Gold Standards in Medical Field

What is a 'gold standard'?

Download

The term 'gold standard' can be referred to a test or a method. A test which shows the true status of the patient is termed gold standard. These test are assumed to have 100% sensitivity and specificity. Diagnostic power of other tests are evaluated based on the comparison with the gold standard test.When the term applies to a method or a procedure, a 'gold standard' serves as a basis for evaluation
of other methods.

Gold standard method for estimating resting energy expenditure - indirect calorimetry

Gold standard investigation for diagnosis of Iron deficiency anemia – Estimation of serum Ferritin

Gold standard for proving that the life span of red cell is decreased ( useful in Hemolytic anemia) - Red cell survival study

Gold standard for evaluation of stem cell transplantation therapy - Hemopoietic stem cell transplantation

Gold standard technique for differentiating allograft rejection and reactivation of disease after heart transplantation - Endo-myocardial Biopsy

Gold standard investigation for diagnosis of DVT - Contrast Venography

Gold standard investigation for diagnosis of acute pharyngitis - Throat Culture

Gold standard investigation for diagnosis of pertussis - Culture of nasopharyngeal secretions

Gold standard investigation for diagnosis of Otitis externa caused by P. aeruginosa - Technetium99 bone scan

Gold standard investigation for diagnosis of Acoustic Neuroma – Gadolinium MRI

Gold standard investigation for diagnosis of Shigella infection - Isolation and identification of pathogen from fecal material

Gold standard investigation for diagnosis of Tuberculous meningitis - Culture of CSF

Gold standard investigation for diagnosis of HSV Encephalitis - Brain biopsy (CSF PCR largely replaced brain biopsy in recent times)

Gold standard investigation for diagnosis of histoplasmosis - Fungal Culture

Gold standard investigation for diagnosis of hypertrophic cardiomypathy and atrial myxoma - Echocardiogram

Gold standard investigation for imaging heart valves and valve motion abnormalities - 2D echocardiography

Gold standard investigation for assessment of Myocardial viability (Identification of ischemic or hibernating myocardium)– PET

Gold standard investigation for assessment of LV mass and volume - MRI

Gold standard method for evaluation of renal arteries and identification of renal artery lesions - Contrast arteriography

Gold standard method for evaluation of respiratory gas exchange - ABG

Gold standard investigation for assessment of albuminuria - 24 hr urine collection

Gold standard investigation for diagnosis of PNH (Paroxysmal Nocturnal Haemoglobinuria) – Flow cytometry

Gold standard investigation for diagnosis of ATTR and other AF mutations - DNA sequencing

Gold standard method for identifying and quantifying atherosclerosis in cerebral arteries - X-ray cerebral angiography

Gold standard investigation for evaluating anatomy of arterio-venous malformation - X-ray angiography

Gold standard for diagnosis and classification of ataxia - genotype

Gold standard investigation for diagnosis of of lung infection (Radiotherapy induced) in a cancer patient - open-lung biopsy

Gold standard medical treatment for symptomatic progressive pulmonary hypertension – Prostacyclin

Gold standard investigation for diagnosis of PIH – Serum Urea

Gold standard for assessment of visual impairment - Snellen's chart

Gold standard method of treatment of non-castrate metastatic disease - surgical orchidectomy

Gold standard method for bacterial stain analysis - Pulse-field gel electrophoresis

Gold standard method of treatment of DCIS - Mastectomy

Gold standard approach for resection of anterior and middle mediastinal masses - median or lateral thoracotomy

Gold standard method of treatment of Coarctation of aorta - Surgical repair

Gold standard method for evaluation of coronary artery disease - Cardiac Catheterization

Gold standard method for culture of V. cholerae o139 - Conventional culture method

Gold standard to determine cut-off titer of widal test for diagnosis of Typhoid fever – Nested PCR

Gold standard treatment of brucellosis in adults - IM Streptomycin + Doxycyclin

Gold standard investigation for diagnosis of of chronic arterial mesentric ischemia - Angiography

Gold standard method for treatment of chronic ulcerative colitis - Total proctocolostomy with end ileostomy

Gold standard method for evaluation of imaging modalities for liver tumors - Intraoperative ultrasonography

Gold standard investigation for diagnosis of common bile duct stones - Endoscopic cholangiography

Gold standard investigation for measurement of GFR - Inulin clearance

Gold standard for treatment of organ confined, muscle invasive, bladder cancer is - Radical cystoprostatectomy in men and anterior pelvic exenteration in woman


Gold standard for treatment of femoral shaft fractures - Reamed locked intramedullary nailing

Gold standard method in case of difficult intubation - Flexible fibreoptic intubation scope

Gold standard method for diagnosis and treatment of Ventilator Associated Pneumonia (VAP) - Broncho alveolar lavage

Gold standard treatment of hyperparathyroidism - Surgery

Gold standard investigation to differentiate follicular and papillary carcinoma of thyroid gland- Histology

Gold standard procedure for thymectomy - Trans cervical mediastinoscopy and surgery

Gold standard for treatment of adrenal tumors - Laparoscopic adrenalectomy

Gold standard investigation for diagnosis of breast cancer - Mammography

Gold standard method for staging of breast cancer - Axillary lymph node dissection

Gold standard for evaluation of a stable patient with suspected vascular injury - Angiography

Gold standard investigation for diagnosis of GERD - Ambulatory 24 hr PH monitoring

Gold standard method for treatment of GERD - Laparoccopic Nissens fundoplication

Gold standard for evaluating cure rate in duodenal ulcer patients – Vagotomy

 Gold standard finding for the diagnosis of GI perforation - Finding pneumoperitoneum

