The Hands-on Guide to Data Interpretation E-Book

Sasha Abraham

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Hands-on Guides
• Sprache: Englisch

Seitenzahl: 311

Veröffentlichungsjahr: 2011

Beschreibung

Not sure how to interpret the wealth of data in front of you?

Do you lack confidence in applying the results of investigations to your clinical decision making?

Then this pocket-sized, quick reference guide to data interpretation may be just right for you.

The Hands-on Guide to Data Interpretation is the perfect companion for students, doctors, nurses and other health care professionals who need a reference guide on the ward or when preparing for exams. It focuses on the most common investigations and tests encountered in clinical practice, providing concise summaries of how to confidently interpret investigative findings and, most importantly, how to apply this to clinical decision making.

The benefits of this book include:

• An overview of the normal ranges of test results, followed by a consideration of the differential diagnoses suggested by variance from these values
• Arranged by system to allow quick access to the key investigations encountered in different specialties
• A summary 'patient data' chapter to bring the different specialties together, providing an overview to completing investigation documentation and charts
• Summary table and bullet point format, with a full index, to aid rapid retrieval of information
• Each chapter reviewed by a specialist to ensure an accurate, practical approach to data interpretation

Take the stress out of data interpretation with The Hands-on Guide!

Leseprobe

Contents

Preface

Acknowledgements

Abbreviations

Chapter 1: NORMAL RANGES

Haematology

Chemistry

Hormones

Tumour markers

Cerebrospinal fluid

Sweat

Immunoglobulins

Units and conversion tables

Chapter 2: CARDIOVASCULAR

Introduction

Electrocardiogram (ECG) interpretation

Exercise tolerance test (ETT)

Cardiac enzymes

Infective endocarditis

Rheumatic fever

Pressures and sounds

Other cardiac investigations

Peripheral vascular disease

Chapter 3: RESPIRATORY

Introduction

Asthma

Determining severity (acute attack)

Peak expiratory flow rate (PEFR)

Spirometry

Flow-volume loops

Acid-base balance

Anion gap

Arterial blood gas (ABG)

Respiratory failure

Alveolar-arterial (A-a) gradient calculation

Pneumonia severity

Pleural effusion

Pulmonary embolus (PE)

Pulmonary fibrosis

Tumours of the lung

Other tests

Chapter 4: GASTROENTEROLOGY

Introduction

General investigations

Helicobacter pylori (H. pylori)

Endoscopy

Inflammatory bowel disease

Autoimmune gut disease

Gastrointestinal (GI) bleed

Jaundice

Liver function tests (LFTs)

Autoimmune liver and biliary tract disease

Hepatitis

Ascites

Severity of liver disease: Child-Pugh classification

Decompensated liver disease

Paracetamol poisoning

Indications for liver transplant

1 King's College criteria

Acute pancreatitis

Nutrition

Histological findings in GI disease

Chapter 5: ENDOCRINOLOGY

Introduction

Glucose metabolism and diabetes mellitus (DM)

Thyroid disease

Pituitary hormones

Adrenal hormones

Calcium, phosphate and bone

Multiple endocrine neoplasia (MEN)

Chapter 6: RENAL

Introduction

Urinary tract imaging

Urine microscopy

Urine cytology

Renal biopsy

Urea, creatinine and electrolytes

Prostate specific antigen

Calculi

Nephrotic syndrome

Nephritic syndrome (glomerulonephritis)

Acute versus chronic renal failure

Chapter 7: NEUROLOGY

Introduction

Approach to neurological localisation

Neurological examination

Cranial nerves

Key neurological investigations

Approach to neurological disorders

Chapter 8: HAEMATOLOGY

Introduction

Components of the full blood count

Haematinics

Anaemia

Haemolytic anaemia

Pancytopaenia

Coagulopathy (bleeding disorders)

Anticoagulant/antiplatelet/thrombolytic agents

Myeloproliferative disorders

Blood transfusion

Inflammatory markers

Chapter 9: RHEUMATOLOGY

Introduction

Basic investigations

Rheumatoid factor (RF)

Seronegative spondylarthritis

Other plasma autoantibodies associated with disease

Ophthalmic manifestations of systemic disease

Human leucocyte antigen (HLA)

