B LAN GE Abbreviations and Acronyms Ab Abn AFB Ag AIDS ALT ANA AST CBC CF CHF CIE CK CNS CSF CXR CYP Diff EDTA ELISA GI GNR GNCB GPC GVCB HLA Ig IM INR IV Antibody Abnormal Acid-fast bacillus Antigen Acquired immunodeficiency syndrome Alanine aminotransferase Antinuclear antibody Aspartate aminotransferase Complete blood cell count Complement fixation Congestive heart failure Counterimmunoelectrophoresis Creatine kinase Central nervous system Cerebrospinal fluid Chest x-ray Cytochrome P450 Differential cell count Ethylenediaminetetraacetic acid (edetate) Enzyme-linked immunosorbent assay Gastrointestinal Gram-negative rod Gram-negative coccobacillus Gram-positive coccus Gram-variable coccobacillus Human leukocyte antigen Immunoglobulin Intramuscular(ly) International Normalized Ratio Intravenous(ly) MN MRI Minute Mononuclear cell Magnetic resonance imaging N Normal Neg Negative NPO Nothing by mouth (nil per os) PCR Polymerase chain reaction PMN Polymorphonuclear neutrophil (leukocyte) PO Orally (per os) Pos Positive PTH Parathyroid hormone RBC Red blood cell RPR Rapid plasma reagin (syphilis test) SIADH Syndrome of inappropriate antidiuretic hormone (secretion) SLE Systemic lupus erythematosus T3 Triiodothyronine T4 Tetraiodothyronine (thyroxine) TSH Thyroid-stimulating hormone V Variable VDRL Venereal Disease Research Laboratory (syphilis test) WBC White blood cell wk Week yr Year Increased ↑ ↓ Decreased ↔ No change Pocket Guide to Diagnostic Tests sixth edition Diana Nicoll, MD, PhD, MPA Clinical Professor and Vice Chair Department of Laboratory Medicine University of California, San Francisco Associate Dean University of California, San Francisco Chief of Staff and Chief, Laboratory Medicine Service Veterans Affairs Medical Center, San Francisco Chuanyi Mark Lu, MD Associate Professor of Laboratory Medicine University of California, San Francisco Chief, Hematology and Hematopathology Director, Molecular Diagnostics Laboratory Medicine Service Veterans Affairs Medical Center, San Francisco Michael Pignone, MD, MPH Professor of Medicine Chief, Division of General Internal Medicine Department of Medicine University of North Carolina, Chapel Hill Stephen J McPhee, MD Professor of Medicine, Emeritus Division of General Internal Medicine Department of Medicine University of California, San Francisco With Associate Authors New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2012 by The McGraw-Hill Companies, Inc All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-176624-1 MHID: 0-07-176624-3 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-176625-8, MHID: 0-07-176625-1 All trademarks are 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LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise Contents Abbreviations Inside Front Cover Associate Authors v Preface vii Diagnostic Testing and Medical Decision Making Diana Nicoll, MD, PhD, MPA, Michael Pignone, MD, MPH, and Chuanyi Mark Lu, MD Point-of-Care Testing and Provider-Performed Microscopy 25 Chuanyi Mark Lu, MD, and Stephen J McPhee, MD Common Laboratory Tests: Selection and Interpretation 47 Diana Nicoll, MD, PhD, MPA, Chuanyi Mark Lu, MD, Stephen J McPhee, MD, and Michael Pignone, MD, MPH Therapeutic Drug Monitoring and Pharmacogenetic Testing: Principles and Test Interpretation 291 Diana Nicoll, MD, PhD, MPA, and Chuanyi Mark Lu, MD Microbiology: Test Selection 305 Barbara Haller, MD, PhD Diagnostic Imaging: Test Selection and Interpretation 375 Benjamin M Yeh, MD Basic Electrocardiography and Echocardiography 421 Fred M Kusumoto, MD Diagnostic Tests in Differential Diagnosis 487 Stephen J McPhee, MD, Chuanyi Mark Lu, MD, Diana Nicoll, MD, PhD, MPA, and Michael Pignone, MD, MPH Diagnostic Algorithms 567 Chuanyi Mark Lu, MD, Stephen J McPhee, MD, Diana Nicoll, MD, PhD, MPA, and Michael Pignone, MD, MPH iii iv Contents 10 Nomograms and Reference Material 599 Michael Pignone, MD, MPH, Stephen J McPhee, MD, Diana Nicoll, MD, PhD, MPA, and Chuanyi Mark Lu, MD Index 611 Associate Authors Barbara Haller, MD, PhD Associate Clinical Professor of Laboratory Medicine Chief of Microbiology San Francisco General Hospital & Trauma Center, San Francisco Microbiology: Test Selection Fred M Kusumoto, MD Associate Professor of Medicine Department of Medicine Division of Cardiovascular Diseases Director of Electrophysiology and Pacing Mayo Clinic Jacksonville, Florida Basic Electrocardiography and Echocardiography Benjamin M Yeh, MD Associate Professor of Radiology Department of Radiology University of California, San Francisco Diagnostic Imaging: Test Selection and Interpretation Phil Tiso UCSF Principal Editor Division of General Internal Medicine Department of Medicine University of California, San Francisco v Preface Purpose The Pocket Guide to Diagnostic Tests, sixth edition, is intended to serve as a pocket reference manual for medical, nursing, and other health professional students, house officers, and practicing physicians and nurses It is a quick reference guide to the selection and