DIAGNOSIS
] Most important
] Helps detect, confirm, document or exclude a disease
] May be differential
[
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PROGNOSIS
] Predicted by noting the degree of test abnormality
The higher the transaminase level in hepatitis, and the higher the creatine kinase
MB isomer level in acute MI, the more serious the disease and usually the worse
the prognosis
SPECIFIC COMPLAINTS
Perform a battery of chemistry tests
CBC
Urinalysis
MONITORING
] Measure progression or regression of a disease
] Response to treatment
] Response to drugs (levels)
EXAMPLES OF TESTS USED TO MONITOR PATIENT DISEASE STATUS
DISEASE
TEST
Glycosylated hemoglobin
Heparin anticoagulation
ORDER OF TESTING
] From cheap to costly
] From less to more risky
] And from simple to more complex
[
[
Within the constraints of time, risk and cost, try to do the test or procedure
with the most efficiency as soon as possible
The procedure with the highest sensitivity, specificity, and predictable values
[
[
[
[
They have a significant drop in the GFR, which renders them susceptible to
drug toxicity if they are given drugs that are excreted by the kidneys
A hemolyzed sample of blood results in a false elevation of serum lactate
dehydrogenase, potassium, and iron, since they are present in RBCs
A fasting blood sample is necessary in order to obtain accurate serum glucose and
serum triacylglycerol (TG) levels, since diet affects these two analytes
Because alcohol enhances the activity of the cytochrome P450 system in the liver,
which is involved in drug metabolism, the serum concentration of a prescribed
drug is likely to be lower than expected if alcohol is consumed
Cimetidine, a histamine blocker used in treating peptic ulcer disease, blocks
cytochrome P450 system, so there is a potential for drug toxicity by drugs normally
metbolized in the liver
ANALYTICAL VARIABLES
[ Refers to the problems with performance of the test in the laboratory such as
turbidity (due to TG) or hypo-albuminemia, which automatically lowers the total
calcium concentration