APPENDIX II
Common Medical Tests
A large number of tests are widely available. Many tests are specialized for a particular disorder or group of related disorders (which are usually described with the appropriate disorders in this book). Other tests are commonly used for a wide range of disorders.
Tests are done for a variety of reasons, including
Screening
Diagnosing a disorder
Evaluating the severity of a disorder so that treatment can be planned
Monitoring the response to treatment
Sometimes a test is used for more than one purpose. A blood test may show that a person has too few red blood cells (anemia). The same test may be repeated after treatment to determine whether the number of red blood cells has returned to normal. Sometimes a disorder can be treated at the same time a screening or diagnostic test is done. For example, when colonoscopy (examination of the inside of the large intestine with a flexible viewing tube) detects growths (polyps), they can be removed before colonoscopy is completed.
Types of Tests
There are different types of medical tests but the lines that separate them often become blurred. For example, endoscopy of the stomach enables the examiner to view the inside of the stomach as well as obtain tissue samples for examination in a laboratory. Tests are usually one of the six following types.
Analysis of Body Fluids: The most commonly analyzed fluids are
Blood
Urine
Fluid that surrounds the spinal cord and brain (cerebrospinal fluid)
Fluid within a joint (synovial fluid)
Less often, sweat, saliva, and fluid from the digestive tract (such as gastric juices) are analyzed. Sometimes the fluids analyzed are present only if a disorder is present, as when fluid collects in the abdomen, causing ascites, or in the space between the two-layered membrane covering the lungs and lining the chest wall (pleura), causing pleural effusion.
Imaging: These tests provide a picture of the inside of the body—in its entirety or only of certain parts (see page 2034). Ordinary x-rays are the most common imaging tests. Others include ultrasonography, radioisotope (nuclear) scanning, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and angiography.
Endoscopy: A viewing tube (endoscope) is used to directly observe the inside of body organs or spaces (cavities). Most often, a flexible endoscope is used, but in some cases, a rigid one is more useful. The tip of the endoscope is usually equipped with a light and a camera, so that the examiner can watch the images on a television monitor rather than look directly through the endoscope. Tools are often passed through a channel in the endoscope. One type of tool is used to cut and remove tissue samples.
In endoscopy, the viewing tube is usually passed through an existing body opening, such as the following:
Nose: To examine the voice box (laryngoscopy) or the lungs (bronchoscopy)
Mouth: To examine the esophagus (esophagoscopy), stomach (gastroscopy), or small intestine (upper gastrointestinal endoscopy)
Anus: To examine the large intestine, rectum, and anus (coloscopy)
Urethra: To examine the bladder (cystoscopy)
Vagina: To examine the uterus (hysteroscopy)
However, sometimes an opening in the body must be created. A small cut (incision) is made through the skin and the layers of tissue beneath the skin, so that the endoscope can be passed into a body cavity. Such incisions are used to view the inside of the following:
Joints (arthroscopy)
Abdominal cavity (laparoscopy)
Area of the chest between the lungs (mediastinoscopy)
Lungs and pleura (thoracoscopy)
Measurement of Body Functions: Often, body functions are measured by recording and analyzing the activity of various organs. For example, electrical activity of the heart is measured with electrocardiography (ECG), and electrical activity of the brain is measured with electroencephalography (EEG). The lungs’ ability to hold air, to move air in and out, and to exchange oxygen and carbon dioxide is measured with pulmonary function tests.
Biopsy: Tissue samples are removed and examined, usually with a microscope. The examination often focuses on finding abnormal cells that may provide evidence of inflammation or of a disorder, such as cancer. Tissues that are commonly examined include skin, breast, lung, liver, kidney, and bone.
Analysis of Genetic Material (Genetic Testing):
Usually, cells from skin, blood, or bone marrow are analyzed. Cells are examined to check for abnormalities of chromosomes, genes (including DNA), or both. Genetic testing may be done in the following:
Fetuses: To determine whether they have a genetic disorder
Children and young adults: To determine whether they have a disorder or are at risk of developing a disorder
Adults: Sometimes to help determine the likelihood that their relatives, such as children or grandchildren, will develop certain disorders
Risks and Results
Every test has some risk. The risk may be the possibility of injury during the test, or it may be the need for further testing if the result is abnormal. Further testing is often more expensive, dangerous, or both. Doctors weigh the risk of a test against the usefulness of the information it will provide.
