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Pap Test

Definition

The Pap test is a procedure in which a physician scrapes cells from the cervix or vagina to check for cervical cancer, vaginal cancer, or abnormal changes that could lead to cancer. It often is called a "Pap smear."

Purpose

The Pap test is used to detect abnormal growth of cervical cells at an early stage so that treatment can be started when the condition is easiest to treat. This microscopic analysis of cells can detect cervical cancer, precancerous changes, inflammation (vaginitis), infections, and some sexually transmitted diseases (STDs). The Pap test can occasionally detect endometrial (uterine) cancer or ovarian cancer, although it was not designed for this purpose.

Women should begin to have Pap tests at the age of 21 or within three years of becoming sexually active, whichever comes first. Young people are more likely to have multiple sex partners, which increases their risk of certain diseases that can cause cancer, such as human papillomavirus (HPV).

The American Cancer Society (ACS) updated its guidelines concerning Pap test frequency in late 2002. In brief, women should continue screening every year with regular Pap tests until age 30, every two years if using the liquid-based Pap test. Once a woman age 30 and older has had three normal results in a row, she may get screened every two to three years. A doctor may suggest more frequent screening if a woman has certain risk factors for cervical cancer. Women who have had total hysterectomies including the removal of the cervix do not need Pap tests unless the hysterectomy resulted from cervical cancer. Those over age 70 who have had three normal results generally do not need to continue having Pap tests under the new guidelines.

Women with certain risk factors may have yearly tests. Those at highest risk for cervical cancer are women who started having sex before age 18, those with many sex partners (especially if they did not use condoms, which protect against STDs), those who have had STDs such as genital herpes or genital warts, and those who smoke. Women older than 40 may have the test yearly, if experiencing bleeding after menopause. Women who have had a positive test result in the past may need screening every six months. Women who have had cervical cancer or precancer should have regular Pap smears.

Other women also benefit from the Pap test. Women over age 65 account for 25% of all cases of cervical cancer and 41% of deaths from this disease. Women over age 65 who have never had a Pap smear benefit the most from the test. Some women have the cervix left in place after hysterectomy and will continue to receive regular Pap tests. Finally, a pregnant woman should have a Pap test as part of her first prenatal examination.

The Pap smear is a screening test. It identifies women who are at increased risk of cervical dysplasia (abnormal cells) or cervical cancer. Only an examination of the cervix with a special lighted instrument (colposcopy) and samples of cervical tissue (biopsies) can actually diagnose these problems.

Precautions

The Pap test is usually not done during the menstrual period because of the presence of blood cells. The best time is in the middle of the menstrual cycle.

Description

The Pap test is an extremely cost-effective and beneficial exam. Cervical cancer used to be a leading cause of cancer deaths in American women, but widespread use of this diagnostic procedure reduced the death rate from this disease by 74% between 1955 and 1992. A 2003 study reported that the test reduces rates of invasive cervical cancer by as much as 94%. In 2003, the FDA approved a new screening test that combines DNA testing for the HPV type that causes the most cases of cervical cancer with the standard Pap test, increasing its screening value.

The Pap test, sometimes called a cervical smear, is the microscopic examination of cells scraped from both the outer cervix and the cervical canal. (The cervix is the opening between the vagina and the uterus, or womb.) It is called the "Pap" test after its developer, Dr. George N. Papanicolaou. This simple procedure is performed during a gynecologic examination and is usually covered by insurance. For those with coverage, Medicare will pay for one screening Pap smear every three years.

During the pelvic examination, an instrument called a speculum is inserted into the vagina to open it. The doctor then uses a tiny brush, or a cotton-tipped swab and a small spatula to wipe loose cells off the cervix and to scrape them from the inside of the cervix. The cells are transferred or "smeared" onto glass slides, the slides are treated to stabilize the cells, and the slides are sent to a laboratory for microscopic examination. The entire procedure is usually painless and takes five to 10 minutes at most.

