INFANT AND CHILD SCREENING

Guthrie test

The Guthrie, or heel prick test is a screening test carried out on the newborn baby in the days after birth (typically day 6 or 7). The Guthrie test is offered to all infants in the U.K. with the aim of screening for up to 5 disorders. Blood is taken from your baby’s heel. The sample is analysed for the following conditions: Phenylketonuria, Congenital Hypothyroidism, Cystic Fibrosis, MCAD Deficiency, and Sickle Cell Disease. (www.midwivesonline.com[online], 2011)

Blood is collected by pricking the baby's heel. This is then used to cover four circles on an absorbent card, which is then forwarded to the public health laboratory. Hence the more popular name the 'heel prick test'. It is much like a blood test for adults and older people, although the blood is taken from a different spot due to the infants size and age. (www.yourdiscovery.com, 2010)
When looking for Phenylketonuria, the doctors will be looking for raised or higher than normal levels of phenylalanine, which they will then use to diagnose the infant with Phenylketonuria.

Phenylketonuria is condition that affects the individual’s ability to metabolise a particular type of amino acid – phenylalanine. A build up of this can lead to severe mental handicap. Simply avoiding exposure to phenylalaine can minimise the effects of the condition. (www.midwivesonline.com[online], 2011)

A positive result for Phenylketonuria would show that raised levels of the chemical phenylalanine in the blood taken from the infant in the Guthrie test.

A negative result would show the body successfully breaking down the chemical phenylalanine and therefore having normal amounts of the chemical in the infants bloodstream.

Blood tests for a child

Blood test are performed between day 6 and 14 after the birth of the child. It can be carried out up to the age of one year of age.
Most children with moderate to severe Thalassemia show signs and symptoms within their first two years of life. If your doctor suspects your child has thalassemia, he or she may confirm a diagnosis using blood tests. (Mayo Clinic staff, www.mayoclinic.com[online], February 2011)

Blood tests for children are often taken in different ways than they are taken in adults. Young babies often have blood taken from a ‘heel prick’ sample, similar to that taken by midwives and health visitors in the first few days of life. Blood can also be taken by using a neo-safe needle which is the name given to a special needle which is put into a vein, and the blood drips out of the end into the collection bottle. It is most frequently used for babies and infants whose veins are
too small to allow the use of a syringe and butterfly method. The butterfly method is the name given to a small needle attached to a plastic tube through which blood is
collected into a syringe. This is most frequently used for older babies and young children. Alternativley, it can be taken by using the usual method used for adults called a vacutainer. Also, if your child needs to have a cannula (or ‘drip’) put in so that medicine or fluids can be given into a vein, blood can be collected at the same time. (Tracey Farnon, NHS Parents guide to blood tests[leaflet], February 2010)

Thalassaemia is an inherited condition affecting the blood. There are different types, which vary from a mild condition with no symptoms, to a serious or life-threatening condition. In Thalassaemia, part of the haemoglobin is faulty - usually either the alpha chains or the beta chains. This means that some of the haemoglobin does not work properly. As a result, there is not enough normal haemoglobin and the red blood cells break down easily. This makes the person 'anaemic' (lacking in haemoglobin), with various symptoms. (NHS Choice[online], 2010)

A positive test result for Thalassaemia would show a low level of blood red cells, smaller than average red blood cells, pale red blood cells, red blood cells varying in shape and size, and red blood cells with uneven hemoglobin distribution, which gives the cells a bull's-eye appearance under the microscope

A negative test result would show normal looking and normal behaving red blood cells and thus resulting in the child not being diagnosed with Thalassaemia.

