Podcast
Questions and Answers
Which of the following lab tests is relevant for assessing a patient's bleeding risk when taking Eliquis?
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?
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?
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?
Which lab examination result is appropriate for a chronic liver disease patient in relation to dental practice?
In what context is an A1C test relevant in dental practice?
In what context is an A1C test relevant in dental practice?
Which of the following tests is NOT typically associated with assessing bleeding risk?
Which of the following tests is NOT typically associated with assessing bleeding risk?
What is a primary purpose for requesting lab test results in dental practice?
What is a primary purpose for requesting lab test results in dental practice?
What is the significance of understanding blood coagulation in relation to dental procedures?
What is the significance of understanding blood coagulation in relation to dental procedures?
What does the Metavir fibrosis scoring system categorize?
What does the Metavir fibrosis scoring system categorize?
Which of the following blood tests is NOT involved in the FIB 4 calculation?
Which of the following blood tests is NOT involved in the FIB 4 calculation?
What is the primary purpose of Vibration Controlled Transient Elastography (VCTE) in liver diagnosis?
What is the primary purpose of Vibration Controlled Transient Elastography (VCTE) in liver diagnosis?
What is a common reason dentists do not frequently order lab exams?
What is a common reason dentists do not frequently order lab exams?
Which test combines bilirubin, gamma-glutamyltransferase, and age for liver assessment?
Which test combines bilirubin, gamma-glutamyltransferase, and age for liver assessment?
Which imaging modality is specifically associated with measuring liver steatosis?
Which imaging modality is specifically associated with measuring liver steatosis?
Why might biopsies ordered by dentists be treated differently from other lab tests?
Why might biopsies ordered by dentists be treated differently from other lab tests?
Which laboratory test assesses the AST to platelet ratio?
Which laboratory test assesses the AST to platelet ratio?
What percentage of diagnoses can be established by analyzing data from the initial history and physical examination?
What percentage of diagnoses can be established by analyzing data from the initial history and physical examination?
Which of the following components is NOT part of the general appraisal in the oral diagnostic process?
Which of the following components is NOT part of the general appraisal in the oral diagnostic process?
What is laboratory examination primarily utilized for?
What is laboratory examination primarily utilized for?
Which type of exam is considered an extension of the physical examination?
Which type of exam is considered an extension of the physical examination?
What type of specimens are used in laboratory examinations?
What type of specimens are used in laboratory examinations?
Which specialized exam is included in the laboratory tests for diagnosis?
Which specialized exam is included in the laboratory tests for diagnosis?
Which statement accurately reflects the purpose of the diagnostic process in oral medicine?
Which statement accurately reflects the purpose of the diagnostic process in oral medicine?
Which of the following does NOT represent a possible type of exam conducted in the diagnostic process?
Which of the following does NOT represent a possible type of exam conducted in the diagnostic process?
What should a dentist consider when interpreting a patient's lab results?
What should a dentist consider when interpreting a patient's lab results?
Which factor is NOT relevant to the variations in lab test values?
Which factor is NOT relevant to the variations in lab test values?
Which of the following describes intra-individual variations in lab results?
Which of the following describes intra-individual variations in lab results?
What is the significance of serum creatinine in relation to GFR?
What is the significance of serum creatinine in relation to GFR?
Why must healthcare professionals know the basic terminology of lab test interpretation?
Why must healthcare professionals know the basic terminology of lab test interpretation?
What can lead to analytical variations in lab results?
What can lead to analytical variations in lab results?
When are lab test results particularly important in dental practice?
When are lab test results particularly important in dental practice?
What is a key element to remember about the applicability of lab results?
What is a key element to remember about the applicability of lab results?
What is the primary use of GFR in clinical settings?
What is the primary use of GFR in clinical settings?
Which factor is least likely to increase intra-individual variation in lab results?
Which factor is least likely to increase intra-individual variation in lab results?
What distinguishes a reference limit from a reference range in laboratory testing?
What distinguishes a reference limit from a reference range in laboratory testing?
Which lab test is used to assess glycemic control over the past three months?
Which lab test is used to assess glycemic control over the past three months?
What does WNL stand for in the context of lab test results?
What does WNL stand for in the context of lab test results?
Which of the following is a reason for interpreting lab results in context?
Which of the following is a reason for interpreting lab results in context?