The newer method called liquid-based cytology, or the liquid-based Pap test, involves spreading the cells more evenly on a slide after removing them from the sample. The liquid-based method prevents cells from drying out and becoming distorted. Studies show that liquid-based testing slightly improves cancer detection and greatly improves detection of precancers, but it costs more than the traditional Pap test. Trade names in 2003 for liquid-based Pap smears were ThinPrep and AutoCyte.

Preparation

The Pap test may show abnormal results when a woman is healthy or normal results in women with cervical abnormalities as much as 25% of the time. It may even miss up to 5% of cervical cancers. Some simple preparations may help to ensure that the results are reliable. Among the measures that may help increase test reliability are:

avoiding sexual intercourse for two days before the test
not using douches for two or three days before the test

The Pap test is a procedure used to detect abnormal growth of cervical cells which may be a precursor to cancer of the cervix. It is administered by a physician who inserts a speculum into the vagina to open and separate the vaginal walls. A spatula is then inserted to scrape cells from the cervix. These cells are transferred onto glass slides for laboratory analysis. The Pap test may also identify vaginitis, some sexually transmitted diseases, and cancers of the uterus and ovaries.

(Illustration by Electronic Illustrators Group.)

avoiding tampons, vaginal creams, or birth control foams or jellies for two to three days before the test
scheduling the Pap smear when not menstruating.

However, most women are not routinely advised to make any special preparations for a Pap test.

If possible, women may want to ensure that their test is performed by an experienced gynecologist, physician, or provider and sent to a reputable laboratory. The physician should be confident in the accuracy of the chosen lab.

Before the exam, the physician will take a complete sexual history to determine a woman's risk status for cervical cancer. Questions may include date and results of the last Pap test, any history of abnormal Pap tests, date of last menstrual period and any irregularity, use of hormones and birth control, family history of gynecologic disorders, and any vaginal symptoms. These topics are relevant to the interpretation of the Pap test, especially if any abnormalities are detected. Immediately before the Pap test, the woman should empty her bladder to avoid discomfort during the procedure.

Aftercare

Harmless cervical bleeding is possible immediately after the test; a woman may need to use a sanitary napkin. She should also be sure to comply with her doctor's orders for follow-up visits.

Risks

No appreciable health risks are associated with the Pap test. However, abnormal results (whether valid or due to technical error) can cause significant anxiety. Women may wish to have their sample double-checked, either by the same laboratory or by the new technique of computer-assisted rescreening. The Food and Drug Administration (FDA) has approved the use of AutoPap and PAPNET to doublecheck samples that have been examined by technologists. AutoPap may also be used to perform initial screening of slides, which are then checked by a technologist. Any abnormal Pap test should be followed by colposcopy, not by double checking the Pap test.

Normal results

Normal (negative) results from the laboratory exam mean that no atypical, dysplastic, or cancer cells were detected, and the cervix is normal.

Abnormal results

Terminology

Abnormal cells found on the Pap test may be described using two different grading systems. Although this can be confusing, the systems are quite similar. The Bethesda system is based on the term "squamous intraepithelial lesion" (SIL). Precancerous cells are classified as atypical squamous cells of undetermined significance, low-grade SIL, or high-grade SIL. Low-grade SIL includes mild dysplasia (abnormal cell growth) and abnormalities caused by HPV; high-grade SIL includes moderate or severe dysplasia and carcinoma in situ (cancer that has not spread beyond the cervix).

Another term that may be used is "cervical intraepithelial neoplasia" (CIN). In this classification system, mild dysplasia is called CIN I, moderate is CIN II, and severe dysplasia or carcinoma in situ is CIN III.

Regardless of terminology, it is important to remember that an abnormal (positive) result does not necessarily indicate cancer. Results may be falsely abnormal after infection or irritation of the cervix. Up to 40% of mild dysplasia reverts to normal tissue without treatment, and only 1% of mild abnormalities ever develop into cancer.