Synovial fluid analysis

X-ray changes in rheumatological disease

Chapter 10: OBSTETRICS AND GYNAECOLOGY

Introduction

Sex hormones and the menstrual cycle

Polycystic ovarian syndrome (PCOS)

Infertility

Pregnancy testing

Antenatal tests

Physiological changes of pregnancy

Cardiotocography (CTG)

Chapter 11: OPHTHALMOLOGY

Introduction

Fundoscopy

Other eye imaging modalities

Visual acuity

Visual fields

Corneal topography

Chapter 12: ONCOLOGY

Introduction

Cancer statistics

Language of cancer therapy

Screening

Tumour markers

Tumour stage and grade

Chapter 13: MICROBIOLOGY

Introduction

Infection

Systemic inflammatory response syndrome (SIRS)

Approach to diagnosing infection

Initial and further investigations

Gram staining and identifying bacteria

Imaging

Antibiotic therapy

Pyrexia of unknown origin (PUO)

Nosocomial infections

Neutropaenic sepsis

HIV/AIDS

Chapter 14: GENETICS

Introduction

Patterns of inheritance

Chromosomal abnormalities

Chapter 15: IMAGING

Introduction

The basics

Chest X-ray (CXR) interpretation

Abdominal X-ray (AXR) interpretation

Ultrasound

Echocardiography

Computed tomography (CT)

Magnetic resonance imaging (MRI)

Nuclear imaging

Contrast studies

Bone density imaging

Radiation doses

Presenting imaging findings

Tips on making radiology requests

Chapter 16: PATIENT DATA

Introduction

Observation charts

Specialised charts

Intravenous fluid composition

Documentation in clinical notes

Pre-operative assessment

Index

This edition first published 2010, © 2010 by S Abraham, K Kulkarni, R Madhu, D Provan

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell's publishing program has been merged with Wiley's global Scientific, Technical and Medical business to form Wiley-Blackwell.

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Library of Congress Cataloging-in-Publication Data

The hands-on guide to data interpretation/Sasha Abraham… [et al.].

p.; cm.

Includes index.

ISBN 978-1-4051-5256-3

1. Reference values (Medicine)-Handbooks, manuals, etc. 2. Diagnosis, Laboratory-Handbooks, manuals, etc. I. Abraham, Sasha.

[DNLM: 1. Diagnostic Techniques and Procedures-Handbooks. 2. Laboratory Techniques and Procedures-Handbooks. 3. Medical Records-Handbooks. WB 39 H23698 2010]

RB38.2.H373 2010

616.07'5-dc22

2010015124

Preface

There is no shortage of data - the attributes or measures assigned to a variable - in clinical medicine. With growth in both the number of available investigative} modalities and the volume of investigations performed in clinical practice, the challenge of data interpretation lies in the translation of relevant raw data into information that can be appropriately applied to clinical decision making.

To condense the vast potential remit of this book, we have decided to focus on the interpretation of data derived from the more commonly encountered investigations in clinical practice. We have therefore attempted to limit the inclusion of approaches to interpreting data derived from other clinical activities such as clinical history taking and examination. However, this has not been an easy task (particularly in certain specialties, such as neurology), as these activities are - quite rightly - inextricably linked to the investigations performed as part of the management of patients. Notwithstanding the subject of this book, it is important to remember that the history and examination of patients remains at the core of patient management and investigations should be performed only as an adjunct to these processes - not as a replacement. Fundamentally, the interpretation of data derived from investigative procedures should always be undertaken with the clinical context in mind.

For medical students and junior doctors alike, data interpretation is a common feature of both examinations and clinical practice. This textbook aims to serve as an aide memoire, providing a concise repository of facts, figures and succinct explanations that can be used during both revision and clinical attachments. With the origins of this book stemming from our own clinical finals examination revision notes, each chapter has been written with close input from specialists in the field and highlights the approach to interpreting the key data sets encountered in a particular specialty. The 'patient data' chapter aims to bring all of these specialties together to consider some of the more practical aspects of interpreting and presenting data encountered in a clinical setting.

