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clinicians should not perform any diagnostic tests or procedures in patients before obtaining a full medical history, including a physical examination, review of systems, and pertinent laboratory tests (see appropriate chapters in the text). these exams are vital to prevent unnecessary diagnostic tests or treatments that may be harmful to the patient. it is important to identify patients who are candidates for screening tests and refer them to appropriate screening facilities. screening tests are those in which the patient has no signs or symptoms of illness. some tests are not recommended for healthy people (e.g., colonoscopy for average-risk patients and psa testing for healthy men). screening tests may be repeated if conditions warrant.


a negative test does not rule out a condition. patients with a negative test who have symptoms of a disease may be directed to further evaluation. for example, a negative psa test in men who have symptoms of prostate cancer may not exclude a diagnosis of prostate cancer. a negative test for a specific disease in a person with symptoms does not rule out the presence of another disease in that person.


the normal reference range for the esr is 0 to 15 mm/hr in males and 0 to 20 mm/hr in females. the normal reference range is less than 10 mm/hr in children. [52] the normal esr in adults is less than 20 mm/hr. the esr is normal in the presence of normal sedimentation rates. [20] an adult male with an esr >20 mm/hr may have disseminated gonococcal infection, a malignancy, or inflammatory bowel disease, although the test is negative in these cases. [20] patients with chronic inflammatory disease or malignancy usually have a higher esr than the normal reference range. [20] the normal reference range for the esr should be used with caution in areas where the prevalence of schistosomiasis or malaria is high. schistosomiasis is an endemic disease in many parts of the world and there is a possibility of cross reactivity with an igm antibody. [53] 84d34552a1