Changes of unknown cause

ASCUS or LSIL cells are found in 5%-10% of all Pap tests. The most common abnormality is atypical squamous cells of undetermined significance, which are found in 4% of all Pap tests. Sometimes these results are described further as either reactive or precancerous. Reactive changes suggest that the cervical cells are responding to inflammation, such as from a yeast infection. These women may be treated for infection and then undergo repeat Pap testing in three to six months. If those results are negative, no further treatment is necessary. This category may also include atypical "glandular" cells, which could imply a more severe type of cancer and requires repeat testing and further evaluation.

Dysplasia

The next most common finding (in about 25 of every 1,000 tests) is low-grade SIL, which includes mild dysplasia or CIN I and changes caused by HPV. Unlike cancer cells, these cells do not invade normal tissues. Women are most susceptible to cervical dysplasia between the ages of 25 and 35. Typically, dysplasia causes no symptoms, although women may experience abnormal vaginal bleeding. Because dysplasia is precancerous, it should be treated if it is moderate or severe.

Treatment of dysplasia depends on the degree of abnormality. In women with no other risk factors for cervical cancer, mild precancerous changes may be simply observed over time with repeat testing, perhaps every four to six months. This strategy works only if women are diligent about keeping later appointments. Premalignant cells may remain that way without causing cancer for five to ten years, and may never become malignant.

In women with positive results or risk factors, the gynecologist must perform colposcopy and biopsy. A colposcope is an instrument that looks like binoculars, with a light and a magnifier, used to view the cervix. Biopsy, or removal of a small piece of abnormal cervical or vaginal tissue for analysis, is usually done at the same time.

High-grade SIL (found in three of every 50 Pap tests) includes moderate to severe dysplasia or carcinoma in situ (CIN II or III). After confirmation by colposcopy and biopsy, it must be removed or destroyed to prevent further growth. Several outpatient techniques are available: conization (removal of a cone-shaped piece of tissue), laser surgery, cryotherapy (freezing), or the "loop electrosurgical excision procedure." Cure rates are nearly 100% after prompt and appropriate treatment of carcinoma in situ. Of course, frequent checkups are then necessary.

Cancer

HPV, the most common STD in the United States, may be responsible for many cervical cancers. Cancer may be manifested by unusual vaginal bleeding or discharge, bowel and bladder problems, and pain. Women are at greatest risk of developing cervical cancer between the ages of 30 and 40 and between the ages of 50 and 60. Most new cancers are diagnosed in women between 50 and 55. Although the likelihood of developing this disease begins to level off for Caucasian women at the age of 45, it increases steadily for African Americans for another 40 years. Biopsy is indicated when any abnormal growth is found on the cervix, even if the Pap test is negative.

Doctors have traditionally used radiation therapy and surgery to treat cervical cancer that has spread within the cervix or throughout the pelvis. In severe cases, postoperative radiation is administered to kill any remaining cancer cells, and chemotherapy may be used if cancer has spread to other organs. Recent studies have shown that giving chemotherapy and radiation at the same time improves a patient's chance of survival. The National Cancer Institute has urged physicians to strongly consider using both chemotherapy and radiation to treat patients with invasive cervical cancer. The survival rate at five years after treatment of early invasive cancer is 91%; rates are below 70% for more severe invasive cancer. That is why prevention, risk reduction, and frequent Pap tests are the best defense for a woman's gynecologic health.

Resources

Periodicals

"American Cancer Society Issues New Early Detection Guidelines." Women's Health Weekly December 19, 2002: 12.

Law, Malcolm. "How Frequently Should Cervical Screening Be Conducted." Important Journal of Medical Screening (Winter 2003): 159-161.

Other

"Pap smear: Simple, life-saving test." April 29, 1999. April 26, 2001. [cited June 28, 2001]. 〈http://www.mayohealth.org/home?id=HQ01177〉.

