement scale (AIMS)

• Rating scale used to measure involuntary movements or tardive dyskinesia

• As monitoring for patient’s improvement

Diagnostic tests for myopathy

• ↑ creatine kinase or creatine phosphokinase (CPK)

Diagnostic tests for Neuropathy, Peripheral

• Assess sensation with 10-g monofilament

• Pinprick

• Temperature and/or

• Vibration tests

Diagnostic tests for Osteoarthritis

• X-ray

• MRI

Diagnostic tests for osteoporosis

• Bone mineral density (BMD) using dual-energy X-ray absorptiometry

Diagnostic tests for Pancreatitis

• ↑ amylase/lipase

Diagnostic tests for Psychiatric Disease such as depression or schizophrenia

• DSM-5 diagnostic criteri

• Depression-specific: Ham-D or HDRS assessment scale

Diagnostic tests for renal diseases

• ↑ BUN/SCr

• Creatinine clearance (CrCl)

• Glomerular filtration rate (eGFR)

• Urine albumin

Diagnostic tests for dehydration seen in renal diseases

• BUN/SCr ratio > 20:1

• plus symptoms such as:

  • ↓ urine output

  • Dry mucus membranes

  • Tachycardia

Diagnostic tests for Seizures/Epilepsy

• Electroencephalogram (EEG)

Diagnostic tests for Weight (underweight, normal, overweight, obesity)

• BMI (plus waist circumference for risks associated with overweight/obesity)

• Ideal body weight (IBW)

• Total body weight (TBW)