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Western Diagnosis

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chantalinha's version from 2017-09-25 13:00

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Question Answer
Name 5 reasons to refer for lab testsa) to screen for a disease; b) to monitor disease; c) to rule out a disease; d) to confirm a diagnosis;  e) to monitor a treatment;
There is laboratory test and laboratory imaging
The normal curve applies to most part of a healthy population, but an individual might be off these numbers and still be healthy.
What is diagnosisthe process to determine/identify a possible disease/disorder, and name it. Or the process of determining by examination/testing  the nature and circumstances of a diseased condition.
What are the criteria for Dx (DC)A combination of signs, symptoms and test results we use to determine a cause (? I don't agree w/ that)
Differential Diagnosis (Ddx)the use of SSX and test results to differentiate between similar conditions.
True positivewhen a patient has the disease and the test is positive - has +, test +
False positivewhen the patient doesn't have the disease and the test is positive - has -, test +
True negativewhen a patient doesn't have the disease and the test is negative - has -, test -
False negativewhen a patient has the disease and the test is negative - has +, test -
What is Sensitivity and SpecificityThey are measures of performance for diagnostic tests, they describe how well a test can determine the presence of  a specific condition.
What is Test SensitivityIt's the ability of a test to correctly identify those with the condition (gives the true positive rate)
What is Test SpecificityIt's the ability of a test to correctly identify those without the condition (gives the true negative rate) (Test sensitivity correctly identifies those w/ the condition. Test specificity correctly identifies those w/o the condition)
What does it mean for a test to be high sensitiveA test w/ 100% sensitivity means it correctly identifies all patients with the disease. A test with 80% sensitivity detects 8 patients with the disease out of 10 that have the disease. The other 2 go undetected (false negative).
What does it mean for a test to be high specificA test w/ 100% specificity correctly identifies all patients without the disease. A test with 80% specificity detects 8 patients without the disease out of 10 that don't have it. The other 2 are incorrectly identified as having the disease (false positive). In other words, Sensitivity identifies the True Positive, Specificity identifies the True Negative.
Test with high sensitivity and low specificitymany disease-free patients identified as having the disease.
What drives choices for testinga) Cost of the procedure; b) location; c) severity of the condition; d) ?
What are the 2 main testinga) Imaging and; 2) Laboratory tests
Name 5 different types of imaginga) endoscopy; b) x-ray; c) MRI (Magnetic Resonance Imaging); d) CT (Computed Axial Tomography; e) Ultrasound
Name 3 or 4 Laboratory Testsa) Blood CBC (Complete Blood Count); b) Urine; c) Fecal/Stool analysis; d) Microscopic Studies (biopsies)
Name the components of CBCa) Red Blood Cells count; b) hemoglobin (Hb); c) Hematocrit (Hct); d) RBC indices that relate to shape/size/color of RBC
Name 2 or 3 components of WBC/Plateletsa) WBC count; b) WBC differential (the subsets of WBCs); c) Platelet count; d) Mean platelet volume; e) Platelet distribution width (PDW)
Describe the tests of a SMP (Simple Metabolic Panel)glucose, calcium, KID tests, serum protein, electrolytes;
What does SMP includes ?a) glucose (for diabetes); b) calcium (for parathyroid, bone diseases); c) KD tests (for KID failure); d) Serum protein (for LIV/KID diseases; e) electrolytes (Na, K, Cl, CO2, Phosphorus) (for sportists).
What's the difference b/w CMP (Comprehensive) and SMP (Simple Metabolic Panel) SMP includes: a) glucose (for diabetes); b) calcium (for parathyroid, bone diseases); c) KD tests (for KID failure); d) Serum protein (for LIV/KID diseases; e) electrolytes (Na, K, Cl, CO2, Phosphorus) (for sportists). CMP includes SMP plus LIV tests (bilirubin, ALP, ALT, AST...)
Name some of the Cardiovascular Blood Testinga) Lipid Panel (Risk factor); b) CMP (Risk factor); c) Homocysteine (Vit-b defic.) (Risk factor); d) Troponin (Evidence of cardiac damage); e) Myoglobulin (evidence of cardiac damage); f) Creatine Phosphokinase (evidence of cardiac damage)
Name some of the Cardiovascular Electrical Testing/Imaginga) EKG(electrical tests); b) ECG (Echo-cardiogram - ultrasound); c) Stress testing; d) MRI; e) Arteriography/Angiography; f) Vascular US
In Lipid Panel, why do we need to measure them in separate?Because we need to know the ratios of the components
Name the components in the Lipid Panela) Total cholesterol; b) HDL; c) LDL; d) VLDL; e) Cholesterol ratio; f) triglycerides
What's is hyperlipidaemia?Raised serum levels of one or more of TC, LDL, VLDL, TG.
What's combined hyperlipidaemia?Raised serum levels of both TC and TG
What's is dyslipidaemia?Raised serum levels of HDL. This is is good! Protection!
Cholesterol testing is used to determine risk for CHD (Coronary Heart Disease).