"Pap Smears: The simple test that can save your life." January 29, 2001. April 26, 2001. [cited June 28, 2001]. 〈http://www.mayohealth.org/home?id=HQ01178〉.

Key terms

Carcinoma in situ — Malignant cells that are present only in the outer layer of the cervix.

Cervical intraepithelial neoplasia (CIN) — A term used to categorize degrees of dysplasia arising in the epithelium, or outer layer, of the cervix.

Dysplasia — Abnormal changes in cells.

Human papillomavirus (HPV) — The most common STD in the United States. Various types of HPV are known to cause cancer.

Neoplasia — Abnormal growth of cells, which may lead to a neoplasm, or tumor.

Squamous intraepithelial lesion (SIL) — A term used to categorize the severity of abnormal changes arising in the squamous, or outermost, layer of the cervix.

test (test)

1. an examination or trial.

2. a significant chemical reaction.

3. a reagent.

abortus Bang ring test , ABR test an agglutination test for brucellosis in cattle, performed by mixing a drop of stained brucellae with 1 mL of milk and incubating for 1 hour at 37°C; agglutinated bacteria rise to the surface to form a colored ring.

acid elution test air-dried blood smears are fixed in 80 per cent methanol and immersed in a pH 3.3 buffer; all hemoglobins are eluted except fetal hemoglobin, which is seen in red cells after staining.

acidified serum test incubation of red cells in acidified serum; after centrifugation, the supernatant is examined by colorimetry for hemolysis, which indicates paroxysmal nocturnal hemoglobinuria.

acoustic reflex test measurement of the acoustic reflex threshold; used to differentiate between conductive and sensorineural deafness and to diagnose acoustic neuroma.

Adson's test one for thoracic outlet syndrome; with the patient in a sitting position, hands on thighs, the examiner palpates both radial pulses as the patient rapidly fills the lungs by deep inhalation and, holding breath, hyperextends the neck, turning the head toward the affected side. If the radial pulse on that side is markedly or completely obliterated, the result is positive.

agglutination test cells containing antigens to a given antibody are mixed into the solution being tested for a particular antibody, with agglutination indicative of antibody presence.

alkali denaturation test a spectrophotometric method for determining the concentration of fetal (F) hemoglobin.

Ames test a strain of Salmonella typhimurium that lacks the enzyme necessary for histidine synthesis is cultured in the absence of histidine and in the presence of the suspected mutagen and certain enzymes known to activate procarcinogens. If the substance causes DNA damage resulting in mutations, some of the bacteria will regain the ability to synthesize histidine and will proliferate to form colonies; almost all of the mutagenic substances are also carcinogenic.

anti-DNA test , anti–double-stranded DNA test an immunoassay that uses native double-stranded DNA as an antigen to detect and monitor increased serum levels of anti-DNA antibodies; used in the detection and management of systemic lupus erythematosus.

antiglobulin test (AGT) a test for nonagglutinating antibodies against red cells, using antihuman globulin antibody to agglutinate red cells coated with the nonagglutinating antibody. The direct antiglobulin test detects antibodies bound to circulating red cells in vivo. It is used in the evaluation of autoimmune and drug-induced hemolytic anemia and hemolytic disease of the newborn. The indirect antiglobulin test detects serum antibodies that bind to red cells in an in vitro incubation step. It is used in typing of erythrocyte antigens and in compatibility testing (cross-match).

aptitude tests tests designed to determine ability to undertake study or training in a particular field.

association test one based on associative reaction, usually by mentioning words to a patient and noting what other words the patient will think of and give in reply.

automated reagin test (ART) a modification of the rapid plasma reagin (RPR) test for use with automated analyzers used in clinical chemistry.

basophil degranulation test an in vitro procedure testing allergic sensitivity to a specific allergen at the cellular level by measuring staining of basophils after exposure to the allergen; a reduced number of granular cells is a positive result.

Benedict's test a qualitative or quantitative test for the determination of glucose content of urine.