Normal test values are expressed as a range, which is based on the average values in a healthy population. That is, 95% of healthy people have values within this range. However, average values are slightly different for women and men and may vary by age. For some tests, these values also vary among laboratories. Thus, when doctors get a laboratory test result, the laboratory also gives them its own normal range for that test. The table below lists some typical normal results. However, because values vary by laboratory, people should consult their doctor about the significance of their own test results rather than refer to this table.
BLOOD TESTS*
| TEST | REFERENCE VALUES (CONVENTIONAL UNITS†) |
| Acidity (pH) | 7.35-7.45 |
| Alcohol (ethanol) | 0 mg/dL (more than 0.1 mg/dL usually indicates intoxication) |
| Ammonia | 15-50 units/L |
| Amylase | 53-123 units/L |
| Antinuclear antibodies (ANA)‡ | 0 (a negative result) |
| Ascorbic acid | 0.4-1.5 mg/dL |
| Bicarbonate (carbon dioxide content) | 18-23 mEq/L |
| Bilirubin | Direct: Up to 0.4 mg/dL Total: Up to 1.0 mg/dL |
| Blood volume | 8.5-9.1% of body weight |
| Calcium | 8.5-10.5 mg/dL (slightly higher in children) |
| Carbon dioxide pressure§ | 35-45 mm Hg |
| Carboxyhemoglobin (carbon monoxide in hemoglobin) | Less than 5% of total hemoglobin |
| CD4 cell count | 500-1500 cells/μL |
| Ceruloplasmin | 15-60 mg/dL |
| Chloride | 98-106 mEq/L |
| Complete blood cell count (CBC) | See individual tests: Hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume, platelet count, and white blood cell count |
| Copper | 70-150 μg/dL |
| Creatine kinase (CK), also called creatine phosphokinase (CPK) | Male: 38-174 units/L Female: 96-140 units/L |
| Creatine kinase (CK) in its different forms (isoenzymes) | 5% or less of CK-MB (the form of CK that occurs mainly in heart muscle) |
| Creatinine | 0.6-1.2 mg/dL |
| Electrolytes | See individual tests: Calcium, chloride, magnesium, potassium, and sodium (which are routinely tested) |
| Erythrocyte sedimentation rate (ESR) | Male: 1-13 mm/hour Female: 1-20 mm/hour |
| Glucose | Fasting: 70-110 mg/dL |
| Hematocrit | Male: 45-52% Female: 37-48% |
| Hemoglobin | Male: 13-18 g/dL Female: 12-16 g/dL |
| Iron | 60-160 μg/dL (higher in males) |
| Iron-binding capacity | 250-460 μg/dL |
| Lactate (lactic acid) | Venous: 4.5-19.8 mg/dL Arterial: 4.5-14.4 mg/dL |
| Lactic dehydrogenase | 50-150 units/L |
| Lead | 20 μg/dL or less (much lower in children) |
| Lipase | 10-150 units/L |
| Lipids: | |
| Cholesterol, total | Less than 225 mg/dL for people aged 40-49 yr (increases with age) |
| High-density lipoprotein (HDL) | 30-70 mg/dL |
| Low-density lipoprotein (LDL) | 60 mg/dL |
| Triglycerides | 40-200 mg/dL (higher in males) |
| Liver function tests | Include bilirubin (total), phosphatase (alkaline), protein (total and albumin), transaminases (alanine and aspartate), and prothrombin |
| Magnesium | 1.5-2.0 mg/dL |
| Mean corpuscular hemoglobin (MCH) | 27-32 pg/cell |
| Mean corpuscular hemoglobin concentration (MCHC) | 32-36% hemoglobin/cell |
| Mean corpuscular volume (MCV) | 76-100 cubic μm |
| Osmolality | 280-296 mOsm/kg plasma |
| Oxygen pressure§ | 83-100 mm Hg |
| Oxygen saturation (arterial) | 96-100% |
| Partial thromboplastin time (PTT) | 30-45 seconds |
| Phosphatase (alkaline) | 50-160 units/L (higher in infants and adolescents, lower in females) |
| Phosphorus | 3.0-4.5 mg/dL |
| Platelet count | 150,000-350,000/mL |
| Potassium | 3.5-5.0 mEq/L |
| Prostate-specific antigen (PSA) | 0-4 ng/mL (increases with age) |
| Protein: | |
| Total | 6.0-8.4 g/dL |
| Albumin | 3.5-5.0 g/dL |
| Globulin | 2.3-3.5 g/dL |
| Prothrombin time (PT) | 10-13 seconds |
| Red blood cell (RBC) count | 4.2-5.9 million/mL |
| Sodium | 135-145 mEq/L |
| Thyroid-stimulating hormone (TSH) | 0.5-5.0 milliunits/L |
| Transaminases (liver enzymes): | |
| Alanine (ALT) | 1-21 units/L |
| Aspartate (AST) | 7-27 units/L |
| Troponin in its different forms: | |
| I | Less than 1.6 ng/mL |
| T | Less than 0.1 ng/mL |
| Urea nitrogen (BUN) | 7-18 mg/dL |
| Uric acid | 3.0-7.0 mg/dL |
| Vitamin A|| | 30-65 μg/dL |
| White blood cell (WBC) count | 4,300-10,800 /mL |
*Blood can be tested for many other substances as well.
