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(BQ) Part 2 book Mosby''s manual of diagnostic and laboratory tests presents the following contents: Electrodiagnostic tests, endoscopic studies, fluid analysis studies, manometric studies, microscopic studies and associated testing, nuclear scanning, stool tests, ultrasound studies, urine studies,...
CHAPTER Electrodiagnostic Tests OVERVIEW Reasons for Performing Electrodiagnostic Studies, 536 Procedural Care for Electrodiagnostic Studies, 536 Potential Complications of Electrodiagnostic Studies, 537 Reporting of Results, 538 TESTS Caloric Study, 538 Cardiac Stress Testing, 540 Electrocardiography, 544 Electroencephalography, 549 Electromyography, 554 Electromyoneurography, 574 Electronystagmography, 557 Electrophysiologic Study, 559 Evoked Potential Studies, 562 Fetal Contraction Stress Test, 566 Fetal Nonstress Test, 569 Holter Monitoring, 571 Nerve Conduction Studies, 573 Pelvic Floor Sphincter Electromyography, 576 Overview REASONS FOR PERFORMING ELECTRODIAGNOSTIC STUDIES Most electrodiagnostic studies use electrical activity and electronic devices to evaluate disease or injury to a specified area of the body The electrical impulses can be generated spontaneously or can be stimulated For example, electrocardiography records spontaneous electrical impulses generated by the heart during the cardiac cycle In electromyography, the electrical impulses are stimulated by an electrical shock applied to the body For the caloric study, nystagmus is induced by irrigating the ear canal with water The electrical activity is usually detected by electrodes placed on the body The electrodes are attached to instruments for receiving and recording electrical impulses Table 3-1 lists the various areas of the body that can be evaluated by electrodiagnostic studies PROCEDURAL CARE FOR ELECTRODIAGNOSTIC STUDIES Before Explain the procedure to the patient • O btain baseline values for comparison during and after the test 536 Overview 537 Evaluation Caloric study Cranial nerve VIII Cardiac stress Cardiac muscle Electrocardiography Cardiac muscle and conduction system Electroencephalography Brain Electromyography Neuromuscular system Electroneurography Peripheral nerves Electronystagmography Oculovestibular reflex pathway Electrophysiologic studies Cardiac conduction system Evoked potential studies Sensory pathways of the eyes, ears, and peripheral nerves Contraction stress (fetal) Fetal viability Nonstress (fetal) Fetal viability Holter monitoring Cardiac rhythm Pelvic floor sphincter electromyography Urinary or fecal continence Explain food restrictions, if indicated For example, caloric studies require fasting to reduce the possibility of nausea and vomiting On the other hand, fasting would affect electroencephalography results by causing hypoglycemia • Determine if there are any drug restrictions Sedatives may adversely affect most test results • Because of its stimulating effect, caffeine is restricted before most studies • Most of these studies are considered noninvasive and not require a consent form During • F or most tests, some type of electrode is applied to the patient to record electrical activity • Some tests (such as electromyography) require some type of stimulation Slight discomfort may be felt if electrical stimulation is applied • The patient needs to remain still during testing Any movement can alter test results After • M onitor the patient for a return to pretest baseline activity • Some studies may cause nausea and vomiting The patient should rest until these symptoms subside • If any sedation was given, safety precautions should be in effect POTENTIAL COMPLICATIONS OF ELECTRODIAGNOSTIC STUDIES Most tests in this category have few potential complications Those mentioned below apply to specific tests and are grouped accordingly Cardiac Stress Testing Cardiac arrhythmias Severe angina Fainting Myocardial infarction Name of Test Electrodiagnostic Tests TABLE 3-1 Body Areas Evaluated by Electrodiagnostic Studies 538 Caloric Study Contraction Stress Test Premature labor REPORTING OF RESULTS Many of these tests are performed by technicians Test results are available after interpretation by a physician Caloric Study (Oculovestibular Reflex Study) NORMAL FINDINGS Nystagmus with irrigation INDICATIONS This test is used to evaluate the function of cranial nerve VIII It also can indicate disease in the temporal portion of the cerebrum TEST EXPLANATION Caloric studies are used to evaluate the vestibular portion of the eighth cranial nerve (CN VIII) by irrigating the external auditory canal with hot or cold water This is usually part of a complete neurologic examination Stimulation with cold water normally causes rotary nystagmus (involuntary rapid eye movement) away from the ear being irrigated; hot water induces nystagmus toward the side of the ear being irrigated If the labyrinth is diseased or CN VIII is not functioning (e.g., from tumor compression), no nystagmus is induced This study aids in the differential diagnosis of abnormalities that may occur in the vestibular system, brainstem, or cerebellum When results are inconclusive, electronystagmography (p 557) may be performed CONTRAINDICATIONS • P atients with a perforated eardrum Cold air may be substituted for the fluid, although this method is less reliable • Patients with an acute disease of the labyrinth (e.g., Ménière syndrome) The test can be performed when the acute attack subsides INTERFERING FACTORS Drugs such as sedatives and antivertigo agents can alter test results Clinical Priorities • This study aids in evaluating the vestibular portion of the eighth cranial nerve • During this test, the external auditory canal is irrigated with hot or cold water to induce nystagmus • Most patients experience nausea and dizziness during this test Patients with a decreased level of consciousness should be safely positioned to avoid potential aspiration from vomiting Caloric Study 539 PROCEDURE AND PATIENT CARE Before • Although the exact procedures for caloric studies vary, note the following steps in a typical test: Before the test, the patient is examined for the presence of nystagmus, postural deviation (Romberg sign), and past-pointing This examination provides the baseline values for comparison during the test The ear canal should be examined and cleaned before testing to ensure that the water will flow freely to the middle ear area The ear on the suspected side is irrigated first because the patient's response may be minimal After an emesis basin is placed under the ear, the irrigation solution is directed into the external auditory canal until the patient complains of nausea and dizziness, or nystagmus is observed This usually occurs in 20 to 30 seconds If after minutes no symptoms occur, the irrigation is stopped The patient is tested again for nystagmus, past-pointing, and Romberg sign After approximately minutes, the procedure is repeated on the other side • Note that this procedure is usually performed by a physician or technician in approximately 15 minutes Tell the patient that he or she will probably experience nausea and dizziness during the test If the patient has a decreased level of consciousness, position safely to avoid potential aspiration from vomiting After • U sually, place the patient on bed rest for approximately 30 to 60 minutes until nausea or vomiting subsides • Ensure patient safety related to dizziness TEST RESULTS AND CLINICAL SIGNIFICANCE Brainstem inflammation, infarction, or tumor, Cerebellar inflammation, infarction, or tumor, Vestibular or cochlear inflammation or tumor, Acoustic neuroma, Eighth nerve neuritis or neuropathy: The above-noted diseases involve the central nervous system (CNS) from the vestibular/cochlear end organ to the temporal area of the cerebrum RELATED TEST Electronystagmography (p 557) During this test, nystagmus is stimulated in a manner similar to that described for caloric studies The direction, velocity, and amplitude of the nystagmus are recorded through the use of electrodes During Electrodiagnostic Tests Explain the procedure to the patient • H old solid foods before the test to reduce the incidence of vomiting 540 Cardiac Stress Testing Cardiac Stress Testing (Stress Testing, Exercise Testing, Electrocardiograph [EKG] Stress Testing, Nuclear Stress Testing, Echo Stress Testing) NORMAL FINDINGS Patient able to obtain and maintain maximal heart rate of 85% for predicted age and gender with no cardiac symptoms or EKG change No cardiac muscle wall dysfunction INDICATIONS Stress testing is used in the following situations: To evaluate chest pain in a patient with suspected coronary disease (Occasionally a person may have significant coronary stenosis that is not apparent during normal physical activity If, however, the pain can be reproduced with exercise, coronary occlusion may be present.) To determine the limits of safe exercise during a cardiac rehabilitation program or to assist patients with cardiac disease in maintaining good physical fitness To detect labile or exercise-related hypertension To detect intermittent claudication in patients with suspected vascular occlusive disease in the extremities (In this situation, the patient may experience leg muscle cramping while performing the exercise.) To evaluate the effectiveness of treatment in patients who take antianginal or antiarrhythmic medications To evaluate the effectiveness of cardiac intervention (such as bypass grafting or angioplasty) TEST EXPLANATION Stress testing is a noninvasive study