Binet's test , Binet-Simon test a method of ascertaining a child's or youth's mental age by asking a series of questions adapted to, and standardized on, the capacity of normal children at various ages.

Bing test a vibrating tuning fork is held to the mastoid process and the auditory meatus is alternately occluded and left open; an increase and decrease in loudness is perceived by the normal ear and in sensorineural hearing loss, whereas the hearing of no difference occurs in conductive hearing loss.

caloric test irrigation of the normal ear with warm water produces a rotatory nystagmus toward that side; irrigation with cold water produces a rotatory nystagmus away from that side.

chi-square test any statistical hypothesis test employing the chi-square (χ2) distribution, measuring the difference between theoretical and observed frequencies and hypothesized to approach the χ2-distribution as the sample size increases.

chromatin test determination of genetic sex of an individual by examination of somatic cells for the presence of sex chromatin.

cis-trans test a test in microbial genetics to determine whether two mutations that have the phenotypic effect, in a haploid cell or a cell with single phage infection, are located in the same gene or in different genes; the test depends on the independent behavior of two alleles of a gene in a diploid cell or in a cell infected with two phages carrying different alleles.

clomiphene citrate challenge test measurement of fertility potential in a woman by examination of the response of follicle-stimulating hormone level to administration of clomiphene citrate early in the menstrual cycle.

complement fixation test see under fixation.

contraction stress test (CST) the monitoring of the response of the fetal heart rate to spontaneous or induced uterine contractions by cardiotocography, with deceleration indicating possible fetal hypoxia.

Coombs' test antiglobulin t.

Denver Developmental Screening test a test for identification of infants and preschool children with developmental delay.

DFA-TP test direct fluorescent antibody

Dick test an intracutaneous test for determination of susceptibility to scarlet fever.

direct fluorescent antibody–Treponema pallidum test DFA-TP t.; a serologic test for syphilis using direct immunofluorescence.

disk diffusion test a test for antibiotic sensitivity in bacteria; agar plates are inoculated with a standardized suspension of a microorganism. Antibiotic-containing disks are applied to the agar surface. Following overnight incubation, the diameters of the zones of inhibition are interpreted as sensitive (susceptible), indeterminate (intermediate), or resistant.

drawer tests tests for the integrity of the cruciate ligaments of the knee; with the knee flexed 90 degrees, if the tibia can be drawn too far forward there is rupture of the anterior ligaments (anterior drawer t.), if too far back then the rupture is of the posterior ligaments (posterior drawer t.) .

early pregnancy test a do-it-yourself immunological test for pregnancy, performed as early as one day after menstruation was expected (missed period); a variety of tests exist, all based on an increase in urinary levels of human chorionic gonadotropin after fertilization.

EP test , erythrocyte protoporphyrin test determination of erythrocyte protoporphyrin levels as a screening test for lead toxicity; levels are increased in lead poisoning and iron deficiency.

exercise tests , exercise stress tests any of various stress tests in which exercise is used in the electrocardiographic assessment of cardiovascular health and function, particularly in the diagnosis of myocardial ischemia. The most widely used forms are the treadmill and bicycle ergometer exercise tests; they are usually graded, consisting of a series of incrementally increasing workloads sustained for defined intervals.

FAB test fluorescent antibody t.

FeNa test excreted fraction of filtered sodium test, a measure of renal tubular reabsorption of sodium, calculated as (urine Na × plasma Cr) ÷ (urine Cr × plasma Na) × 100.

finger-nose test one for coordinated limb movements; with upper limb extended to one side the patient is asked to try to touch the end of the nose with the tip of the index finger.

Finn chamber test a type of patch test in which the materials being tested are held in shallow aluminum cups (Finn chambers) that are taped against the skin, usually for a few days.

