ABBREVIATIONS AND ACRONYMS Ab Antibody mo Month Abn Abnormal MRI Magnetic resonance AFB Acid-fast bacillus imaging Ag Antigen N Normal AIDS Acquired immuno- Neg Negative deficiency syndrome PCR Polymerase chain reaction ALT Alanine aminotransferase NPO Nothing by mouth ANA Antinuclear antibody (nil per os) AST Aspartate amino- PO Orally (per os) transferase Pos Positive CF Complement fixation PMN Polymorphonuclear CHF Congestive heart failure neutrophil (leukocyte) CIE Counterimmuno- PTH Parathyroid hormone electrophoresis RBC Red blood cell CK Creatine kinase RPR Rapid plasma reagin CNS Central nervous system (syphilis test) CSF Cerebrospinal fluid s Second CXR Chest x-ray SIADH Syndrome of d Day inappropriate anti- Diff Differential cell count diuretic hormone EDTA Ethylenediaminetetra- (secretion) acetic acid (edetate) SLE Systemic lupus ery- ELISA Enzyme-linked thematosus immunosorbent assay T3 Triiodothyronine FT4I Free thyroxine index T4 Tetraiodothyronine GI Gastrointestinal (thyroxine) GNR Gram-negative rod TSH Thyroid-stimulating GNCB Gram-negative hormone coccobacillus V Variable GPC Gram-positive coccus VDRL Venereal Disease GVCB Gram-variable Research Laboratory coccobacillus (syphilis test) h Hour WBC White blood cell Ig Immunoglobulin wk Week IM Intramuscular(ly) yr Year IV Intravenous(ly) ↑ Increased min Minute ↓ Decreased MN Mononuclear cell ↔ No change Copyright 2001 The McGraw-Hill Companies. Click Here for Terms of Use. Pocket Guide to Diagnostic Tests third edition Diana Nicoll, MD, PhD, MPA Clinical Professor and Vice Chair Department of Laboratory Medicine University of California, San Francisco Associate Dean University of California, San Francisco Chief of Staff and Chief, Laboratory Medicine Service Veterans Affairs Medical Center, San Francisco Stephen J. McPhee, MD Professor of Medicine Division of General Internal Medicine University of California, San Francisco Michael Pignone, MD, MPH Assistant Professor of Medicine University of North Carolina, Chapel Hill William M. Detmer, MD, MS Assistant Clinical Professor of Medicine Department of Health Evaluation Sciences University of Virginia, Charlottesville Tony M. Chou, MD Assistant Clinical Professor of Medicine University of California, San Francisco With Associate Authors Lange Medical Books/McGraw-Hill Medical Publishing Division New York St. Louis San Francisco Auckland Bogotá Caracas Lisbon London Madrid Mexico City Milan Montreal New Delhi San Juan Singapore Sydney Tokyo Toronto McGraw-Hill abc Copyright © 2001 by The McGraw-Hill Companies. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-137385-3 The material in this eBook also appears in the print version of this title: 0-8385-8135-8. All trademarks are trademarks of their respective owners. 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Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, pub- lish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS”. McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICU- LAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the func- tions contained in the work will meet your requirements or that its operation will be unin- terrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. DOI: 10.1036/0071373853 Contents Abbreviations . Inside Front Cover Preface . v 1. Basic Principles of Diagnostic Test Use and Interpretation . 1 Diana Nicoll, MD, PhD, MPA, and Michael Pignone, MD, MPH 2. Laboratory Procedures in the Clinical Setting . 23 Stephen J. McPhee, MD 3. Common Laboratory Tests: Selection and Interpretation . 41 Diana Nicoll, MD, PhD, MPA, Stephen J. McPhee, MD, and Michael Pignone, MD, MPH 4. Therapeutic Drug Monitoring: Principles and Test Interpretation . 187 Diana Nicoll, MD, PhD, MPA 5. Microbiology: Test Selection . 195 Mary K. York, PhD 6. Diagnostic Imaging: Test Selection and Interpretation . 243 Sean Perini, MD, and Susan D. Wall, MD 7. Basic Electrocardiography . 283 G. Thomas Evans, Jr., MD 8. Diagnostic Testing: Algorithms, Nomograms, and Tables . 333 Stephen J. McPhee, MD, Diana Nicoll, MD, PhD, MPA, and Michael Pignone, MD, MPH Index . 403 Quick Reference Guide . Back Cover Copyright 2001 The McGraw-Hill Companies. Click Here for Terms of Use. Associate Authors G. Thomas Evans, Jr., MD Associate Clinical Professor of Medicine University of California, San Francisco Director of Electrocardiography Moffit-Long Hospitals, San Francisco Basic Electrocardiography Sean Perini, MD Clinical Fellow Section of Interventional Radiology Department of Radiology University of California, San Francisco Diagnostic Testing: Algorithms, Nomograms, and Tables Susan D. Wall, MD Professor of Radiology and Assistant Chief Department of Radiology Veterans Affairs Medical Center, San Francisco Associate Dean, Graduate Medical Education University of California, San Francisco Diagnostic Imaging: Test Selection and Interpretation Mary K. York, PhD Clinical Professor of Laboratory Medicine University of California, San Francisco Microbiology: Test Selection Copyright 2001 The McGraw-Hill Companies. Click Here for Terms of Use. Preface Purpose Pocket Guide to Diagnostic Tests is intended to serve as a pocket reference manual for medical and other health professional students, house officers, and practicing physicians. It is a quick reference guide to the selection and interpretation of commonly used diagnostic tests, including laboratory procedures in the clinical setting, laboratory tests (chemistry, hematology, and immunology), microbiology tests (bacte- riology, virology, and serology), diagnostic imaging tests (plain radi- ography, CT, MRI, and ultrasonography), and electrocardiography. This book will enable readers to understand commonly used diagnostic tests and diagnostic approaches to common disease states. Outstanding Features • Over 350 tests are presented in a concise, consistent, and readable format. • Fields covered include internal medicine, pediatrics, general surgery, neurology, and gynecology. • Costs and risks of various procedures and tests are emphasized. • Literature references are included for most diagnostic tests. • An index for quick reference is included on the back cover. Organization This pocket reference manual is not intended to include all diag- nostic tests or disease states. Rather, the authors have selected those tests and diseases that are most common and relevant to the general practice of medicine. The Guide is divided into eight sections: 1. Basic Principles of Diagnostic Test Use and Interpretation 2. Laboratory Procedures in the Clinical Setting 3. Common Laboratory Tests: Selection and Interpretation 4. Therapeutic Drug Monitoring: Principles and Test Interpretation 5. Microbiology: Test Selection 6. Diagnostic Imaging: Test Selection and Interpretation 7. Basic Electrocardiography 8. Diagnostic Testing: Algorithms, Nomograms, and Tables Intended Audience In this era of rapidly changing medical technology, many new diagnostic tests are being introduced every year and are replacing older tests as they are shown to be more sensitive, specific, or cost-effective. Copyright