that provides information about the patient's cardiac function In stress testing the heart is stressed in some way The heart is then evaluated during the stress Changes indicating ischemia point to coronary occlusive disease By far the most commonly used method of stress is exercise (usually treadmill) Chemical stress methods are becoming more common because of their safety and increased accuracy A third method, less frequently used, is pacer stress (Box 3-1) During exercise stress testing, the EKG, heart rate, and blood pressure are monitored while the patient engages in some type of physical activity (stress) Two methods of stress testing are pedaling a stationary BOX 3-1 Commonly Used Methods of Stressing the Heart Exercise Chemical Pacing • Bicycle • Treadmill • Adenosine • Dipyridamole • Dobutamine • Stimulatory drugs • Vascular dilation drugs • Cardiac pacemaker bike and walking on a treadmill With the stationary bicycle the pedaling tension is slowly increased to increase the heart rate With the treadmill test the speed and grade of incline are increased The treadmill test is the most frequently used because it is the most easily standardized and reproducible (Figure 3-1) The various grades of exercise are determined by the cardiologist in attendance based on estimation of cardiac function capabilities The usual goal of the exercise stress testing is to increase the heart rate to just below maximal levels or to the “target heart rate.” This target heart rate is usually 80% to 90% of the maximal heart rate The test is usually discontinued if the patient reaches that target heart rate or develops any symptoms or EKG changes The maximal heart rate is determined by a chart that takes into account the patient's age (about 220 minus the patient's age) and gender The normal maximal heart rate for adults varies from 150 to 200 beats/min; patients taking calcium channel blockers and sympathetic blockers have a lowerthan-expected maximal heart rate Exercise stress testing is based on the principle that occluded arteries will be unable to meet the heart's increased demand for blood during the testing This may become obvious with symptoms (e.g., chest pain, fatigue, dyspnea, tachycardia, cardiac arrhythmias [dysrhythmias], fall in blood pressure) or EKG changes (e.g., ST-segment variance >1 mm, increasing premature ventricular contractions, other rhythm disturbances) An advantage of stress testing is that these symptoms can be stimulated and identified in a safe environment Besides the electrodiagnostic method of cardiac evaluation, the stressed heart also can be evaluated by nuclear scanning or echocardiography, which are more sensitive and accurate Findings of ischemia are discussed in “Test Results and Clinical Significance.” When exercise testing is not advisable or the patient is unable to exercise to a level adequate to stress the heart (patients with an orthopedic, arthritic, neurologic, or pulmonary limitation), chemical stress testing is recommended Chemical stress testing is being increasingly used because of its accuracy and ease of performance Although chemical stress testing is less physiologic than exercise testing, it is safer and more controllable Dipyridamole (Persantine) is a coronary vasodilator If one coronary artery is significantly occluded, the coronary blood flow is diverted to the opened vessels This causes a “steal syndrome” away from the stenotic or occluded coronary vessel That is, the dipyridamole-induced vascular dilation “steals” the blood from the ischemic areas and diverts it to the open, dilated coronary vessels Caution must be taken, however, because this can precipitate angina or myocardial infarction (MI) This test should be performed only with a cardiologist in attendance Intravenous (IV) aminophylline can reverse the effect of dipyridamole Adenosine works similarly to dipyridamole Figure 3-1 Patient taking exercise stress test while nurse monitors the EKG response Electrodiagnostic Tests 541 Cardiac Stress Testing 542 Cardiac Stress Testing BOX 3-2 Commonly Used Methods of Cardiac Evaluation During Stress Testing • Cardiac nuclear scanning (p 791) • Echocardiography (p 877) • Electrophysiologic parameters: EKG, blood pressure, and heart rate BOX 3-3 Criteria for Discontinuation of an Exercise Stress Test • Abnormal EKG changes • Ectopy • Flipped T waves • ST changes • Attainment of maximal performance • Chest pain • Cyanosis • Excessive heart rate changes: tachycardia or bradycardia • Excessive hypertension or hypotension • Leg claudication • Severe shortness of breath • Syncope Dobutamine is another chemical that can stress the heart Dobutamine stimulates heart muscle function This entails administration of progressively greater amounts of dobutamine over 3-minute intervals The normal heart muscle increases its contractility (wall motion) Ischemic muscle has no augmentation In fact, in time the ischemic area becomes hypokinetic Infarcted tissue is akinetic In chemical stress testing the stressed heart is evaluated by nuclear scanning or echocardiography Pacing is another method of stress testing In patients with permanent pacemakers, the rate of capture can be increased to a rate that would be considered a cardiac stress The heart is then evaluated electrodiagnostically or with nuclear scanning or echocardiography As indicated in Box 3-2, the methods of evaluating the heart are nuclear scanning, echocardiography, and electrophysiologic parameters Echocardiography is fast becoming the method of choice for urgent and elective cardiac evaluation with or without stress testing Stress testing is discontinued with any of the criteria noted in Box 3-3 CONTRAINDICATIONS • P atients with unstable angina, because stress may induce an infarction • Patients with severe aortic valvular heart disease (especially stenotic lesions), because their stress tolerance is easily reached and is quite low • Patients who cannot participate in an exercise program because of their impaired lung or motor function However, they can be stressed chemically • Patients who have recently had a myocardial infarction (MI) However, limited stress testing may be done • Patients with severe congestive heart failure Cardiac Stress Testing 543 • P atients who have severe claudication and cannot walk adequately to stress their hearts However, they can be stressed chemically • Patients with known severe left main coronary artery disease atal cardiac arrhythmias F Severe angina MI Fainting INTERFERING FACTORS • • • • eavy meals before testing can divert blood to the gastrointestinal tract H Nicotine from smoking can cause coronary artery spasm Caffeine blocks the effect of dipyridamole Medical problems such as hypertension, valvular heart disease (especially of the aortic valve), severe anemia, hypoxemia, and chronic pulmonary disease can affect results • Left ventricular hypertrophy may affect test results • The EKG is not a reliable indicator of ischemia in patients with left bundle branch block Drugs that can affect test results include beta blockers (e.g., propranolol [Inderal]), calcium channel blockers, digoxin, and nitroglycerin PROCEDURE AND PATIENT CARE Before xplain the procedure to the patient E Instruct the patient to abstain from eating, drinking, and smoking for hours Inform the patient about the risks of the test and obtain informed consent Instruct the patient to bring comfortable clothing and athletic shoes for exercise Slippers are not acceptable Inform the patient if any medications should be discontinued before testing • Obtain a pretest EKG • Record the patient's vital signs for baseline values Monitor the blood pressure during the testing • Apply and secure appropriate EKG electrodes During • N ote that a physician usually is present during stress testing • After the patient begins to exercise, adjust the treadmill machine settings to apply increasing levels of stress at specific intervals Encourage and support the patient at each level of increased stress Encourage patients to verbalize any symptoms • Note that during the test the EKG tracing and vital signs are monitored continuously • Terminate the test if the patient complains of chest pain, exhaustion, dyspnea, fatigue, or dizziness • Note that testing usually takes approximately 45 minutes Inform the patient that the physician in attendance usually interprets the results and explains them to the patient • • • • Electrodiagnostic Tests POTENTIAL COMPLICATIONS 544 Electrocardiography After • P lace the patient in the supine position to rest after the test • Monitor the EKG tracing and record vital signs at poststress intervals until recordings and values return to pretest levels • Remove electrodes and paste TEST RESULTS AND CLINICAL SIGNIFICANCE Coronary artery occlusive disease: Subclinical coronary artery occlusive disease often becomes evident with stress testing Exercise-related hypertension or hypotension: The blood pressure is higher or lower than what is considered normal for the level of exercise Intermittent claudication: As with the coronary system, peripheral vascular stenosis or occlusion may not become evident until the legs are stressed as in an exercise stress test Abnormal cardiac rhythms such as ventricular tachycardia or supraventricular tachycardia: Ectopy may not occur or become symptomatic until the person is stressed RELATED TESTS Cardiac Nuclear Scan (p 791) This test is used to evaluate the heart during stress testing Echocardiography (p 877) This test is also used to evaluate the heart during stress testing Electrocardiography (Electrocardiogram [ECG, EKG]) NORMAL FINDINGS Normal heart rate (60-100 beats/min), rhythm, and wave deflections INDICATIONS This electrodiagnostic test records the electrical impulses that stimulate the heart to contract It is used to evaluate arrhythmias, conduction defects, myocardial injury and damage, hypertrophy— both left and right, and pericardial diseases It is also used to assist in the diagnosis of other noncardiac conditions such as electrolyte abnormalities, drug level abnormalities, and pulmonary diseases TEST EXPLANATION The EKG is a graphic representation of the electrical impulses that the heart generates during the cardiac cycle These electrical impulses are conducted to the body's surface, where they are detected by electrodes placed on the patient's limbs and chest The monitoring electrodes detect the electrical activity of the heart from a variety of spatial perspectives The EKG lead system is composed of several electrodes that are placed on each of the four extremities and at varying sites on the chest Each combination of electrodes is called a lead A 12-lead EKG provides a comprehensive view of the flow of the heart's electrical currents in two different planes There are six limb leads (combination of electrodes on the extremities) and six chest leads (corresponding to six sites on the chest) 545 The limb leads provide a frontal plane view that bisects the body, separating it front to back The chest leads provide a horizontal plane view that bisects the body, separating it top to bottom (Figure 3-2) Leads I, II, and III are considered the standard limb leads Lead I records the difference in electrical potential between the left arm (LA) and the right arm (RA) Lead II records the electrical potential between the RA and the left leg (LL) Lead III reflects the difference between the LA and the LL The right leg (RL) electrode is an inactive ground in all leads There are three augmented limb leads: aVR, aVL, and aVF (a, augmented; V, vector [unipolar]; R, right arm; L, left arm; F, left foot or leg) The augmented leads measure the electrical potential between the center of the heart and the right arm (aVR), the left arm (aVL), and the left leg (aVF) The six standard chest, or precordial, leads (V1, V2, V3, V4, V5, V6) are recorded by placing electrodes at six different positions on the chest, surrounding the heart (The exact locations of the leads are indicated in “Procedure and Patient Care.”) In general, leads II, III, and aVF look at the inferior portion of the heart Leads aVL and I look at the lateral portion of the heart Leads V2 to V4 look at the anterior portion of the heart Electrodiagnostic Tests Electrocardiography A Frontal plane aVL aVR aVR aVL I III aVF I II II III aVF B Horizontal plane V6 V6 V5 V5 V3 V1 V2 V4 V4 V3 V1 V2 Figure 3-2 Planes of reference A, The frontal plane B, The horizontal plane 1166 Index EPO (erythropoietin), 224 EPS (electrophysiologic study), 559 Epstein-Barr virus testing (EBV antibody titer), 217, 218t ERA (estrogen receptor assay), 728 ERCP (endoscopic retrograde cholangiopancreatography), 605, 606f, 742 Erect abdominal film, 1051 ERV (expiratory reserve volume), 1119, 1119f Erythrocyte count, 439 Erythrocyte fragility, 219 Erythrocyte indices, 442 Erythrocyte sedimentation rate (ESR, Sed rate test), 221, 223f Erythropoietin (EPO), 224 Esophageal function studies, 691, 694f Esophageal manometry, 691 Esophageal motility studies, 691 Esophageal pH monitoring, 692 Esophagogastroduodenoscopy (EGD), 608, 609t Esophagogram, 999 ESR (erythrocyte sedimentation rate), 221, 223f Estimated glomerular filtration rate (eGFR), 194, 194t Estradiol, 226 Estradiol receptor, 728 Estriol excretion, 226 Estrogen fraction, 226 Estrogen receptor assay (ERA), 728 Estrone, 226 ESV (end-systolic volume), 1009t Ethanol, 229 Ethyl alcohol, 229 EUG (excretory urography), 1056 Event recorder, 571, 572f–573f Evoked brain potentials, 562 Evoked potential studies (EP studies), 562, 563t, 564f Evoked responses, 562 Excretory urography (EUG), 1056 Exercise stress test, 796 Exercise testing, 540, 540b, 542b Exocrine pancreatic enzymes, 660 Expiratory reserve volume (ERV), 1119, 1119f Extractable nuclear antibody, 79 Extractable nuclear antigen, 79 Extrahepatic ducts, ultrasound of, 868, 870 Exudate, transudate versus, 663t Eye fluorescein angiography of, 1091 ultrasonography of, 886 F F1+2 (prothrombin fragment), 482 FA (fluorescein angiography), 1091 F-actin smooth muscle antibody, 95 Factor assay, 163, 164t–165t, 166f–167f Factor I, 241 Factor V-Leiden (FVL), 231 Fallopian tube computed tomography of, 1025 hysterosalpingography and, 1038 Familial adenomatous polyposis (FAP), 1095–1096 FAP (familial adenomatous polyposis), 1095–1096 Fasting blood sugar (FBS), 253 Fat absorption, 851 Fatty casts, 962, 970 FBS (fasting blood sugar), 253 FDPs (fibrin degradation products), 202, 482 Fe (iron), 322 Febrile agglutinins, 233 Febrile antibodies, 233 Fecal fat test, 851, 852b Fecal immunochemical test (FIT), 857 Fecal occult blood test (FOBT), 857, 858t FEF (forced expiratory flow), 1120 FeNa (fractionated excretion of sodium), 946–947 FEP (free erythrocyte protoporphyrin), 940 Ferritin, 234, 236t Fetal activity determination, 569 Fetal biophysical profile (BPP), 881 Fetal body movements, 882 Fetal breathing movements, 882 Fetal contraction stress test (CST), 566, 567b Fetal effects of radiation exposure, 985 Fetal fibronectin (fFN), 647 Fetal heart rate reactivity, 881–882 Fetal hemoglobin testing, 237 Fetal lung maturity test (FLM), 633 Fetal muscle tone, 882 Fetal nonstress test (NST), 569 Fetal nuchal translucency (FNT), 888 Fetal oxygen saturation monitoring (FSpo2), 1115 Fetal scalp blood pH, 239 Fetoscopy, 612, 613f FEV1 (forced expiratory volume in second), 1119 fFN (fetal fibronectin), 647 Fiberoptic bronchoscopy, 589–590, 590f Fibrin clot formation, 167f Fibrin degradation products (FDPs), 202, 482 Fibrin monomers, 482 Fibrin split products (FSPs), 202, 482 Fibrin stabilizing factor, 164t Fibrinogen, 164t–165t, 166, 168, 241 Fibrinolysin, 394 Fibrinolysis, 167f Fibrinopeptide A (FPA), 482 First morning urine specimen, 904–905 FISH (fluorescence in situ hybridization), 5, 1105 bladder cancer markers and, 914–915 bone marrow biopsy and, 714 in measurement of HER-2 protein, 719 pancreatobiliary, 741 FIT (fecal immunochemical test), 857 Flat plate of abdomen, 1040, 1041f–1042f Flexible fiberoptic scope, 580, 580f FLM (fetal lung maturity test), 633 Flow cytometry, 147 Flow studies, 791, 792t Fluid analysis studies, 630–686 Fluorescein angiography (FA), 1091 Fluorescence in situ hybridization (FISH), 5, 1105 bladder cancer markers and, 914–915 bone marrow biopsy and, 714 Fluorescence in situ hybridization (Continued) in measurement of HER-2 protein, 719 pancreatobiliary, 741 Fluorescent immunoassay, Fluorescent treponemal antibody (FTA), 473, 474b Fluorescent treponemal antibody absorption test (FTA-ABS), 473–474 Fluorodeoxyglucose (FDG), 822 Fluoroscopy, 983, 1015 FNT (fetal nuchal translucency), 888 FOBT (fecal occult blood test), 857, 858t Folate, 242 Folic acid, 242 Follicle-stimulating hormone (FSH), 227, 348 Food ingestion effect on test results, Forced expiratory flow (FEF), 1120 Forced expiratory volume in second (FEV1), 1119 Forced midexpiratory flow, 1119 Forced vital capacity (FVC), 1119 Forensic genetic testing, 1093 FPA (fibrinopeptide A), 482 Fractionated excretion of sodium (FENa), 946–947 Fracture risk assessment (FRAX), 1003–1004 Fragility capillary, 698 red blood cell, 219 Fragment D-Dimer, 202 Framingham Coronary Prediction algorithm, 155, 156b–157b FRAX (fracture risk assessment), 1003–1004 FRC (functional residual capacity), 1119f, 1120 Free cortisol, 920 Free erythrocyte protoporphyrin (FEP), 940 Free kappa and lambda light chains, 911 Free prostate specific antigen, 422, 422t Free thyroxine, 497 Free triiodothyronine, 506 FSH (follicle-stimulating hormone), 227, 348 FSpo2 (fetal oxygen saturation monitoring), 1115 FSPs (fibrin split products), 482 FT4 (thyroxine screen), 497 FTA (fluorescent treponemal antibody), 473, 474b FTA-ABS (fluorescent treponemal antibody absorption test), 473–474 Functional antithrombin III assay, 100 Functional residual capacity (FRC), 1119f, 1120 Functioning thyroid nodule, 839–841 Fungal antibody, 729 Fungitell (fungal antibody), 729, 730t Fusion CT/PET scan, 1022 FVC (forced vital capacity), 1119 FVL (factor V-Leiden), 231 G G6PD quantification (glucose-6-phosphate dehydrogenase), 259, 260b G6PD screen (glucose-6-phosphate dehydrogenase screen), 259, 260b GAD Ab (glutamic acid decarboxylase antibody), 206 1167 GAL-3 (galectin-3), 245 Galectin-3 (GAL-3), 245 Gallbladder computed tomography of, 1025 nuclear scanning of, 796, 798t ultrasonography of, 866, 866t, 868f Gallium scan, 799 Gamma globulin levels, 431 Gamma-glutamyl transferase (GGT), 246 Gamma-glutamyl transpeptidase (GGTP, g-GTP), 246 Gas dilution studies, 1120 Gas exchange studies, 1118–1121 Gastric emptying scan, 801, 802f Gastrin, 248 Gastroesophageal reflux scan (GE reflux scan), 803 Gastrointestinal bleeding scan, 805, 806b Gastrointestinal endoscopy, 580 Gastrointestinal tract computed tomography of, 1025 upper GI series of, 1072, 1074f x-ray visualization of, 1065t Gastroscopy, 608, 609t Gated blood pool scan, 793, 794f GE reflux scan (gastroesophageal reflux scan), 803 Gender effect on test results, Genetic effects of radiation exposure, 985 Genetic testing, 1093 for drug monitoring, 212–215 Genital warts, 731 German measles, 457, 458t GFR (glomerular filtration