Fishberg concentration test determination of the ability of the kidneys to maintain excretion of solids under conditions of reduced water intake and a high protein diet, in which urine samples are collected and tested for specific gravity.

flocculation test any serologic test in which a flocculent agglomerate is formed; usually applied to a variant form of the precipitin reaction.

fluorescent antibody test FAB t.; a test for the distribution of cells expressing a specific protein by binding antibody specific for the protein and detecting complexes by fluorescent labeling of the antibody.

fluorescent treponemal antibody absorption test , FTA-ABS test the standard treponemal antigen serologic test for syphilis, using fluorescein-labeled antihuman globulin to demonstrate specific treponemal antibodies in patient serum.

gel diffusion test see immunodiffusion.

glucose tolerance test a test of the body's ability to utilize carbohydrates by measuring the plasma glucose level at stated intervals after ingestion or intravenous injection of a large quantity of glucose.

glycosylated hemoglobin test measurement of the percentage of hemoglobin A molecules that have formed a stable keto–amine linkage between their terminal amino acid position of the β-chains and a glucose group; in normal persons this is about 7 per cent of the total, in diabetics about 14.5 per cent.

guaiac test one for occult blood; glacial acetic acid and a solution of gum guaiac are mixed with the specimen; on addition of hydrogen peroxide, the presence of blood is indicated by a blue tint.

Ham's test acidified serum t.

histamine test

1. subcutaneous injection of 0.1 per cent solution of histamine to stimulate gastric secretion.

2. after rapid intravenous injection of histamine phosphate, normal persons experience a brief fall in blood pressure, but in those with pheochromocytoma, after the fall, there is a marked rise in blood pressure.

horse cell test a modification of the Paul-Bunnell-Davidsohn test for antibodies associated with infectious mononucleosis, using horse erythrocytes instead of sheep erythrocytes.

Huhner test postcoital t.

hydrogen breath test a test for deficiency of lactase or other hydrolases or for colonic overgrowth of bacteria, in which the exhalations are trapped and measured after administration of carbohydrate, with excess carbohydrate fermentation in the colon resulting in high levels of exhaled hydrogen.

hypo-osmotic swelling test determination of sperm viability by placing a sample in a hypo-osmotic solution, which causes swelling and curling of the tails of spermatozoa with normal plasma membranes.

immobilization test detection of antibody based on its ability to inhibit the motility of a bacterial cell or protozoan.

inkblot test Rorschach t.

intelligence test a set of problems or tasks posed to assess an individual's innate ability to judge, comprehend, and reason.

intracutaneous test , intradermal test skin test in which the antigen is injected intradermally.

Kveim test an intradermal test for the diagnosis of sarcoidosis.

latex agglutination test , latex fixation test a type of agglutination test in which antigen to a given antibody is adsorbed to latex particles and mixed with a test solution to observe for agglutination of the latex.

limulus test an extract of blood cells from the horseshoe crab (Limulus polyphemus) is exposed to a blood sample from a patient; if gram-negative endotoxin is present in the sample, it will produce gelation of the extract of blood cells.

Lundh test a test for pancreatic function in which trypsin concentrations in the duodenum after a test meal are measured, with lowered levels of trypsin indicating low pancreatic secretion.

lupus band test an immunofluorescence test to determine the presence and extent of immunoglobulin and complement deposits at the dermal-epidermal junction of skin specimens from patients with systemic lupus erythematosus.

McMurray's test as the patient lies supine with one knee fully flexed, the examiner rotates the patient's foot fully outward and the knee is slowly extended; a painful “click” indicates a tear of the medial meniscus of the knee joint; if the click occurs when the foot is rotated inward, the tear is in the lateral meniscus.

Mantoux test an intracutaneous tuberculin test.

Master “two-step” exercise test an early exercise test for coronary insufficiency in which electrocardiograms were recorded while and after the subject repeatedly ascended and descended two steps.

MIF test , migration inhibitory factor test an in vitro test for production of MIF by lymphocytes in response to specific antigens; used for evaluation of cell-mediated immunity. MIF production is absent in certain immunodeficiency diseases.