†Units are explained in Appendix I. Conventional units can be converted to international units by using a conversion factor. International units (IU), a different system, are sometimes used by laboratories.
‡Other antibodies can also be identified.
§Expressed as a comparison with the level of mercury (Hg) in a tube, which results from air pressure at sea level.
||Other vitamins can also be measured.
DIAGNOSTIC PROCEDURES
| PROCEDURE | BODY AREA OR SAMPLE TESTED | DESCRIPTION |
| Amniocentesis | Fluid from the sac surrounding the fetus | Analysis of fluid, removed by a needle inserted through the abdominal wall, to detect an abnormality in the fetus |
| Arteriography (angiography) | Any artery in the body, commonly in the brain, heart, kidneys, aorta, or legs | X-ray study using radiopaque dye injected through a thin tube (catheter), which is threaded to the artery being studied, to detect and outline or highlight a blockage or defect in an artery |
| Audiometry | Ears | Assessment of the ability to hear and distinguish sounds at specific pitches and volumes using headphones |
| Auscultation | Heart | Listening with a stethoscope for abnormal heart sounds |
| Barium x-ray studies | Esophagus, stomach, intestine, or rectum | X-ray study to detect ulcers, tumors, or other abnormalities |
| Biopsy | Any tissue in the body | Removal and examination of a tissue sample under a microscope to check for cancer or another abnormality |
| Blood pressure measurement | Usually an arm | Test for high or low blood pressure, usually using an inflatable cuff wrapped around the arm |
| Blood tests | Usually a blood sample from an arm | Measurement of substances in the blood to evaluate organ function and to help diagnose and monitor various disorders |
| Bone marrow aspiration | Hipbone or breastbone | Removal of a bone marrow sample by a needle for examination under a microscope to check for abnormalities in blood cells |
| Bronchoscopy | Airways of the lungs | Direct examination with a viewing tube to check for a tumor or other abnormality |
| Cardiac catheterization | Heart | Study of heart function and structure using a catheter inserted into a blood vessel and threaded to the heart |
| Chorionic villus sampling | Placenta | Removal of a sample for examination under a microscope to check for abnormalities in the fetus |
| Chromosomal analysis | Blood | Examination under a microscope to detect a genetic disorder or to determine a fetus’s sex |
| Colonoscopy | Large intestine | Direct examination with a viewing tube to check for a tumor or other abnormality |
| Colposcopy | Cervix | Direct examination of the cervix with a magnifying lens |
| Computed tomography (CT) | Any part of the body | Computer-enhanced x-ray study to detect structural abnormalities |
| Cone biopsy | Cervix | Removal and examination of a cone-shaped piece of tissue, usually using a heated wire loop or a laser |
| Culture | A sample from any area of the body (usually a fluid such as blood or urine) | Growth and examination of microorganisms from the sample to identify infection with bacteria or fungi |
| Dilation and curettage (D and C) | Cervix and uterus | Examination of a sample under a microscope to check for abnormalities in the uterine lining using a small, sharp instrument (curet) |
| Dual x-ray absorptiometry (DEXA) | Skeleton, focusing on specific regions, usually the hip, spine, and wrist | Low-dose x-ray study to determine the density of bones |
| Echocardiography | Heart | Study of heart structure and function using sound waves |
| Electrocardiography (ECG) | Heart | Study of the heart’s electrical activity using electrodes attached to the arms, legs, and chest |
| Electroencephalography (EEG) | Brain | Study of the brain’s electrical function using electrodes attached to the scalp |
| Electromyography | Muscles | Recording of a muscle’s electrical activity using small needles inserted into the muscle |
| Electrophysiologic testing | Heart | Test to evaluate rhythm or electrical conduction abnormalities using a catheter inserted into a blood vessel and threaded to the heart |
| Endoscopic retrograde cholangiopancreatography (ERCP) | Biliary tract | X-ray study of the biliary tract done after injection of a radiopaque dye and using a flexible viewing tube |
| Endoscopy | Digestive tract | Direct examination of internal structures using a flexible viewing tube |
| Enzyme-linked immunosorbent assay (ELISA) | Usually blood | Test that involves mixing the sample of blood with substances that can trigger allergies (allergens) or with microorganisms to test for the presence of specific antibodies |