rate), 193, 194t GGT (gamma-glutamyl transferase), 246 g-GTP (gamma-glutamyl transpeptidase), 246 GGTP (gamma-glutamyl transpeptidase), 246 GH (growth hormone), 269 stimulation test of, 272 suppression test of, 270 GH provocation, 272 GHB (glycosylated hemoglobin), 266, 267t GHb (glycosylated hemoglobin), 266, 267t GI scintigraphy, 805, 806b Gliadin antibodies, 250 Globulin, 424 Glomerular basement antibody, 81 Glomerular filtration rate (GFR), 193, 194t Glucagon, 251 Glucagon stimulation test, 389 Glucose blood, 253 postprandial, 257 urine, 924 Glucose tolerance (GT), 261, 262t, 263f Glucose-6-phosphate dehydrogenase deficiency DNA sequencing (G6PD), 259, 260b Glucose-6-phosphate dehydrogenase screen (G6PD), 259, 260b Glucosuria, 924 Glutamic acid decarboxylase antibody (GAD Ab), 206 Glycan(s), 82 Glycan antibody, 82 Index Index 1168 Index Glycated protein, 266, 267t Glycohemoglobin, 266, 267t Glycosylated hemoglobin (GHb, GHB), 266, 267t GOLPH2 biomarker, 423 Gonorrhea, 756, 759t Goodpasture's antibody, 81 Gram stain, 704 sputum culture and, 761, 762f wound culture and, 777 Granular casts, 962, 969 Granulocyte antibodies, 370, 371b Growth factors, 199 Growth hormone (GH), 269 stimulation test of, 272 suppression test of, 270 GT (glucose tolerance), 261, 262t, 263f Gynecologic procedures, 596t Gynecologic video laparoscopy, 617, 618f, 618t H H pylori, 1101, 1102t HAA (hepatitis-associated antigen), 286, 288t Hageman factor, 164t–165t, 170 HAI (hemagglutination inhibition), 457, 458t Haptoglobin, 274 Hb (hematocrit), 281, 281b hCG (human chorionic gonadotropin), 304, 305t hCG beta subunit (human chorionic gonadotropin), 304, 305t HCO-3 (bicarbonate), 110, 111t, 112, 141 HCS (human chorionic somatomammotropin), 308 Hct (hematocrit), 277, 277b, 278f HCT (human calcitonin), 136 HCY (homocysteine), 301 HDLs (high-density lipoproteins), 154, 342, 342b, 343t Health Insurance Portability and Accountability Act (HIPAA), Heart cardiac catheterization and, 1008, 1009t, 1010f, 1011b, 1012f cardiac stress testing of, 540, 542b computed tomography of, 1031–1032, 1033f, 1034t echocardiography of, 877, 878f, 880f electrophysiologic study of, 559 Holter monitoring of, 571, 572f–573f magnetic resonance imaging of, 1108–1109, 1113–1114 positron emission tomography of, 823 x-ray of, 1019 Heart scan, 791 Heavy metals, 56 Heinz body preparation, 275 Helical CT arteriography, 1022 Helical/spiral CT scan of abdomen and pelvis, 1020 of brain, 1026 of chest, 1029 Helicobacter pylori antigen stool test, 1101 Helicobacter pylori breath test, 1101, 1102t, 1130 Helicobacter pylori testing, 1101, 1102t Hemagglutination, Hemagglutination inhibition (HAI), 457, 458t Hematocrit (Hct), 277, 277b, 278f Heme, 122, 122f Hemoccult slide test, 859 Hemochromatosis, genetic testing for, 1093 Hemochromatosis-associated HFE genes, 1098–1099 Hemoglobin (Hgb, Hb), 281, 281b Hemoglobin A1c (HbA1c), 266, 267t Hemoglobin electrophoresis (Hgb electrophoresis), 284, 285t Hemoglobin F, 284, 285t Hemoglobin M, 359 Hemoglobin S (Hgb S), 464, 465f Hemolytic blood transfusion, 176b Hemorrhagic fever, 1082, 1083t Hemostasis, 164, 167f, 434–435 Heparin cofactor, 100 Heparin-induced thrombocytopenia antibodies, 400 Hepatitis virus studies, 286, 288t Hepatitis-associated antigen (HAA), 286, 288t Hepatobiliary imaging, 796, 798t Hepatobiliary scintigraphy, 796, 798t HER-2 (c erbB2, neu) protein, 717 Hereditary hemochromatosis (HH), 1098–1099 Hereditary nonpolyposis colorectal cancer (HNPCC), 1095–1096, 1096t Heroin, 953 Herpes genitalis, 731 Herpes simplex (HSV), 731 Herpesvirus types and2, 731 Heterophil antibody test, 363 Hex A (hexosaminidase), 290 Hexosaminidase (Hex A), 290 Hgb (hematocrit), 281, 281b Hgb electrophoresis (hemoglobin electrophoresis), 284, 285t Hgb S (hemoglobin S), 464, 465f HGH (human growth hormone), 269 HH (hereditary hemochromatosis), 1098–1099 HIDA scanning, 796, 798t High-density lipoproteins (HDLs, HDL-C), 154, 342, 342b, 343t High-sensitivity C-reactive protein (hs-CRP), 184 HIPAA (Health Insurance Portability and Accountability Act), Histocompatibility leukocyte A antigen, 306, 307t Histone antibodies, 71 HIV drug resistance testing, 292 HIV drug sensitivity testing, 293 HIV genotype, 292 HIV RNA quantification, 294, 295t HIV serologic and virologic testing, 297, 297t, 298t, 299f HIV tropism, 292 HIV viral load, 294, 295t HIV-RNA viral test, 297, 297t, 298t, 299f HLA antigen (human leukocyte antigen), 306, 307t HLA-B27 antigen, 306, 307t HNPCC (hereditary nonpolyposis colorectal cancer), 1095–1096, 1096t Holter monitoring, 571, 572f–573f Homocysteine (HCY), 301 Homovanillic acid (HVA), 975 hPL (human placental lactogen), 308 HPV test (human papillomavirus), 648, 650t hs-CRP (high-sensitivity C-reactive protein), 184 HSV (herpes simplex), 731 5-HT (5-hydroxytryptamine), 462 HTLV-I/II antibody (human T-cell lymphotrophic virus), 310 Human calcitonin (HCT), 136 Human chorionic gonadotropin (hCG, hCG beta subunit), 18, 304 Human chorionic somatomammotropin (HCS), 308 Human epidermal growth factor receptor (HER 2/neu), 718 Human growth hormone (HGH), 269 Human immunodeficiency virus antibody test, 297, 297t, 298t, 299f Human interferon inducible protein10, 199 Human leukocyte A antigen, 306, 307t Human leukocyte antigen (HLA antigen), 306, 307t Human papillomavirus (HPV test), 648, 650t Human placental lactogen (hPL), 308 Human T-cell lymphotrophic virus (HTLV-I/II antibody), 310 HVA (homovanillic acid), 975 Hyaline casts, 962, 970 Hyaluronan binding assay, 672 Hybrid Capture II DNA assay, 649 Hydrocortisone, 179, 920 Hydrogen breath test, 333 3-Hydroxy cotinine, 936 25-Hydroxy vitamin D and D3, 520, 522t Hydroxyapatite stone, 972 17-Hydroxycorticosteroids (17-OCHS), 926 5-Hydroxyindoleacetic acid (5-HIAA), 928 21-Hydroxylase antibodies, 311 17-Hydroxypregnenolone, 29 17-Hydroxyprogesterone, 29 5-Hydroxytryptamine (5-HT), 462 Hypercalcemia, 139–141 Hyperchloremia, 153 Hypercoagulability, 481 Hyperglycemia, 256 Hyperkalemia, 409–411 Hyperlipidemias, 345t Hypernatremia, 467–468 Hyperphosphatemia, 392–393 Hypoalbuminemia, 139 Hypocalcemia, 139, 141 Hypochloremia, 153–154 Hypocoagulability, 481 Hypoglycemia, 256 Hypokalemia, 409–412 Hyponatremia, 467–469 Hypophosphatemia, 393 Hysterosalpingography, 1038 Hysteroscopy, 614, 615f I IAA (insulin autoantibody), 206 IAT (indirect antiglobulin test), 177 IC (inspiratory capacity), 1119f, 1120 ICA (islet cell antibody), 206 ICD-CM (International Classification of Diseases, Clinical Modification), 1–2 1169 Icotest tablets, 125 IDA gallbladder scanning, 796, 798t IF ab (intrinsic factor antibody), 320 IFA (immunofluorescent immunoassay) for herpes simplex virus, 732 for SARS antibodies, 755 skin biopsy and, 760 IFE (immunofixation electrophoresis), 3, 424, 429f, 912 iFOBT (immunochemical fecal occult blood test), 857 IgE antibody test, 49 IGF BP (insulin-like growth factor binding proteins), 270, 317, 318t–319t, 319b IGF-1 (insulin-like growth factor), 270, 317, 318t–319t, 319b IGRA (interferon gamma release assay), 770 IMA (ischemia-modified albumin), 326 Immunoassay, 3–4 Immunochemical fecal occult blood test (iFOBT), 857 Immunoelectrophoresis, Immunofixation electrophoresis (IFE), 3, 424, 429f, 912 Immunofluorescent immunoassay (IFA) for herpes simplex virus, 732 for SARS antibodies, 755 skin biopsy and, 760 Immunoglobulin A, 68–69, 314 Immunoglobulin E, 315 Immunoglobulin G, 68–69, 314 Immunoglobulin M, 68–69, 314–315 Immunoglobulin quantification, 312 Immunohematology, 129f Immunohistochemistry, HER-2 protein, 719 Immunologic antithrombin III, 100 Implantable loop recorder, 571 Indirect antiglobulin test (IAT), 177 Indirect bilirubin, 122, 122f, 125–126 Indirect Coombs test, 177 Indirect IFA antibodies, 197 Indirect immunofluorescence antibody test, 760 Indwelling urinary catheter, 974 Indwelling venous catheter, 18 Infection scan, 844 Infertility screen, 96 Inflammatory scan, 844 Inhalation tests, 1121–1122 Inhibin A, 356 Insomnia, 1124 Inspiratory capacity (IC), 1119f, 1120 Inspiratory reserve volume (IRV), 1119, 1119f Insulin assay, 315 Insulin autoantibody (IAA), 206 Insulin C-peptide, 182 Insulin tolerance (IT), 272 Insulin-like growth factor (IGF-1), 270, 317, 318t–319t, 319b Insulin-like growth factor binding proteins (IGF BP), 270, 317, 318t–319t, 319b Interferon, 199 Interferon gamma release assay (IGRA), 770 Interleukins, 199 International Classification of Diseases, Clinical Modification (ICD-CM), 1–2 International normalized ratio (INR), 434, 436t International System of Units (SI units), Index Index 1170 Index Intestinal bleeding scan, 805, 806b Intracoronary stent, 1010 Intradermal allergy testing, 1080–1081 Intrauterine device (IUD) localization, 875 Intravascular ultrasound (IVUS), 884 Intravenous cholangiography, 1054t Intravenous pyelography (IVP), 1056 Intravenous urography (IUG, IVU), 1056 Intrinsic factor antibody (IF ab), 320 Iodinated dye, allergic reaction to, 985–986, 986t Ionized calcium, 138 Iontophoretic sweat, 678, 680f Iron level (Fe), 322 Iron-building capacity, 235, 236t, 322 IRV (inspiratory reserve volume), 1119, 1119f Ischemia-modified albumin (IMA), 326 Islet cell antibody (ICA), 206 Isoenzymes of alkaline phosphatase, 47 of lactic dehydrogenase, 329, 330t Isonitrile stress test, 791 IT (insulin tolerance), 272 IUD localization (intrauterine device localization), 875 IUG (intravenous urography), 1056 IVP (intravenous pyelography), 1056 IVU (intravenous urography), 1056 IVUS (intravascular ultrasound), 884 J Jaundice, 122–123 Joint aspiration, 640 Joint fluid analysis, 