Moloney test one for detection of delayed hypersensitivity to diphtheria toxoid.

multiple-puncture test a skin test in which the material used (e.g., tuberculin) is introduced into the skin by pressure of several needles or pointed tines or prongs.

neostigmine test on injection of neostigmine methylsulfate mixed with atropine sulfate, lessening of myasthenic symptoms indicates myasthenia gravis.

neutralization test one for the neutralization power of an antiserum or other substance by testing its action on the pathogenic properties of a microorganism, toxin, virus, bacteriophage, or toxic substance.

nocturnal penile tumescence test monitoring of erections occurring during sleep; used in the differential diagnosis of psychogenic and organic impotence.

nonstress test (NST) the monitoring of the response of the fetal heart rate to fetal movements by cardiotocography.

nontreponemal antigen test any of various tests detecting serum antibodies to reagin (cardiolipin and lecithin) derived from host tissues in the diagnosis of the Treponema pallidum infection of syphilis.

NPT test nocturnal penile tumescence t.

osmotic fragility test heparinized or defibrinated blood is placed in sodium chloride solutions of varying concentrations; increased fragility, measured as hemolysis, indicates spherocytosis.

oxytocin challenge test (OCT) a contraction stress test in which the uterine contractions are stimulated by intravenous infusion of oxytocin.

Pap test , Papanicolaou test an exfoliative cytological staining procedure for detection and diagnosis of various conditions, particularly malignant and premalignant conditions of the female genital tract; also used in evaluating endocrine function and in the diagnosis of malignancies of other organs.

patch tests tests for hypersensitivity, performed by observing the reaction to application to the skin of filter paper or gauze saturated with the substance in question.

Patrick's test thigh and knee of the supine patient are flexed, the external malleolus rests on the patella on the opposite leg, and the knee is depressed; production of pain indicates arthritis of the hip. Also known as fabere sign, from the first letters of movements that elicit it (f lexion, ab duction, e xternal r otation, e xtension).

Paul-Bunnell test determination of the highest dilution of the patient's serum that will agglutinate sheep erythrocytes; used to detect serum heterophile antibodies in the diagnosis of infectious mononucleosis.

Paul-Bunnell-Davidsohn test a modification of the Paul-Bunnell test that differentiates among three types of heterophile sheep agglutinins: those associated with infectious mononucleosis and serum sickness, and natural antibodies against Forssman antigen.

postcoital test determination of the number and condition of spermatozoa in mucus aspirated from the cervical canal soon after intercourse.

precipitin test any serologic test based on a precipitin reaction.

projective test any of various tests in which an individual interprets ambiguous stimulus situations according to their own unconscious dispositions, yielding information about their personality and possible psychopathology.

psychological test any test to measure a subject's development, achievement, personality, intelligence, thought processes, etc.

psychomotor test a test that assesses the subject's ability to perceive instructions and perform motor responses.

Queckenstedt's test see under sign.

Quick's test

1. a test for liver function based on excretion of hippuric acid after administration of sodium benzoate.

2. prothrombin time.

radioallergosorbent test (RAST) a radioimmunoassay test for the measurement of specific IgE antibody in serum, using allergen extract antigens fixed in a solid-phase matrix and radiolabeled anti–human IgE.

radioimmunosorbent test (RIST) a radioimmunoassay technique for measuring serum IgE concentration, using radiolabeled IgE and anti–human IgE bound to an insoluble matrix.

rapid plasma reagin test RPR test; a screening flocculation test for syphilis, using a modified VDRL antigen.

Rinne test a test of hearing made with tuning forks of 256, 512, and 1024 Hz, comparing the duration of perception by bone and by air conduction.

rollover test comparison of the blood pressure of a pregnant woman lying on her back versus on her side; an excessive increase when she rolls to the supine postion indicates increased risk of preeclampsia.