We hope that readers will find this textbook of use and that it will help put some structure to the multiple - and at times unwieldy - channels of data encountered in medical practice.

SA, KK, RM, DP

Acknowledgements

We would like to thank the following people for their help in the preparation of this book.

Sonya Abraham, Senior Lecturer in Rheumatology and Medicine, Kennedy Institute of Rheumatology, Imperial College Healthcare NHS Trust, London

Philip Bejon, Senior Research Fellow, Biomedical Research Centre, Oxford

Mark Blunden, Consultant Nephrologist, Barts and The London Hospitals, London

Anne Bolton, Head of Ophthalmic Imaging, Oxford Eye Hospital, Oxford

Muhammed Zameel Cader, Clinician Scientist and Honorary Consultant Neurologist, Oxford Centre for Gene Function, Oxford

Peter J Charles, Lead Biomedical Scientist, Translational Research, Kennedy Institute of Rheumatology, Imperial College, London

Fiona Cuthbertson, Specialist Registrar in Ophthalmology, Oxford Eye Hospital, Oxford

Andrew Davies, Senior Lecturer in Medical Oncology, and Honorary Consultant Cancer Sciences Division, University of Southampton School of Medicine, Southampton

Michelle Emery, Consultant in Endocrinology and Diabetes, Homerton University Hospital, London

Adrian Lim, Consultant Radiologist, Imperial College Healthcare NHS Trust, Hammersmith and Charing Cross Hospitals, London

Taya Kitiyakara, Consultant Gastroenterologist, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

George Markose, Consultant Radiologist, St George's Hospital, London

Peter Morgan-Warren, Specialty Registrar in Ophthalmology, West Midlands

Abdul Mozid, Cardiology Specialist Registrar, Essex Cardiothoracic Centre, Basildon

Geoffrey E Packe, Consultant Physician in Chest and General Medicine, Newham University Hospital, London

Zeudi Ramsey-Marcelle, ST7 Obstetrics and Gynaecology, North Middlesex University Hospital, London

Simon Richardson, Academic Clinical Fellow, Haemato-oncology, University College, London

Stefanie Christina Robert, Locum Consultant in Acute Medicine, Royal London Hospital, London

Sherif Sadek, Consultant Radiologist, Whipps Cross University Hospital, London

Parveen Vitish-Sharma, CT2 in General Surgery, St George's Hospital, London

Abbreviations

1/7

one day

1/12

one month

1/52

one week

18-FDG

18-fluorodeoxyglucose

AIH1

autoimmune hepatitis 1

AIH2

autoimmune hepatitis 2

ABG

arterial blood gas

ABP

arterial blood pressure

ABP1

Ankle Brachial Pressure Index

AC

air conduction

ACE

angiotensin-converting enzyme

ACS

acute coronary syndrome

ACTH

adrenocorticotrophic hormone

ADH

antidiuretic hormone

ADP

adenosine diphosphate

ADPKD

autosomal dominant polycystic kidney disease

AF

atrial fibrillation

AFP

alpha-fetoprotein

ALP

alkaline phosphatase

ALT

alanine aminotransferase

AMA

anti-mitochondrial antibody

AML

acute myeloid leukaemia

ANA

anti-nuclear antibody

ANCA

anti-neutrophil cytoplasmic antibody

APTT

activated partial thromboplastin time

ARDS

acute respiratory distress syndrome

ARPKD

autosomal recessive polycystic kidney disease

ASM

anti-smooth muscle antibody

ASOT

anti-streptolysin O titre

AST

aspartate transaminase

ATN

acute tubular necrosis

AV

atrioventricular

AVPU

Alert, Voice, Pain, Unresponsive

BC

bone conduction

Bd

bis in die (twice per day)

BE

base excess

B-HCG

beta human chorionic gonadotrophin

BMI

body mass index

BPH

benign prostatic hyperplasia

BS

bowel/breath sounds

BSEP

brainstem sensory evoked potential

CABG

coronary artery bypass graft

CCP

cyclic citrullinated peptide

CEA

carcinoembryonic antigen

CF

cystic fibrosis

CHD

coronary heart disease

CJD

Creutzfeldt-Jakob disease

CK

creatine kinase

CLO

Campylobacter-like organism

CMAP

compound muscle action potential

CML

chronic myeloid leukaemia

CMV

cytomegalovirus

CNS

central nervous system

COPD

chronic obstructive pulmonary disease

COX

cyclooxygenase

CPET

cardiopulmonary exercise testing

CRP

C-reactive protein

CSF

cerebrospinal fluid

CT

computed tomography

CTG

cardiotocography

CTPA

computed tomography pulmonary angiogram

CTU

computed tomography urogram

CVA

cerebrovascular accident (stroke)

