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Clinical Pathology > Lecture 2: Interpreting test results > Flashcards

Lecture 2: Interpreting test results Flashcards

1
Q

Name the 4 stages of utility of tests?

A
  1. Diagnosis
  2. Monitoring
  3. Screening.
  4. Research
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2
Q

What is meant by diagnosis?

A

to rule in or rule out a diagnosis

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3
Q

What is meant by monitoring?

A

the effect of drug therapy

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4
Q

What is meant by screening?

A

eg, for congenital hypothyroidism via neonatal thyroxine testing

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5
Q

What is ment by research?

A

to understand the pathophysiology of a particular disease process

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6
Q

What questions need to be asked BEFORE ordering a test?

A

Why is the test being ordered?
What are the consequences of not ordering the test?
How good is the test in discriminating between health versus disease?
How are the test results interpreted?
How will the test results influence patient management and outcome?

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7
Q

What 3 areas make up the clinical process?

A
  1. History
  2. Clinical examination
  3. Laboratory investagations
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8
Q

What are the 3 areas of the clinical process?

A
  1. History
  2. Clinical examination
  3. Laboratory investigations
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9
Q

What are the 3 sections of the laboratory testing cycle?

A
  1. Pre-analytic phase
  2. Analytic phase
  3. Post-analytic phase
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10
Q

What are included in the pre-analytic phase of the laboratory testing cycle?

A
  1. Decision to perform the test
  2. Order placed
  3. Order transferred to the lab
  4. Identifying information entered
  5. Specimen obtained
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11
Q

What is included in the analytic phase of the lab test cycle?

A

Specimen analysed

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12
Q

What is included in the post-analytic phase of the lab test cycle?

A
  1. Report generated
  2. Results conveyed to clinician
  3. Data interpreted
  4. Clinical response to result
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13
Q

What is the ‘Normal/Reference Range’ in biochemistry?

A

Defines the values of a biochemical test found in healthy subjects against which patient values can be compared.
Artificial concept - no clear boundaries exist.

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14
Q

What is an appropriate ‘normal’ population?

A
  1. Patients with similar presenting symptoms
  2. Same age
  3. Same gender
  4. Hospitalised ‘normals’
  5. Same underlying disease
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15
Q

What is the problem with overlap between ‘normal’ populations and diseased populations?

A

Leads to false negatives and false positives

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16
Q

What does a ‘Reference Range look like on a graph?

A

Bell-curved
2SD

17
Q

what does an ideal diagnostic test look like on a graph?

A

2 Bell-shaped curves
2SD
separate graphs for ‘Normal’ and diseased

18
Q

Why are ideal test rarely available in routine practice?

A
  • High sensitivity and specificity rarely coexist
  • Increased sensitivity traded for decreased specificity and vice versa
  • In general, a useful laboratory test will have a sum of sensitivity + specificity >170
19
Q

What is the difference between sensitivity and specificity?

A

The key difference between sensitivity and specificity is that sensitivity measures the probability of actual positives, while specificity measures the probability of actual negatives.

20
Q

Name 3 ways to improve tests?

A
  1. Select a more appropriate ‘Normal’ population
  2. Use a combination of tests - e.g.. LFT profiles
  3. Combine tests to achieve a diagnostic goal, e.g. neonatal screening for PKU and hypothyroidism
    • Sensitive first line test (low cost)
    • Specific test for screen positives (higher cost)
21
Q

List pre analytical factors that affect tests?

A

Age
Gender
Diet
Pregnancy
Time of month
Time of day
Time of year
Weight
Stimulus- DFTs, Drugs
Underlying disease
Fasting/ non-fasting

22
Q

What percent of errors of lab testing are due to Pre-analytical factors?

A

62%

23
Q

What percent of errors of lab testing are due to analytical factors?

A

15%

24
Q

What percent of errors of lab testing are due to Post-analytical factors?

A

23%

25
Q

When is levels of cortisol in the body the highest?

A

Morning

26
Q

Name 2 action limits which aid interpretation in diagnostic testing?

A

cholesterol
Paracetamol

27
Q

What are 3 therapeutic ranges for drugs?

A

lithium
Digoxin
Phenytoin

28
Q

What are action limits and therapeutic ranges used for?

A

Used to trigger therapeutic / investigative actions

29
Q

What 3 things need to be considered when interpreting biochemical values?

A
  1. Biochemical measurements must be made under appropriate conditions.
  2. Any biochemical value must be interpreted in the light of the appropriate reference range.
  3. An understanding of normal physiological regulation is assumed.
30
Q

What is HbA1c?

A

stable glycosylated haemoglobin

31
Q

What does HbA1c percentage concentration indicate?

A

cumulative glucose exposure

Clinical Pathology (6 decks)

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