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The Yale University School of Medicine
Patient's Guide to Medical Tests

Detailed Descriptions Of The Most Diagnostic Procedures
by Barry L. Zaret (Editor), Peter I. Jatlow (Editor), and Lee D. Katz (Editor)

Patient's Guide to Medical Tests
The Yale University School of Medicine Patient’s Guide to Medical Tests is a comprehensive guide to hundreds of the most commonly performed medical diagnostic tests. The tests are described in clear, understandable language and presented in concise, easy-to-follow charts. It is more important than ever to have objective, reliable sources of medical information. This is especially critical in the area of diagnostic tests — the fastest-growing and most costly aspect of modern medicine. Users will consult this reference again and again.

Key Features:

• The most valuable screening tests for every age and stage of life
• What you should know before undergoing a test
• Advice from the doctors, nurses, and technicians who actually perform the tests
• A guide to helpful home tests
• Authoritative content—Each section of this reference is written by a Yale University faculty member who is an authority in his or her field. It also includes practical advice from other doctors, nurses, and technicians

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Patient's Guide to Medical Tests

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Table of Contents



Chapter 1 Patients’ Rights and Informed Consent 9
Angela R. Holder, LLM What Is Informed Consent? 9 Refusal of Tests or Treatment 11 Giving Your Consent 11 Medical Testing for Nonmedical Reasons 15 Mandatory Reporting of Test Results 16 HIV Testing 16

Chapter 2 The Role of Screening: Tests for People Without Symptoms 17
Ralph I. Horwitz, MD Screening for Undetected Diseases 18 When Is Screening Beneficial? 18 The Risks of Screening 19 Early Detection Revisited 20 Controversy over Guidelines 20 Screening in Special Situations 21 Most Common and Beneficial Screening Tests 24

Chapter 3 Diagnostic Imaging 33
Lee D. Katz, MD Historical Overview 34 Overview of Noninvasive Imaging Techniques 35 Invasive Imaging Procedures 40 Tests Covered in This Chapter X-Rays 41 Fluoroscopy 43 Computed Tomography (CT) Scans 45 Nuclear Scans 47 Positron-Emission Tomography 50 Ultrasound Tests 52 Magnetic Resonance Imaging (MRI) 55 Arteriography 57

Chapter 4 An Overview of Diagnostic Laboratory Testing 61
Peter Jatlow, MD and Jose C. Costa, MD Introduction 61 How Tests Are Used 62 Clinical Pathology 62 Anatomical Pathology 76


Chapter 5 The Heart 85
Barry L. Zaret, MD Introduction 86 What Your Doctor Looks for When Examining Your Heart 87 Tests Covered in This Chapter Electrocardiogram 90 Holter Monitoring 93 Signal-Averaged Electrocardiogram (SAECG) 95 Exercise Stress Test 96 Exercise Echocardiography 98 Myocardial Perfusion Scan 99 Muga Scan 101 Echocardiography 103 Transesophageal Echocardiography (TEE) 106 Cardiac Catheterization and Angiography 108 Positron-emission Tomography 112 Electrophysiology Studies (EPS) 113 Pacemaker or AICD Follow-up 115 Tilt Table Test 117

Chapter 6 The Vascular System 119
Richard J. Gusberg, MD Introduction 120 Signs and Symptoms 120 How Your Doctor Diagnoses Vascular System Disorders 121 Pulse Volume Recordings (PVRS) 124 Transcutaneous Oxygen Measurements 125