CVD

cardiovascular disease

CVP

central venous pressure

CXR/AXR

chest/abdominal X-ray

DI

diabetes insipidus

DIC

disseminated intravascular coagulation

DKA

diabetic ketoacidosis

DM

diabetes mellitus

DMSA

dimercaptosuccinic acid

DTPA

diethylene triamine penta-acetic acid

DVT

deep vein thrombosis

DWI

diffusion weighted imaging

ECG

electrocardiogram

ECT

electroconvulsive therapy

EEG

electroencephalogram

ELISA

enzyme-linked immunosorbent assay

EMG

electromyelogram

EOG

electrooculography

ERCP

endoscopic retrograde cholangio-pancreatograhy

ERV

expiratory reserve volume

ESR

erythrocyte sedimentation rate

ESWL

extracorporeal shock wave lithotripsy

FBC

full blood count

FDP

fibrin degradation product

FEV1

forced expiratory volume (in 1 second)

FLAIR

fluid attenuated inversion recovery

FNA

fine needle aspiration

FOB

faecal occult blood

FRC

functional residual capacity

FSH

follicle-stimulating hormone

FVC

forced vital capacity

G6PD

glucose-6-phosphate dehydrogenase deficiency

GBS

Guillain-Barré syndrome

GCS

Glasgow Coma Scale

GFR

glomerular filtration rate

GGT

gamma glutamyl transferase

GH

growth hormone

GI

gastrointestinal

GORD

gastro-oesophageal reflux disease

Hb

haemoglobin

HBV

hepatitis B virus

HCC

hepatocellular carcinoma

hCG

human chorionic gonadotrophin

Hct

haematocrit

HDL

high density lipoprotein

HIFU

high intensity focused ultrasound

HLA

human leukocyte antigen

HMMA

hydroxymethylmandelic acid

HMPAO

hexamethylene propyleamine oxime

HONK

hyperosmolar non-ketotic

HR

heart rate

HSV

herpes simplex virus

HUS

haemolytic uraemic syndrome

IBD

inflammatory bowel disease

IC

inspiratory capacity

IGF-1

insulin-like growth factor

IHD

ischaemic heart disease

IM

intramuscularly

INR

international normalised ratio

IRV

inspiratory reserve volume

IU

international units

IV

intravenous

IVC

inferior vena cava

IVDU

intravenous drug use

IVP

intravenous pyelogram

IVU

intravenous urogram

JACCOL

jaundice/anaemia/cyanosis/ clubbing/oedema/ lymphadenopathy

JVP

jugular venous pressure

KCO

carbon monoxide gas transfer coefficient

LAD

left axis deviation

LBBB

left bundle branch block

LDH

lactate dehydrogenase

LDL

low density lipoprotein

LFT

liver function test

LH

luteinising hormone

LHRH

luteinising hormone-releasing hormone

LFTs

liver function tests

LMN

lower motor neuron

LMWH

low-molecular weight heparin

LP

lumbar puncture

L/RIF

left/right iliac fossa

L/RUQ

left/right upper quadrant of the abdomen

L/RVF

left/right ventricular failure

LVH

left-ventricular hypertrophy

MAC

Mycobacterium avium complex

MCH

mean corpuscular haemoglobin

MCHC

mean cell haemoglobin concentration

MCUG

micturating cysturethrogram

MCV

mean cell volume, mean corpuscular volume

MEN

multiple endocrine neoplasia

MI

myocardial infarction

MIBG

meta-iodo-benzyl-guanidine

MMSE

mini-mental state examination

MRA

magnetic resonance angiography

MRI

magnetic resonance imaging

MRSA

methicillin-resistant Staphylococcus aureus

MRV

magnetic resonance venography

MS

multiple sclerosis

MSU

mid-stream urine

NABQI

N-acetyl-p-benzoquinone imine

NAC

N-acetylcysteine

NAD

nothing abnormal detected

NASH

non-alcoholic steato hepatitis

NCS

nerve conduction studies

NHL

non-Hodgkin's lymphoma

NSAID

non-steroidal anti-inflammatory drug

OCP

ova, cysts, parasites

OD

omni die (once per day)