interpretation of commonly used diagnostic tests, including laboratory procedures in the clinical setting, laboratory tests (chemistry, hematology, immunology, microbiology, pharmacogenetic, and molecular and genetic testing), diagnostic imaging tests (plain radiography, CT, MRI, and ultrasonography), electrocardiography, echocardiography, and the use of tests in differential diagnosis, helpful algorithms, and nomograms and reference material This book enables readers to understand commonly used diagnostic tests and diagnostic approaches to common disease states Outstanding Features • Over 450 tests presented in a concise, consistent, and readable format • Full coverage of more than two dozen new laboratory tests • Expanded content regarding molecular and genetic tests, including pharmacogenetic tests • New section on basic echocardiography • Updated and additional microbiologic coverage of emerging (new) and reemerging pathogens and infectious agents • Fields covered: internal medicine, pediatrics, surgery, neurology, and obstetrics and gynecology • Costs and risks of various procedures and tests • Full literature citations with PubMed (PMID) numbers included for each reference Organization This pocket reference manual is not intended to include all diagnostic tests or disease states The authors have selected the tests and diseases that are most common and relevant to the general practice of medicine vii viii Preface The Guide is divided into 10 sections: 10 Diagnostic Testing and Medical Decision Making Point-of-Care Testing and Provider-Performed Microscopy Common Laboratory Tests: Selection and Interpretation Therapeutic Drug Monitoring and Pharmacogenetic Testing Microbiology: Test Selection Diagnostic Imaging: Test Selection and Interpretation Basic Electrocardiography and Echocardiography Diagnostic Tests in Differential Diagnosis Diagnostic Algorithms Nomograms and Reference Material New to This Edition More than two dozen new or substantially revised clinical laboratory test entries, including: urine albumin, beta-hCG, CCP antibody, celiac disease serology, serum C-telopeptide and urine N-telopeptide, dehydroepiandrosterone, estradiol, glucagon, hepatitis E, intrinsic factor blocking antibody, urine iodine, islet cell antibody, kappa and lambda light chains, osteocalcin, pancreatic elastase, Quantiferon TB, somatostatin, and thyroid stimulating immunoglobulin Microbiologic tests for emerging (new) and reemerging pathogens and infectious agents More than two dozen new or substantially revised tables and algorithms concerning diagnostic approaches to: amenorrhea or oligomenorrhea; ascites and ascitic fluid profiles in various disease states; autoantibodies; molecular diagnostic testing in various genetic diseases; common serologic test patterns in hepatitis B virus infection; hemochromatosis; hyperaldosteronism; female infertility; classification and immunophenotyping of leukemias and lymphomas; severity index for acute pancreatitis; pulmonary embolism, including the revised Geneva Score for pulmonary embolism probability assessment, including a prognostic model (PESI Score) and risk stratification; clinical and laboratory diagnosis in untreated patients with syphilis; genetics and laboratory characteristics of thalassemia syndromes; summary of blood component therapy in transfusion; and diagnostic evaluation of valvular heart disease Intended Audience Medical students will find the concise summary of diagnostic laboratory, microbiologic, and imaging studies, and of electrocardiography and Preface ix echocardiography in this pocket-sized book of great help during clinical ward rotations Busy house officers, physician’s assistants, nurse practitioners, and physicians will find the clear organization and current literature references useful in devising proper patient management Nurses and other health practitioners will find the format and scope of the Guide valuable for understanding the use of laboratory tests in patient management Acknowledgments The editors acknowledge the invaluable editorial contributions of William M Detmer, MD, and Tony M Chou, MD, to the first three editions of this book In addition, the late G Thomas Evans, Jr., MD, contributed the electrocardiography section of Chapter for the second and third editions In the fourth, fifth, and this sixth edition, this section has been revised by Fred M Kusumoto, MD We thank Jane Jang, BS, MT (ASCP) SM, for her revision of the microbiology chapter in the fifth edition In this sixth edition, the chapter has been substantially revised by Barbara Haller, MD, PhD We thank our associate authors for their contributions to this book and are grateful to the many clinicians, residents, and students who have made useful suggestions We welcome comments and recommendations from our readers for future editions Diana Nicoll, MD, PhD, MPA Chuanyi Mark Lu, MD Michael Pignone, MD, MPH Stephen J McPhee, MD 626 Index Left anterior fascicular block (LAFB), 443–444, 446 Left atrial enlargement (LAE), 441 