640 K K (potassium) blood, 409 urine, 942 Karyotype, 161, 163t Ketones in urine, 960–961, 963, 968 17-Ketosteroid (17-KS), 477, 929 Ki67 protein, 717 Kidney angiography of, 988, 989f, 992f computed tomography of, 1025 scan of, 829, 830t ultrasonography of, 866, 866t, 867f Kidney, ureter, and bladder x-ray (KUB), 1040, 1041f–1042f Kidney biopsy, 751, 752f Kidney stone analysis, 971 Kleihauer-Betke test, 237 KUB (kidney, ureter, and bladder x-ray), 1040, 1041f–1042f L Laboratory genetics, 1104 Laboratory handling of specimen, 705 Laboratory methods, 2–5 Lactate (lactic acid), 327 Lactate dehydrogenase (LDH), 329, 330t Lactic acid (lactate), 327 Lactic acidosis from iodinated contrast, 986 Lactic dehydrogenase (LDH), 329, 330t Lactoferrin, 853 Lactose breath test, 333 Lactose tolerance test, 332 Lamellar body count, 634 Laminaribioside carbohydrate antibody, 82 LAP (leucine aminopeptidase), 337 Laparoscopy, 617, 618f, 618t Laparotomy, 617–618, 618t Laryngoscopy, 588 Lasix renal scan, 832 Lateral view in chest x-ray, 1015, 1017f Latex agglutination, LATS (long-acting thyroid stimulator), 491 LBCC (liquid-based cervical cytology), 743 LDLs (low-density lipoproteins), 154, 342, 342b, 343t–345t Lead, 334 Leads in echocardiogram, 880f in electrocardiogram, 544, 545f, 548f Lecithin and sphingomyelin ratio, 633–634 LEEP cervical biopsy (loop electrosurgical excision procedure), 720 Legionnaire's disease antibody, 336 Leiden factor, 231 Leucine aminopeptidase (LAP), 337 Leukocyte count, 526, 526b–527b, 528f–529f, 532t Leukocyte esterase (WBC esterase), 960, 964, 968 Leukocyte scan, 844 LH (luteinizing hormone), 227, 348, 417 Lipase, 339 Lipid fractionation, 342, 342b, 343t–345t Lipid profile, 342, 342b, 343t–345t Lipocalin-2, 372 Lipoprotein (a) (Lp(a)), 106, 107t Lipoprotein electrophoresis, 342, 342b, 343t–345t Lipoprotein phenotyping, 342, 342b, 343t–345t Lipoprotein-associated phospholipase A2 (Lp-PLA2), 185, 341 Lipoproteins, 342, 342b, 343t–345t Liquid phase hybridization, 4–5 Liquid-based cervical cytology (LBCC), 743 Liver biopsy of, 734, 735f computed tomography of, 1025 magnetic resonance imaging of, 1109 scan of, 808, 810f ultrasonography of, 866, 866t Liver/spleen scanning, 808, 810f Long bone x-ray, 1006 Long-acting thyroid stimulator (LATS), 491 Loop electrosurgical excision procedure (LEEP cervical biopsy), 720 Low-density lipoproteins (LDLs, LDL-C), 154, 342, 342b, 343t–345t Lower GI series, 994, 995f, 998b Lower-extremity arteriography, 988 Lp(a) (Lipoprotein (a)), 106, 107t Lp-PLA2 (lipoprotein-associated phospholipase A2), 341 Lumbar myelogram, 1048 Lumbar puncture and cerebrospinal fluid examination, 651, 653f, 654t–655t Lumbar spine, magnetic resonance imaging of, 1109, 1110f Lumbar x-ray, 1067 Lung biopsy of, 738, 740f computed tomography of, 1031 pulmonary function tests and, 1117, 1119f scan of, 811, 812b, 813f–814f x-ray of, 1018–1019 Lung capacity, 1118 Lupus anticoagulant, 68 Luteinizing hormone (LH), 227, 348, 417 Lutropin, 348 Lyme disease, 350 Lymphocyte count, 526, 526b–527b, 528f–529f, 532t Lymphocyte immunophenotyping, 147 Lymphoscintigraphy, 837 M MA (microalbumin), 931 Macroprolactin, 419 Macular degeneration, 38 Magnesium (Mg), 352 Magnesium ammonium phosphate stone (struvite), 972 Magnetic resonance angiography (MRA), 1107–1108 Magnetic resonance cholangiopancreatography (MRCP), 1109, 1114 Magnetic resonance enterography (MRE), 1109, 1114 Magnetic resonance imaging (MRI), 1106, 1108f, 1110f, 1112f Magnetic resonance spectroscopy (MRS), 1107 Magnetoencephalography (MEG), 550 MammaPrint, 1086 Mammary ductoscopy, 603, 603f Mammogram, 1043, 1045f–1046f, 1048f Mammography, 1043, 1045f–1046f, 1048f Mannobioside carbohydrate antibody, 82 Manometric studies, 1078, 687–702 Mantoux test, 1126 Marijuana (cannabis), 953 Maternal quadruple screen, 354 Maternal screen testing, 354 Maternal triple screen, 354 Maximal breathing capacity, 1119 Maximal midexpiratory flow (MMEF), 1119 Maximal volume ventilation (MVV), 1119 MCH (mean corpuscular hemoglobin), 442 MCHC (mean corpuscular hemoglobin concentration), 442 MCV (mean corpuscular volume), 442 MDCT (multidetector CT), 1021, 1033f MDRD study equation (Modification of Diet in Renal Disease), 194 M/E ratio (myeloid to erythroid ratio), 714 Mean corpuscular hemoglobin (MCH), 442 Mean corpuscular hemoglobin concentration (MCHC), 442 Mean corpuscular volume (MCV), 442 Mean plasma glucose level (MPG), 267, 267t Mean platelet volume (MPV), 407 Measles, 459 Meckel diverticulum nuclear scan, 815 1171 Mediastinoscopy, 621 Mediastinum computed tomography of, 1032 x-ray of, 1019 MEG (magnetoencephalography), 550 Megakaryocytes, 402 Melanoma, genetic testing for, 1093 Meninges, magnetic resonance imaging of, 1107 Mesenteric angiography, 988 Metabolic acidosis, 112t, 117 Metabolic alkalosis, 112t, 115 Metanephrine, 357, 975 Methamphetamine, 953 Methemoglobin, 359 Methylated septin (mSEPT9), 460 Methylmalonic acid (MMA), 518 Metyrapone, 36 Mg (magnesium), 352 MIBC scintigraphy, 817 Microalbumin (MA), 931 Microalbuminuria, 932 Microarray analysis, 4–5 Microarray FISH testing, 1105 Microarray genetic testing, 1105 Microglobulin, 360, 933 Microsatellite instability (MSI), 724 Microscopic examination of urine sediment, 961 Microsomal antibody, liver/kidney, 83 Microsomal thyroid antibody, 104 Microviscosity, 634 Microvolt T-wave alternans (MTWA), 547 Midstream urine specimen, 906, 974 Minute ventilation, 1120 Minute volume (MV), 1120 Miraluna scan, 789 Mitochondrial antibodies, 84 MMA (methylmalonic acid), 518 MMEF (maximal midexpiratory flow), 1119 M-mode echocardiography, 877 M-mode scan, 862 MMR (DNA mismatch repair genetic testing), 724 Modification of Diet in Renal Disease (MDRD) study equation, 194 Modified albumin, 326 Molecular genetics, 1105 Monocyte count, 526, 526b–527b, 528f–529f, 532t Mononuclear heterophil test, 363 Mononucleosis rapid test, 363 Monospot test, 363 Morphine, 953 MPG (mean plasma glucose level), 267, 267t MPO (myeloperoxidase antibody), 87 MPV (mean platelet volume), 407 MRA (magnetic resonance angiography), 1107–1108 MRCP (magnetic resonance cholangiopancreatography), 1109, 1114 MRE (magnetic resonance enterography), 1109, 1114 MRI (magnetic resonance imaging), 1106, 1108f, 1110f, 1112f MRI myelogram, 1109 MRS (magnetic resonance spectroscopy), 1107 mSEPT9 (methylated septin 9), 460 Index Index 1172 Index MSI (microsatellite instability testing), 724 MSLT (multiple sleep latency tests), 1123 MTWA (microvolt T-wave alternans), 547 Mucin clot test, 641 MUGA scan (multi-gated acquisition scan), 791, 792t, 794f Multi Gated Acquisition Scan (MUGA scan), 791, 794f Multidetector CT (MDCT), 1033, 1033f Multipanel drug screen, 949t Multiple sclerosis antibody panel, 82 Multiple sleep latency tests (MSLT), 1123 Multiple wake test (MWT), 1123 Mutation analysis, 231 MV (minute volume), 1120 MVV (maximal volume ventilation), 1119 MWT (multiple wake test), 1123 Myasthenia gravis, 23 Mycobacterium tuberculosis culture, 683 Mycoplasma pneumoniae antibodies, 364 Mycoplasma pneumoniae serum antibodies, 171 Myelogram, 1048, 1109 Myelography, 1048 Myeloid to erythroid ratio (M/E ratio), 714 Myeloperoxidase antibody (MPO), 87 Myocardial antibody, 86 Myocardial nuclear stress testing, 792 Myocardial perfusion imaging, 791, 792t Myocardial perfusion scan, 791 Myocardial scan, 791 Myoglobin, 365 N Na (sodium) in urine, 946 NAAT (nucleic acid amplification for TB), 770 NAATs (nucleic acid amplification tests), 299 Narcolepsy, 1124 Narcotic alkaloids, 953 Nasal culture, 765, 765f Nasopharyngeal swab, 755 Nasopharyngeal wash/aspirate, 755 NAT (nucleic acid testing), 756–757 National Institute of Health on mammography, 1043–1044 Native double-stranded DNA, 78 Natriuretic peptides, 367 NCS (nerve conduction studies), 573 Neonatal screening, 374 Neonatal stool test, 848 Nephelometry, Nephrotoxicity of contrast medium, 984b Nerve conduction studies (NCS), 573 Neural tube defect, 160 Neuroendocrine nuclear scan, 817 Neuron-specific enolase (NSE), 369 Neutrophil antibodies, 370, 371b Neutrophil antibody screen, 370, 371b Neutrophil count, 526, 526b–527b, 528f–529f, 532t Neutrophil cytoplasmic antibody, 87 Neutrophil gelatinase-associated lipocalin (NGAL), 372 Newborn metabolic screening, 374 Nicotine and metabolites, 936 Nipple discharge fluid analysis, 643 Nipple stimulation technique, 567 Nitrites in urine, 960, 968 NMP22 (nuclear matrix protein 22), 914 NMRI (nuclear magnetic resonance imaging), 1106, 1108f, 1110f, 1112f Nonfunctioning thyroid nodule, 839–841 Non-HDL cholesterol, 342, 342b, 343t Noninvasive prenatal paternity testing, 1099–1100 Nonstress test, fetal, 569 Norepinephrine, 975 Normetanephrine, 975 Nornicotine, 936 Nose culture, 765, 765f NSE (neuron-specific enolase), 369 NST (fetal nonstress test), 569 N-telopeptide (NTx), 915 N-terminal fragment of pro-brain (B-type) natriuretic peptide (NT-pro-BNP), 368 NT-pro-BNP (N-terminal fragment of pro-brain (B-type) natriuretic peptide), 368 NTx (N-telopeptide), 915 Nuclear antibody, 88, 89t–90t, 91f Nuclear imaging of breast, 789 of kidney, 829, 830t of pancreatobiliary system, 1054t Nuclear magnetic resonance imaging (NMRI), 1106, 1108f, 1110f, 1112f Nuclear matrix protein 22 (NMP22), 914 Nuclear peptide scanning, 817 Nuclear stress test, 540, 791, 792t Nucleic acid amplification for TB (NAAT), 770 Nucleic acid amplification tests (NAATs), 299 Nucleic acid testing (NAT), 756–757 5'-Nucleotidase, 376 O O2 content (oxygen content), 110, 113 O2 saturation (oxygen saturation), 110, 112–113 Oblique view in chest