Dental Procedures and Lab Tests Assessment
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Questions and Answers

Which of the following lab tests is relevant for assessing a patient's bleeding risk when taking Eliquis?

  • Complete Blood Count (CBC) and differential (correct)
  • Liver function tests
  • Bleed time (BT) test
  • Whole blood clotting assay - Thromboelastography (TEG) (correct)

    • What has replaced the terms "Liver function tests" and "Liver panel" in clinical practice?

  • Serum protein electrophoresis
  • Hepatic profile test
  • Comprehensive metabolic panel (correct)
  • Liver enzyme assay

    • Why is the consultation requesting a Bleed Time (BT) test considered meaningless when a patient is on Eliquis?

  • BT no longer has clinical significance (correct)
  • Eliquis does not affect bleeding time
  • BT is required for all surgical patients
  • BT test results are always misleading

    • Which lab examination result is appropriate for a chronic liver disease patient in relation to dental practice?

    <p>Comprehensive metabolic panel</p> Signup and view all the answers

    In what context is an A1C test relevant in dental practice?

    <p>To evaluate risk for surgical site infection (SSI)</p> Signup and view all the answers

    Which of the following tests is NOT typically associated with assessing bleeding risk?

    <p>A1C for diabetes management</p> Signup and view all the answers

    What is a primary purpose for requesting lab test results in dental practice?

    <p>To support comprehensive oral health diagnosis</p> Signup and view all the answers

    What is the significance of understanding blood coagulation in relation to dental procedures?

    <p>It assists in assessing bleeding risks during surgeries</p> Signup and view all the answers

    What does the Metavir fibrosis scoring system categorize?

    <p>Stages of liver fibrosis from F0 to F4</p> Signup and view all the answers

    Which of the following blood tests is NOT involved in the FIB 4 calculation?

    <p>Hyaluronic acid</p> Signup and view all the answers

    What is the primary purpose of Vibration Controlled Transient Elastography (VCTE) in liver diagnosis?

    <p>To measure liver stiffness related to fibrosis</p> Signup and view all the answers

    What is a common reason dentists do not frequently order lab exams?

    <p>Most conditions are unrelated to dental practice.</p> Signup and view all the answers

    Which test combines bilirubin, gamma-glutamyltransferase, and age for liver assessment?

    <p>Hepascore</p> Signup and view all the answers

    Which imaging modality is specifically associated with measuring liver steatosis?

    <p>FibroScan</p> Signup and view all the answers

    Why might biopsies ordered by dentists be treated differently from other lab tests?

    <p>They are often separated from typical lab work.</p> Signup and view all the answers

    Which laboratory test assesses the AST to platelet ratio?

    <p>APRI</p> Signup and view all the answers

    What percentage of diagnoses can be established by analyzing data from the initial history and physical examination?

    <p>90%</p> Signup and view all the answers

    Which of the following components is NOT part of the general appraisal in the oral diagnostic process?

    <p>Patient's occupation</p> Signup and view all the answers

    What is laboratory examination primarily utilized for?

    <p>Searching for further information for diagnosis</p> Signup and view all the answers

    Which type of exam is considered an extension of the physical examination?

    <p>Laboratory exam</p> Signup and view all the answers

    What type of specimens are used in laboratory examinations?

    <p>Blood, urine, and tissue</p> Signup and view all the answers

    Which specialized exam is included in the laboratory tests for diagnosis?

    <p>Biopsies</p> Signup and view all the answers

    Which statement accurately reflects the purpose of the diagnostic process in oral medicine?

    <p>Different diagnoses can emerge at various examination stages.</p> Signup and view all the answers

    Which of the following does NOT represent a possible type of exam conducted in the diagnostic process?

    <p>Psychological profiling</p> Signup and view all the answers

    What should a dentist consider when interpreting a patient's lab results?

    <p>The gender and race of the patient</p> Signup and view all the answers

    Which factor is NOT relevant to the variations in lab test values?