Which of the following tests is NOT commonly used to evaluate the risk of prolonged bleeding post-surgery?
Which of the following tests is NOT commonly used to evaluate the risk of prolonged bleeding post-surgery?
What does 'reference range' refer to in laboratory testing?
What does 'reference range' refer to in laboratory testing?
What is the reference range for platelet counts in a healthy adult?
What is the reference range for platelet counts in a healthy adult?
What condition is indicated by a platelet count less than 150,000/mm3?
What condition is indicated by a platelet count less than 150,000/mm3?
Which of the following represents the level of hemoglobin that indicates anemia in men?
Which of the following represents the level of hemoglobin that indicates anemia in men?
What is the primary function of thrombopoietin receptor agonists (TPO-RAs)?
What is the primary function of thrombopoietin receptor agonists (TPO-RAs)?
What is the critical platelet count threshold where there is an increased risk of spontaneous bleeding?
What is the critical platelet count threshold where there is an increased risk of spontaneous bleeding?
In women, what is the normal hemoglobin range?
In women, what is the normal hemoglobin range?
Which type of thrombocytopenia is specifically associated with liver cirrhosis?
Which type of thrombocytopenia is specifically associated with liver cirrhosis?
Which component is NOT included in a Complete Blood Count (CBC)?
Which component is NOT included in a Complete Blood Count (CBC)?
What percentage of diagnoses is typically established from the combined initial history and physical examination?
What percentage of diagnoses is typically established from the combined initial history and physical examination?
Which of the following is considered an extension of the physical examination?
Which of the following is considered an extension of the physical examination?
Which type of specimen is NOT typically used in laboratory examinations?
Which type of specimen is NOT typically used in laboratory examinations?
What is one of the primary purposes of laboratory examinations in diagnosing conditions?
What is one of the primary purposes of laboratory examinations in diagnosing conditions?
What kind of information can be derived from biochemical, microbiological, or genetic exams?
What kind of information can be derived from biochemical, microbiological, or genetic exams?
Which aspect of the diagnostic process is primarily responsible for gathering important components of patient history?
Which aspect of the diagnostic process is primarily responsible for gathering important components of patient history?
Which of the following is NOT a factor that can influence the outcomes of laboratory tests?
Which of the following is NOT a factor that can influence the outcomes of laboratory tests?
Which type of conditions relies on the integration of medical and dental consultations for diagnosis?
Which type of conditions relies on the integration of medical and dental consultations for diagnosis?
What is a significant factor affecting inter-individual variations in lab values?
What is a significant factor affecting inter-individual variations in lab values?
Which of the following accurately describes a factor that can lead to analytical variations in lab results?
Which of the following accurately describes a factor that can lead to analytical variations in lab results?
Which aspect must be understood to effectively apply lab test results to patient care?
Which aspect must be understood to effectively apply lab test results to patient care?
What principle should be prioritized when interpreting lab test results?
What principle should be prioritized when interpreting lab test results?
Which condition can particularly increase the degree of intra-individual variation in lab values?
Which condition can particularly increase the degree of intra-individual variation in lab values?
In the context of lab test results, what does 'wrong test' refer to?
In the context of lab test results, what does 'wrong test' refer to?
What is the relationship between analytical variations and laboratory reference ranges?
What is the relationship between analytical variations and laboratory reference ranges?
Which factor is least likely to affect the precision of a lab test within a lab setting?
Which factor is least likely to affect the precision of a lab test within a lab setting?
What distinguishes the Metavir fibrosis scoring system from other fibrosis scoring systems?
What distinguishes the Metavir fibrosis scoring system from other fibrosis scoring systems?
Which factor is NOT considered in the Fibrotest (FibroSure) assessment for liver fibrosis?
Which factor is NOT considered in the Fibrotest (FibroSure) assessment for liver fibrosis?
What role does the Controlled Attenuation Parameter (CAP) serve in liver diagnostics?
What role does the Controlled Attenuation Parameter (CAP) serve in liver diagnostics?
Which biomarker is part of the APRI calculation used in evaluating chronic liver disease?
Which biomarker is part of the APRI calculation used in evaluating chronic liver disease?
What is a notable reason why dentists do not frequently order lab exams?
What is a notable reason why dentists do not frequently order lab exams?
Which blood test includes a combination of age, platelet count, and AST for assessing liver fibrosis?