Gold standard for diagnosis of Zollinger-Ellison syndrome - Serum gastrin levels( Most patients have serum gastrin levels above 1000pg/mL)

Gold standard investigation for diagnosis of colonic mucosal disease - Colonoscopy

Gold standard investigation for diagnosis of steatorrhoea - Timed quantitative stool fat determination

Gold standard method for treatment of incontinence with an isolated sphincter defect - Overlapping sphincteroplasty

Gold standard investigation for diagnosis and method of management of Acute arterial occlusion – Laparotomy

Gold standard method for confirmation of mesentric arterial occlusion - Mesentric angiography

Gold standard investigation for diagnosis of celiac disease – Small intestine biopsy

Gold standard for identifying choledocholithiasis – ERCP

Gold standard method of treatment of Symptomatic cholelitiasis – Lap cholecystectomy

Gold standard method for diagnosis of Primary sclerosing cholangitis - ERCP

Gold standard investigation for diagnosis of Hepatitis C – HCV RNA assay

Gold standard test for diagnosis of intraluminal bile duct abnormalities - ERCP

Gold standard method for management of hydatid disease – Surgery

Gold standard for assessing degree of liver injury and fibrosis - Liver Biopsy

Gold standard method for management of blunt hepatic trauma - Non-operative management

Gold standard test for assessment of function of sphincter of oddi – Manometry

Gold standard investigation of diagnosis of Klatskin tumor - Cholangiography

Gold standard investigation for diagnosis of invasive amoebiasis - ELISA

REFERENCES

1. Harrison's principles of Internal Medicine 17th Edition

2. Schwartz's Manual of Surgery 8th Edition

Download the list of Gold standards in PDF format here

25 signs in Obstetrics and Gynaecology

Download

These are 25 clinical and radiological signs in obstetrics and gynaecology.

Bagel sign : Ultrasonographic sign. Gestational sac in the adnexa with hyperechoic ring.

Ball Sign : Radiological sign of intrauterine fetal death. X-ray shows crumpled up spine of
the fetus.

Banana Sign : Ultrasound sign in open spina bifida. Shows abnormal anterior curvature of
cerebellum. Due to the associated Arnold-Chiari malformation.

Chadwick’s Sign : Bluish hue to the vestibule and anterior vaginal wall. Seen in first trimester of
pregnancy. Cause is increased blood flow to the pelvic organs. Also known as
jacquemier’s Sign.

Cullen Sign : Bluish discoloration of skin around umbilicus. Occurs due to intra peritoneal
hemorrhage. Seen in ruptured ectopic pregnancy.

Double Bubble Sign : Useful in prenatal diagnosis of duodenal atresia. Duodenal atresia usually
presents with polyhydramnios and produces dilatation of stomach and first part of
duodenum.

Double decidual sac Sign : Normal Ultrasonographic appearance of intrauterine gestational sac. Seen as two concentric echogenic rings separated by a hyperechoic space.

Goodell Sign : Marked softening of the cervix in contrast to non pregnant state. Also due to
increased blood flow.

Hegar Sign : An indication of Pregnancy. Softening of the lower parts of the uterus enables
approximation of vaginal and abdominal fingers in bimanual pelvic examination. Vaginal
fingers are placed in the posterior fornix and abdominal hand pressed down behind the
uterus.

Jacquemier’s sign : Refer Chadwick Sign

Kustner’s Sign : Sign of placental separation. On pushing the uterus upwards does not move the
cord with it due to the separation.

Ladin’s Sign : Softening in the midline of the uterus anteriorly at the junction of the uterus and
cervix. It occurs at about 6 weeks gestation.

Lambda Sign : Ultrasonographic sign seen in dichorionic pregnancies. Due to the chorionic tissue
in between the two layers of the membrane between the twins.

Lemon Sign : Ultrasound sign in open spina bifida. Shows abnormal anterior curvature of
cerebellum. Due to the associated Arnold-Chiari malformation.

Osiander’s Sign : Pulsations in the lateral fornix due to the increased vascularity.

Palmer’s Sign : Regular rhythmic contractions of uterus felt as early as 6-8 weeks . It is a sign of
pregnancy.

Piskacek’s Sign : Asymmetric growth occurs to the uterus in initial stages of pregnancy due to the
lateral implantation of the blastocyst. The area of implantation feels soft compared to
the other parts.

Robert’s Sign : Radiological sign of intrauterine fetal death. X-ray shows presence of gas in the
fetal great vessels. Earliest radiological sign of intrauterine fetal death

Schroder’s Sign : A sign of placental separation. Uterus rises up when the separated placenta is
passed downwards.

Spalding Sign : Sign of intrauterine fetal death. Overlapping of skull bones after fetal demise.
Observed by ultrasonogrm.

Stallworthy’s Sign : Slowing of fetal heart rate on pressing the head down I to the pelvis and prompt
recovery on release of pressure is termed Stallworthy’s sign. This sign is suggestive of
posterior placenta praevia.

Stuck Twin Sign : Seen in twin to twin transfusion syndrome. Due to the severe oligohydramnios
smaller twin is held in a fixed position along the uterine wall. This is called stuck twin
sign.

‘T’ Sign : Ultrasonographic sign seen in monochromic twins. As the intertwin membrane
does not have any chorionic tissue it gives rise to ‘T’ sign in ultrasound.

Turtle Sign : Failure of restitution seen in shoulder dystocia is called turtle sign.

Von Braun-Fernwald's Sign : Irregular softening and enlargement of the uterine fundus during early
pregnancy. It occurs at 5-8 weeks gestation.

Use the link below to download the file in pdf format for free

25 signs in obstetrics and gynaecology