(BQ) Part 2 book Ferris best test - A practical guide to laboratory medicine and diagnostic imaging presents the following contents: Imaging and laboratory tests and algorithms, aseptic necrosis, cardiomegaly on chest radiograph, dysuria,...
REFERENCES Dhingra R et al: C-reactive protein, inflammatory conditions, and cardiovascular disease risk, Am J Med 120:1054-1062, 2007 Jeremias A, Gibson M: Narrative review: Alternative cause for elevated cardiac troponin levels when acute coronary syndromes are excluded, Ann Intern Med 142:786-791, 2005 Jones JS: Four no more: The PSA cutoff era is over Cleveland Clin J Med 75:30-32, 2008 McKie PM, Burnett JC: B-type natriuretic peptide as a marker beyond heart failure: Speculations and opportunities, Mayo Clin Proc 80(8):1029-1036, 2005 Pagana KD, Pagana, TJ: Mosby’s Diagnostic and Laboratory Test Reference, ed 8, St Louis, Mosby, 2007 Sarmak MJ et al: Cystatin C concentration as a risk factor for heart failure in older adults, Ann Intern Med 142:497-505, 2005 Wu AHB: Tietz Clinical Guide to Laboratory Tests, Philadelphia, WB Saunders, 2006 159 162 This section includes the diagnostic modalities (imaging and laboratory tests) and algorithms useful to diagnose the following 231 diseases and disorders It is assumed that the patient has had a detailed history and physical examination before any testing sequence is initiated These algorithms are designed to assist clinicians in the evaluation and treatment of patients They may not apply to all patients with a particular disease or disorder, and they are not intended to replace a clinician’s individual judgment Please note that specific findings in the patient’s history and physical examination may significantly alter any of the proposed testing sequences 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Abdominal abscess p Abruptio placentae p Achalasia p Acoustic neuroma p Acquired immunodeficiency syndrome (AIDS) p Acromegaly p Actinomycosis p Acute respiratory distress syndrome (ARDS) p Addison’s disease p Adrenal mass p Aldosteronism p Alkaline phosphatase elevation p Alpha1-antitrypsin deficiency p ALT/AST elevation p Alzheimer’s disease p Amaurosis fugax p Amebiasis p Amenorrhea, primary p Amenorrhea, secondary p Amyloidosis p Amyotrophic lateral sclerosis p Anemia, macrocytic p Anemia, microcytic p Aneurysm of abdominal aorta p Antinuclear antibody (ANA) positive p Antiphospholipid antibody syndrome p Aortic dissection p Appendicitis p Arthritis, infectious (bacterial) p Ascariasis p Ascites p Aseptic necrosis p Back pain, acute, lumbosacral (LS) area p Baker’s cyst p Bilirubin elevation p Bleeding disorder, congenital p Brain abscess p Breast abscess` p Breast implant rupture p Breast mass p Breast nipple discharge p Bronchiectasis p Budd-Chiari syndrome p 163 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 Carcinoid syndrome p Cardiomegaly on chest radiograph p Cat-scratch disease p Cavernous sinus thrombosis p Celiac disease p Cerebrovascular accident (CVA) (stroke) p Cholangitis p Cholecystitis p Cholelithiasis p Claudication p Constipation p CPK elevation p Cushing’s syndrome p Cyanosis p Deep vein thrombosis (DVT) p Delirium p Diabetes insipidus p Diarrhea p Disseminated intravascular coagulation (DIC) Diverticulitis p Dyspepsia p Dysphagia p Dyspnea p Dysuria p Echinococcosis p Ectopic pregnancy p Edema, generalized p Edema, lower extremity p Endocarditis, infective p Endometriosis p Enuresis p Epiglottitis p Esophageal perforation p Fatigue p Fever of undetermined origin (FUO) p Genital lesions/ulcers p Goiter p Gout p Gynecomastia p Hearing loss p Hematuria p Hemochromatosis p Hemophilia p Hemoptysis p Hepatitis A p Hepatitis B, acute p Hepatitits C p Hepatomegaly p Hepatorenal syndrome p Hirsutism p Hydrocephalus, normal pressure (NPH) p Hypercalcemia p Hyperkalemia p Hypermagnesemia p Hypernatremia p Hyperphosphatemia p p 164 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 Hyperthyroidism p Hypocalcemia p Hypogonadism p Hypokalemia p Hypomagnesemia p Hyponatremia p Hypophosphatemia p Hypothyroidism p Infertility p Insulinoma p Intracranial mass p Jaundice p Joint effusion p Knee pain p Liver abscess p Liver function test elevations p Liver mass p Lung abscess p Lymphadenopathy, axillary p Lymphadenopathy, cervical p Lymphadenopathy, epitrochlear p Lymphadenopathy, generalized p Lymphadenopathy, inguinal p Lymphedema p Macrocytosis p Malabsorption, suspected p Mastoiditis p Meckel’s diverticulum p Mediastinal adenopathy p Meningioma p Meningitis p Mesenteric venous thrombosis p Mesothelioma p Metabolic acidosis p Metabolic alkalosis p Microcytosis p Multiple myeloma p Multiple sclerosis p Muscle cramps p Muscle weakness p Myasthenia gravis (MG) p Myocardial ischemia, suspected p Neck mass Neutropenia p Oliguria p Osteomyelitis p Osteonecrosis p Osteoporosis p Paget’s disease of bone p Pancreatic cancer p Pancreatic mass p Pancreatitis, acute p Pelvic abscess p Pelvic mass p Pelvic pain, reproductive age woman p Peptic ulcer disease p 165 