Which blood test includes a combination of age, platelet count, and AST for assessing liver fibrosis?
What is a primary function of using imaging modalities like MRI and FibroScan in diagnosing liver conditions?
What is a primary function of using imaging modalities like MRI and FibroScan in diagnosing liver conditions?
In the context of liver diagnostics, what does the term 'Vibration Controlled Transient Elastography (VCTE)' specifically refer to?
In the context of liver diagnostics, what does the term 'Vibration Controlled Transient Elastography (VCTE)' specifically refer to?
Which lab test is relevant for assessing the risk of prolonged bleeding in a patient on warfarin?
Which lab test is relevant for assessing the risk of prolonged bleeding in a patient on warfarin?
What is the significance of a Comprehensive Metabolic Panel in dental practice?
What is the significance of a Comprehensive Metabolic Panel in dental practice?
Which statement accurately describes the relevance of lab test results in supporting oral health diagnosis?
Which statement accurately describes the relevance of lab test results in supporting oral health diagnosis?
Why is a CBC and differential test still relevant in the context of a patient on anticoagulants?
Why is a CBC and differential test still relevant in the context of a patient on anticoagulants?
What is a critical consideration when interpreting lab results for dental patients on anticoagulation therapy?
What is a critical consideration when interpreting lab results for dental patients on anticoagulation therapy?
In patients with chronic liver disease, which lab test is critical for assessing bleeding risk?
In patients with chronic liver disease, which lab test is critical for assessing bleeding risk?
Which lab exam result assessment is least relevant when considering a patient scheduled for a dental procedure?
Which lab exam result assessment is least relevant when considering a patient scheduled for a dental procedure?
What is an important aspect of the new coagulation tests like Thromboelastography (TEG) compared to traditional tests?
What is an important aspect of the new coagulation tests like Thromboelastography (TEG) compared to traditional tests?
What defines thrombocytopenia?
What defines thrombocytopenia?
What is the critical platelet count threshold that significantly increases the risk of spontaneous bleeding?
What is the critical platelet count threshold that significantly increases the risk of spontaneous bleeding?
Which condition is associated with a hemoglobin level less than 12.0 grams/dl in women?
Which condition is associated with a hemoglobin level less than 12.0 grams/dl in women?
What distinguishing characteristic is observed in idiopathic thrombocytopenia?
What distinguishing characteristic is observed in idiopathic thrombocytopenia?
How does the reference range for hemoglobin differ between genders?
How does the reference range for hemoglobin differ between genders?
What is the primary aim of thrombopoietin receptor agonists (TPO-RAs) in clinical use?
What is the primary aim of thrombopoietin receptor agonists (TPO-RAs) in clinical use?
In terms of hematocrit, what is the normal reference range for men?
In terms of hematocrit, what is the normal reference range for men?
Which factor is unlikely to cause intra-individual variation in lab test results?
Which factor is unlikely to cause intra-individual variation in lab test results?
In the context of lab test interpretation, what does the term 'WNL' signify?
In the context of lab test interpretation, what does the term 'WNL' signify?
Which of the following characteristics is essential when interpreting a laboratory test result?
Which of the following characteristics is essential when interpreting a laboratory test result?
What is the primary use of the A1C test in clinical practice?
What is the primary use of the A1C test in clinical practice?
Which of the following best describes the usage of International Normalized Ratio (INR) in patients on warfarin?
Which of the following best describes the usage of International Normalized Ratio (INR) in patients on warfarin?
How does food intake affect lab test values like A1C?
How does food intake affect lab test values like A1C?
What role does physiologic context play in interpreting lab test results?
What role does physiologic context play in interpreting lab test results?
Flashcards
Laboratory Examinations
Laboratory Examinations
Specialized examinations that extend the physical examination by analyzing patient specimens.
Laboratory Tests
Laboratory Tests
Another name for laboratory examinations, which use patient samples for diagnostic purposes.
Patient Specimens
Patient Specimens
Samples (like blood, urine, or tissue) used in lab tests to find clues about medical conditions/diseases.