x-ray, 1015 Obstetric echography, 887, 890f Obstetric ultrasonography, 887, 890f Obstruction series, 1051 Obstructive sleep apnea, 1124–1125 OCT (oxytocin challenge test), 566 Octreotide scan, 817 Ocular photography, 1091 Ocular ultrasonography, 886 Oculovestibular reflex study, 538 OF (osmotic fragility), 219 OGT (oral glucose tolerance), 261, 262t, 263f, 316 OMT (oral mucosal transudate), 298–299 Oncotype DX Colon Cancer Assay, 724 Oncotype DX genotyping, 1086 1,25(OH)2 D (1,25-Dihydroxyvitamin D), 520, 522t One-hour glucose screen for gestational diabetes mellitus, 257 O&P (ova and parasites), 855 Open lung biopsy, 740 Operative cholangiography, 1070 Operative endoscopy, 582 Oral cholecystography, 1054t Oral glucose tolerance (OGT), 261, 262t, 263f, 316 Oral mucosal transudate (OMT), 298–299 Orbit ultrasonography, 886 Oropharyngeal culture, 758 Oropharyngeal swab, 755 Osmolal gap, 379 Osmolality blood, 378 urine, 938 Osmotic fragility (OF), 219 Osteocalc, 915 Osteocalcin, 915 Osteopenia, 1002 Osteoporosis, 1002 O'Sullivan test, 257, 263 Ova and parasites (O&P), 855 Ovarian cancer genetic testing, 1093, 1095b Ovary, computed tomography of, 1025 Oximetry, 1114, 1117f Oxygen content (O2 content), 110, 113 Oxygen saturation (O2 saturation), 110, 112–113, 1114 Oxytocin challenge test (OCT), 566 P P (phosphorus), 391 P wave, 546, 546f p24 direct serologic antigen assay, 297, 297t, 298t, 299f p53 protein, 717 PAB (prealbumin), 412 Pacing, 540b, 542 Packed cell volume (PCV), 277, 277b, 278f Packed red blood cell volume, 277, 277b, 278f PAI-1 (plasminogen activator inhibitor antigen/activity), 396 Pancreas computed tomography of, 1025 ultrasonography of, 866, 866t Pancreatic enzymes, 660 Pancreatic secretory test, 660 Pancreatobiliary system diagnostic tests of, 983 FISH testing of, 741 ultrasonography of, 866, 866t PAP (prostatic acid phosphatase), 25 Papanicolaou test (Pap test), 743, 747f, 759 human papillomavirus test and, 649 PAPP-A (pregnancy-associated plasma protein-A), 414 PapSpin, 745 Paracentesis, 662, 663t Parasomnias, 1124 Parathormone, 380 Parathyroid hormone (PTH), 380 Parathyroid scan, 818 Parathyroid scintigraphy, 818 Parentage analysis, 1093 Parietal cell antibody, 92 Parotid gland nuclear imaging, 834, 835t Partial thromboplastin time (PTT), 383 Partial thromboplastin time, activated (aPTT), 383 1173 Parvovirus B19 antibody, 386 Patch test, 1080, 1082 Paternity genetic testing, 1093 Patient care during test, Patient education, Patient identification, Patient preparation, 6–8 PCA3 (prostate cancer gene 3), 423 PChE (pseudocholinesterase), 159 PC-MRI (phase-contrast magnetic resonance imaging), 1109 PCO2 (arterial carbon dioxide tension), 110–112, 111t PCP (phencyclidine), 953 PCR (polymerase chain reaction assay), 4–5 for herpes simplex virus, 732 PCS (Procedure Coding System), 1–2 PCT (platelet closure time), 404, 405f, 406t PCV (packed cell volume), 277, 277b, 278f Peak expiratory flow rate (PEFR), 1120 Peak inspiratory flow rate (PIFR), 1120 Peak level of drug, 21 PEFR (peak expiratory flow rate), 1120 Pelvic endoscopy, 617, 618f, 618t Pelvic floor sphincter electromyography, 576 Pelvic ultrasonography, 887, 890f Pelvis, computed tomography of, 1020, 1020f, 1024f PEM (positron emission mammography), 825 Pentagastrin stimulation, 137 Pepsinogen, 387 Percutaneous needle biopsy of kidney, 751–752, 752f of lung, 740 for pleural fluid, 748 Percutaneous transhepatic cholangiography (PTC,PTHC), 1053, 1054t, 1055f Percutaneous transluminal coronary angioplasty, 1010 Perflutren (DEFINITY), 879, 879 Perfusion scan, 814 Pericardiocentesis, 667, 669f Perinuclear ANCA (p-ANCA), 87 Peripheral blood smear, 710 Peritoneal fluid analysis, 662 Peritoneal tap, 662 Peritoneoscopy, 617, 618f, 618t Peritoneum, computed tomography of, 1026 PET (positron emission tomography), 821, 821f, 822t, 823f–825f PET mammography, 825 PET/CT co-registration, 822, 823f PET/CT image fusion, 822, 823f PET/CT scan, 822, 823f PFTs (pulmonary function tests), 1117, 1119f PgR (progesterone receptor assay), 750 pH, 109–111, 111t fetal scalp blood, 239 pleural fluid, 684 urine, 958–959, 963, 966 Pharmacogenetics, 212–215 Pharyngeal culture, 765, 765f Phase-contrast magnetic resonance imaging (PC-MRI), 1109 Phencyclidine (PCP), 953 Phenotyping, alpha1-antitrypsin, 52 Index Index 1174 Index Phenylketonuria (PKU), 374 Pheochromocytoma suppression and provocative testing, 389 Phlebography, 1076 Phosphate (PO4), 391 Phosphate crystals in urine, 961 Phosphatidylglycerol, 634 Phosphatidylinositol antigen (PI-linked antigen), 393 Phosphorus (P), 391 Photostimulation in electroencephalography, 551 PIB (Pittsburgh Agent B), 639 PIFR (peak inspiratory flow rate), 1120 PINP (amino-terminal propeptide of type procollagen), 915 Pittsburgh Agent B (PIB), 639 PKU (phenylketonuria), 374 PLAC test (lipoprotein-associated phospholipase A2), 341 Plague, 1082, 1083t Plain film of abdomen, 1040, 1041f–1042f Plain radiography, 983 Plasma, 15 Plasma ammonia, 59 Plasma free metanephrine, 357 Plasma renin activity (PRA), 447 Plasma renin assay, 447, 448f, 448t Plasma renin concentration (PRC), 447 Plasma thromboplastin antecedent, 164t Plasminogen, 394 Plasminogen activator inhibitor antigen/activity (PAI-1), 396 Platelet aggregation, 398 Platelet antibody, 399 Platelet closure time (PCT), 404, 405f, 406t Platelet count, 401 Platelet examination, 711 Platelet function assay, 404, 405f, 406t Platelet volume, mean, 407 Pleocytosis, 654 Plethysmography, arterial, 695 Pleural biopsy, 748 Pleural fluid analysis, 681, 682f Pleural fluid antinuclear antibody, 684 Pleural tap, 681, 682f Ploidy (DNA index), 718 PMN ab (polymorphonucleocyte antibodies), 370, 371b PO2 (arterial oxygen tension), 110, 112 PO4 (phosphate), 391 Poisoning testing, 951, 952t Polymerase chain reaction AFB smear, 768 Polymerase chain reaction assay (PCR), 4–5 for herpes simplex virus, 732 Polymorphonucleocyte antibodies (PMN ab), 370, 371b Polysomnography (PSG), 1123 Porphobilinogens, 940 Porphyria, 940–941 Porphyrin(s), 940 Porphyrin fractionation, 941 Positron emission mammography (PEM), 825 Positron emission tomography (PET), 821, 821f, 822t, 823f–825f Postcoital cervical mucus, 676 Posteroanterior view in chest x-ray, 1015, 1016f Postprandial glucose, 257 Posttest care, Posture effect on test results, Potassium (K) blood, 409 urine, 942 PPD test (purified protein derivative), 771–772, 1126, 1127b–1128b PR interval, 546, 546f PRA (plasma renin activity), 447 PRA (progesterone receptor assay), 750 PRC (plasma renin concentration), 447 Prealbumin (PAB), 412 Precipitation, Precordial leads, 545, 545f Pregnancy as contraindication for x-ray studies, 985 effect on test results, fetal contraction stress test during, 566, 567b pelvic ultrasonography in, 887, 890f Pregnancy test, 304, 305 in sexual assault testing, 675 Pregnancy-associated plasma protein-A (PAPP-A), 414 Pregnanediol, 944 Pregnant uterus ultrasonography, 887, 890f Pregnenolone, 29 Preoperative mammogram localization, 1045 Pretest preparation procedures, 6–7 Prick-puncture test, 1080–1081 Privacy Rule, PRL (prolactin level), 418 Proaccelerin, 164t–165t, 169 Probe DNA, 4–5 pH, 692 ultrasound, 865, 865f vaginal, 889 Procedure Coding System (PCS), 1–2 Processing of specimen, Proconvertin stable factor, 164t–165t, 169 Proctoscopy, 623 Progesterone assay, 416 Progesterone receptor assay (PRA,PgR), 750 Proinsulin C-peptide, 182 Prolactin level (PRL), 418 Prolonged DS test, 204 ProstaScint scan, 827 Prostate computed tomography of, 1025 sonography of, 891, 891f Prostate cancer gene (PCA3), 423 Prostate cancer specific biomarkers, 423 Prostate scan, 827 Prostate-specific antigen (PSA), 420, 421b, 422t Prostate-specific proteins, 422–423 Prostatic acid phosphatase (PAP), 25 Prostatic specific membrane antigen, 422–423 Protein, 424, 426t, 427f–429f in urine, 959–960, 963, 966 Protein C, 432 Protein electrophoresis, 424, 426t, 912 Protein S, 432 Proteinuria, 959–960 Prothrombin, 164t–165t, 166, 169 Prothrombin fragment (F1+2), 482 Prothrombin time (PT), 434, 436t Pro-Time, 434 Protoporphyrin, 940 PSA (prostate specific antigen), 420, 421b, 422t Pseudocholinesterase (PChE), 159 PSG (polysomnography), 1123 PT (prothrombin time), 434, 436t PTC (percutaneous transhepatic cholangiography), 1053, 1054t, 1055f PTH (parathyroid hormone), 380 PTHC (percutaneous transhepatic cholangiography), 1053, 1054t, 1055f PTT (partial thromboplastin time), 383 Pulmonary artery pressure, 1009t Pulmonary embolism, 811, 812b Pulmonary endoscopy, 580 Pulmonary function tests (PFTs), 1117, 1119f Pulmonary scan, 811, 812b, 813f–814f Pulmonary wedge pressure, 1009t Pulse oximetry, 113, 1114, 1117f Punch biopsy, cervical, 720 Purified protein derivative (PPD), 771–772, 1126, 1127b– 1128b PYD (pyridinium crosslinks), 915 Pyelography, 1056 Pyridinium crosslinks (PYD), 915 Q QCT (quantitative computed tomography), 1003 QFT-G (QuantiFERON-TB Gold), 770 QRS complex, 546, 546f QT interval, 546, 546f Qualitative fetal hemoglobin stool test, 848 QuantiFERON-TB Gold (QFT, QFT-G, TB gold test, TB blood test), 770 Quantitative computed tomography (QCT), 1003 Quantitative fibrinogen, 241 Quantitative stool fat determination, 851 Queckenstedt-Stookey test, 658 R R factor, 66 Rabies-neutralizing antibody, 438 Race effect on test results, Radiation exposure, 985 Radioallergosorbent test (RAST), 49 Radioimmunoassay (RIA), Radioimmunoscintigraphy (RIS), 827 Radiology principles, 982 Radionuclide(s), 780, 822t Radionuclide renal imaging, 829, 830t Radiopharmaceuticals, 780 Radiorenography, 829, 830t