Left axis deviation, 446 Left bundle branch block (LBBB), 442–443 Left posterior fascicular block (LPFB), 444, 446 Left ventricular hypertrophy (LVH), 447–448 Legionella antibody, 200t Leukemia phenotyping by flow cytometry, 201t Leukemias and lymphomas, immunophenotyping and genetics, 521t–530t acute lymphoblastic leukemias/ lymphomas, 524t acute myeloid leukemias, 521t–523t mature B-cell neoplasms, 524t–527t mature T-cell and NK-cell neoplasms, 528t–530t Leukocyte scan, 402t Lidocaine therapeutic monitoring, 297t Likelihood ratio (LR), 12–14, 14t posttest probability and, 12–14, 15f, 16f Limited scleroderma, 500t Lipase, 202t Lithium therapeutic monitoring, 298t Liver abscess microbiology tests, 343t Liver diagnostic imaging, 405t–409t computed tomography, 405t hepatic angiography, 408t magnetic resonance imaging, 406t percutaneous transhepatic cholangiogram, 407t spleen scan, 409t ultrasound, 405t Liver function tests, 531t–532t Liver, spleen scan, 409t Low-voltage QRS complex, 449 Lung diagnostic imaging computed tomography, 388t ventilation-perfusion scan, 388t Lung infection microbiology tests, 325t–330t anerobic lung abscess, 326t empyema, 330t pneumonia anerobic, 326t community-acquired, 325t hospital-acquired, 327t in immunocompromised, 328t mycobacterial, 329t Lung volumes, 542t Lupus erythematosus, cerebral, cerebrospinal fluid profiles in, 503t Luteinizing hormone (LH), 203t Lyme disease, 366t antibody, 204t microbiology tests, 366t Lymphoblastic leukemia, 524t lymphoma, 524t Lymphocytes, interpretation of, 564t Lymphoma phenotyping by flow cytometry, 201t Lymphomas, immunophenotyping and genetics, 521t–530t See also Leukemias and lymphomas, immunophenotyping and genetics Lymphomatoid granulomatosis, 527t Lymphoplasmacytic lymphoma, 525t M Macrocytic, hypochromic anemia, 493t Magnesium (Mg2+), 205t Magnetic resonance angiography (MRA) of aorta and its branches, 420t of brain, 379t of neck, 381t Index Magnetic resonance angiography/ venography (MRA/MRV), of brain, 379t Magnetic resonance cholangiopancreatography (MRCP), 404t Magnetic resonance imaging (MRI) of abdomen, 395t of breast, 390t of chest, 387t of genitourinary tract, 412t of head, 378t of liver, 406t of musculoskeletal system, 417t of neck, 381t of pelvis, 414t of spine, 416t Magnetic resonance venography (MRV), of brain, 379t Malignancy, 499t See also specific cancers ascitic exudates, 575f pleural exudates, 537t MALT lymphoma, 526t Mammogram, 389t Mantle cell lymphoma, 526t Mature B-cell neoplasms, 524t–527t Mature NK-cell neoplasms, 528t–530t Mature T-cell neoplasms, 528t–530t Mean corpuscular hemoglobin (MCH), 206t Mean corpuscular hemoglobin concentration (MCHC), 206t Mean corpuscular volume (MCV), 207t Mean QRS axis determination, 444–446 in front plane (limb leads), 444–445 left axis deviation, 446 right axis deviation, 446 right superior axis deviation, 446 Mediastinal large B-cell lymphoma, 527t 627 Meningitis cerebrospinal fluid profiles bacterial, 502t carcinomatous, 503t fungal, 502t parasitic, 503t spirochetal, 504t syphilitic, 504t tuberculous, 502t viral (aseptic), 502t microbiology tests aseptic, 309t bacterial, 310t fungal, 311t spirochetal, 312t tuberculous, 314t Mesenteric angiography, 396t Meta-analysis, 21 Metabolic acidosis, 490t, 570f Metabolic alkalosis, 490t, 570f Meta-iodobenzyl-guanidine (MIBG) imaging, 411t Metanephrines free (unconjugated) plasma, 208t urine, 209t Metapneumovirus, human (huMPV), microbiology tests for, 361t Methanol, 210t Methemoglobin (MetHb), 211t Methicillin-resistant Staphylococcus aureus (MRSA) microbiology tests, 372t Methotrexate therapeutic monitoring, 298t Methylenetetrahydrofolate reductase (MTHFR) mutation, 212t Methylmalonic acid (MMA), 213t Metyrapone test (overnight), 214t MIBG (meta-iodobenzyl-guanidine) imaging, 411t Microbiology test selection for abdominal infections, 336t–344t See also Abdominal infections, microbiology tests for for arthritis, bacterial/septic, 355t 628 Index Microbiology test selection (Cont.): for bacteremia of unknown source, 359t for CNS infections, 307t–314t See also Central nervous system [CNS] infections, microbiology tests for ear infections otitis externa, 319t otitis media, 318t for emerging and reemerging pathogens/agents, 360t–373t Acinetobacter, 368t avian influenza A/H5N1, 360t Clostridium difficile, 369t diarrheagenic Escherichia coli, 370t–372t diarrheagenic Escherichia coli: DAEC, 371t diarrheagenic Escherichia coli: EAEC, 371t diarrheagenic Escherichia coli: EHEC, 372t diarrheagenic Escherichia coli: EIEC, 370t diarrheagenic Escherichia coli: EPEC, 371t diarrheagenic Escherichia coli: ETEC, 371t human metapneumovirus (huMPV), 361t human monkeypox, 362t human monocytic ehrlichiosis, 367t methicillin-resistant Staphylococcus aureus (MRSA), 372t mumps, 364t novel H1N1 influenza A, 360t severe acute respiratory syndrome coronavirus A (SARS-CoA), 363t Streptococcus pneumoniae, resistant, 373t transmissible spongiform encephalopathy (TSE), 365t vancomycin-resistant enterococcus (VRE), 373t West Nile virus (WNV), 364t for eye infections, 315t–317t conjunctivitis, 315t endophthalmitis, 317t keratitis, 316t for gas gangrene, 356t for genitourinary infections, 345t–353t See also Genitourinary infections, microbiology tests for for heart and vessels, 331t–335t See also Heart and vessels microbiology tests for for lung infections, 325t–330t See also Lung infections, microbiology tests for organisms in, 305–306 for osteomyelitis, 354t for sinusitis, 320t for skin infections cellulitis, 358t impetigo, 357t specimen collection in, 306 for upper airway infections, 321t–324t epiglottitis, 324t laryngitis, 322t laryngotracheobronchitis, 323t pharyngitis, 321t Microbiology test selection, 305–371 See also specific diseases Microcytic, hypochromic anemia, 491t, 494t Microscopic examination of amniotic fluid, fern test, 41 of semen, 44 of synovial fluid for crystals, 40, 40f of urinalysis, 33, 36, 37f of vaginal fluid KOH preparation, 39, 39f wet-mount preparation, 36, 38f Mirror image dextrocardia, right-left arm cable reversal, 467 Index Mitochondrial antibodies (AMA), 216t Mitral regurgitation, 480, 558t–563t echocardiography of, 482, 483f Mitral stenosis, 558t–563t echocardiography of, 482, 482f Mitral valve, echocardiography of, 482, 482f–483f Mobitz type I block, 439 Mobitz type II block, 439 Monitoring, therapeutic drug See Therapeutic drug monitoring Monkeypox, human, microbiology tests for, 362t Monocytes, interpretation of, 564t Monospot, 172t Monotonic dystrophy (MD) molecular diagnostic testing, 510t Mucopurulent cervicitis, 352t, 557t Multifocal atrial tachycardia (MAT), 426f, 429–430, 430f Multigated acquisition (MUGA), of heart, 392t Mumps microbiology tests, 364t Muscle infection microbiology tests, 356t Muscular dystrophy, spinal and bulbar, molecular diagnostic testing, 510t Musculoskeletal system diagnostic imaging, MRI, 417t Mycobacterial pneumonia microbiology tests, 329t Mycosis fungoides/Sézary syndrome, 529t Myocardial infarction (MI), 450–461 definition of, 450 extensive lateral and apical, right axis deviation in, 446 GUSTO study definitions of, 451–452, 451t inferior, left axis deviation in, 446 mimics of, 459, 460t posterior, tall R waves in right precordial leads in, 450 629 steps in diagnosis of, 451–461 overview, 450 step 1: ST-segment deviations, 451–452 step 2: areas of injury by lead groupings, 451–452 step 3: primary area and culprit artery, 452–456 posterior injury or infarction, 455–456 primary anterior process, 452–454 primary inferior process, 454–455 step 4: lesion location in artery, 456–457 primary anterior process, 456 primary inferior process, 456 step 5: QRS complexes, 457–460, 458t–460t step 6: age of infarction, 460 step 7: combine observations, 460–461 Myocardial injury, 450 See also Myocardial infarction Myocardial perfusion scan, 391t Myocarditis, infectious, microbiology tests for, 333t N Name, test, 48 See also specific tests Narrow QRS tachycardia with irregular rhythm (irregular SVT), 429–430, 430f with regular rhythm (regular SVT), 425–429, 427f, 429f Narrow therapeutic index, drug monitoring with, 291 Navy tube, 48t Neck diagnostic imaging computed tomography, 382t magnetic resonance angiography, 381t magnetic resonance imaging, 381t ultrasound, 381t–382t 630 Index Needles, handling and disposing of, 26 “Neighborhood” meningeal reaction, cerebrospinal fluid profiles in, 504t Nephrotic syndrome ascitic transudates, 498t, 575f pleural transudates, 536t urinalysis, 555t Neurofibromatosis (NF) molecular diagnostic testing, 510t Neurologic diseases, microbiology tests, 312t Neutrophil cytoplasmic antibodies (ANCA), 217t Neutrophils, interpretation of, 564t Niemann Pick disease, molecular diagnostic testing, 511t NK-cell leukemia, aggressive, 528t NK-cell lymphoma, blastic, 523t NK-cell neoplasms, mature, 528t–530t NK/T-cell lymphoma, extranodal, nasal type, 529t Nodal marginal zone B-cell lymphoma, 526t Nomograms acetaminophen hepatotoxicity, 600f acid–base, 601f hypercalcemia, 607f parathyroid hormone, 607f of posttest probability from pretest probability, and likelihood ratio, 14–17, 15f salicylate toxicity, 609f Nongonococcal urethritis microbiology tests, 349t Nonischemic cardiomyopathy, 477 Nontreponemal tests, 535t Normocytic, hypochromic anemia, 492t Nortriptyline therapeutic monitoring, 298t Novel H1N1 influenza A virus microbiology tests, 360t N-telopeptide, crosslinked (NTx), 218t Nuclear antibody (ANA), 219t O Obstructive jaundice, uncomplicated, 531t Obstructive pulmonary disease, pulmonary function tests in, 542t Odds converting between probability and, 16–17, 16f likelihood ratios, 12–22 posttest, 16–17, 16f Oligoclonal bands (OCBs), 220t Oligomenorrhea, 573f Orchitis microbiology tests, 350t Organisms See also specific organisms in microbiology tests, 305–306 Orthodromic atrioventricular reentrant tachycardia (AVRT), 426f, 427f, 428–429 Osmolal gap, calculation and application in toxicology, 533t Osmolality serum or plasma (Osm), 221t urine (urine Osm), 222t Osteocalcin, 