Name 2 reasons for increased TCa) genetics; b) high-cholesterol diet;
Name 2 reasons for decreased TCa) GIT malabsorption/malnutrition; b) cholesterol lowering medication;
Homocysteine may act as an independent risk factor for CVD It appears to promote the progression of atherosclerosis (causes endothelial damage, promotes LDL deposition, promotes vascular smooth muscle growth);
Name 2 reasons for increased levels of Homocysteinea) CV disease; b) malnutrition
Name 2 or 3 indications for EKGa) chest pain; b) arrhythmia; c) MI, angina;
EKG uses 12 leads, 6 in the limbs, 6 in the chest, it monitors the QRS complex.
EKG on its own isn't enough, as mechanic disorders aren't necessarily represented in an electrical exam. EKG is all about electrical exam (electrical conduction) of the HT
Name 2 contraindications for EKGthere's NONE other than patient refusal!!! BUT… some patients may have allergies/sensitivities to the gel/adhesive used to affix the leads. One can then use hypoallergenic alternatives.
Name 2 results of EKGarrhythmia, acute MI, past MI;
ECG tests the mechanical aspect of the HT, both structure and function. It's non-invasive.
Name 2 indications for ECGMI, valvular diseases, HT wall abnormalities.
Name 2 contra-indications for ECGnone!!!
Name 2 results & significance for ECGvalvular HT disease, poor ventricular muscle motion, pericardial effusion/outflow
Name 2 stress tests for CVDexercise in treadmill, chemical;
Name 2 stress test indicationschest pain in suspected coronary disease, determine safe exercise limits during cardiac rehabilitation.
Name 1 stress test contraindicationrecent MI, unstable angina
Name 1 Stress test complicationsevere angina, MI
Name 2 stress test results/significanceabnormal cardiac rhythms, exercise-related hypertension/hypotension
When is it better for patients to do chemical stress test? When they are old, or in delicate condition, cannot do stress exercise test. Also, this is more accurate, safer, and more predictable.
Name 3 imaging tests for MIcoronary angiogram, ecg (ultrasound), chest-x-ray
Name lab tests for MIEKG, myoglobulin, Creatine/CPK-MB, troponin
Name further lab tests for MIFBC, electrolyte disturbance, renal function, lipid profile, cardiac enzymes
Is myoglobulin specific for MI?No
Name 1 risk of increased levels of myoglobulinit is nephrotoxic, can damage KID.
Name 2 results/significance for increased levels of myoglobulinMI, skeletal muscle trauma
Name 1 result/significance for decreased levels of myoglobulinpolymyositis (presence of antimyoglobin antibodies in the blood)
Name the main cardiac enzyme studied in HT diseaseCPK - Creatine Phosphokinase (aka CK)
Name the 3 CK-isoenzymesCK-BB, CK-MB, CK-MM.
Which CK is specific for myocardial cells?CK-MB. But they don't usually rise w/ transient chest pain (angina, pulmonary embolism, CHF).
How does CK-MB work?CK-MB quantifies the degree of MI and timing of the onset of infarction, often used to determine when to use thrombolytic therapy.
CK-BB indicates ? brain/lung damage
CK-MM usually makes up ?almost all total CK enzymes in healthy people. If elevated, indicates injury/disease of skeletal muscle. It varies according to person's total muscle.
Which is the most specific and sensitive indicator for MI injury?Troponin. It's used to diagnose chest pain, or to predict future cardiac events. It exists both in cardiac and skeletal muscle.
Name the 2 types of troponinscTnI (levels are elevated for 7-10d after MI) and cTnT (levels are elevated for 10-14d after MI
Troponins become elevated sooner and stay for longer? Yes
Name the results/significance of troponinsMI shows increased levels
Name 2 indications for catheterizationchest pain, acute MI, occlusive coronary artery disease, to evaluate success of previous cardiac surgery, to evaluate cardiac muscle function
Name 1 contraindication for cardiac catheterisationpatients w/ iodine dye allergy, or w/ renal disorders (iodine dye is nephrotoxic)
Name 2 results/significance of cardiac catheterisationvalvular abnormalities, anatomic variation of cardiac chambers/vessels, pulmonary emboli
Name 2 diseases/locations that vascular images can help to find about arterial occlusive diseasekidneys, heart, abdomen
Arteriography/angiography is invasive? Yes
Name 2 indications for arteriographyevaluate arterial occlusive disease, provide an accurate picture of the vascular anatomy
What can be done if a short-segment arterial stenosis is identified?Balloon dilation and stenting
Name 2 contraindications for arteriographypregnancy, patients w/ propensity to bleeding, allergy to iodinated dye
Name the results/significance of arteriographymany!!! Depends on the organ being investigated.
Name the risk factors for thrombosisage, smoking, obesity, long-distance travel
Is vascular ultrasound invasive? No
Name 2 indications of vascular ultrasoundvenous US, indicates if venous flow is proper on swollen painful leg, varicosities, and arterial-doppler indicates if there's arterial insufficiency.
Name contraindications for vascular ultrasoundnone!
Name 2 results of vascular ultrasounda) Veins: venous occlusion and venous varicosities; b) Arteries: arterial occlusive disease, embolic arterial occlusion
Name the indications for venographysuspected venous obstruction (swollen limbs)
Name 2 contraindications for venographysevere edema of the legs and allergy to iodinated dye
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