Random urine specimen, 905 Rape testing, 674, 675b Rapid Antigen Detection Test (strep screen), 766 Rapid DS test, 204 Rapid eye movement disorder, 1124 1175 Rapid plasma reagin (RPR), 473, 474b Rapid urease test, 1101 RAST (radioallergosorbent test), 49 RBC count (red blood cell count), 439 RBC indices (red blood cell indices), 442, 443b RBC smear, 710 RBC volume, 843 Real-time imaging, ultrasound, 862 Real-time polymerase chain reaction assay, Rectal EMG procedure, 576 Rectal sonography, 891, 891f Red blood cell cholinesterase, 159 Red blood cell count (RBC count), 439 Red blood cell distribution width (RDW), 442 Red blood cell fragility, 219 Red blood cell indices (RBC indices), 442, 443b Red blood cell morphology, 710 Red blood cell scan, 843 Red blood cell volume, 843 Red blood cells in urine, 962–965, 970 Renal angiography, 988, 989f, 992f Renal biopsy, 751, 752f Renal blood flow (perfusion) scan, 830 Renal calculus analysis, 971 Renal function scan (renogram), 830–831 Renal function studies, 191 Renal hypertension scan, 831 Renal obstruction scan, 831–832 Renal scanning, 829, 830t Renal structural scan, 830 Renal tubular casts, 962 Renal vein assay, 448–449 Renin activity, 447 Renin assay, 447, 448f, 448t Renography, 829, 830t Reporting of test results, 9–10 Residual volume (RV), 1119, 1119f Respiratory acidosis, 112t, 117 Respiratory alkalosis, 112t, 116–117 Respiratory virus panel, 774 Retic count, 452 Reticulocyte count, 452 Retinol-binding protein, 360, 933 Retrograde pyelography, 1056 Retroperitoneum, computed tomography of, 1025–1026 Reverse transcriptase polymerase chain reaction assay (RT PCR), for SARS virus, 755 in virus testing, 774, 775b RF (rheumatoid factor), 454, 455f Rh factor, 128 Rh immunoglobulin, 238 Rh isoimmunization, 635 Rheumatoid arthritis (RA) factor, 454, 455f Rheumatoid factor (RF), 454, 455f RhoGAM, 238 RIA (radioimmunoassay), Ribonucleotideprotein antibody, 79 Ribosomal P Ab (ribosome P antibodies), 456 Ribosome P antibodies (ribosomal p Ab), 456 Rigid mediastinoscope, 621 Index Index 1176 Index Rigid metal scope, 580 RIS (radioimmunoscintigraphy), 827 RNA polymerase III antibody, 93 Routine void specimen, 906 RPR (rapid plasma reagin), 473, 474b RT PCR (reverse transcriptase polymerase chain reaction assay), for SARS virus, 755 in virus testing, 774, 775b Rubella antibody, 457, 458t Rubeola antibody, 459 RV (residual volume), 1119, 1119f S Saccharomyces cerevisiae antibody, 82 SACE (serum angiotensin converting enzyme), 64 Sacral x-ray, 1067 SAEKG (signal-averaged electrocardiogram), 547 Saliva alcohol testing, 230 Salivary cortisol, 179 Salivary glands nuclear imaging of, 834, 835t sialography of, 1060 SARS viral testing, 754 SBF (small bowel follow-through), 1064, 1065t sBPP (soluble amyloid beta protein precursor), 639 SCC antigen (squamous cell carcinoma antigen), 469 Scheduling of tests, 5–6 Schick test, 1128b Scintigram, 780 Scintimammography, 789 Scl-70 antibody (antiscleroderma antibody), 93 Scleroderma antibody, 93 Scout film, 1040, 1041f–1042f Scratch test, 1080–1081 Scrotal nuclear imaging, 836 Scrotal scan, 836 Scrotal ultrasonography, 893 SDFA (sperm DNA fragmentation assay), 672 Sed rate test, 221, 223f Sedimentation rate, 221, 223f Segmented gradient gel electrophoresis (SGGE), 343 Semen analysis, 671 Semen examination, 671 Sentinel lymph node biopsy (SLNB), 837 Septin DNA methylation assay, 460 Sequencing of tests, 5–6 Sequential maternal screening, 356 Serine protease antibody, 87 Serine protease inhibitor, 100 Serologic test for syphilis (STS), 473, 474b Serology for group A streptococcus, 766 for Helicobacter pylori, 1102t, 1103 for herpes simplex virus, 732 for human immunodeficiency virus, 297, 297t, 298t, 299f for syphilis, 656 for tuberculosis, 771–772, 771t Serotonin, 462 SERs (somatosensory-evoked responses), 562, 563t Serum, 15 Serum aldolase, 41 Serum aluminum, 56 Serum amylase test, 61 Serum angiotensin converting enzyme (SACE), 64 Serum calcium test, 138–139 Serum CO2 test, 141 Serum complement, 172 Serum cortisol assay, 179 Serum creatinine, 190, 192b Serum ferritin, 234, 236t Serum glucose, 254 Serum glutamic oxaloacetic transaminase (SGOT), 119 Serum glutamic-pyruvic transaminase (SGPT), 39 Serum iron, 235, 236t, 322 Serum methylmalonic acid, 519 Serum osmolality, 378 Serum protein electrophoresis (SPEP), 424, 426t, 427f–428f Serum protein quantification, 312 Serum urea nitrogen, 511 Sestamibi cardiac scan, 791 Severe acute respiratory syndrome viral testing, 754 Sexual assault testing, 674, 675b Sexually transmitted disease testing (STD culture), 756, 758f, 759t SGGE (segmented gradient gel electrophoresis), 343 SGOT (serum glutamic oxaloacetic transaminase), 119 SGPT (serum glutamic-pyruvic transaminase), 39 SH (somatotropin hormone), 269 SI units (International System of Units), Sialography, 1060 Sickle cell screen, 464, 465f Sickledex, 464, 465f Sigmoidoscopy, 623 Signal-averaged electrocardiogram (SAEKG), 547 Simple cervical biopsy, 720 Sims-Huhner test, 676 Single tracer double phase test (STDP), 819 Single-photon emission computerized tomography, 787, 800 Sinus endoscopy, 625, 626f SjÖgren antibodies, 98 Skin biopsy, 760 Skin biopsy antibodies, 760 Skin immunohistopathology, 760 Skin testing for allergies, 1079, 1128b for tuberculosis, 1126, 1127b–1128b, 1129f Skull x-ray, 1062, 1062f–1063f Sleep apnea, 1124 Sleep electroencephalography, 551 Sleep studies, 1123, 1125t Sleep-screening study, 1124 SLNB (sentinel lymph node biopsy), 837 SMA (smooth muscle antibodies), 83 Small bowel enema, 1064, 1065t Small bowel follow-through (SBF), 1064, 1065t Smallpox, 1082, 1083t Smear acid-fast bacilli, 706 blood, 710 Pap, 649 Smith antibody, 79 Smooth muscle antibodies (SMA), 83 Sodium (Na) blood, 466 urine, 946 Soft tissue culture and sensitivity, 776, 778f Soluble amyloid beta protein precursor (sBPP), 639 Somatic effects of radiation exposure, 985 Somatomedin C, 270, 317, 318t–319t, 319b Somatosensory-evoked responses (SERs), 562, 563t Somatotropin hormone (SH), 269 Specific gravity of urine, 960, 964, 967 Specimen collection of, laboratory handling of, 705 transport of, SPEP (serum protein electrophoresis), 3, 424, 426t, 427f–428f Sperm agglutination and inhibition, 96 Sperm antibodies, 96 Sperm count, 671 Sperm DNA fragmentation assay (SDFA), 672 Sperm DNA integrity, 672 Sperm examination seminal cytology, 671 Sperm penetration assay, 672 Spermatozoa antibody, 96 S-phase fraction, 717 Spinal puncture, 651, 653f, 654t–655t Spinal tap, 651, 653f, 654t–655t Spinal x-ray, 1067, 1068f Spine, magnetic resonance imaging of, 1109, 1110f SPINK1 biomarker, 423 Spirometry, 1118, 1121 Spleen computed tomography of, 1025 scan of, 808, 810f Sputum culture and sensitivity, 722b, 761, 762f, 774–775 Sputum cytology, 763 SQID (superconducting quantum interference device), 550 Squamous cell carcinoma antigen (SCC antigen), 469 SS antibody, 98 ST segment, 546, 546f Stable factor, 164t–165t, 169 Standard limb leads, 545, 545f Standard precautions, 5, 6b Static scanning, 780–781 STD culture (sexually transmitted disease testing), 756, 758f, 759t STDP (single tracer double phase test), 819–820 Steal syndrome, 541 Stereotactic biopsy of breast, 1045–1046 Stomach scan, 801, 802f Stool for occult blood, 857 for reducing agents, 858 for swallowed blood, 848 Stool culture, 855 Stool fat, 851, 852b Stool tests, 847–860 Strep test (Rapid Antigen Detection Test), 766 Strept screen, 472 Streptococcus group B antigen detection, 470 1177 Streptococcus serologic testing, 470 Streptozyme, 470 Stress testing, 540 Stroke volume (SV), 1009t Structural renal scan, 833 Struvite stone, 972 STS (serologic test for syphilis), 473, 474b Stuart factor, 164t–165t, 170 Submandibular gland scan, 834, 835t Submaxillary gland scan, 834, 835t Substance abuse testing, 948, 949t, 950f Sugar, blood, 253 Superconducting quantum interference device (SQID), 550 Supine abdominal x-ray, 1051 Suprapubic aspiration of urine, 907, 975 SV (stroke volume), 1009t Swallowing examination, 1069 Sweat electrolytes, 678, 680f Synovial fluid analysis, 640 Syphilis, serology for, 656 Syphilis detection, 473, 474b Systolic left ventricular pressure, 1009t T T lymphocyte, 147 T scores, 1003 T wave, 546, 546f T3 by RIA (total T3 radioimmunoassay), 506 Tablet test, 859 Tandem mass spectrometry, 374 Tape test, 856 Tartrate-resistant acid phosphatase (TRAP), 25 Tau protein, 639 Tay-Sachs disease genetic testing for, 1093 hexosaminidase test for, 290 TB antibody, 770 TB smear, 768 TB testing (tuberculosis testing), 770 TBG (thyroxine-binding globulin), 495 TBII (thyroid-binding inhibitory immunoglobulin), 491 TBPA (thyroxine-binding prealbumin), 412 TDM (therapeutic drug monitoring), 297t, 211, 213b, 213t–214t TDx fetal lung maturity test (FLM), 633 TEE (transesophageal echocardiography), 897, 898f Terrorism, 1082, 1083t Testicle ultrasound, 893 Testicular imaging, 836 Testosterone, 476 Tetrahydrocannabinol (THC), 953 TfR (transferrin receptor assay), 502, 503t Tg (thyroglobulin), 484 TGs (triglycerides), 504 Thallium scan, 791, 793f THC (tetrahydrocannabinol), 953 Therapeutic bronchoscopy, 587 Therapeutic drug monitoring (TDM), 297t, 211, 213b, 213t–214t ThinPrep, 745 Index Index 1178 Index Thiopurine methyltransferase gene mutation testing (TPMT), 215 Thoracentesis and pleural fluid analysis, 681, 682f Thoracic x-ray, 1067, 1068f Thoracoscopic biopsy of lung, 740–741 Thoracoscopy, 627 pleural biopsy and, 748 Three-D mammography, 1046 Three-D volumetric imaging, 1021, 1030 Three-dimensional echocardiography, 877 