Pocket Guide to Diagnostic Tests-0838581358.pdf

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26 Pocket Guide to Diagnostic Tests TABLE 2–1. BODY FLUID TESTS, HANDLING, AND INTERPRETATION. Body Fluid Commonly Requested Tests Specimen Tube and Handling Interpretation Guide Arterial blood pH, PO 2 , PCO 2 Glass syringe. Evacuate air bubbles; remove needle; position rubber cap; place sample on ice; deliver immediately. See acid-base nomogram p 337. Ascitic fluid Cell count, differential Protein, amylase Gram stain, culture Cytology (if neoplasm suspected) Lavender top Red top Sterile Cytology See ascitic fluid profiles, p 365. Cerebrospinal fluid Cell count, differential Gram stain, culture Protein, glucose VDRL or other studies (oligoclonal bands) Cytology (if neoplasm suspected) Tube #1 Tube #2 Tube #3 Tube #4 Cytology See cerebrospinal fluid profiles, p 369. Pleural fluid Cell count, differential Protein, glucose, amylase Gram stain, culture Cytology (if neoplasm suspected) Lavender top Red top Sterile Cytology See pleural fluid profiles, p 382. Synovial fluid Cell count, differential Protein, glucose Gram stain, culture Microscopic examination for crystals Cytology (if neoplasm [villonodular synovitis, metastatic disease] suspected) Lavender top Red top Sterile Green top Cytology See synovial fluid profiles, p 389, and Figure 2–6. Urine Urinalysis Dipstick Microscopic examination Gram stain, culture Cytology (if neoplasm suspected) Clean tube Centrifuge tube Sterile Cytology See Table 8–24, p 395. See Table 2–2, p 31. See Figure 2–3, p 34. Staining Technique a. Put on gloves. b. Stain with crystal violet (10 seconds). c. Rinse with gently running water (5 seconds). d. Flood with Gram iodine solution (10–30 seconds). e. Rinse with gently running water (5 seconds).
Laboratory Procedures in the Clinical Setting 27 f. Decolorize with acetone-alcohol solution until no more blue color leaches from the slide (5 seconds). g. Rinse immediately with water (5 seconds). h. Counterstain with safranin O (10 seconds). i. Rinse with water (5 seconds). j. Let the slide air-dry (or carefully blot with filter paper), then examine it under the microscope. Microscopic Examination a. Examine the smear first using the low-power lens for leukocytes and fungi. Screen for the number and color of polymorphonuclear cells (cell nuclei should be pink, not blue). b. Examine using the high-power oil-immersion lens for microbial forms. Screen for intracellular organisms. Review the slide systematically for (1) fungi (mycelia, then yeast), (2) small gram-negative rods (bacteroides, haemophilus, etc) (3) gram-negative cocci (neisseria, etc), (4) gram-positive rods (listeria, etc), and (5) gram-positive cocci (streptococcus, staphylococcus, etc). c. Label positive slides with the patient’s name and identification number and save them for later review. d. Figure 2–1 illustrates typical findings on a Gram-stained smear of sputum. B. Wright Stain of Peripheral Blood Smear Preparation of Smear a. Obtain a fresh specimen of blood by pricking the patient’s finger with a lancet. If alcohol is used to clean the fingertip, wipe it off first with a gauze pad. b. Place a single drop of blood on a glass slide. Lay a second glass slide over the first one and rapidly pull it away lengthwise to leave a thin smear. c. Let the smear air-dry. Do not heat-fix. Staining Technique a. Stain with fresh Wright stain (1 minute). b. Gently add an equal amount of water and gently blow on the smear to mix the stain and water. Repeat by adding more water and blowing to mix. Look for formation of a shiny surface scum. Then allow the stain to set (3–4 minutes). c. Rinse with gently running water (5 seconds). d. Clean the back of the slide with an alcohol pad if necessary. Microscopic Examination a. Examine the smear first using the low-power lens to select a good area for study (red and white cells separated from one another).
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
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Test /Range/Collection Physiologic
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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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