Biochemical Tests
Biochemical Tests
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Microbiological Tests
Microbiological Tests
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Histomorphological Tests
Histomorphological Tests
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Histochemical Tests
Histochemical Tests
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Immunological Tests
Immunological Tests
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Paradigm shift
Paradigm shift
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Liver fibrosis/cirrhosis diagnosis
Liver fibrosis/cirrhosis diagnosis
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Fibrosis staging
Fibrosis staging
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Biomarkers (e.g., APRI, FIB-4, Hepascore)
Biomarkers (e.g., APRI, FIB-4, Hepascore)
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Imaging tests (MRI, Ultrasound, FibroScan)
Imaging tests (MRI, Ultrasound, FibroScan)
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Metavir fibrosis score
Metavir fibrosis score
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Laboratory test limitations
Laboratory test limitations
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Lab Exam Use
Lab Exam Use
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Relevance of lab tests in dentistry
Relevance of lab tests in dentistry
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CBC and differential
CBC and differential
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Bleeding time (BT) obsolescence
Bleeding time (BT) obsolescence
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INR and Warfarin
INR and Warfarin
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A1c and Diabetes Mellitus
A1c and Diabetes Mellitus
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Metabolic panel and CKD
Metabolic panel and CKD
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Thromboelastography (TEG)
Thromboelastography (TEG)
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Meaningless dental consultation
Meaningless dental consultation
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CBC
CBC
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Hematocrit
Hematocrit
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Hemoglobin
Hemoglobin
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Thrombocytopenia
Thrombocytopenia
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Platelet Count
Platelet Count
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What is the clinical significance of thrombocytopenia?
What is the clinical significance of thrombocytopenia?
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CMP
CMP
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TPO-RAs
TPO-RAs
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Lab test relevance in dental practice
Lab test relevance in dental practice
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Interpreting lab test results
Interpreting lab test results
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Analytical variations
Analytical variations
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Sample variations
Sample variations
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Inter-individual variations
Inter-individual variations
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Intra-individual variations
Intra-individual variations
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Reference range
Reference range
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GFR (Glomerular Filtration Rate)
GFR (Glomerular Filtration Rate)
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Reference Limit
Reference Limit
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Why is context important?
Why is context important?
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Complete Blood Count (CBC)
Complete Blood Count (CBC)
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INR (International Normalized Ratio)
INR (International Normalized Ratio)
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Lab Tests
Lab Tests
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What is the purpose of lab tests?
What is the purpose of lab tests?
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Who orders lab tests?
Who orders lab tests?
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Types of Lab Tests
Types of Lab Tests
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Lab test interpretation
Lab test interpretation
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Lab test relevance in dentistry
Lab test relevance in dentistry
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International Normalized Ratio (INR)
International Normalized Ratio (INR)
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FibroScan
FibroScan
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APRI, FIB-4, Hepascore
APRI, FIB-4, Hepascore
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MRI, Ultrasound
MRI, Ultrasound
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Lab Tests in Dentistry
Lab Tests in Dentistry
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Judicious Use of Lab Tests
Judicious Use of Lab Tests
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Why is this dental consultation meaningless?
Why is this dental consultation meaningless?
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When are lab test results relevant in dentistry?
When are lab test results relevant in dentistry?
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Lab test relevance - dental implant and bleeding risk
Lab test relevance - dental implant and bleeding risk
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What's the key difference between INR and TEG for bleeding risk?
What's the key difference between INR and TEG for bleeding risk?
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What is the correct Lab Test Interpretation?
What is the correct Lab Test Interpretation?
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How do lab test results impact dental practice?
How do lab test results impact dental practice?
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What is the main purpose of lab examinations in dentistry?
What is the main purpose of lab examinations in dentistry?
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Why is a comprehensive metabolic panel relevant in dental practice?
Why is a comprehensive metabolic panel relevant in dental practice?
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Why are lab tests relevant in dentistry?
Why are lab tests relevant in dentistry?
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What are the main factors affecting lab test results?
What are the main factors affecting lab test results?
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What are analytical variations?
What are analytical variations?
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What are inter-individual variations?
What are inter-individual variations?
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What are intra-individual variations?
What are intra-individual variations?
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What is the reference range?
What is the reference range?
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What does GFR measure?
What does GFR measure?
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Why is context important when interpreting lab tests?
Why is context important when interpreting lab tests?
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Clinical Significance of Thrombocytopenia
Clinical Significance of Thrombocytopenia
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Glycohemoglobin (HbA1c)
Glycohemoglobin (HbA1c)
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What are the limitations of lab tests in dentistry?
What are the limitations of lab tests in dentistry?
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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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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.
