Diagnostic Tests Flashcards
Testing for autoimmune condition (4)
Increased
Erythrocyte sedimentation rate (ESR) - sign of inflammation
C-Reactive Protein (CRP) - sign of inflammation
Positive rheumatoid factor (RF) antibodies - sign of autoimmune
Positive anti-nuclear antibody (ANA) - sign of autoimmune
Rheumatoid arthritis
all 4 standard autoimmune tests + positive anti-citrullinated peptide antibody (ACPA)
Systemic Lupus Erythematosus (SLE)
all 4 standard autoimmune tests + positive anti-dsDNA antibodies
Multiple Sclerosis
MRI
anemia
Low Hgb, RBC, Hct
If microlytic (iron deficiency related), decreased MCV < 80 because RBCs are smaller
if macrolytic (B12 or folate deficiency) increased MCV >100 because RBCs are bigger via schilling test
Venous Thromboembolism (VTE)
D-dimer test (marker of fibrinolysis) , positive is sign of blood clot
DVT: ultrasound (US) , venography, or MRI
PE: pulmonary computed tomographic anigiography (CTA)
Stroke prevention
CHA2DS2-VASc
CHF
HTN
Age > 65 =1 pt, >75 = 2 pt
DM
Stroke/Transischemic Attack = 2 pt
VA = vascular disease or previous MI
Sc = sex category
Patients with 2 or more points are to be treated with full anticoagulation and anyone with 1 can be on ASA
Heparin induced thrombocytopenia
Unexplained drop in platelets >50% from baseline 5-14 days after starting heparin
positive antibodies revealed on a heparin platelet factor 4 (PF4) ELISA and/or serotonin release assay
ACS
ECG or EKG (electrocardiogram) (to understand the rhythm and function of the heart)
Cardiac enzymes like creatine kinase muscle/brain (CK-MB), troponin I, T
ECG /EKG vs Echo
ECG/EKG are both aka electrocardiograms where a provider will be able to hear the hearts rhythm and function “hear the heart”. Echocardiogram aka Echo is just a heart ultrasound to be able to see the heart.
Arrythmias
ECG/EKG, Holter monitor (portable device), HR
Cerebrovascular accident (CVA or stroke)
Computed tomography (CT), MRI
Chronic Heart Failure
ECHO, increased B type Natriuretic peptide (BNP), increased N-terminal pro BNP (NT-proBNP)
Stable Ischemic Heart Disease (SIHD)/Chronic Stable Angina)
Cardiac stress test, angiography
Dyslipidemia
Increased TC, non-HDL, TGs, coronary artery calcium (CAC- non invasive scan of heart measuring calcium containing plaque)
HTN
increased systolic and diastolic BP
Hypertensive emergency
> /= 180/120mmHg with sign of acute target organ damage
(chest discomfort (myocardial ischemia or MI), back pain (aortic dissection), altered level of consciousness, headache, visual disturbances (hypertensive encephalopathy), or shortness of breath)
Hypertensive urgency
> /=180/120 WITHOUT sign of acute target organ damage
(chest discomfort (myocardial ischemia or MI), back pain (aortic dissection), altered level of consciousness, headache, visual disturbances (hypertensive encephalopathy), or shortness of breath)
10 year risk for atherosclerotic CVD
Use the calculator if they haven’t had any ASCVD history in the past. ACS/IHD, stroke, PAD.
Diabetes/prediabetes
FBG, OGTT, A1c
Hyperthyroidism
decreased TSH, increased free T4 (FT4)
Hypothyroidism
increased TSH, decreased free T4 (FT4)
Ovulation
LH - when it’s at its peak. This is the optimal time for intercourse to become pregnant
Pregnancy
Positive human chorionic gonadotropin (hCG) in urine (at home test) or blood
Bacterial vaginitis
Clear white or gray vaginal discharge with a fishy odor and pH > 4.5 little or no pain.
Candida vaginitis
White, thicker vaginal discharge, pruritis (itchy itchy)
Trichomoniasis
Yellow, green, frothy, foul smelling vaginal discharge =, pH > 4.5, soreness and pain with sex
Peptic Ulcer Disease
Upper gastrointestinal endoscopy (mouth to small intestine
Duodenal ulcer - pain whenever food is not in stomach and 2-3 hrs after eating. pain relief with food and antacids
Gastric ulcer - pain whenever food is in the stomach, little to no pain relief with food and antacids
GERD
Esophogeal pH monitoring , endoscopy
H. Pylori
Urea breath test (UBT), fecal antigen test
Inflammatory bowel disease (Ulcerative colitis, crohn’s disease)
Endoscopy (for crohn’s disease, which affects any part of the GI tract)
Sigmoidoscopy (for ulcerative colitis, which affects the colon (large intestine) and rectum)
Bronchospastic diseases
Spirometry, measures FEV1, FVC, FEV1/FVC
FEV1 - how much air can be forcefully exhaled in one second
FVC - max amount of air that can be forcefully exhaled
FEV1/FVC - percentage of total air capacity (“vital capacity”) that can be forcefully exhaled in one second
Asthma
FVC, FEV1 and peak expiratory flow rate
Allergy testing: a skin test to detect allergen
Chronic obstructive pulmonary disease
Post bronchodilator FEV1/FVC < 0.7 (less than 70%)
eosinophils >/300 cells/microL indicated inflammation and the patient will have a better response to inhaled corticosteroids.