Ortolani-Barlow test

The Ortolani-barlow test is performed by the midwife as soon as the baby is born, and again at the baby's six week and eight month checks. (http://www.babycentre.co.uk/baby/health/clickyhips/, January 2009)

It is a procedure used to evaluate the stability of the hip joints in newborns and infants. The baby is placed on his or her back, and the hips and knees are flexed at right angles and abducted until the lateral aspects of the knees are touching the table. The examiner's fingers are extended along the outside of the thighs, with the thumbs grasping the insides of the knees. Internal and external rotation are attempted, and symmetry of mobility is evaluated. A click or a popping sensation (Ortolani's sign) may be felt if the joint is unstable, caused by the head of the femur moving out of the acetabulum under pressure from the examiner's hands during rotation and abduction. The doctor will be looking for a positive sign that is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum. This means that the hip is dislocatable, meaning that it can be easily popped out of it's socket. (http://medical-dictionary.thefreedictionary.com/dysplasia[online], 2002)

DDH is the instability of the hip joint leading to dislocation in the neonatal period; it may be associated with various neuromuscular disorders or occur in utero but occurs most commonly in neurologically normal infants and is multifactorial in origin. In other words, it is the congenital or acquired deformation or misalignment of the hip joint. (http://medical-dictionary.thefreedictionary.com/dysplasia[online], 2002).

The doctor or midwife will check for the condition when examining your baby straight after she’s born. She will manipulate your baby’s hips to check the stability of her hip joints. These movements include opening her legs wide and then bending and unbending them. If the examiner detects any instability, further investigation, such as an ultrasound scan, will be performed. Sometimes an x-ray is used but this is usually for older babies (young babies have very soft bones which are difficult to see properly on an x-ray). The hip test will be done again at your baby’s six week and eight month checks. (http://www.babycentre.co.uk/baby/health/clickyhips/, January 2009)

A positive result would mean that a clunk may indicate that both thigh bones are moving in or out of their sockets in the pelvis. This is called clinical hip instability. Babies born with this condition do not feel any pain or discomfort and often grow out of the problem without treatment. This can be confirmed by doing an x-ray to look closer at the hips, and to diagnose the infant with DDH. (http://www.babycentre.co.uk/baby/health/clickyhips/, January 2009)

A negative result for the Ortolani-Barlow test would show the infants hips and limbs behaving normally and being flexible without noises or popping sensations/reactions.


Dental checks: Visual examinations

The standard recommendation is to visit your dentist twice a year for check-ups and cleanings. This frequency level works well for most people, although some people with gum disease, a genetic predisposition for plaque build-up or cavities, or a weakened immune system might need to visit the dentist more frequently for optimal care. (orchidheart.com[online], 2008)

The dentist may start with a visual check using a small mirror and hand light. The dentist will use these tools to check your gums as well as your teeth. This preliminary check is to identify gum disease and any other potential problems that may be easily visible, such as loose teeth, damaged gums, plaque, or the presence of bacteria that cause bad breath. As part of a routine check, the dentist will also check the foundations of your teeth. The dentist may use a small probe to gently test the area where the teeth meet the gums. By doing this check, the dentist can identify areas where gum disease is present. (www.dental.net[online], August 2010)

A 'positive result' for a dental check would show some kind of problem with the teeth or gums. This could be the beginnings or progression of gum disease, or a build of bacteria or plaque, to damage to the teeth or in-adequate cleaning. It could also show if the teeth are growing wrong, in which case further treatment from an orthodontist may be needed.

A negative result for a dental check would show a normal and healthy mouth, teeth and gums, and so no further treatment would be needed at that current time.


Dental checks - X-rays on teeth

The frequency of getting X-rays of your teeth often depends on your medical and dental history and current condition. Some people may need X-rays as often as every six months; others with no recent dental or gum disease and who visit their dentist regularly may get X-rays only every couple of years. In children, X-rays are taken every 12 to 24 months if the teeth are touching and all surfaces cannot be visualized or probed. (Elverne M Tonn,www.webmd.com[online], 2009)

There are four types of x-rays: Bitewing, Periapical, Palatal and Panoramic.
The bitewing is when the patient bites on a paper tab and shows the crown portions of the top and bottom teeth together. The periapical shows one or two complete teeth from crown to root. A palatal or occlusal x-ray captures all the upper and lower teeth in one shot while the film rests on the biting surface of the teeth. A panoramic x-ray requires a special machine that rotates around the head. The x-ray captures the entire jaws and teeth in one shot. It is used to plan treatment for dental implants, check for impacted wisdom teeth, and detect jaw problems. A panoramic x-ray is not good for detecting cavities, unless the decay is very advanced and deep. (Jack D Rosenberg, http://www.nlm.nih.gov[online], February 2010)