Chapter 7 The Respiratory System 129
Lynn Tanoue, MD and Jack A. Elias MD Introduction 131 Common Respiratory Disorders 131 Signs and Symptoms of Respiratory Disease 132 How Your Doctor Diagnoses Lung Disease 134 Tests Covered in This Chapter Chest X-Ray 13 Chest Computed Tomography (CT Scan) 136 Chest Magnetic Resonance Imaging (MRI) 136 Pulmonary Angiography 137 Fluoroscopy 137 Chest Ultrasound 137 Lung Scan 138 Bronchoscopy 140 Mediastinoscopy 143 Needle Biopsy of the Lung 145 Thoracentesis 146 Thoracoscopy 148 Open Lung Biopsy 150 Pulmonary Function Tests 152 Bronchial Challenge Test 154 Peak Flow Measurement 156 Mouth Pressure Test 158 Pulmonary Exercise Testing 159 Body Plethysmography 162 Oxygen Saturation 163 Arterial Blood Gases (ABG) 165

Chapter 8 The Digestive System 167
Robert M. Donaldson Jr, MD Introduction 169 How Your Doctor Diagnoses a Digestive Disorder 170 Tests Covered in This Chapter Abdominal X-Ray 172 Abdominal Ultrasound 174 Contrast X-Rays of the Digestive Tract 175 Cholecystography 178 Computed Tomography (CT) Scan of the Abdomen 179 Radionuclide Scanning of the Digestive System 181 Abdominal Angiography 184 Esophagogastroduodenoscopy (EGD) 186 Endoscopic Retrograde Cholangiopancreatography 189 Sigmoidoscopy 192 Colonoscopy 194 Laparoscopy 198 Esophageal Manometry 200 PH Testing 202 Anorectal Manometry 204 Needle Biopsy 205 Paracentesis 207 Stool Fat 209 Occult Blood in Stool 210 Liver Function Tests 212

Chapter 9 The Endocrine System 215
Richard J. Robbins, MD Introduction 216 How Your Doctor diagnoses Endocrine System Disorders 218 Common Disorders of the Endocrine System and Their Diagnosis 223 Test Covered in This Chapter lodine Uptake and Thyroid Scan 226

Chapter 10 The Male Reproductive System 229
Robert M. Weiss, MD and Kevin R. Anderson MD Introduction 230 Reproductive System Disorders and Symptoms 231 How Your Doctor Diagnoses Reproduction System Disorders 234 Test Covered in This Chapter Testicular Biopsy 237 Scrotal Exploration 238 Prostatic Biopsy 239 Cavernosometry and Cavernosonography 241 Semen Analysis 242

Chapter 11 The Female Reproductive System 245
Peter E. Schwartz, MD and David L. Olive, MD Introduction 246 Reproductive System Disorders 247 Reproductive System Symptoms 248 How Your Doctor Diagnoses Reproductive System Disorders 248 Tests Commonly Used to Diagnose Female
Reproductive System Disorders 251 Test Covered in This Chapter Pelvic Exam and Pap Smear 255 Transvaginal Ultrasound 257 Colposcopy 258 Cervical Biopsy 260 Culdocentesis 263 Hysterosalpingogram 26 Laparoscopy 265 Dilation and Curettage (D & C) 267 Endometrial Biopsy 270 Cone Biopsy 272

Chapter 12 The Renal System 275
Margaret J. Bia MD Introduction 276 How Your Doctor Diagnoses Renal Disease 277 Common Kidney and Urinary Tract Disorders 280 Test Covered in This Chapter Kidney-Ureter-Bladder (KUB) Radiography 281 Renal Ultrasound 282 Intravenous Pyelography (IVP) 283 Voiding Cystourethrography (VCUG) 285 Renal Computed Tomography 287 Renal Scan 288 Renal Angiography 288 Cystoscopy 290 Percutaneous Kidney Biopsy 292

Chapter 13 Rheumatoid and Musculoskeletal Disorders 295
Leo M. Cooney Jr, MD Introduction 296 How Your Doctor Diagnoses Musculoskeletal Problems 297 Test Covered in This Chapter Arthrocentesis 301 Arthroscopy 302 Rheumatoid Factor (RF) 305 Lyme Disease Antibody 306 Alkaline Phosphatase (ALP) 308 Creatine Kinase (CK) 309 Bone X-Rays 310 Musculoskeletal Magnetic Resonance Imaging (MRI) 312 Musculoskeletal Computed Tomography (CT) Scan 313 Musculoskeletal Ultrasound 313 Bone Scan 314 Bone Biopsy 314 Muscle Biopsy 317