    <p>Patient's last dental appointment</p> Signup and view all the answers

    Which of the following describes intra-individual variations in lab results?

    <p>Variability in test results when the same individual is tested multiple times</p> Signup and view all the answers

    What is the significance of serum creatinine in relation to GFR?

    <p>It is a calculated value used to derive GFR.</p> Signup and view all the answers

    Why must healthcare professionals know the basic terminology of lab test interpretation?

    <p>To interpret test results effectively</p> Signup and view all the answers

    What can lead to analytical variations in lab results?

    <p>Variations in testing methods and equipment</p> Signup and view all the answers

    When are lab test results particularly important in dental practice?

    <p>When coordinating with a patient's cancer therapy</p> Signup and view all the answers

    What is a key element to remember about the applicability of lab results?

    <p>Results can be affected by the validity of the test conducted.</p> Signup and view all the answers

    What is the primary use of GFR in clinical settings?

    <p>To evaluate kidney function</p> Signup and view all the answers

    Which factor is least likely to increase intra-individual variation in lab results?

    <p>Regular exercise</p> Signup and view all the answers

    What distinguishes a reference limit from a reference range in laboratory testing?

    <p>Reference limit is a single value related to health outcomes</p> Signup and view all the answers

    Which lab test is used to assess glycemic control over the past three months?

    <p>Hemoglobin A1C (HbA1c)</p> Signup and view all the answers

    What does WNL stand for in the context of lab test results?

    <p>Within Normal Limits</p> Signup and view all the answers

    Which of the following is a reason for interpreting lab results in context?

    <p>To consider physiologic conditions and demographics</p> Signup and view all the answers

    Which of the following tests is NOT commonly used to evaluate the risk of prolonged bleeding post-surgery?

    <p>Absolute Neutrophil Count (ANC)</p> Signup and view all the answers

    What does 'reference range' refer to in laboratory testing?

    <p>The range established by a healthy population</p> Signup and view all the answers

    What is the reference range for platelet counts in a healthy adult?

    <p>150,000 - 450,000/mm3</p> Signup and view all the answers

    What condition is indicated by a platelet count less than 150,000/mm3?

    <p>Thrombocytopenia</p> Signup and view all the answers

    Which of the following represents the level of hemoglobin that indicates anemia in men?

    <p>13.5 grams/dl</p> Signup and view all the answers

    What is the primary function of thrombopoietin receptor agonists (TPO-RAs)?

    <p>Stimulate platelet production</p> Signup and view all the answers

    What is the critical platelet count threshold where there is an increased risk of spontaneous bleeding?

    <p>20,000/mm3</p> Signup and view all the answers

    In women, what is the normal hemoglobin range?

    <p>12 - 16 grams/dl</p> Signup and view all the answers

    Which type of thrombocytopenia is specifically associated with liver cirrhosis?

    <p>Liver cirrhosis-related thrombocytopenia</p> Signup and view all the answers

    Which component is NOT included in a Complete Blood Count (CBC)?

    <p>Serum glucose levels</p> Signup and view all the answers

    What percentage of diagnoses is typically established from the combined initial history and physical examination?

    <p>90%</p> Signup and view all the answers

    Which of the following is considered an extension of the physical examination?

    <p>Laboratory examination</p> Signup and view all the answers

    Which type of specimen is NOT typically used in laboratory examinations?

    <p>Vocal cords</p> Signup and view all the answers

    What is one of the primary purposes of laboratory examinations in diagnosing conditions?

    <p>To search for further information for diagnosis</p> Signup and view all the answers

    What kind of information can be derived from biochemical, microbiological, or genetic exams?

    <p>Pathological conditions affecting health</p> Signup and view all the answers

    Which aspect of the diagnostic process is primarily responsible for gathering important components of patient history?

    <p>Review of systems</p> Signup and view all the answers

    Which of the following is NOT a factor that can influence the outcomes of laboratory tests?