223t Osteomyelitis microbiology tests, 354t Otitis externa microbiology tests, 319t Otitis media microbiology tests, 318t Oxygen, partial pressure (PO2), 224t P Pancreas diagnostic imaging computed tomography, 410t endoscopic retrograde cholangiopancreatography, 404t Index magnetic resonance cholangiopancreatography, 404t ultrasound, 410t Pancreatic ascitic exudates, 575f elastase, 225t Pancreatitis acute Ranson criteria for severity evaluation, 534t severity index, 535t exudates ascitic, 499t pleural, 537t Parapneumonic effusion, uncomplicated, pleural exudates in, 537t Parasitic meningitis, cerebrospinal fluid profiles in, 503t Parasitic meningo-encephalitis microbiology tests, 313t Parathyroid hormone (PTH), 226t, 607f Parathyroid hormone-related protein (PTHrP), 227t Parathyroid scan, 385t Partial thromboplastin time (aPTT), 228t Patient identification, Patient management, Patient preparation, 3–4 Paul-Bunnell test, 172t Pelvic inflammatory disease (PID) microbiology tests, 353t Pelvis diagnostic imaging magnetic resonance imaging, 414t ultrasound, 414t Percutaneous transhepatic cholangiogram (PTC), 407t Pericardial effusion, 479, 479f Pericardial tamponade, 479 Pericarditis microbiology tests for, 331t with PR-segment abnormalities, 469 631 tuberculous, microbiology tests for, 332t vs early repolarization, 469 Perinephric abscess microbiology tests, 348t Peripheral T-cell lymphoma, 530t Peritonitis bacterial, ascitic exudates, 575f microbiology tests, 340t, 341t tuberculous ascitic, 498t ascitic exudates, 575f PFA-100 closure time (PFA-100 CT), 234t pH, 229t Pharmacogenetic testing, 301t–303t, 295 BRAF gene, 303t clinical use of, 295 of cytochrome P450 (CYP) 2C9 variants, 301t of cytochrome P450 (CYP) 2C19 variants, 301t HLA-B*1502 allele, 301t HLA-B*B5701 allele, 302t thiopurine methyltransferase (TPMT) variants, 302t underlying assumptions in, 291 uridine diphosphoglucuronosyltransferase 1A1 (UGT 1A1) variants, 303t vitamin K epoxide reductase complex (VKORC1) variants, 303t Pharmacokinetic parameters, 293 Pharyngitis microbiology tests, 321t Phenobarbital therapeutic monitoring, 298t Phenylketonuria (PKU), molecular diagnostic testing, 511t Phenytoin therapeutic monitoring, 298t Pheochromocytoma, 589f Phosphorus, 230t–231t Physiologic basis, 48 See also specific test Pink tube, 48t 632 Index Pinworm tape test, 41, 43f Plasma cell myeloma/plasmacytoma, 525t Plasma preparation tube (PPT), 48t Plasmacytoma, 525t Platelet antibodies, 232t Platelet count (Plt), 233t Platelet function (PFA-100 closure time, PFA-100 CT), 234t Platelet function defect, 501t Platelet transfusion, 553t Pleural effusion, pleural fluid profiles in various disease states in, 536t–538t Pleural fluid tests, handling, and interpretation of, 28t in various disease states, 536t–538t Pneumonia microbiology tests anerobic, 326t community-acquired, 325t hospital-acquired, 327t in immunocompromised, 328t mycobacterial, 329t Point-of-care (POC) testing, 25–45, 30t–32t advantages of, 29 disadvantages of, 29 Polycythemia, 590f Polymorphic ventricular tachycardia, 437–438 Polymyositis, 500t Poor R-wave progression (PRWP), 449 Porphobilinogen (PBG), 235t Portal hypertension with underlying cirrhosis, ascitic exudates, 575f Positron emission tomography (PET), of brain, 380t Positron emission tomography/ computed tomography (PET/CT) of abdomen, 395t of chest, 387t Posttest odds, 16–17, 16f after sequential tests, 17 Posttest probability, 10f–11f, 11–12, 12t from pretest probability and likelihood ratio, 14–17, 14t, 15f, 16f Potassium (K+), 236t Practice guidelines, clinical, 21 Prader-Willi syndrome molecular diagnostic testing, 512t Precision, 5–6, 5f of drug monitoring, 292 Precursor B lymphoblastic leukemia/ lymphoma, 524t Precursor T lymphoblastic leukemia/ lymphoma, 524t Pregnancy, thyroid function tests in, 549t Premature atrial complex (PAC), 424–425 Premature junctional complex (PJC), 424–425 Premature QRS activity, 424–425 Premature ventricular complex (PVC), 424–425 Prenatal diagnosis, 539t Preparation patient, 3–4 test, Pretest probability, 11–12, 11f, 12t, 13f Primary cutaneous CD30-positive T-cell lymphoproliferative disorders, 530t Primary effusion lymphoma, 527t Probability converting between odds and, 16–17, 16f posttest, 10f–11f , 11–12, 12t pretest, 11–12, 11f, 12t, 13f Procalcitonin, 237t Prolactin (PRL), 238t Prostate cancer, pretest and posttest probability of, 11–12, 11f, 13f Prostate-specific antigen (PSA), 239t pretest and posttest probability of, 11–12, 11f, 13f Index receiver operator characteristic curves for, 10–11, 11f Prostatitis microbiology tests, 346t Protein binding, drug, 293 Protein C, 240t Protein electrophoresis, 241t Protein S (total antigen), 242t Protein, total, 243t Prothrombin G20110A mutation, 131t Prothrombin time (PT), 244t Provider-performed microscopy procedures (PPM), 25–45 fern test of amniotic fluid, 40–41, 42f pinworm tape test, 41, 43f qualitative semen analysis, 44 skin KOH preparation, 38–39 synovial fluid examination for crystals, 