In children, dental x-rays are used to watch for decay, determine if there is enough space in the mouth to fit all incoming teeth, determine if primary teeth are being lost quickly enough to allow permanent teeth to erupt properly and to check for the development of wisdom teeth and identify if the teeth are impacted (unable to emerge through the gums). Whereas, in adults the dentist will be looking for areas of decay that may not be visible with an oral exam, especially small areas of decay between teeth, identifying decay occurring beneath an existing filling, reveal bone loss that accompanies gum disease, to reveal changes in the bone or in the root canal resulting from infection, to assist in the preparation of tooth implants, braces, dentures, or other dental procedures, to reveal abscesses (an infection at the root of a tooth or between the gum and a tooth)and to reveal other developmental abnormalities, such as cysts and some types of tumors.

A positive result for the dental x-ray would show unemerged or impacted teeth, the presence and extent of dental caries (cavities), bone damage, abscessed teeth, a fractured jaw, malocclusion of teeth or other abnormalities of the teeth and jaw bones.

A negative result would mean that the x-rays show a normal number, structure, and position of the teeth and jaw bones. There are no cavities or other problems. (Jack D Rosenberg, http://www.nlm.nih.gov[online], February 2010)

Dental checks - Surface probing

The dentist will usually do a surface probing everytime you visit for an oral check up, which will usually be twice a year, more if you have a current oral issue you are receiving treatment for.

The dental ‘probe’ or ‘explorer’ can be used by your dentist to gently feel the bumps and valleys on the surface of the tooth. If the dentist notices any ‘tackiness’ on the surface of the tooth, it might be a soft area which would indicate decay is present. As part of a routine check of your mouth, the dentist will also want to have a look at the foundations of your teeth, or your gums. The dentist has a small probe with a special tiny ball on the end of it. This is used to gently run around the necks of your teeth where they meet the gums. The first signs of gum disease always start here and your dentist will not want to press hard at all on the gums. By doing this check, the dentist can identify any areas where gum disease is present. (John Urquhart, http://www.dentalfearcentral.org/faq/check-up/[online], 2006)
The dentist will evaluate the following during a surface probe screening test; any lumps or other abnormal areas in the mouth, which may include changes in the color of the gums, inner cheeks or tongue, whether any of your teeth are missing or loose, and how loose they are, the color, texture, size and shape of your gums, whether you have any fillings, crowns, bridges, dentures or implants, how much plaque is on your teeth, the depth of the space between your tooth and gum, whether your gums bleed during probing, if you have receding gums, and how your teeth come together when you bite or how well your teeth sit in your mouth. (http://www.simplestepsdental.com/[online], January 2009)

A positive result for a dental surface probing test would mean that there were lumps or other abnormal areas in the mouth. This could indicate oral cancer, a condition that could lead to cancer or an infection. A positive result could also mean that there were loose teeth which could be a sign of periodontal disease, or showing that the gums or not healthy; diseased gums are usually reddish, swollen and abnormally shaped. A positive test result may also be returned if you have bleeding gums, receding gums or if you have ill-fitting teeth, in which further treatment with an orthodontist may be needed. (http://www.simplestepsdental.com/[online], January 2009)

A negative result for a dental surface probing test would show a healthy mouth and gums, and good overall oral hygiene, therefore not needing further treatment apart from the annual checkup twice yearly.

Visual examinations, X-rays and surface probing are screening for irregularities, disease or infection within the mouth or any problems that need to be corrected as mentioned previously.

Dental caries is the medical term for tooth decay or cavities. It is caused by specific types of bacteria. They produce acid that destroys the tooth's enamel and the layer under it, the dentin. (http://www.simplestepsdental.com, January 2011)


Eye tests - Snellen charts

Snellen charts are usually performed as the initial screening method as part of an eye test.

