Merck Manual

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Common Medical Tests

By

The Manual's Editorial Staff

Reviewed/Revised May 2023
VIEW PROFESSIONAL VERSION
Topic Resources

A large number of medical tests are widely available. Many tests are used for a particular disorder or group of related disorders. 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.

Table

Some 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 thickness 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

The space between the pleura, a two-layered membrane that covers the lungs and lines the chest wall (pleural space)

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

Types of Tests

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.

Table

Blood Tests*

Test

Reference Range or Threshold (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 (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 (expressed as a comparison with how high the level of mercury [Hg] rises in a tube due to air pressure at sea level)

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 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 age 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), 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 (expressed as a comparison with the level of mercury [Hg] in a tube, which results from air pressure at sea level)

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 m units/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.

§Other vitamins can also be measured.

Imaging

Imaging tests provide a picture of the body’s interior—of the whole body or part of it. Imaging helps doctors diagnose a disorder, determine how severe the disorder is, and monitor people after the disorder is diagnosed. Most imaging tests are painless, relatively safe, and noninvasive (that is, they do not require an incision in the skin or the insertion of an instrument into the body).

Imaging tests may use the following:

For information regarding imaging tests common for specific diagnoses and screenings, see the following:

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 the examiner watches the images on a television monitor rather than looking 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.

Endoscopy usually consists of passing the viewing tube 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), and 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

Biopsy

A biopsy is a procedure in which a sample of tissue is removed from the body for examination. A diagnosis is made when cells are examined through 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)

  • 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

Genetic diagnostic technology is rapidly improving. Various methods may be used to copy segments of a gene or to find changes in genes.

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 Blood Tests table 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.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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