| Fluoroscopy | Digestive tract, heart, or lungs | A continuous x-ray study that enables a doctor to see the inside of an organ as it functions |
| Hysteroscopy | Uterus | Direct examination of the inside of the uterus with a flexible viewing tube |
| Intravenous urography | Kidneys and urinary tract | X-ray study of the kidneys and urinary tract after a radiopaque dye is injected into a vein (intravenously) |
| Joint aspiration | Joints, especially those of the shoulders, elbows, fingers, hips, knees, ankles, and toes | Removal and examination of fluid from the space within joints to check for blood cells, crystals formed from minerals, and microorganisms |
| Laparoscopy | Abdomen | Direct examination using a viewing tube inserted through an incision in the abdomen to diagnose and treat abnormalities in the abdomen |
| Magnetic resonance imaging (MRI) | Any part of the body | Imaging test using a strong magnetic field and radio waves to check for structural abnormalities |
| Mammography | Breasts | X-ray study to check for breast cancer |
| Mediastinoscopy | Chest | Direct examination of the area of the chest between the lungs using a viewing tube inserted through a small incision just above the breastbone |
| Myelography | Spinal column | Simple or computer-enhanced x-ray study of the spinal column after injection of a radiopaque dye |
| Nerve conduction study | Nerves | Test to determine how fast a nerve impulse travels using electrodes or needles inserted along the path of the nerve |
| Occult blood test | Large intestine | Test to detect blood in stool |
| Ophthalmoscopy | Eyes | Direct examination using a handheld device that shines light into the eye to detect abnormalities inside the eye |
| Papanicolaou (Pap) test | Cervix | Examination of cells scraped from the cervix under a microscope to detect cancer |
| Paracentesis | Abdomen | Insertion of a needle into the abdominal cavity to remove fluid for examination |
| Percutaneous transhepatic cholangiography | Liver and biliary tract | X-ray study of the liver and biliary tract after a radiopaque dye is injected into the liver |
| Positron emission tomography (PET) | Brain and heart | Imaging test using particles that release radiation (positrons) to detect abnormalities in function |
| Pulmonary function tests | Lungs | Tests to measure the lungs’ capacity to hold air, to move air in and out of the body, and to exchange oxygen and carbon dioxide as people blow into a measuring device |
| Radionuclide imaging | Many organs | Imaging test using particles that release radiation (radionuclides) to detect abnormalities in blood flow, structure, or function |
| Reflex tests | Tendons | Tests using a physical stimulus (such as a light tap) to detect abnormalities in nerve function |
| Retrograde urography | Bladder and ureters | X-ray study of the bladder and ureters after a radiopaque dye is inserted into the ureter |
| Sigmoidoscopy | Rectum and last portion of the large intestine | Direct examination using a viewing tube to detect tumors or other abnormalities |
| Skin allergy tests | Usually an arm or the back | Tests for allergies done by placing a solution containing a possible allergen on the skin, then pricking the skin with a needle |
| Spinal tap (lumbar puncture) | Spinal canal | Removal of spinal fluid, using a needle inserted into the hipbone, to check for abnormalities in spinal fluid |
| Spirometry | Lungs | Test of lung function that involves blowing into a measuring device |
| Stress testing | Heart | Test of heart function during exertion using a treadmill or other exercise machine and electrocardiography (if people cannot exercise, a drug is used to simulate exercise’s effects) |
| Thoracentesis | Pleural space (the space between the pleura, a two-layered membrane that covers the lungs and lines the chest wall) | Removal of fluid from this space with a needle to detect abnormalities |
| Thoracoscopy | Lungs | Examination of the lung surfaces, pleura, and pleural space through a viewing tube |
| Tympanometry | Ears | Measurement of the resistance to pressure (impedance) in the middle ear using a device inserted in the ear and sound waves to help determine the cause of hearing loss |
| Ultrasonography (ultrasound scanning) | Any part of the body | Imaging using sound waves to detect structural or functional abnormalities |
| Urinalysis | Kidneys and urinary tract | Chemical analysis of a urine sample to detect protein, sugar, ketones, and blood cells |
| Venography | Veins | X-ray study using a radiopaque dye (similar to arteriography) to detect blockage of a vein |