The Snellen Chart provides a standardized test of visual acuity. The chart is placed 20 feet from the subject. The chart consists of a series of symbols, for example, block letters in gradually decreasing sizes. The visual acuity is stated as a fraction: the distance from the chart, (6 metres) is the numerator; the distance at which a 'normal eye' would be able to read the last line that the patient is able to read is the denominator. For example, 6/6 vision signifies normal vision; a patient can read a line of symbols at six metres that a person with 'normal visual acuity' would be able to read at six metres.

A person with poor vision may have, for example, 6/10 vision; they are able to read at 6 metres what a person with normal vision can read at 10 metres. A person with better than normal vision will have a denominator that is less than 6, for example, 6/5; a person with this grading of visual acuity can read at six metres what a person with normal visual acuity can only read at 5 metres.

A positive result for a snellen test would show that the person being screened would have a denominator less than six, and therefore have poorer that average vision and may need glasses or contacts.

A negative result for the snellen test would show the person being screened being able to read the letters on the chart easily, and therefore having good vision.

Behavioural responses for baby’s
When is the test performed?
Testing for behavioral responses in babies is suitable for examining newborns and infants up to two months old. (The Neonatal Behavioral Assessment , http://www.brazelton-institute.com/, 1995)

Behavioural Observation Audiometry (BOA) involves presenting sounds to a baby
and observing their responses.
There are a few different kinds of tests which are carried out; the Auditory brainstem response (ABR) test, which involves placing tiny earphones in the ear canals and small electrodes are placed behind the ears and on the forehead. Usually, click-type sounds are introduced through the earphones, and the electrodes measure the hearing nerve's response to the sounds. A computer averages these responses and displays waveforms. There is also the Auditory steady state response (ASSR) test, the Otoacoustic emissions (OAE) test and the Tympanometry test. (Thierry Morlet, http://kidshealth.org[online], October 2009)

The behavioral response might be an infant's eye movements, a head-turn by a toddler, placement of a game piece by a preschooler, or a hand-raise by a gradeschooler. Speech responses may involve picture identification of a word or repeating words at soft or comfortable levels. Very young children are capable of a number of behavioral tests

Positive result =

Negative result =

Eye tests are screening for;
Visual acuity, which is the clarity or clearness of the vision, a measure of how well a person sees. The ability to distinguish details and shapes of objects; also called central vision. (http://www.medterms.com[online], April 2011)

Colour blindness, which is an abnormal condition characterized by the inability to clearly distinguish different colors of the spectrum. The difficulties can be mild to severe. It is a misleading term because people with color blindness are not blind. Rather, they tend to see colors in a limited range of hues; a rare few may not see colors at all. (Myron Yanoff, http://medical-dictionary.thefreedictionary.com[online], 2000)

Hearing tests for deafness - Audiogram

This test can detect hearing loss at an early stage.
The first steps are to see whether you need an audiogram. The specific procedures may vary, but they generally involve blocking one ear at a time and checking your ability to hear whispers, spoken words, or the sound of a ticking watch. (Linda J. Vorvick, http://www.nlm.nih.gov, 2010)

The most simple test of hearing ability is called 'pure tone audiometry' where you listen to a range of beeps and whistles (called pure tones) and indicate when you can hear them, maybe by pressing a button. The loudness of each tone is reduced until you can just hear the tone. The softest sounds you can hear (your hearing thresholds) are then marked on a graph called an audiogram.
Normal, young, healthy human ears can hear frequencies as low as 20 Hz and as high as 20,000 Hz, but the range tested is only 250 Hz to 8000 Hz, as most sounds of speech occur in this frequency range.(Australian Hearing, www.mydr.com.au[online], 2001)

There are many different kinds and degrees of hearing loss. In some types, you only lose the ability to hear high or low tones, or you lose only air or bone conduction. The inability to hear pure tones below 25 dB indicates some hearing loss., and would therefore be a positive result and the person being tested will need further treatment to aid their hearing. (Linda J. Vorvick, http://www.nlm.nih.gov, 2010)

