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ABBREVIATIONS AND ACRONYMS
Ab

Antibody

mo

Month

Abn

Abnormal

MRI

Magnetic resonance

AFB

Acid-fast bacillus

Ag

Antigen

N

Normal

AIDS

Acquired immuno-

Neg

Negative

ALT

imaging

deficiency syndrome

PCR

Polymerase chain reaction

Alanine aminotransferase

NPO

Nothing by mouth
Orally (per os)

(nil per os)

ANA

Antinuclear antibody

AST

Aspartate amino-

PO

transferase

Pos

Positive

CF

Complement fixation

PMN

Polymorphonuclear
Parathyroid hormone

neutrophil (leukocyte)

CHF

Congestive heart failure

CIE

Counterimmuno-

PTH

electrophoresis

RBC

Red blood cell

CK

Creatine kinase

RPR

Rapid plasma reagin

CNS

Central nervous system

CSF

Cerebrospinal fluid

s

Second

CXR

Chest x-ray

SIADH

Syndrome of

d

Day

inappropriate anti-

Diff

Differential cell count

diuretic hormone

EDTA

Ethylenediaminetetraacetic acid (edetate)

ELISA

(syphilis test)

(secretion)
SLE

Systemic lupus ery-

T3

Triiodothyronine

T4

Tetraiodothyronine

TSH

Thyroid-stimulating

V

Variable

VDRL

Venereal Disease

thematosus

Enzyme-linked
immunosorbent assay

FT4I

Free thyroxine index

GI

Gastrointestinal

GNR

Gram-negative rod

GNCB

Gram-negative
coccobacillus

GPC

Gram-positive coccus

GVCB

Gram-variable

(thyroxine)
hormone

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

abc

McGraw-Hill

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.
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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 (bacteriology, virology, and serology), diagnostic imaging tests (plain radiography, 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 diagnostic 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 2001 The McGraw-Hill Companies. Click Here for Terms of Use.

In this environment, students, house officers, and practicing physicians
are looking for a pocket reference on diagnostic tests.
Medical students will find the concise summary of diagnostic laboratory, microbiologic, and imaging studies, and of electrocardiography in
this pocket-sized book of great help during clinical ward rotations.
Busy house officers will find the clear organization and citations
to the current literature useful in devising proper patient management.
Practitioners (internists, family physicians, pediatricians, surgeons,
and other specialists who provide generalist care) may use the Guide as
a refresher manual to update their understanding of laboratory tests and
diagnostic approaches.
Nurses and other health practitioners will find the format and
scope of the Guide valuable for understanding the use of laboratory
tests in patient management.
In 1998, the contents of this book were integrated with the contents of Pocket Guide to Commonly Prescribed Drugs, 2nd ed., by
Glenn N. Levine, MD, in a new CD-ROM, Current Medical Diagnosis
& Treatment 1998 on CD-ROM. An updated version of the CD-ROM,
including this book, will be published in 2000.
Acknowledgments
We wish to thank our associate authors for their contributions to
this book. In addition, we are grateful to the many physicians, residents,
and students who contributed useful suggestions and to Jim Ransom for
his careful editing of the manuscript.
We welcome comments and recommendations from our readers
for future editions.
Diana Nicoll, MD, PhD, MPA
Stephen J. McPhee, MD
Michael Pignone, MD, MPH
William M. Detmer, MD, MS
Tony M. Chou, MD
San Francisco
September 2000

1
Basic Principles of Diagnostic
Test Use and Interpretation *

Diana Nicoll, MD, PhD, and Michael Pignone, MD, MPH

The clinician’s main task is to make reasoned decisions about patient
care despite incomplete clinical information and uncertainty about
clinical outcomes. While data elicited from the history and physical
examination are often sufficient for making a diagnosis or for guiding
therapy, more information may be required. In these situations,
clinicians often turn to diagnostic tests for help.

BENEFITS; COSTS, AND RISKS
When used appropriately, diagnostic tests can be of great assistance to
the clinician. Tests can be helpful for screening, ie, to identify risk factors for disease and to detect occult disease in asymptomatic persons.
Identification of risk factors may allow early intervention to prevent
disease occurrence, and early detection of occult disease may reduce

*Chapter modified, with permission, from Tierney LM Jr, McPhee SJ, Papadakis MA
(editors): Current Medical Diagnosis & Treatment 2000. McGraw-Hill, 2000.

1

Copyright 2001 The McGraw-Hill Companies. Click Here for Terms of Use.


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