Rorschach test an association technique for personality testing based on the patient's response to a series of inkblot designs.

RPR test rapid plasma reagin test.

Rubin's test one for patency of the uterine tubes, performed by transuterine inflation with carbon dioxide gas.

Schick test an intradermal test for determination of susceptibility to diphtheria.

Schiller's test one for early squamous cell carcinoma of the cervix, performed by painting the uterine cervix with a solution of iodine and potassium iodide, diseased areas being revealed by a failure to take the stain.

Schilling test a test for vitamin B12 absorption employing cyanocobalamin tagged with Co-57; used in the diagnosis of pernicious anemia and other disorders of vitamin B12 metabolism.

Schirmer's test a test of tear production in keratoconjunctivitis sicca, performed by measuring the area of moisture on a piece of filter paper inserted over the conjunctival sac of the lower lid, with the end of the paper hanging down on the outside.

Schwabach's test a hearing test made, with the opposite ear masked, placing the stems of vibrating tuning forks on the mastoid process first of the patient and then of the examiner. If heard longer by the patient it indicates conductive hearing loss and if heard longer by the examiner it indicates sensorineural hearing loss in the patient.

scratch test a skin test in which the antigen is applied to a superficial scratch.

sheep cell agglutination test (SCAT) any agglutination test using sheep erythrocytes.

sickling test one for demonstration of abnormal hemoglobin and the sickling phenomenon in erythrocytes.

skin test any test in which an antigen is applied to the skin in order to observe the patient's reaction; used to determine exposure or immunity to infectious diseases, to identify allergens producing allergic reactions, and to assess ability to mount a cellular immune response.

sperm agglutination test any of various tests for the presence of antisperm antibodies as a cause of infertility, based on the ability of large multivalent isotypes such as IgM or secretory IgA to cross-link and agglutinate spermatozoa with such antibodies.

stress tests any of various tests that assess cardiovascular health and function after application of a stress, usually exercise, to the heart.

swinging flashlight test with the eyes fixed at a distance and a strong light shining before the intact eye, a crisp bilateral contraction of the pupil is noted; on moving the light to the affected eye, both pupils dilate for a short period, and on moving it back to the intact eye, both pupils contract promptly and remain contracted; indicative of minimal damage to the optic nerve or retina.

Thematic Apperception Test (TAT) a projective test in which the subject tells a story based on each of a series of standard ambiguous pictures, so that the responses reflect a projection of some aspect of the subject's personality and current psychological preoccupations and conflicts.

thyroid suppression test after administration of liothyronine for several days, radioactive iodine uptake is decreased in normal persons but not in those with hyperthyroidism.

tine test four tines or prongs, 2 mm long, attached to a handle and coated with dip-dried PPD or Old tuberculin (OT) are pressed into the skin of the volar surface of the forearm; 48 to 72 hours later the skin is checked for palpable induration around the wounds.

treponemal antigen test any of various tests detecting specific antitreponemal antibodies in serum in the diagnosis of the Treponema pallidum infection of syphilis.

tuberculin test any of a number of skin tests for tuberculosis using a variety of different types of tuberculin and methods of application.

unheated serum reagin test , USR test a modification of the VDRL test using unheated serum; used primarily for screening.

VDRL test [V enereal D isease R esearch L aboratory] a flocculation test for syphilis using VDRL antigen, which contains cardiolipin, cholesterol, and lecithin, to test heat-inactivated serum.

Weber's test the stem of a vibrating tuning fork is placed on the vertex or midline of the forehead. If the sound is heard best in the affected ear, it suggests conductive hearing loss; if heard best in the normal ear, it suggests sensorineural hearing loss.

Widal's test a test for agglutinins to O and H antigens of Salmonella typhi and Salmonella paratyphi in the serum of patients with suspected Salmonella infection.

Pap test

See Pap smear.

Pap smear, Pap test.

See Papanicolaou test.

Pap test (redirected from Pap tests)