Chapter 14 Allergies 319
Fred S. Kantor, MD Introduction 320 How Your Doctor Diagnoses an Allergy 322 Test Covered in This Chapter Skin Tests 323 Penicillin Skin Tests 325 >Delayed-type Hypersensitivity Test (DTH) 327 >Radioallergosorbent Test (RAST) 328 Paper Radioimmunosorbent Test (PRIST) 330 Enzyme-linked immunosorbent Assay (ELISA) 331 Precipitating Antibodies 332 Blood and Urine Histamine 334 Nasal Challenge Test 335 Bronchial Challenge Test 336 Food Allergy Test 338 Nasal Smear for Eosinophils 340 Transillumination of the Sinuses 341

Chapter 15 The Immune System 343
Joseph E. Craft, MD and Fred Kantor, MD Introduction 344 How Your Doctor Diagnoses Immune
Disorders and Deficiencies 347 Test Covered in This Chapter Sedimentation Rate 350 C-Reactive Protein (CRP) 351 Autoantibody Testing 352 Schirmer’s Test 354 Lower Lip Biopsy 355 HLA Typing 356 Complement Assay 358 Immune Complex Detection 359 Lymphocyte Typing 360 Phagocytic Cell Assay 361

Chapter 16 The Blood and Lymphatic Systems 363
Thomas P. Duffy, MD Introduction 364 Disorders of the Blood and Lymphatic Systems 364 How Your Doctor Diagnoses Disorders of the Blood and Lymphatic Systems 366 Test Covered in This Chapter Bone Marrow Aspiration 369 Bone Marrow Biopsy 372 Bleeding Time Test 373

Chapter 17 The Skin 377
Philip E. Shapiro, MD Introduction 378 Common Skin Disorders 379 How Your Doctor Diagnoses a Skin Condition 381 Test Covered in This Chapter Skin Biopsy 382 Koh Preparation 386 Skin Fungus Culture 388 Tzanck Smear 389 Ectoparasitic Demonstration 390 Microscopic Hair Shaft Evaluation 391 Patch Test( and Photopatch variation 393 Dark-Field Examination 395

Chapter 18 The Sensory Organs 397
Craig Friedman, MD and Kathleen M. Stoessel, MD The Eye 398 How Your Doctor Diagnoses Eye Disorders 399 The Eye Exam 400 The Head and Neck 401 How Your Doctor Diagnoses Head and Neck Disorders 405 Test Covered in This Chapter Electro-Oculography (EOG) 411 Electroretinography (ERG) 412 Fluorescein Angiography 413 Tonometry 415 Visual Field Test (Perimetry) 416 Modified Barium Swallow 417 Nasal Endoscopy 419 Pure-Tone Audiometry 420 Fiber-Optic Laryngoscopy 422 Fine-Needle Aspiration of a Neck Mass 424

Chapter 19 Diabetes 427
Robert S. Sherwin, MD Introduction 428 Types of Diabetes 428 How Your Doctor Diagnoses Diabetes 430 Evaluation Before Therapy 431 Test Covered in This Chapter Oral Glucose Tolerance Test (OGTT) 434

Chapter 20 Hypertension 437
John F. Setaro, MD Introduction 438 Signs and symptoms of Hypertension 438 Types of Hypertension 439 How Your Doctor Diagnoses Hypertension 439 Tests to Determine the Causes of Hypertension 442 Test Covered in This Chapter Plasma Renin Activity (PRA) Tests 443 Renal Scan 445

Chapter 21 Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) 447
Michael O. Rigsby, MD and Gerald Friedland, MD Introduction 448 How Your Doctor Diagnoses HIV 450 Test Covered in This Chapter Enzyme-linked Immunosorbent Assay (ELISA) for HIV 453 Western Blot for AIDS 454 CD4 Count 455 Viral Load Test 456