40, 40f urinalysis, 29, 33–36, 37f vaginal fluid wet-mount, 36, 38–39 PR-segment abnormalities, in pericarditis, 469 Pseudomyxoma peritonei, ascitic, 498t PTT, isolated prolongation of, laboratory evaluation, 591f Pulmonary embolism pleural exudates in, 537t risk evaluation and diagnostic algorithm diagnostic approach, 592f revised Geneva score, 540t–541t Pulmonary function tests lung volumes, 542t in obstructive and restrictive pulmonary disease, 542t spirometry, 542t, 608f Pulmonary infarction, pleural exudates in, 537t Pure erythroid leukemia, 523t Pyelonephritis microbiology tests, 347t urinalysis, 555t 633 Q Q fever antibody, 245t QRS activity, premature, 424–425 QRS axis determination, calculating mean, 444–446 QRS complex diagnosis, 422–423, 423t low voltage, 449 QRST patterns, basic, 440 QT interval, 466–467 prolonged, 466–467 QT nomogram use, 466 short, 467 QuantiFERON-TB (Interferongamma releasing assay), 246t R R wave progression of, in precordial leads, 449 tall, in right precordial leads, 450 Radiograph abdominal plain, 393t chest, 386t valvular heart disease, 561t–563t Radionuclide ventriculography, of heart, 392t Ranson criteria for pancreatitis severity evaluation, 534t Rapid plasma reagin (RPR), 247t Reciprocal changes, 451 Red blood cell (RBC) count, 248t transfusion, 551t–552t Red tube, 48t Reference interval, 6–7, 6f, 7t See also specific tests Regurgitation echocardiography of aortic, 481, 481f mitral, 482, 482f–483f tricuspid, 483–484, 484f, 485f 634 Index Renal failure chronic, urinalysis, 555t classification and differential diagnosis, 543t Renal scan (radionuclide), 413t Renal tubular acidosis (RTA), laboratory evaluation, 544t Renin activity (PRA), 249t Repolarization abnormalities in left ventricular hypertrophy, 447 in right ventricular hypertrophy, 449 Repolarization, early normal variant ST-T abnormality, 468 vs pericarditis, 469 Respiratory acidosis, 490t, 570f Respiratory alkalosis, 490t, 570f Restrictive pulmonary disease, pulmonary function tests in, 542t Reticulocyte count, 250t Reversed R-wave progression (RRWP), 449 Reviews, systematic, 21–22 Rh typing (Rh), 251t Rheumatic diseases, autoantibodies in, 500t Rheumatoid arthritis (RA) autoantibodies, 500t pleural exudates, 537t Rheumatoid factor (RF), 252t Ribonucleoprotein antibody (RNP), 253t Right atrial enlargement (RAE), 441 Right axis deviation, 446 Right bundle branch block (RBBB), 442 incomplete, 443 tall R waves in right precordial leads, 450 Right light cable misplacement, 467–468 Right superior axis deviation, 446 Right ventricular hypertrophy (RVH), 448–449 right axis deviation, 447–449 tall R waves in right precordial leads, 450 Right-left arm cable reversal, vs mirror image dextrocardia, 467 Risk factors, identification of, 1–2 Risks, of diagnostic tests, 1–2 Rubella antibody, 254t Russell viper venom time (dilute, dRVVT), 255t S Safety considerations, with specimen handling, 26 Salicylates, 256t nomogram for toxicity of, 609f Salpingitis microbiology tests, 353t Scl-70 antibody, 257t Scleroderma, autoantibodies in, 500t Scleroderma-associated antibody (Scl-70 antibody), 257t Screening procedures, 1, 2t Second-degree AV block, 439 Sediment examination, urinalysis, 33, 36, 37f Semen analysis, 44, 258t Sensitivity, 8–11, 9f–11f of drug monitoring, 292 Septic arthritis microbiology tests, 355t Sequential testing, 17 Serum free light chains, 195t–196t Serum separator tube (SST), 48t Sestamibi scan, of heart, 391t Severe acute respiratory syndrome coronavirus A (SARS-CoA) microbiology tests, 363t Severity index for pancreatitis, 535t Sézary syndrome, 529t Shared decision making, 21–22 Shiga toxin-producing Escherichia coli infection (STEC) microbiology tests, 372t Single photon emission tomography (SPECT), of brain, 380t Sinus arrhythmia, 424 Index Sinus bradycardia, 424, 438 Sinus node, 424 Sinus pauses, 439 Sinus rhythm, 424 Sinus tachycardia, 424, 425, 427f Sinusitis microbiology tests, 320t Sirolimus therapeutic monitoring, 299t Sjögren syndrome, autoantibodies in, 500t Skin infection microbiology tests cellulitis, 358t impetigo, 357t Sleep disturbance, 593f Small bowel follow-through, 398t Smith (anti-Sm) antibody, 259t Smooth muscle antibodies, 259t Sodium (Na+), 260t Somatomedin C, 188t Somatostatin, 261t Specificity, 8–11, 9f–11f of drug monitoring, 292 Specimen collection, Specimen handling and collection, 26–29 safety considerations with, 26 Specimen identification, 26 Specimen labeling, Specimen tubes, 27 Spectrum bias, Spinal muscular dystrophy molecular diagnostic testing, 510t Spine diagnostic imaging computed tomography, 416t magnetic resonance imaging, 416t Spirochetal meningitis cerebrospinal fluid profiles, 504t microbiology tests, 312t Spirometry, 542t, 608f Spleen diagnostic imaging, liver, spleen scan (radionuclide), 409t Splenic marginal zone lymphoma, 525t SS-A/Ro antibody, 262t SS-B/La antibody, 263t 635 ST segments, 461 depression, 463t elevation, 462t Storage, of test specimens, Streptococcus pneumoniae, resistant, microbiology