Metabolic acidosis
Arterial blood gas measurements
pH low, HCO3- low - body compensates through respiratory alkalosis
Respiratory acidosis
Arterial blood gas measurements
pH low, high pCO2 - body compensates through metabolic alkalosis
Metabolic alkalosis
arterial blood gas
pH high, high HCO3-, compensation is respiratory acidosis
Respiratory alkalsosis
arterial blood gas
pH high , low pCO2, compensation is metabolic acidosis
Anion gap metabolic acidosis
check the anion gap . if > 12 mEq, that means its anion gap
AG = Na+ - Cl - HCO3
Infection
temp >/= 100.4 or 38 C, increased WBC left shift = increased bands aka immature neutrophils always = inflammation or infection
C difficile
Positive C diff. test from stool toxin or PCR
HIV
HIV antigen/antibody immunoassay, HIV - 1/ HIV - 2 antibody differentiation immunoassay, HIV RNA viral load, nucleic acid test
Infective endocarditis
Echo (to check for vegetation), blood culture to ID the organism
lyme disease
round red bullseye rash, enzyme linked immunosorbent assay ELISA test
meningitis
Lumbar puncture (LP) plus symptoms of severe headache, stiff neck, and altered mental status.
Onychomycosis (fungal infection of toenail or fingernail)
20% KOH smear
Lice (pediculosis)
Pruritis, visible lice on the scalp and nits (eggs) on hair shafts
Pinworm (vermicularis)
Tape test - on the skin adjacent to anus to check the presence of the eggs , helminths worms in blood, feces or urine
Pneumonia
Chest xray showing infiltrates, consolidates, opacities
Syphilis
Positive nontreponomal assay (rapid plasma reagin - RPR) or venereal diseases research laboratory (VDRL) blood test, and treponemal assay
Toxoplasma gondii encephalitis
Toxoplasma IgG test
Tuberculosis
Latent TB: positive tuberculin skin test (TST) aka Purified protein derivative (PPD) or interferon gamma release assay (IGRA) blood test
Active TB : positive sputum acid fast bacilli (AFB) stain and culture , chest X ray with cavitation
urinary tract infection
urinalysis (showing positive leukocyte esterase (meaning that there are wbc’s present in the urine) or WBC > 10 cells/mm3, nitrites, bacteria), urine cultures
Breast cancer
mammogram
cervical cancer
pap smear, HPV test
Colon cancer
Colonoscopy, sigmoidoscopy, double contrast barium enema, CT colonography, stool DNA, fecal occult blood test (FOBT), fecal immunochemical test
Lung cancer
CT chest
Skin cancer
skin biopsy
prostate cancer
Digital rectam exam (DRE), prostate specific antigen (PSA)
General
Carcinoembryonic antigen (CEA) test - a marker to identify cancer
Positron emission tomography (PET)
Allergic reactions
skin prick (scratch) test
immunoglobulin (IgE) blood test
Bleeding conditions
decreased Hgb/hct, coffee ground emesis, dark/tarry stools (upper GI bleeding), red blood in stool (lower GI bleeding or hemorrhoid)
Cholestasis (bile duct blockage)
increased alkaline phosphatase (Alk Phos), increased total bilirubin (Tbili), increased gamma-glutamyltransferase (GGT)
Cognitive impairment
mini-mental state exam (MMSE), score of <24 means impairment
Cystic Fibrosis
Sweat test (checking for chloride) if the test is positive, it means that the child has high chloride levels in their body because they don’t have the channels to move chloride in or out of the body’s cells, so they build up. When chloride (a apart of salt) cannot move properly in and out of cells, this means water can’t either and it can’t hydrate cells surfaces, so the patient ends up having thick and sticky mucus
Glaucoma
increased intraocular pressure (IOP), visual field test (to identify the optic nerve damage)
Gout
increased uric acid (UA) level
Liver disease
Liver function tests (LFTs) increased ALT/AST, alkPhos, Tbilli, lactate dehydrogenase (LDH)
- For cirrhosis: increased INR/PT, and decreased albumi
- For Alcoholic liver disease: increased AST > increased ALT, increased GGT
- For hepatic encephalopathy: increased ammonia level in blood
Movement disorders
ex: parkinsons
abnormal involuntary movement scale (AIMS),
rating scale used to measure involuntary movements or tardive dyskanesias as monitoring for patient improvement
Myopathy
creatinine kinase or creatine phosphokinase (CPK)
Neuropathy, Peripheral
Assess sensation with a 10g monofilament pinprick, temperature and vibration tests
Osteoarthritis
Xray, MRI
Osteoporosis
Bone mineral density (BMD) using dual energy. x ray absorptiometry (DEXA or DXA)
if T score </= - 2.5 then osteoporosis is present
if T score is -1 to -2.4 then osteopenia is present
Pain
Pain scales, non-verbal signs of discomfort
Pancreatitis
increased amylase/lipase
psychiatric disease
DSM5 criteria
depression: HAM-D or HDRS assessment scale
Renal disease
increased BUN/SCr, creatinine clearance (CrCl), glomerular filtration rate (eGFR), urine albumin
Dehydration: BUN/SCr ratio >20:1 with symptoms like decreased urine output and dry mucous membranes and tachycardia
Seizures/epilepsy
electroencephalogam (EEG)
Weight
BMI + waist circumference, IBW, TBW