A negative result would show the ability to hear a whisper, normal speech, and a ticking watch, the ability to hear a tuning fork through air and bone, and in detailed audiometry, hearing is normal if you can hear tones from 250 Hz - 8,000 Hz at 25 dB or lower.(Linda J. Vorvick, http://www.nlm.nih.gov, 2010)


Automated Auditory Brainstem Response (AABR) test

All babies in the UK have this hearing test within the first few days after being born. (NDCS, www.ndcs.org.uk[online], 2011)

The AABR screening test works by recording brain activity in response to sounds. Sound travels through the outer ear as vibrations. When it reaches the cochlea it is converted into an electrical signal. This travels along the nerve of hearing to the brain where it processed into recognizable sounds.
The AABR test does this by playing a series of clicking sounds through headphones that cover the baby’s ears. Three small sensors are placed on the baby’s head and connected to the computer equipment. If the hearing system is working normally then the computer will report strong responses. If there is no strong response then the computer will report that a referral should be made. (NDCS, www.ndcs.org.uk[online], 2011)

A positive result would show that the computer did not report strong response, meaning that the brain activity in response to sounds was not as strong as the usual response for the average child, and therefore further tests may be needed. (www.nhs.uk [online], January 2011)

A negative result would mean that the computer returned a strong or normal result therefore meaning that the brain activity in the infant in response to sounds was strong and no further treatment would be needed. (NDCS, www.ndcs.org.uk[online], 2011)

Otoacoustic Emissions (OEA) tests

All babies in the UK have this hearing test within the first few days after being born. (NDCS, www.ndcs.org.uk[online], 2011)

The OAE test works on the principle that a healthy cochlea (inner ear) will produce a faint echo when stimulated with sound. A small ear-piece, containing a speaker and a microphone, is placed in the baby’s ear. A clicking sound is played and if the cochlea is functioning properly the ear-piece will pick up the echo. This is recorded on a computer that tells the screener if the baby needs to be referred for a further screening test. If the test records strong responses from the baby’s ear then they will not need any further tests. (NDCS, www.ndcs.org.uk[online], 2011)

When a baby has a hearing loss, no echo can be measured on the OAE test, which would therefore mean a positive result would be shown for the screen.

A negative result, which would therefore mean the baby was hearing normally, would show an echo being reflected back into the ear canal and measured by the microphone.


Adult Screening

Blood pressure test using a sphygmomanometer
A sphygmomanometer is a device that is used to measure blood pressure.

To perform blood pressure test using a manometric sphygmomanometer, a cuff of fabric is wrapped around the arm and then slightly inflated. A stethoscope is used to hear the sound of blood rushing back through the artery. A gauge measures the blood pressure. The healthcare provider reads two numbers from the gauge while air is released from the cuff. The first number is arrived at when a thumping sound is first heard (systolic pressure). The second number is determined when the thumping sound is no longer heard (diastolic pressure). With a digital sphygmomanometer, the stethoscope is not used; instead, the two numbers are generated electronically.

The two numbers that represent your blood pressure are written like a fraction: one number on top and one on the bottom. For example, a normal blood pressure would be read as 120/80. The number on top refers to systolic pressure. It measures the pressure inside your blood vessels at the moment your heart beats. The number on the bottom is the diastolic pressure reading. It measures the pressure in your blood vessels between heartbeats, when your heart is resting.
(Arthur Schoenstadt, www.blood-pressure.emedtv.com[online], 2008)

What blood pressure testing is looking for:
High blood pressure, or hypertension, means that your blood pressure is constantly higher than the recommended level. High blood pressure is not usually something that you can feel or notice, but over time if it is not treated, your heart may become enlarged making your heart beat less effectively, which could lead to heart failure. Having high blood pressure increases your chance of having a heart attack or stroke. (British Heart Foundation, http://www.bhf.org.uk/[online])

A positive result when testing for hypertension by using a sphygmomanometer would show that, in general terms, people with a systolic blood pressure consistently above 140mmHg and/or a diastolic pressure over 85mmHg need treatment to lower their blood pressure. There is a natural tendency for blood pressure to rise with age due to the reduced elasticity of the arterial system. Age is therefore one of the factors that needs to be taken into account in deciding whether a person's blood pressure is too high. (Dr Sabine Gill, http://www.netdoctor.co.uk, 2011)