    <p>Physical examination techniques</p> Signup and view all the answers

    Which type of conditions relies on the integration of medical and dental consultations for diagnosis?

    <p>Complex systemic diseases</p> Signup and view all the answers

    What is a significant factor affecting inter-individual variations in lab values?

    <p>Geographic location of the patient</p> Signup and view all the answers

    Which of the following accurately describes a factor that can lead to analytical variations in lab results?

    <p>Measurement techniques employed in the lab</p> Signup and view all the answers

    Which aspect must be understood to effectively apply lab test results to patient care?

    <p>The implications of variations in test results</p> Signup and view all the answers

    What principle should be prioritized when interpreting lab test results?

    <p>The reason the test was ordered</p> Signup and view all the answers

    Which condition can particularly increase the degree of intra-individual variation in lab values?

    <p>Recent physical exercise</p> Signup and view all the answers

    In the context of lab test results, what does 'wrong test' refer to?

    <p>A test that does not pertain to the patient's condition</p> Signup and view all the answers

    What is the relationship between analytical variations and laboratory reference ranges?

    <p>Variants in performance specifications can alter reference ranges</p> Signup and view all the answers

    Which factor is least likely to affect the precision of a lab test within a lab setting?

    <p>Individual patient stress levels at the time of testing</p> Signup and view all the answers

    What distinguishes the Metavir fibrosis scoring system from other fibrosis scoring systems?

    <p>It categorizes fibrosis from F0 to F4.</p> Signup and view all the answers

    Which factor is NOT considered in the Fibrotest (FibroSure) assessment for liver fibrosis?

    <p>AST to platelet ratio</p> Signup and view all the answers

    What role does the Controlled Attenuation Parameter (CAP) serve in liver diagnostics?

    <p>It estimates liver steatosis.</p> Signup and view all the answers

    Which biomarker is part of the APRI calculation used in evaluating chronic liver disease?

    <p>ALT (Alanine aminotransferase)</p> Signup and view all the answers

    What is a notable reason why dentists do not frequently order lab exams?

    <p>Most lab tests are not applicable in dental practice.</p> Signup and view all the answers

    Which blood test includes a combination of age, platelet count, and AST for assessing liver fibrosis?

    <p>FIB 4</p> Signup and view all the answers

    What is a primary function of using imaging modalities like MRI and FibroScan in diagnosing liver conditions?

    <p>They provide a non-invasive assessment of liver stiffness.</p> Signup and view all the answers

    In the context of liver diagnostics, what does the term 'Vibration Controlled Transient Elastography (VCTE)' specifically refer to?

    <p>An imaging technique to measure liver stiffness.</p> Signup and view all the answers

    Which lab test is relevant for assessing the risk of prolonged bleeding in a patient on warfarin?

    <p>INR</p> Signup and view all the answers

    What is the significance of a Comprehensive Metabolic Panel in dental practice?

    <p>It evaluates metabolic function and can indicate systemic conditions affecting oral health.</p> Signup and view all the answers

    Which statement accurately describes the relevance of lab test results in supporting oral health diagnosis?

    <p>They can reveal systemic conditions that impact oral health.</p> Signup and view all the answers

    Why is a CBC and differential test still relevant in the context of a patient on anticoagulants?

    <p>To evaluate the immune response and detect possible infections.</p> Signup and view all the answers

    What is a critical consideration when interpreting lab results for dental patients on anticoagulation therapy?

    <p>The specific type of anticoagulant used and its mechanism of action.</p> Signup and view all the answers

    In patients with chronic liver disease, which lab test is critical for assessing bleeding risk?

    <p>INR</p> Signup and view all the answers

    Which lab exam result assessment is least relevant when considering a patient scheduled for a dental procedure?

    <p>A1C for diabetic patients</p> Signup and view all the answers

    What is an important aspect of the new coagulation tests like Thromboelastography (TEG) compared to traditional tests?

    <p>TEG assesses the dynamic process of clot formation and dissolution.</p> Signup and view all the answers

    What defines thrombocytopenia?