Chapter 22 Infectious Diseases 459
Vincent Quagliarello, MD Introduction 460 Types of Infectious Agenst 461 The Body’s Defense 462 How Your Doctor Diagnoses an Infectious Disease 462 Test Covered in This Chapter Tuberculin Skin Testing 470 Stool Examination for Parasites and/or Their Eggs (OVA) 471

Chapter 23 The Nervous System 473
Lawrence M. Brass, MD Introduction 474 Common Nervous System Disorders 475 Signs and Symptoms of Nervous System Disorders 476 How Your Doctor Diagnoses Neurological Disorders 477 Test Covered in This Chapter Electoencephalography (EEG) 479 Single-Photon Emission Computed Tomography (SPECT) 481 Positron-Emission Tomography (PET) 48 Skull and Spinal X-Rays 482 Cranial And Spinal Computed Tomography (CT) Scan 483 Magnetic Resonance Imaging (MRI) of the Brain and Spinal Cord 484 Brain Ultrasound 484 Brain Angiography 485 Myelography 485 Lumbar Puncture (LP) 487 Electomyography (EMG) and Nerve Conduction Velocity(NCV) 489 Evoked Potentials 491 Oculoplethysmography (OPG) 493 Electronystagmography)(ENG) 494 The Tensilon (Edrophonium) Test 496 Brain Biosphy 497 Muscle and Nerve Biopsy 498

Chapter 24 Genetic Diseases 501
Maurice J. Mahoney, MD Introduction 502 Genetic Disorders 503 How your Doctor Diagnoses Genetic Disorders 504 Test Covered in This Chapter Chromosome Analysis 506 Gene Analysis 508 Linkage Analysis 510

Chapter 25 Pregnancy 513
Joshua A. Copel, MD Introduction 514 How Your Doctor Diagnoses Pregnancy 515 Tests Ordered at First Prenatal Visit Tests Ordered at Follow-up Prenatal Visits 517 Genetic Counseling and Prenatal Diagnosis
of Genetic Disorders 518 Test Covered in This Chapter Pregnancy Test 519 Alpha-Fetoprotein (AFP) 520 Pregnancy Ultrasound 522 Amniocentesis 525 Chorionic Villi Sampling (CVS) 528 Fetal Blood Test 530 Fetal Blood Test 530 Kleihauer-Betke (K-B) 535

Chapter 26 Testing in Women 537
Janet B. Henrich, MD and Florence Comite, MD Introduction 538 How Your Doctor Diagnoses Illnesses Common to Women 539 How Diagnostic Tests May Differ in Women 540 Disorders and Screening at Different Ages 541 Test Covered in This Chapter Mammography 544 Breast Ultrasound 547 Percutaneous (Nonsurgical) Breast Biopsy 548 Surgical Breast Biopsy 550 Computed Transaxial Tomography, Bone-Density Studies 552

Chapter 27 Testing in Infants and Children 555
Joseph B. Warshaw, MD Introduction 556 Screening Tests for Infants and Children 556 How Your Doctor Diagnoses Pediatric Problems Tests and Techniques That Differ in Infants and Children Common Disorders Affecting Infants and Children<

Chapter 28 Sports Medicine 567
Peter Jokl, MD Introduction 568 How Your Doctor Diagnoses a Sports-related Injury 569 Test Covered in This Chapter Office Arthroscopy 580 Arthrography with Computed Tomography (CT) Scan 580 Ligament Test 581 Kincom Test 582 Dynamic Gait Analysis with Video Recording 583 Compartment Pressure Test 584

Chapter 29 Taxicology, Monitoring of Drug
Therapy, and Testing for Substance Abuse 587

Petrie M. Rainey, MD, PhD and David J. Schonfeld, MD Introduction 588 How Your Doctor Evaluates a Toxic Exposure 589 Testing for Occupational and Environmental Exposure 593

Appendix A An Overview Of Home Tests 597

Index 603