tests for, 373t ST-T changes/abnormalities early repolarization normal variant, 468 left bundle branch block, 443 right bundle branch block, 442 ST-T waves, classes and morphologies of, 464t ST-T-U abnormalities, 465t Subarachnoid hemorrhage, cerebrospinal fluid profiles in, 503t Subcutaneous panniculitis-like T-cell lymphoma, 529t Sustained junctional rhythm, 439 Synovial fluid examination, for crystals, 40, 40f tests, handling, and interpretation, 28t Syphilis, laboratory evaluation, 545t–546t Syphilitic meningitis, cerebrospinal fluid profiles in, 504t Systematic reviews, 21–22 Systemic error, 5, 5f Systemic lupus erythematosus (SLE), autoantibodies in, 500t T Tachycardia, 425–438 accessory pathway-mediated, 426f, 428–429, 429f orthodromic atrioventricular reentrant tachycardia (AVRT), 426f, 427f, 428–429 anatomic classification of, 426f 636 Index Tachycardia (Cont.): antidromic atrioventricular reentrant tachycardia, 426f, 431 atrial, 425, 426f, 427f atrial fibrillation, 426f, 429, 430f atrial fibrillation with anterograde accessory pathway activation, 426f, 438 atrial flutter, 425, 426f, 427–428, 427f atrial flutter with variable block, 430 junctional, 426f, 428 atrioventricular nodal reentrant tachycardia, 426f, 427f, 428 multifocal atrial tachycardia, 426f, 429–430 narrow QRS with irregular rhythm (irregular SVT), 429–430, 430f with regular rhythm (regular SVT), 425–429, 427f, 429f polymorphic ventricular tachycardia, 437–438 sinus, 424, 425, 427f torsade de pointes, 438 ventricular, 426f, 431, 431f ventricular fibrillation, 426f, 437–438 ventricular, morphology algorithms for, 432–437 Brugada algorithm, 434–436 Griffith method, 436–437 quick method, 432–434 wide QRS with irregular rhythm, 437–438 with regular rhythm, 430–432, 431f Tacrolimus therapeutic monitoring, 299t Tay-Sachs disease molecular diagnostic testing, 512t T-cell cutaneous CD30-positive lymphoproliferative disorders, primary, 530t T-cell large granular lymphocytic leukemia, 528t T-cell leukemia/lymphoma, adult, 528t T-cell lymphoma angioimmunoblastic, 530t enteropathy-type, 529t extranodal NK/T-cell lymphoma, nasal type, 529t hepatosplenic, 529t peripheral, 530t subcutaneous panniculitis-like, 529t T-cell neoplasms, mature, 528t–530t T-cell prolymphocytic leukemia, 528t T-cell receptor (TCR) gene rearrangement, 263t Technetium-99m hexamethylpropylene amine oxime (Tc99m-HMPAO)– labeled WBC scan, 402t Technetium-99m methoxyisobutyl isonitrile scan, of heart, 391t Test characteristics See Characteristics, test; specific tests Test name, 48 See also specific tests Test preparation, Testosterone, 264t Thalassemia genetics and laboratory characteristics, 547t molecular diagnostic testing α-, 513t β-, 514t Thalassemia minor, 494t, 547t Thallium scan, heart, 391t Theophylline therapeutic monitoring, 299t Therapeutic drug monitoring, 291–300 for amikacin, 296t for amitryptyline, 296t for carbamazepine, 296t contraindications to, 292 for cyclosporine, 296t for digoxin, 297t Index drug interactions in, 294 for ethosuximide, 297t for gentamicin, 297t for imipramine, 297t indications for, 291 for lidocaine, 297t for lithium, 298t for methotrexate, 298t for nortriptyline, 298t pharmacokinetic parameters in, 293 for phenobarbital, 298t for phenytoin, 298t reliability of analytic method in, 292 reliability of therapeutic range in, 292–293 for sirolimus, 299t for tacrolimus, 299t for theophylline, 299t time to draw levels in, 294 for tobramycin, 299t underlying assumptions in, 291 for valproic acid, 300t for vancomycin, 300t Therapeutic index, narrow, drug monitoring with, 291 Therapeutic range, reliability of, 292–293 Thiopurine methyltransferase (TPMT) variants, 302t Third-degree AV block, 440 Threshold approach, to decision making, 17–18, 18f, 19f Thrombin time, 265t Thrombocytopenia acquired, diagnostic approach, 594f heparin-induced, 161t Thrombocytosis, 595f Thrombophlebitis, infectious, microbiology tests for, 335t Thrombosis, venous, recommended screening for causes, 596f Thymic large B-cell lymphoma, 527t Thyroglobulin, 266t 637 Thyroglobulin antibody, 267t Thyroid diagnostic imaging, 383t–384t thyroid therapy, 384t thyroid uptake and scan, 383t ultrasound, 383t Thyroid function tests and clinical applications, 548t–550t Thyroid nodule, 597f Thyroid stimulating immunoglobulin (TSI), 269t Thyroid therapy (radionuclide), 384t Thyroid uptake and scan (radionuclide), 383t Thyroid-stimulating hormone (TSH; thyrotropin), 268t Thyroperoxidase antibody (TPO), 267t Thyrotropin (TSH), 268t Thyroxine free (FT4), 270t total (T4), 270t Time to draw levels, 294 Tobramycin therapeutic monitoring, 299t Torsade de pointes, 438 Total cholesterol, 99t Total iron-binding capacity (TIBC), 192t Total protein, 243t Toxicity monitoring, 291 Toxoplasma antibody (Toxo), 271t Transesophageal echocardiography, 484 Transferrin (Tf), 272t Transferrin receptor, soluble (sTfR), 273t Transfusion blood component preparation, 598f blood component therapy, 551t–553t Transmissible spongiform encephalopathy (TSE) microbiology tests, 365t 638 Index Transthoracic echocardiography, 471–484 accquisition of four-chamber view in, 472, 473f accquisition of two-chamber view in, 472–473, 474f in left ventricular anatomy and function, 474–479 positioning of, 472f systole and diastole, 474–475, 475f, 476f in valvular anatomy and function, 479–484 “Traumatic” tap, cerebrospinal fluid profiles in, 503t Treponema pallidum antibody by TP-PA, 274t Trichomonas vaginitis, laboratory evaluation, 557t Tricuspid regurgitation, 558t–563t Doppler, four chambered view, 483–484, 484f, 485f Tricuspid stenosis, 558t–563t Tricuspid valve, 482–484 Triglycerides (TG), 275t Triiodothyronine (T3), 276t Troponin-I, cardiac (cTnI), 277t Tuberculosis, pleural exudates in, 536t Tuberculous meningitis cerebrospinal fluid profiles, 502t microbiology tests, 314t Tuberculous pericarditis microbiology tests, 332t Tuberculous peritonitis/enterocolitis ascitic, 498t ascitic exudates, 575f microbiology tests, 341t Tubes, 48 Tularemia agglutinins, 278t T-wave inversion, 463t Type and cross-match (T/C), 279t Type and screen (T/S), 280t U U waves abnormal, 461 inverted, 461, 465t normal, 461 Ultrasound (US) of abdomen, 393t of gallbladder, 403t of genitourinary tract, 412t of liver, 405t of neck, 382t of pancreas, 410t of pelvis, 414t of thyroid, 383t of vasculature, 418t Upper airway infection microbiology tests, 321t–324t epiglottitis, 324t laryngitis, 322t laryngotracheobronchitis, 323t pharyngitis, 321t Upper GI study (UGI), 397t Uremia, 501t, 504t Urethritis microbiology tests, 349t Uric acid, 281t Uridine diphosphoglucuronosyltransferase 1A1 (UGT 1A1) variants, 303t Urinalysis, 29, 33–36 collection and preparation of specimen, 29–33 components, 34t–35t dipstick, 33, 34t–35t findings in various disease states, 554t–555t interpretation, 554t–555t microscopic findings, 37f microscopic urine sediment examination, 33–36 procedural technique, 33 Urinary tract infection (UTI) microbiology tests, 345t Index Urine dipstick, 33, 34t–35t tests, handling, and interpretation, 28t Utility, 18, 20 V Vaginal discharge, laboratory evaluation, 556t–557t Vaginal fluid differential diagnosis, 556t–557t KOH preparation, 38–39, 39f wet-mount preparation, 36, 38–39, 38f Vaginitis/vaginosis laboratory evaluation, 556t–557t microbiology tests, 351t Valproic acid therapeutic monitoring, 300t Valvular heart disease, 558t–563t Valvular regurgitation, 479–480 Vancomycin therapeutic monitoring, 300t Vancomycin-resistant enterococcus (VRE) microbiology tests, 373t Vanillylmandelic acid (VMA), 282t Vasculature diagnostic imaging, ultrasound, 418t Venereal Disease Research Laboratory test (VDRL), 282t–283t Venipuncture, 27 Venous thrombosis, recommended screening for causes, 596f Ventilation-perfusion scan, 388t Ventricular aneurysm, echocardiography four chamber view of, 478f two chamber view of, 477f Ventricular fibrillation, 426f, 437–438 Ventricular hypertrophy, 447–449 left ventricular, 447–448 right ventricular, 448–449 639 Ventricular preexcitation left axis deviation, 446 right axis deviation, 446 Ventricular tachycardia, 426f, 431f polymorphic, 437–438 Ventricular tachycardia morphology algorithms, 432–437 Brugada algorithm, 434–436 Griffith method, 436–437 quick method, 432–434 Vessels, microbiology tests for See Heart and vessels, microbiology tests for V617F mutation, 194t Viral meningitis, cerebrospinal fluid profiles in, 502t Vitamin B12, 284t Vitamin D, 1,25-hydroxy (1,25[OH]2D), 287t Vitamin D, 25-hydroxy (25[OH]D), 285t–286t Vitamin K epoxide reductase complex (VKORC1) variants, 303t Volume of distribution, 293 von Recklinghausen disease (NF1) molecular diagnostic testing, 510t von Willebrand disease, 501t von Willebrand factor (vWF), 288t W Waldenström macroglobulinemia, 525t WBC count, interpretation of, 564t Wegener granulomatosis, autoantibodies in, 500t Wenckebach block, 439 West Nile virus (WNV) microbiology tests, 364t White blood cell (WBC) count and differential, 289t interpretation of, 564t–565t 640 Index White blood cell (WBC) (Cont.): scanning of indium-labeled, 402t technetium-99m hexamethylpropylene amine oxime-labeled, 402t Whole blood transfusion, 551t Wide QRS tachycardia with irregular rhythm, 437–438 with regular rhythm, 430–432, 431f Wolff-Parkinson-White (WPW) pattern, 469 left axis deviation, 446 right axis deviation, 446 tall R waves in right precordial leads, 450 X X-ray See Radiograph Y Yellow tube, 48t ... collaborate to reach a mutually acceptable decision 22 Pocket Guide to Diagnostic Tests Decision aids, tools to help facilitate shared decision making, have been shown in many cases to improve... appropriately, diagnostic tests can be of great assistance to the clinician Tests can be helpful for screening, ie, to identify risk factors for disease and to detect occult disease in asymptomatic... precision of diagnostic tests, which is Pocket Guide to Diagnostic Tests monitored in clinical laboratories by using control material, must be good enough to distinguish clinically relevant changes