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  <head>
    <title>064-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Laboratory tests, imaging, and stewardship">
      <outline text="Orientation, probability and thresholds">
        <outline text="A test changes uncertainty, not reasoning">
          <outline text="Harms: pain, anaemia, radiation, cascades, delay"/>
          <outline text="Order when results change action"/>
        </outline>
        <outline text="State target condition and pretest probability"/>
        <outline text="Sensitivity and specificity">
          <outline text="Predictive values vary with prevalence"/>
          <outline text="Likelihood ratios convert pretest to post-test odds"/>
        </outline>
        <outline text="Sensitive negative excludes, specific positive confirms">
          <outline text="Fails if timing, technique, spectrum, cut-off differ"/>
        </outline>
        <outline text="Thresholds reflect consequences">
          <outline text="Dangerous treatable disease: act at lower probability"/>
        </outline>
        <outline text="Reference intervals hold 95% of healthy people">
          <outline text="Multiple testing adds chance abnormality"/>
        </outline>
      </outline>
      <outline text="Specimen quality and pre-analytical error">
        <outline text="Identity, timing, tube, site, transport"/>
        <outline text="Posture, fasting, medicines, tourniquet alter results"/>
        <outline text="Haemolysis raises potassium and enzymes"/>
        <outline text="Delay changes glucose and gases"/>
        <outline text="Underfilled citrate tubes distort coagulation"/>
        <outline text="Unexpected result: assess patient, check plausibility">
          <outline text="Repeat urgently, never dismiss critical results"/>
        </outline>
        <outline text="Closed loop: recipient, meaning, action, owner"/>
      </outline>
      <outline text="Full blood count and film">
        <outline text="A map rather than a diagnosis"/>
        <outline text="Mean cell volume normal with mixed deficiencies"/>
        <outline text="Reticulocytes adjusted for anaemia severity"/>
        <outline text="Neutropenia risk by depth and duration"/>
        <outline text="Platelet number does not measure function">
          <outline text="Bleeding risk: vessel, drugs, organs, procedure"/>
        </outline>
        <outline text="Film: fragments, blasts, parasites, clumping"/>
      </outline>
      <outline text="Electrolytes, kidney function and osmolality">
        <outline text="Sodium mainly reflects water balance">
          <outline text="Correct chronic change slowly"/>
        </outline>
        <outline text="Potassium: sampling, acid-base, insulin, drugs">
          <outline text="Severe or electrical change: treat immediately"/>
        </outline>
        <outline text="Creatinine imperfect and lags acute injury">
          <outline text="Estimated filtration unreliable when changing"/>
        </outline>
        <outline text="Urinalysis shows patterns serum cannot"/>
        <outline text="Osmolar and anion gaps">
          <outline text="Neither excludes dangerous poisoning"/>
        </outline>
      </outline>
      <outline text="Liver, cardiac, inflammatory and endocrine markers">
        <outline text="Aminotransferases indicate hepatocyte injury">
          <outline text="High enzymes do not mean worse function"/>
        </outline>
        <outline text="Troponin indicates injury, not infarction">
          <outline text="Infarction: rise or fall plus ischaemia"/>
        </outline>
        <outline text="Natriuretic peptides reflect wall stress"/>
        <outline text="CRP and ESR nonspecific inflammation"/>
        <outline text="Autoantibodies need compatible phenotype"/>
        <outline text="Treat suspected adrenal crisis before testing"/>
        <outline text="Glycated haemoglobin distorted by red-cell change"/>
      </outline>
      <outline text="Coagulation and transfusion">
        <outline text="Prothrombin time for vitamin-K antagonists"/>
        <outline text="Normal tests miss platelet and von Willebrand defects"/>
        <outline text="Abnormal tests: deficiency, inhibitor, error"/>
        <outline text="Group, screen and crossmatch prevent incompatibility">
          <outline text="Uncrossmatched blood when haemorrhage outweighs delay"/>
        </outline>
        <outline text="Transfuse by physiology, not one threshold"/>
      </outline>
      <outline text="Microbiology and molecular testing">
        <outline text="Sample infected site before antimicrobials"/>
        <outline text="Positive culture: pathogen, coloniser, contaminant"/>
        <outline text="Susceptibility does not ensure penetration"/>
        <outline text="PCR may stay positive after organisms die"/>
        <outline text="Serology may be negative early"/>
      </outline>
      <outline text="Plain imaging, ultrasound, CT and MR">
        <outline text="Radiography: overlap hides disease">
          <outline text="Normal chest film misses early infection, small pneumothorax"/>
        </outline>
        <outline text="Ultrasound: no radiation, operator dependent"/>
        <outline text="CT: rapid cross-sectional anatomy">
          <outline text="Radiation accumulates, but never delay life-saving scans"/>
          <outline text="Iodinated contrast: weigh benefit and kidney context"/>
        </outline>
        <outline text="MR: soft-tissue contrast, slower, implant limits">
          <outline text="Gadolinium cautiously in kidney failure or pregnancy"/>
        </outline>
      </outline>
      <outline text="Nuclear and interventional imaging">
        <outline text="Radiotracers map physiology">
          <outline text="Inflammation mimics cancer"/>
        </outline>
        <outline text="Interventional: biopsy, drainage, embolisation">
          <outline text="Biopsy route must preserve later surgery"/>
        </outline>
      </outline>
      <outline text="Stewardship and incidental findings">
        <outline text="Ask question, result impact, timing, harm"/>
        <outline text="Stop monitoring that no longer guides care"/>
        <outline text="Least harmful test that answers the question"/>
        <outline text="Screening: low prevalence, overdiagnosis"/>
        <outline text="Describe incidental findings by risk and follow-up"/>
        <outline text="Assign ownership at every transition"/>
      </outline>
    </outline>
  </body>
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