Pocket Guide to Diagnostic Tests-0838581358.pdf

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12 Pocket Guide to Diagnostic Tests A Pretest probability Posttest probability Positive test 0 .5 1 Probability of disease B Pretest probability Posttest probability Positive test 0 .5 1 Probability of disease C Pretest probability Posttest probability 0 .5 1 Probability of disease Figure 1–6. Effect of pretest probability and test sensitivity and specificity on the posttest probability of disease. (See text for explanation.) Probability that test is positive in diseased persons LR+ = Probability that test is positive in nondiseased persons Sensitivity = 1 − Specificity Probability that test is negative in diseased persons LR− = Probability that test is negative in nondiseased persons 1 = − Sensitivity Specificity
Basic Principles of Diagnostic Test Use and Interpretation 13 Lists of likelihood ratios can be found in some textbooks, journal articles, and computer programs (see Table 1–5 for sample values). Likelihood ratios can be used to make quick estimates of the usefulness of a contemplated diagnostic test in a particular situation. The simplest method for calculating posttest probability from pretest probability and likelihood ratios is to use a nomogram (Figure 1–7). The clinician places a straightedge through the points that represent the pretest probability and the likelihood ratio and then reads the posttest probability where the straightedge crosses the posttest probability line. TABLE 1–5. LIKELIHOOD RATIOS (LR) FOR DIAGNOSTIC TESTS. Test Disease LR + LR − Amylase (↑) Pancreatitis 9.1 0.2 Anti-dsDNA (↑) SLE 37 0.28 Antinuclear antibody SLE 4.5 0.13 Carcinoembryonic antigen Dukes A colon cancer 1.6 0.87 Creatine kinase MB Myocardial infarction 32 0.05 Esophagogastroduodenoscopy (+) Upper GI bleeding 18 0.11 ESR > 30 mm/h Temporal arteritis 3.3 0.01 Exercise echocardiography (new wall motion abnormalities) Coronary artery disease 6.2 0.23 Exercise ECG (ST depression > 1 mm) Coronary artery disease 5.9 0.39 Ferritin Iron deficiency anemia 85 0.15 Free T 4 (↑) Hyperthyroidism 19 0.05 Free thyroxine index Hyperthyroidism 6.8 0.06 Hepatitis A IgM antibody Hepatitis A 99 0.01 Heterophil (+) Infectious mononucleosis 97 0.03 Metanephrines (↑) Pheochromocytoma 11 0.23 Pleural fluid protein > 3 g/dL Exudative pleural effusion 10 0.12 Technetium Tc 99m pyrophosphate scan (highly focal uptake) Myocardial infarction > 360 0.64 Testosterone (↓) Erectile dysfunction 32 0.03 TSH (↑) Hypothyroidism 99 0.01 24-Hour urinary free cortisol (↑) Hypercortisolism 10 0.07
Page 2 and 3: ABBREVIATIONS AND ACRONYMS Ab Antib
Page 4 and 5: McGraw-Hill abc Copyright © 2001 b
Page 6 and 7: Associate Authors G. Thomas Evans,
Page 8 and 9: In this environment, students, hous
Page 10 and 11: 2 Pocket Guide to Diagnostic Tests
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188 Pocket Guide to Diagnostic Test
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TABLE 4-1 (CONTINUED). Drug Effecti
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TABLE 4-1 (CONTINUED). Quinidine Sa
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Organism Specimen /Diagnostic Tests
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Sinusitis Organism Specimen /Diagno
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Cellulitis Organism Specimen /Diagn
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Test Indications Advantages BRAIN E
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Test Indications Advantages NECK Ev
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Test Indications Advantages THYROID
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Test Indications Advantages CHEST E
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Test Indications Advantages LUNG Ev
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Test Indications Advantages BREAST
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Test Indications Advantages ABDOMEN
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Test Indications Advantages ABDOMEN
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GI Upper GI study (UGI) $$ GI Enter
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GI Hypaque enema $$ GI Esophageal r
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GALL- BLADDER Ultrasound (US) $ GAL
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Test Indications Advantages LIVER S
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LIVER/ BILIARY TREE Percutaneous tr
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Test Indications Advantages PANCREA
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GENITO- URINARY Renal scan (radionu
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Test Indications Advantages BONE Bo
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MUSCULO- SKELETAL SYSTEM Magnetic r
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AORTA AND ITS BRANCHES Magnetic res
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Normal Isotonic hyponatremia Serum
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Signs and symptoms Typical for PE A
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TABLE 8-1. ACID-BASE DISTURBANCES:
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TABLE 8-3. ANEMIA, MICROCYTIC: LABO
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TABLE 8-4 (CONTINUED). Serum- Ascit
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TABLE 8-5 (CONTINUED). Suspected Pr
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TABLE 8-6 (CONTINUED). Opening CSF
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TABLE 8-8 (CONTINUED). Test/Range/C
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TABLE 8-8 (CONTINUED). Test/Range/C
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TABLE 8-10. HEPATIC FUNCTION TESTS.