    <p>Platelet count less than 150,000/mm3</p> Signup and view all the answers

    What is the critical platelet count threshold that significantly increases the risk of spontaneous bleeding?

    <p>20,000/mm3</p> Signup and view all the answers

    Which condition is associated with a hemoglobin level less than 12.0 grams/dl in women?

    <p>Anemia</p> Signup and view all the answers

    What distinguishing characteristic is observed in idiopathic thrombocytopenia?

    <p>It has an unknown cause</p> Signup and view all the answers

    How does the reference range for hemoglobin differ between genders?

    <p>Men's range is 14 - 18 grams/dl and women's is 12 - 16 grams/dl</p> Signup and view all the answers

    What is the primary aim of thrombopoietin receptor agonists (TPO-RAs) in clinical use?

    <p>To increase platelet production</p> Signup and view all the answers

    In terms of hematocrit, what is the normal reference range for men?

    <p>45 - 52%</p> Signup and view all the answers

    Which factor is unlikely to cause intra-individual variation in lab test results?

    <p>Consistent sleep schedule</p> Signup and view all the answers

    In the context of lab test interpretation, what does the term 'WNL' signify?

    <p>Within Normal Limits</p> Signup and view all the answers

    Which of the following characteristics is essential when interpreting a laboratory test result?

    <p>Reviewing the patient's age and gender.</p> Signup and view all the answers

    What is the primary use of the A1C test in clinical practice?

    <p>To evaluate glycemic control over the past three months.</p> Signup and view all the answers

    Which of the following best describes the usage of International Normalized Ratio (INR) in patients on warfarin?

    <p>To measure therapeutic range and bleeding risk.</p> Signup and view all the answers

    How does food intake affect lab test values like A1C?

    <p>It can increase intra-individual variations in results.</p> Signup and view all the answers

    What role does physiologic context play in interpreting lab test results?

    <p>It provides a necessary background to avoid misinterpretation.</p> Signup and view all the answers

    Study Notes

    Laboratory Examinations (Tests)

    • Laboratory examinations extend the physical examination and are also called laboratory tests or test reports.
    • Specimens like blood, urine, tissue, are used for biochemical, microbiological, histomorphological, histochemical, immunological, or genetic exams to aid diagnosis.
    • Nearly 90% of diagnoses are made by analyzing data from initial history and physical examination.
    • Another 10% of diagnoses require supplemental exams like radiographic, specialized, or laboratory tests, along with biopsies.
    • The way labs are used has evolved, requiring judicious and meaningful application to avoid misdiagnosis, leveraging new concepts and technologies.
    • Current methods integrate laboratory tests with biopsies and imaging studies in diagnosis.

    Oral Diagnostic Process

    • A detailed oral diagnostic process includes demographic information, chief complaint, history of present illness, dental history, medical history (medications included), social history, family history, and review of systems.
    • Initial history and physical examination are crucial to establishing nearly 90% of diagnoses.
    • Vital signs are part of the general appraisal.
    • Extraoral and intraoral exams are part of the physical examination.
    • Supplemental exams, specialized exams, and radiographic exams along with other imaging, laboratory tests, and biopsies are also considered, depending on the specifics of the case and the examiner's expertise.

    Laboratory Exams (Tests)

    • Laboratory examinations complement physical examinations.
    • Patient specimens provide additional data for diagnostics.

    Evolutionary Paradigm Shift

    • Use laboratory tests judiciously and meaningfully to avoid misdiagnosis.
    • Utilizing new technologies and diagnostic concepts enhances the application of laboratory tests.

    Paradigm Shift

    • A fundamental change in thought or practice.
    • The usual way of thinking or doing something is replaced by an alternative approach.

