Using Laboratory Data Flashcards

1
Q

Reasons to order lab test

A

Diagnosis:confirm, screen, rule-out
Management: monitor, follow course, prognosis
Fear: criticism, insecurity

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2
Q

Most common reasons for ordering a lab test?

A

diagnosis, screening, monitoring

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3
Q

Lab test most likely to change the diagnosis and direct therapy?

A

microbiology reports

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4
Q

Reference ranges are based on

A

range of values determined by large numbers of normal, healthy individuals (may be age, sex, race specific)

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5
Q

Reference range is calculated by

A

mean value and the standard deviation

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6
Q

Reference range is a ____________ curve

A

bell-shaped, Gaussian ST of +/-2 to include 95%

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7
Q

Total bilirubin reference range curve

A

Non-Gaussian

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8
Q

Total serum cholesterol reference range

A

is a “healthy” rand based on epidemiological studies

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9
Q

Serum creatinine is a good example of

A

the necessity of comparing current value to previously determined value

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10
Q

Endocrinology tests reference ranges are based on

A

stimulatory and inhibitory recordings

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11
Q

In disease prognosis/progression it is important to

A

monitor change sin value (not reference range) i.e.. LDL, PSA

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12
Q

What is the chance of an abnormal result if you do 1 test?
2 ind tests?
5 ind tests?
10 ind tests?

A

5%
10%
23%
40%

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13
Q

Action levels

A

abnormal result that ay or may not require treatment, cholesterol > 200, LDL > 160, HDL < 35 –> patient should be more active

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14
Q

Sensitivity

A

probability that a patient with a disease will test positive

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15
Q

Sensitivity equation

A

Sn = 100X TP/ (TP + FN)

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16
Q

Specificity

A

probability that a non-diseased patient will test negative

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17
Q

Specificity equation

A

Sp = 100X TN / (TN + FP)

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18
Q

Prevalence

A

pre-test probability of disease in the population

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19
Q

Altering the sensitivity will

A

alter the specificity of a test and vice versa

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20
Q

Choose a test with HIGH Sensitivity when

A

the probable disease is serious and curable

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21
Q

Want a very sensitive test when the

A

benefit of detecting the disease are great

22
Q

Choose a test with a HIGH specificity when

A

the probable disease is serious but not treatable

23
Q

Want a highly specific test when the

A

risks of wrong diagnosis is great

24
Q

Confirmatory test

A

highly sensitive

25
Common order of testing
sensitive tests followed by specific
26
PPV
probability that a positive test result indicates disease
27
PPV equation
PPV= 100X TP/ (TP + FP)
28
NPV
probability that a negative test result indicates no disease
29
NPV equation
NPV= 100X TN/ (TN + FN)
30
Does prevalence effect the predictive value?
Yes, the less prevalent a disease the lower the PPV. Higher prevalence = higher PPV
31
Does sensitivity and specificity effect predictive value?
Yes, the more sensitive/specific, the higher the PPV.
32
Serial testing effect on sensitivity
decreases
33
Serial testing effect on specificity
increases
34
Parallel testing effect on sensitivity? specificity?
higher sensitivity, lower specificity
35
What test would you use for a mild treatable disease?
good sensitivity and specificity
36
Order of testing for clinicians
high sensitivity test followed high by specificity test
37
Once prevalence reaches >50% what effect does it have on predictive value
not much increase in predictive value
38
Is predictive value effected by cut-off values
Yes, cut off values change the sensitivity and specificity of a test and therefore change the PPV and NPV
39
Pre-analytic errors
medication interference, wrong patient prep, inadequate amt of specimen, wrong specimen, delayed transport, wrong storage
40
Pre-analytic variation
age, gender, mass, prep of patient, posture of patient, specimen type
41
Analytic errors
wrong usage of equipment, expired reagents
42
Analytic variables
analytical sensitivity, analytical specificity, analytical interference, precision, accuracy, drug impact, lab instruments
43
Analytical sensitivity
ability to detect a substance; least concentration measurable by the test (high... PCR)
44
Analytical specificity
ability to detect only 1 substance;
45
Precision
reproducible
46
accuracy
closeness to a known accepted value
47
Post-analytical errors
wrong results, time delays
48
Physician Factors influencing decision to order tests
faulty decision-making, over reliance, lack of understanding, lack of appreciation of testing limitations, etc
49
Laboratory Factors influencing decision to order tests
convenience of automation, rapid, new tests without proven results, etc
50
Medical Science factors influencing lab tests
new treatments that require monitoring
51
Patient and Societal factors influencing lab tests
expectations, health ins, etc
52
Hospital factors influencing lab tests
encouragement, ICU and dialysis centers, decreased length of stay, more severely ill patients