Laboratory Medicine
Code
11160
Academic unit
NOVA Medical School|Faculdade de Ciências Médicas
Department
MC
Credits
4
Teacher in charge
Prof. Doutor José Cortez de Almeida
Teaching language
Portuguese
Objectives
Provide the students with the knowledge essential for selecting the most appropriate laboratory tests according to the clinical situation in question, including screening, diagnostic or therapeutic monitoring, the interpretation and ranking based on the individual characteristics of each test.
We also deal with the statistical concepts that underlie the characteristics of the various laboratory tests, its dependence on prevalence of the condition under study, the determination of reference values and diagnostic decision levels. This knowledge has a transverse extent by direct application to courses of clinical training.
Prerequisites
Subject matter
The course consists of 12 classes where, address individually in each class, topics essential to the understanding, appreciation and hierarchization of laboratory tests used for screening, diagnosis and monitoring diseases with high prevalence in current clinical practice:
1- Characteristics of the laboratory tests
- Rational use of laboratory tests: screening, diagnosis, monitoring
- Characteristics of diagnostic laboratory tests: sensitivity, specificity and diagnostic efficiency, likelihood ratio, predictive values
- ROC curves (Receiver Operating Characteristic)
- Reference values: calculation, significance and implications for clinical practice, intuitive method, nonparametric method, parametric method, decision-making levels, and therapeutic levels
- Variables that may affect the outcome: pre-analytical, analytical and biological intra-individual variation
2- Liver function tests
- Evaluation of the hepatic injury, acute and chronic liver diseases, evaluation of hepatic function (static and dynamic tests), tests with prognostic value, clinical evaluation of function tests and liver damage
- Causes and significance of changes in markers of function / liver damage in asymptomatic patients
3- Proteins
- Indication and interpretation of an electrophoretic profile, identification of fractions with clinical interest
- Acute phase proteins
- Monoclonal gammopathy: laboratory diagnosis and monitoring
4- Acute coronary syndromes
- Review of the pathophysiology of acute coronary syndromes
- Classification of acute coronary syndromes and evolution of laboratory diagnosis of acute coronary syndromes
- Laboratory diagnosis of current acute coronary syndromes: troponin I / T, CK-MB, myoglobin
- Tests with prognostic value: C-reactive protein, BNP / NT-pro-BNP and troponin I / T
5- Diabetes mellitus
- Review of the pathophysiology of diabetes mellitus
-Classification of diabetes mellitus: type 1, type 2, gestational diabetes, other
- Micro and macrovascular complications
- Laboratory diagnosis (WHO / ADA), random glucose, fasting glucose, tolerance test oral glucose, glycated haemoglobin (HbA1c)
- Laboratory monitoring: glycated haemoglobin (HbA1c), fructosamine, albuminuria assessment of GFR, autoantibodies
- Acute complications of diabetes: diabetic ketoacidosis, hyperglycaemic hyperosmolar state, hypoglycaemic coma, and lactic acidosis
6- Anaemia
- Review of haemopoiesis and iron metabolism
- CBC parameters (haematimetric constants and automatic parameters)
- Macrocytic, normocytic and microcytic anaemia
- Differential leukocyte count
- Reactive leukopathies
- Thrombocytopenia/thrombocytosis
7- Hemato-oncologic disease
- Basic decisions (neoplastic vs reactive)
- Methods of study
- Chronic myeloid neoplasms vs reactive thrombocytosis and leukocytosis
- Myelodysplastic syndromes vs deficiency cytopenias
- Myeloproliferative neoplasms
- Myelodysplastic syndromes
- Myelodysplastic/myeloproliferative neoplasms
- Acute myeloid leukemia
- Mature T and B-cell neoplasms
- Acute lymphoblastic leukemia
8- Kidney function
- Review of the physiology of kidney function (nephron)
- Evaluation of glomerular function
- Diagnostic sensitivity of creatinine
- Endogenous creatinine clearance (indication and error factors)
- Cystatin C
- Estimated glomerular filtration rate, advantages and limitations
- Assessment of tubular function (acid-basic and hydro-electrolytic balances)
- Pre and post-renal azotemia
9- Thyroid function
- Review of the physiology of thyroid function
- Fractions of total and free thyroid hormones
- Relationship FT4-TSH
- Hyperthyroidism and hypothyroidism, hyper-and sub-clinical hypothyroidism
- Pregnancy and nonthyroidal illness
- Thyroid and autoimmunity
- Laboratory evaluation of common thyroid clinical syndromes
10,11- Thrombosis and Haemostasis
- Samples (type, processing and transport)
- Physiology of coagulation
- Risk factors for bleeding
- Laboratory exploration of hemorrhagic disease
- Risk factors for venous thrombosis
- Laboratory exploration of venous thrombotic disease
- Thrombotic microangiopathic syndromes: thrombotic thrombocytopenic purpura and hemolytic uremic syndrome
- Heparin-induced thrombocytopenia
12- Tumour markers
- Definition
- Diagnostic features
- Clinical utility
- Interpretation and adequacy of the requests
Bibliography
Teaching method
The teaching of the Course Unit of Laboratory Medicine is biannual.
The course takes place in the form of theoretical-practical classes in accordance with the REGULATION ON PROCEDURES AND ORGANIZATION OF EDUCATIONAL MASTER INTEGRATED OF MEDICAL SCIENCES FACULTY OF THE NEW UNIVERSITY OF LISBON (Article 6), which cover the basic principles essential to understanding the theme of the lesson, followed by discussion of clinical cases.
Monitoring of student attendance is the responsibility of the teacher and by signing an attendance sheet.
Evaluation method
The final assessment of students is made by a written exam lasting 60 minutes, consisting of 50 multiple-choice questions with five possibilities (only one real), taking place at the end of each semester on a date scheduled by the Pedagogical Faculty Council. The final classification is from 0 to 20 values. Students under 10 values are not approved, according to the REGULATIONS ON ASSESSMENT OF STUDENT LEARNING OF INTEGRATED MEDICAL MASTERS OF THE FACULTY OF MEDICAL SCIENCES OF NEW UNIVERSITY OF LISBON.
ADMISSION TO THE FINAL EXAM
Are only admitted to the final exam, students who have a minimum of 2/3 attendance at classes, regardless of any justification of absences.
STUDENTS WITH MORE THAN 1/3 OF FAULTS TO CLASSES ARE NOT ADMITTED TO FINAL EXAM AND WILL HAVE TO REPEAT THE SEMESTER WITH 2/3 ATTENDANCES.
Courses