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 Peripheral arterial disease p Peripheral nerve dysfunction p Perirectal abscess p Pheochromocytoma p Pituitary adenoma p Placenta previa p Pleural effusion p Polyarteritis nodosa p Polycystic kidney disease p Polycythemia vera p Portal hypertension p Portal vein thrombosis p Prolactinoma p Prostate cancer p Proteinuria p Pruritus, generalized p Pseudomembranous colitis p Puberty, delayed p Puberty, precocious p Pulmonary embolism p Pulmonary hypertension p Pulmonary nodule p Purpura p Reflex sympathetic dystrophy (RSD) p Renal artery stenosis p Renal insufficiency p Renal mass p Renal vein thrombosis p Respiratory acidosis p Respiratory alkalosis p Retropharyngeal abscess p Rhabdomyolysis p Rotator cuff tear p Sacroiliac joint pain p Salivary gland neoplasm p Sarcoidosis p Scrotal mass p Seizure disorder p SIADH (syndrome of inappropriate antidiuretic hormone secretion) p Sialolithiasis p Sinusitis p Small-bowel obstruction p Spinal epidural abscess p Spinal stenosis p Splenomegaly p Subarachnoid hemorrhage p Subclavian steal syndrome p Subdural hematoma p Superior vena cava syndrome p Syncope p Temporal arteritis p Temporomandibular joint (TMJ) syndrome p Testicular neoplasm p Testicular torsion p Thoracic outlet syndrome p 166 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 Thrombocytopenia p Thrombocytosis p Thyroid nodule p Thyroiditis p Tinnitus p Transient ischemic attack (TIA) p Trigeminal neuralgia p Urethral discharge p Urolithiasis p Urticaria p Vaginal bleeding, 1st trimester p Vaginal discharge p Vertigo p Viral hepatitis p von Willebrand’s disease p Waldenström’s macroglobulinemia p Wegener’s granulomatosis p Weight gain p Weight loss, involuntary p Wilson’s disease p Zollinger-Ellison syndrome p Abdominal Abscess Diagnostic Imaging Lab Evaluation Best Test(s) Best Test(s) • CT of abdomen with contrast • Gram stain and culture and sensitivity (C&S) of abscess Ancillary Tests • Ultrasound of abdomen is useful in young women and children Ancillary Tests • CBC with differential • Blood culture ϫ • ALT, AST • BUN, creatinine, glucose Diagnostic Algorithm Suspected abdominal abscess CT of abdomen with contrast or ultrasound in young women and children CBC with differential Ancillary lab tests CT-guided drainage of abscess and Gram’s stain and C&S of abscess aspirate Abruptio Placentae Diagnostic Imaging Lab Evaluation Best Test(s) Best Test(s) • Obstetric ultrasound • None Ancillary Tests Ancillary Tests • Continuous fetal heart rate monitoring • CBC (to quantify blood loss) • Coagulation profile (PT, PTT, platelets, fibrinogen) • Blood type and antibody screen to identify Rh-negative patients who may need Rh immunoglobulin Diagnostic Algorithm Obstetrical ultrasound Suspected abruptio placentae Initiate continuous fetal heart rate monitoring Laboratory evaluation 167 168 Achalasia Diagnostic Imaging Lab Evaluation Best Test(s) Best Test(s) • Barium swallow with fluoroscopy • None Ancillary Tests Ancillary Tests • Esophageal manometry if barium swallow is inconclusive • Upper endoscopy • CBC • Serum albumin for nutritional assessment Diagnostic Algorithm Diagnostic Suspected achalasia Esophageal manometry Barium swallow Inconclusive Upper endoscopy to rule out malignancy and strictures Normal Achalasia Megaesophagus GEJ Bird's beak Figure 3-1 Achalasia (From Weissleder R, Wittenberg J, Harisinghani MG, Chen JW: Primer of Diagnostic Imaging, ed 4, St Louis, Mosby, 2007.) Acoustic Neuroma Diagnostic Imaging Lab Evaluation Best Test(s) Best Test(s) • MRI with gadolinium of brain and auditory canal • None Ancillary Tests • None Ancillary Tests • CT of brain and auditory canal with IV contrast if MRI is contraindicated Diagnostic Algorithm Suspected acoustic neuroma (hearing loss, unilateral tinnitus, balance problems, facial pain) Detailed neurologic exam with special attention to the cranial nerves MRI of brain and auditory canals with gadolinium Acquired Immunodeficiency Syndrome Diagnostic Imaging Lab Evaluation Best Test(s) Best Test(s) • None • HIV antibody test Ancillary Tests Ancillary Tests • MRI or CT of brain for encephalopathy or focal CNS complications • Pulmonary gallium scan in suspected Pneumocystis pneumonia • T-lymphocyte subset analysis to determine degree of immunodeficiency • Viral load assay to plan long-term antiviral therapy Diagnostic Algorithm Negative Suspected infection with HIV HIV antibody test Repeat in 4–6 weeks T-lymphocyte subset analysis Positive Viral load 169 170 Acromegaly Diagnostic Imaging Lab Evaluation Best Test(s) Best Test(s) • MRI of pituitary and hypothalamus with contrast • Serum insulin-like growth factor (IGF)-I level Ancillary Tests Ancillary Tests • CT of pituitary and hypothalamus if MRI is contraindicated • Suppression test with oral glucose • Serum phosphate (increased) • Serum calcium (increased) Diagnostic Algorithm Diagnosis unlikely Normal Suspected acromegaly Serum IGF-I Elevated Suppression test with oral glucose (failure to suppress GH to