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TABLE 8-11 (CONTINUED). Lipoprotein
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TABLE 8-13. PLEURAL FLUID: PLEURAL
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TABLE 8-14. PRENATAL DIAGNOSTIC MET
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TABLE 8-18. RENAL TUBULAR ACIDOSIS
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TABLE 8-19 (CONTINUED). Gram Type o
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TABLE 8-23 (CONTINUED). PREGNANCY H
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TABLE 8-24 (CONTINUED). Daily Speci
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TABLE 8-26. VALVULAR HEART DISEASE:
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TABLE 8-27. WHITE BLOOD CELLS: WHIT
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TABLE 8-28 (CONTINUED). Not Indicat
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404 Index Acetaminophen (cont.) tox
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406 Index Agammaglobulinemia, prote
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408 Index Amitriptyline therapeutic
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410 Index Anti-insulin antibodies,
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412 Index Arthropathy, neuropathic,
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414 Index Bacteremia (cont.) perine
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416 Index Biliary tract (cont.) obs
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418 Index Brain abscess neighborhoo
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420 Index Candida (cont.) test sele
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422 Index Cervical cancer -fetoprot
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424 Index Chronic obstructive airwa
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426 Index Colitis (cont.) ulcerativ
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428 Index Corynebacterium jeikeium,
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430 Index D D antigen, Rh, testing
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432 Index Digibind, digoxin monitor
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434 Index Echinococcus multilocular
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436 Index Enterobacteriaceae, test
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438 Index Esophageal reflux study,
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440 Index Fecal contamination, urin
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442 Index Furosemide carbon dioxide
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444 Index Glomerulonephritis (cont.
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446 Index Haemophilus influenzae, t
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448 Index Hemolytic anemia cold agg
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450 Index Hepatotoxic drugs (cont.)
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452 Index Hypercoagulability. See a
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454 Index Hyponatremia (cont.) hype
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456 Index Immunodiffusion in fungal
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458 Index Intravascular hemolysis h
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460 Index Kidney disease (cont.) 1
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462 Index Left ventricular hypertro
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464 Index Liver (cont.) cancer of (
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466 Index Lymphadenopathy (cont.) m
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468 Index Medial cutaneous nerve of
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470 Index Mixed connective tissue d
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472 Index Myeloma (cont.) IgG level
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474 Index Neisseria meningitidis, t
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476 Index Nucleic acid assay in muc
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478 Index Paget’s disease (cont.)
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480 Index Pericholecystic fluid, ul
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482 Index Pneumonectomy, evaluation
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484 Index Precordial leads, ECG, lo
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486 Index Protoporphyria, free eryt
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488 Index QRS complex (cont.) in in
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490 Index Renal failure (cont.) cal
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492 Index Rickets 1,25(OH) 2 -resis
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494 Index Seafood, raw, cellulitis
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496 Index Specimen identification,
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498 Index Steroids (cont.) phosphor
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500 Index Synovial fluid sampling i
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502 Index Therapeutic drug monitori
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504 Index Tourniquet, prolonged use
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506 Index Tube feedings, serum osmo
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508 Index Uterus (cont.) enlarged,
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510 Index Vitamin B 6 deficiency (p
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NOTES Copyright 2001 The McGraw-Hil
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