Three-dimensional ultrasound, 863, 864f Throat culture, 765, 765f Thrombin antibody, 100 Thrombocyte count, 401 Thrombocytopenia, 402–404 Thrombocytosis, 402–404 Thromboelastography, 479, 480f Thromboelastometry, 479, 480f Thromboplastin, 164t Thrombosis indicators, 482 Thyretin, 412 Thyrocalcitonin, 136 Thyrogen-stimulating thyroglobulin, 484 Thyroglobulin (Tg), 484 Thyroglobulin antibody, 102, 103t Thyroid antithyroglobulin antibody, 102, 103t Thyroid autoantibody, 102, 103t, 104 Thyroid cancer, genetic testing for, 1093 Thyroid echography, 895, 896f Thyroid microsomal antibody, 104 Thyroid peroxidase antibody, 104 Thyroid scanning, 839, 840f Thyroid sonography, 895, 896f Thyroid ultrasonography, 895, 896f Thyroid-binding globulin, 495 Thyroid-binding inhibitory immunoglobulin (TBII), 491 Thyroid-stimulating hormone (TSH), 486 stimulation test of, 489 Thyroid-stimulating immunoglobulins (TSI), 491 Thyrotropin, 486 Thyrotropin receptor antibody, 491 Thyrotropin-releasing factor stimulation test (TRF), 492, 493t Thyrotropin-releasing hormone stimulation test (TRH), 492, 493t Thyroxine, total and free (T4), 497 Thyroxine screen, 497 Thyroxine-binding globulin (TBG), 495 Thyroxine-binding prealbumin (TBPA), 412 TIBC (total iron-building capacity), 322 Tidal volume (TV or VT), 1119, 1119f Tilt-table testing, 697 Timed urine collection, 905, 905b Tissue factor, 164t Tissue transglutaminase antibodies, 250 TLC (total lung capacity), 1119f, 1120 TMPRSS2-ERG biomarker, 423 Toludine blue dye test, 675 Tomography, 983 Total blood volume (TBV), 843 Total calcium (Ca), 138 Total CD4 count, 147–148 Total complement assay, 173 Total hexosaminidase, 290 Total iron-building capacity (TIBC), 235, 236t, 322 Total lung capacity (TLC), 1119f, 1120 Total protein, 424 Total serum bilirubin, 123 Total T3 radioimmunoassay, 506 Total testosterone serum level, 476 Total thyroxine, 497 Tourniquet test, 698 Toxicology, 951, 952t Toxicology screening tests for drug overdose, 950, 952t Toxoplasmosis antibody titer, 500 TPMT gene mutation testing (thiopurine methyltransferase), 215 TPO-Ab (antithyroid peroxidase antibody), 104 Transesophageal echocardiography (TEE), 897, 898f Transferrin, 322 Transferrin receptor assay (TfR), 502, 503t Transferrin saturation, 322 Transfusion reaction, 176b, 371, 371b Transport of specimen, Transthoracic echocardiography (TTE), 877, 878f, 880f Transthyretin, 412 Transudate, exudate versus, 663t TRAP (tartrate-resistant acid phosphatase), 25 TRF (thyrotropin-releasing factor) stimulation test, 492, 493t TRH (thyrotropin-releasing hormone) stimulation test, 492, 493t Triglycerides (TGs), 504 Triiodothyronine, 506 Triple renal study, 831 Troponins, 508 Trough level of drug, 21 True cholinesterase, 159 Trypsin-like immunoreactivity, 660 TSH (thyroid-stimulating hormone), 486 TSH stimulation (thyroid-stimulating hormone stimulation), 489 TSI (thyroid-stimulating immunoglobulins), 491 TST (tuberculin skin testing), 771–772 TTE (transthoracic echocardiography), 877, 878f, 880f T-tube cholangiography, 1070 Tuberculin skin testing (TST), 771–772, 1126, 1127b–1128b, 1129f Tuberculin test, 1126 Tuberculosis culture (TB culture), 768 Tuberculosis testing (TB testing), 770 Tularemia, 1082, 1083t Twelve-lead electrocardiogram, 544, 545f Twenty-four-hour urine collection, 906–907, 907b Two-dimensional echocardiography, 877, 878f Two-hour postprandial blood sugar, 257 Two-hour postprandial glucose (2-hour PPG), 257 U U bag, 975 U wave, 546, 546f UA (urinalysis), 956 UBT (urea breath test), 1101, 1102t, 1130 UGI (upper GI series), 1072, 1074f UGI (upper gastrointestinal endoscopy), 608, 609t Ultrasound absorption, 1003 Ultrasound mammography, 871, 872f–873f, 872t Ultrasound of testes, 893 Ultrasound probe, 865, 865f Umbilical artery flow velocity, 882 Unconjugated bilirubin, 122, 122f, 125–126 Unsaturated iron binding capacity, 322–323 UPP (urethral pressure profile), 700 Upper gastrointestinal endoscopy (UGI), 608, 609t Upper gastrointestinal tract x-ray, 1072, 1074f Upper GI series (UGI), 1072, 1074f Upright MRI, 1109 Urea breath test (UBT), 1101, 1102t, 1130 Urea nitrogen, blood, 511 Ureteral catheterization through cystoscope, 600f Urethral catheterization, 907 Urethral culture, 733, 756, 758f Urethral pressure profile (UPP), 700 Urethral pressures, 688, 688t Uric acid blood, 514 urine, 954 Uric acid stone, 972 Uricosuria, 955 Urinalysis (UA), 956 Urinary catheterization, 974 Urinary diversion, 975 Urinary methylmalonic acid, 519 Urinary stone analysis, 971 Urine, 903–904 appearance and color of, 957–958, 959t, 963, 965–966 casts in, 962–963, 969 collection of, 906–907, 907b crystals in, 961, 961f, 964, 969 odor of, 958, 963, 966 pH of, 958–959, 963, 966 red blood cells in, 962–965 specific gravity of, 960, 964, 967 white blood cells in, 962, 964, 971 Urine amylase, 909 Urine 11-beta-prostaglandin F(2) alpha, 913 Urine bilirubin, 124–126, 961, 964, 968–969 Urine chloride, 919 Urine cortisol, 920 Urine culture and sensitivity (urine C&S), 973 for sexually transmitted disease, 759 Urine drug testing, 948, 949t, 950f Urine flow studies, 701 Urine glucose, 924 Urine ketones, 960–961, 963, 968 Urine leukocyte esterase, 960, 964, 968 Urine monoclonal immunoglobulins, 432 Urine nitrites, 960, 968 Urine osmolality, 938 Urine potassium, 942 Urine prealbumin, 412 Urine protein, 959–960, 963, 966 1179 Urine reagent strips, 125, 909 Urine sediment, 961 Urine sodium, 946 Urine specimen, 904 collection methods for, 906–907, 907b reporting of results, 909 transport, storage, and preservation of, 908, 908b types of, 904–906, 905b urine reagent strips and, 125, 909 Urine sugar, 924 Urine testing for amphetamines, 952t for ethanol, 230 for human immunodeficiency virus, 298–299 with Icotest tablets, 125 for metanephrine, 358 with multistix reagent strips, 125 Urine uric acid, 954 Urine urobilinogen, 961, 964, 969 Urobilinogen, 961, 964, 969 Uroflowmetry, 701 Uroporphyrinogen-1-synthase, 516, 517b Uroporphyrins, 940 U.S Preventive Services Task Force on mammography, 1044 Uterus computed tomography of, 1025 hysterosalpingography and, 1038 V Vaginal probe, 889 Vaginal ultrasonography, 887 Vanillylmandelic acid (VMA), 975 Vascular duplex scanning, 900 Vascular ultrasound studies, 900 Vasopressin, 73 VAT (video-assisted thoracotomy), 627 VC (vital capacity), 1119f, 1120 VCAs (viral capsid antigen-antibodies), 217–218 VDRL (Venereal Disease Research Laboratory), 473, 474b Venereal Disease Research Laboratory (VDRL), 473, 474b Venogram, 1076 Venography, 1076 Venous Doppler studies, 901–902 Venous puncture, 14–18 Venous/arterial Doppler ultrasound, 900 Venous/arterial duplex scan, 900 Ventilation lung scan, 812–814 Ventilation scan, 812–813 Ventilation/perfusion scanning (VPS), 811, 812b, 813f–814f Ventricular ejection fraction, 793 Ventricular natriuretic peptide, 367 Ventriculography, 1008, 1009t, 1010f, 1011b, 1012f VERs (visual-evoked responses), 562, 563t, 564f Vertebral fracture assessment (VFA), 1003–1004 Very-low-density lipoproteins (VLDLs), 154, 342, 342b, 343t, 345t VFA (vertebral fracture assessment), 1003–1004 Video endoscopy equipment, 580, 581f Video-assisted thoracotomy (VAT), 627 Index Index 1180 Index Videofluoroscopy of swallowing function, 1069 Viral capsid antigen-antibodies (VCAs), 217–218 Viral load, 774–775 Virtual angiography, 1022, 1030 Virtual autopsy, 1022 Virtual bronchoscopy, 1030 Virtual colonoscopy, 1020 Virtual esophagoscopy, 1030 Virus testing, 773 VisoV (volume of isoflow), 1120 Visual-evoked responses (VERs), 562, 563t, 564f Vital capacity (VC), 1119f, 1120 Vitamin B12, 518, 519b Vitamin D, 520, 522t VLDLs (very-low-density lipoproteins), 154, 342, 342b, 343t, 345t VMA (vanillylmandelic acid), 975 Voiding cystography, 1036, 1037f Voiding cystourethrogram, 1036, 1037f Volume of isoflow (VisoV), 1120 von Willebrand factor, 165t, 166, 169 VPS (ventilation/perfusion scanning), 811, 812b, 813f–814f V/Q scan (ventilation/perfusion scan), 811, 812b, 813f–814f W Warfarin pharmacogenomic test panel, 436 Warm/hot thyroid nodule, 839–841 Water deprivation, 979 Water load test, 76, 76b Waxy casts, 962, 969 WBC and differential (white blood cell count and differential), 526, 526b–527b, 528f–529f, 532t WBC differential (white blood cell differential), 710 WBC esterase (leukocyte esterase), 960, 964, 968 WBC scan, 844 West Nile virus testing, 524 Westergren method, 221 Western blot test, 297, 297t, 298t, 299f White blood cell(s), in urine, 962, 964, 971 White blood cell antigens, 304, 307t White blood cell count and differential count (WBC and differential), 526, 526b–527b, 528f–529f, 532t White blood cell differential (WBC differential), 710 White blood cell scan, 844 Wireless capsule endoscopy, 609 Wireless pH probe, 692 Wound culture, 776, 778f X Xanthochromia, 654 D-Xylose absorption, 533 Xylose tolerance, 533 Y Y402H genetic variant, 38 Yellow fever, 1082, 1083t Z Z scores, 1003 Zinc protoporphyrin (ZPP), 534 ZPP (zinc protoporphyrin), 534 ... Name of Test Electrodiagnostic Tests TABLE 3-1 Body Areas Evaluated by Electrodiagnostic Studies 538 Caloric Study Contraction Stress Test Premature labor REPORTING OF RESULTS Many of these tests. .. • Absence of hypothermia (temperature greater than 32. 2° C) • Absence of neuromuscular blockade administration • Absence of possibility of drug- or metabolic-induced coma • Absence of response... locations of the leads are indicated in “Procedure and Patient Care.”) In general, leads II, III, and aVF look at the inferior portion of the heart Leads aVL and I look at the lateral portion of the