    Current Diagnosis and Classification of Fibrosis and Cirrhosis in Chronic Liver Disease (CLD)

    • Liver biopsy (e.g., Metavir fibrosis (F) scoring system) is used to stage fibrosis from F0-F4.
    • Blood tests use biomarkers and special calculations/formulas (e.g., APRI, FIB-4, Hepascore, and Fibrotest) to assess fibrosis and cirrhosis.
    • Imaging, like MRI and ultrasound-based FibroScan, can measure liver stiffness, and/or steatosis.

    Metavir Fibrosis (F) Scoring System

    • A meta-analysis of histological data in viral hepatitis.
    • Stages (F0-F4) classify severity based on fibrosis extent in portal zones.

    MRI Imaging of Liver Cirrhosis

    • A medical image (in black and white) of a person's liver that demonstrates cirrhosis.

    Ultrasound Image of Liver Cirrhosis

    • A medical image showing a patient's liver with cirrhosis, in black and white.

    FibroScan

    • Shows liver damage stages: Healthy Liver, Fatty Liver, Liver Fibrosis, and Cirrhosis.

    Meta-analysis of Histological Data in Viral Hepatitis (Metavir) vs. Fibroscan Score

    • Graph showing a comparison of the Metavir fibrosis stages (0-4) and Fibroscan scores, illustrating how the two scoring systems correlate to varying degrees of fibrosis severity.

    Dentists' Use of Lab Exams

    • Dentists rarely order lab exams as often as they used to.
    • Dentists typically don't diagnose systemic diseases, costs, insurance policies, and in many instances, labs are inapplicable to dental practice.

    Lab Exam Relevance to Dental Practice

    • Lab test results are essential for comprehensive oral health diagnosis.
    • Results guide assessment of treatment complications and outcomes (e.g., prolonged bleeding).
    • Lab tests aid in medical treatment coordination and insurance/third-party payment verification (especially for HIV patients).

    Current Test Results and Interpretation

    • Interpreting test results is crucial to applying them effectively in patient care.
    • Understanding basic terminology is essential; familiarity with why a test is performed, what it measures, and what its results mean is vital.
    • Understanding test result variations and their applicability (accuracy, timing) must be considered for proper interpretation.

    Factors Affecting Lab Values (Variations)

    • Analytical variations (method, machine, agents): precision and specifications within a lab.
    • Sample variations: Differences between individuals (gender, race, age, location, Hb, GFR, or neutrophil count) and variations within a single individual (intra-individual) are relevant factors. Conditions such as food intake, time of day (circadian), exercise, or acute illness can affect lab results.

    Reference Ranges

    • Reference ranges are defined by populations considered healthy.
    • Reference limits are single numbers (e.g., cholesterol or glucose).

    Reference Range vs. Normal Range

    • Lab results should be interpreted considering context (individual circumstances).
    • Number alone can lead to misinterpretation; reference ranges or limits, not normal ranges or limits, are now used.

    Frequently Requested Lab Results and Dental Treatment

    • Complete blood counts (CBCs) with differentials to assess blood characteristics (like RBCs, WBCs, Hb and platelets).
    • Hemoglobin (Hb or Hgb) impacts patient oxygenation.
    • Absolute neutrophil counts (ANC) affect the risk of surgical site infection.
    • International Normalized Ratio (INR) monitors warfarin; it analyzes prothrombin time (PT) in patients taking anti-coagulants.
    • Glycohemoglobin (HbA1c/A1C) tracks long-term blood glucose control in patients with diabetes.

    Components of a Complete Blood Count (CBC)

    • A detailed list (with reference ranges) of different components and their meanings of a CBC with differential.

    Platelet Count

    • Normal platelet count range is 150,000-450,000/mm³ or 150-450K/µL.
    • Lower counts (thrombocytopenia) may lead to bleeding risks.

    Clinical Significance of Thrombocytopenia

    • Thrombocytopenia's severity, cause, and treatment implications vary.

    Thrombopoietin Receptor Agonists (TPO-RAs)

    • Avatrombopag (Doptelet®) is FDA-approved for chronic liver disease patients scheduled for medical or dental procedures.