OGD

oesophageal gastroduodenoscopy

PACS

picture archiving and communication system

PAN

polyarteritis nodosa

PAPP-A

pregnancy associated plasma protein A

PaCO2

partial pressure of carbon dioxide

PaO2

partial pressure of oxygen

PBC

primary biliary cirrhosis

PCOS

polycystic ovarian syndrome

PCP

Pneumocystis carinii pneumonia

PCR

polymerase chain reaction

PCV

packed cell volume

PE

pulmonary embolus

PEFR

peak expiratory flow rate

PERLA

pupils equal and reactive to light and accommodation

PET

positron emission tomography

PKD

polycystic kidney disease; pyruvate kinase deficiency

PL

prolactin

PND

paroxysmal nocturnal dyspnoea

PNS

peripheral nervous system

PO

orally

PR

per rectum, rectally

PRN

as required

PRV

polycythaemia rubra vera

PSA

prostate specific antigen

PSC

primary sclerosing cholangitis

PT

prothrombin time

PTC

percutaneous trans-hepatic cholangiography

PTH

parathyroid hormone

PUBS

percutaneous umbilical cord blood sampling

PUO

pyrexia of unknown origin

QDS

quater die sumendus (four times per day)

RA

rheumatoid arthritis

RBBB

right bundle branch block

RBC

red blood cell

RF

risk factor, rheumatoid factor

RIBA

radioimmunoblot assay

RR

respiration rate

RTA

renal tubular acidosis

rt-PA

recombinant tissue-plasminogen activator

RV

residual volume

SA

sinoatrial

SAH

subarachnoid haemorrhage

SBP

spontaneous bacterial peritonitis

S/C

subcutaneous

SEP

sensory evoked potential

SHBG

sex hormone binding globulin

SIRS

systemic inflammatory response syndrome

SLA

soluble liver antigen

SLE

systemic lupus erythematosus

SOB(OE)

shortness of breath (on exertion)

SPECT

single photon emission computed tomography

STIR

short tau inversion recovery

SVC

superior vena cava

SVT

supraventricular tachycardia

T3

tri-iodo

T4

thyroxine

TB

tuberculosis

TBG

thyroxine-binding globulin

TDS

ter die sumendus (three times per day)

TFTS

thyroid function tests

TIA

transient ischaemic attack

TIBC

total iron-binding capacity

TLC

total lung capacity

TOE

transoesophageal echo

TRH

thyrotrophin-releasing hormone

TRUS

transrectal ultrasound

TSH

thyroid stimulating hormone

TT

thrombin time

TTE

transthoracic echocardiography

tTG

tissue transglutaminase

TTP

thrombotic thrombocytopenic purpura

TV

tidal volume

U&E

urea and electrolytes

UC

ulcerative colitis

UMN

upper motor neuron

US

ultrasound

UTI

urinary tract infection

VC

vital capacity

VEP

visual evoked potential

VF

ventricular fibrillation

VMA

vanillylmandelic acid

VT

ventricular tachycardia

VTE

venous thromboembolism

WCC

white cell count

WHO

World Health Organization

WPW

Wolff-Parkinson-White

ZN

Ziehl-Neelsen

Chapter 1

NORMAL RANGES

Notes

1 All are serum values (unless otherwise stated).

2 'Normal range' values differ between individual laboratories and normal healthy individuals, as well as different ages and sexes. Furthermore, disease processes beyond those commonly associated with a particular abnormality' may be associated with variations in individual measurements. For example, elevated ESR levels may be found in heart failure (even in the absence of the presence of any of the common 'normal' causes of elevated ESR). Quoted reference intervals should therefore be considered as guides rather than absolute values, and should always be considered in the clinical context.