    WBC count and differential

    • Total WBC count range: 4.3 to 10.8 K/mm³.
    • Differential count measures different types of WBCs (neutrophils, lymphocytes, monocytes, eosinophils, basophils).
    • Absolute neutrophil count (ANC) reflects functional neutrophils; low counts indicate neutropenia (mild, moderate, or severe).

    Whole Blood Clotting Assay - Thromboelastography (TEG)

    • TEG measures dynamic aspects of coagulation, fibrinolysis, and hemostatic function.
    • Different patterns (e.g., hemorrhagic, thrombotic) indicate various hemostatic states.

    ROTEM® Thromboelastometry

    • ROTEM delta, an automated testing system, provides detailed coagulation analysis.

    Bleeding Time (BT) Test

    • The BT test is not a reliable indicator of bleeding risk in patients taking aspirin or NSAIDs; patient history is more impactful.

    Evaluation of Risk of Prolonged Bleeding in Patients Taking Aspirin or Nonsteroidal Anti-inflammatory Drugs

    • No reliable lab tests accurately predict the risk of prolonged bleeding post-surgery in patients taking aspirin or NSAIDs.

    Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT)

    • PT measures the extrinsic and common coagulation pathways, while aPTT evaluates the intrinsic and common pathways.

    International Normalized Ratio (INR)

    • INR standardizes prothrombin time (PT) results reported by different laboratories, commonly used to monitor warfarin therapy.

    INR Cannot be Used for Assessing Coagulation Status in Non-Warfarin-Taking Patients

    • INR isn't universally applicable for assessing coagulation. It's crucial for patients on warfarin (vitamin K antagonist).
    • It is not as effective for assessing patients with different conditions.

    INR Value

    • INR has a reference range of 0.8-1.2.
    • Specific therapeutic ranges apply to patients taking warfarin, particularly those with mechanical heart valves.

    PT and aPTT Predicting Bleeding Post-Surgery

    • General coagulation tests like PT and aPTT have only limited usefulness in predicting bleeding risks post-surgery due to their simplistic nature in measuring in vitro, versus the multitude of interactions involved in vivo.

    Predicting Prolonged Bleeding After Dental Surgical Procedures

    • Thorough patient and family/medical history, combined with physical exams, are fundamental in identifying potential elevated bleeding risks.
    • Patients with negative bleeding history do not need routine coagulation screening pre-surgery.
    • INR monitoring is crucial within 24 hours of surgery in patients on coumadin.
    • Patients on heparin require APTT monitoring.

    Patients with Chronic Liver Disease (CLD) and Bleeding Tendency

    • Patients with chronic hepatitis, cirrhosis, or liver failure do not systematically have bleeding tendencies.

    Re-balanced Hemostasis in Liver Cirrhosis

    • Hepatocytes produce pro- and anti-hemostatic factors.
    • Liver cirrhosis disrupts this balance, increasing risks for bleeding and thrombosis.

    No Reliable Lab Test to Predict Bleeding Tendency in CLD Patients After Dental Surgery

    • Patient history and clinical signs (e.g. bleeding history and skin bruises) are more valuable predictors.

    Asking Questions Before Ordering Lab Tests

    • Inquiry of result interpretation method and relevance to dental treatment is crucial.

    Whole Blood Clotting Assay- Thromboelastography

    • Dynamic coagulation and fibrinolysis assessment using thromboelastography (TEG).

    Key Points

    • Understanding lab values, their implications, and limitations is crucial.
    • Comprehensive patient history, and physical examination are crucial for a thorough diagnosis and risk prediction.

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    DOM 8250 Laboratory Exams-Part 1 2024 PDF

    Description

    This quiz covers essential lab tests and their relevance in assessing bleeding risks, particularly for patients taking Eliquis. It also examines the importance of understanding blood coagulation in dental practice and the implications of liver function tests. Test your knowledge on lab examinations and their significance in ensuring safe dental procedures.

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