A negative result would show the blood pressure reading being generally around 120/80 mmHg, and therefore the person's blood pressure who was being read would be normal and healthy, and they would not need to actively take steps to lower it. (Dr Sabine Gill, http://www.netdoctor.co.uk, 2011)


Smear test
When is this test performed?
Women should receive their first invitation for screening at 25, women aged 25-49 are invited for screening every three years, women aged 50-64 are invited for screening every five years, and women aged 65 or over are only screened if they have not been screened since they were 50 or have had recent abnormal test results. (NHS Choices, http://www.nhs.uk[online], 2009)

The doctor or nurse will gently put an instrument, called a speculum, into the vagina. This holds the walls of the vagina open so that the cervix can be seen. A small brush-like instrument is then used to gently wipe some cells off the surface of the cervix. A sample of the cells collected is put on a slide and laboratory staff look at the cells under a microscope to see if there are any abnormal cells. The doctors will be looking for abnormal cells in the sample as this could lead them to identify any underlying issue early. (NHS Choices, http://www.nhs.uk[online], 2009)

What smear tests are looking for:
Cervical Cancer, or Cancer of the cervix, occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body. Cervical cancer occurs when abnormal cells on the cervix grow out of control. (www.webmd.com[online], 2010)

A positive result means that there are no cell changes. No action is needed and you do not need your next cervical screening until it is routinely due. (NHS Choices, http://www.nhs.uk[online], 2009)

A negative result shows that you have abnormal cells in the collected sample, and you may be told you have mild or slight changes (mild dyskaryosis), moderate cell changes (moderate dyskaryosis), or severe cell changes (severe dyskaryosis).
Dyskaryosis is a term used to describe the changes to the cells. Your results may also refer to CIN. This stands for cervical intra-epithelial neoplasia and is the medical name for cervical changes.
All these results show that you have pre-cancerous cells, and if not treated will develop into cancer. (NHS Choices, http://www.nhs.uk[online], 2009)

Mammography

The National Cancer Institute recommends that women 40 years and older should get a mammogram every 1 to 2 years. Women who have had breast cancer or other breast problems or who have a family history of breast cancer might need to start getting mammograms before age 40, or they might need to get them more often. Talk to your doctor about when to start and how often you should have a mammogram. (Richard E. Manrow, www.womenshealth.gov[online], 2010)

A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain.
The person being screened stands front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places the breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. The person being screened will feel pressure on your breast for a few seconds. It may cause them some discomfort; they might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter the breast, the better the picture. Most often, two pictures are taken of each breasts, one from the side and one from above. A screening mammogram takes about 20 minutes from start to finish. (Richard E. Manrow, www.womenshealth.gov[online], 2010)

What mammography is looking for:
Breast cancer is an uncontrolled growth of breast cells. Breast cancer (malignant breast neoplasm) is a type of cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas. Breast cancer is a disease of humans and other mammals; while the overwhelming majority of cases in humans are women, men can also develop breast cancer. (www.breastcancer.org[online], 2011)

A positive result for a mammography would show an abnormal change in cells, which if suggests cancer, the doctor will refer the patient either for a diagnostic mammography, an ultrasound, an MRI or a biopsy. It may also show lumps or masses; the size, shape, and edges of a lump sometimes can give doctors information about whether or not it may be cancer or calcifications. A calcification is a deposit of the mineral calcium in the breast tissue. Calcifications appear as small white spots on a mammogram. (Richard E. Manrow, www.womenshealth.gov[online], 2010)

A negative result would be returned if the cells are normal; normal shape, size and behaving, with no abnormalities, and thus no further treatment will be needed.


Physical examination of the testicles
When is this test performed?
It is recommended that a self-check of the testicles should be done at least once a month. (T. Ernesto Figueroa,kidshealth.org[online],2009)

One testicle is examined at a time, using both hands to gently roll each testicle with slight pressure. The doctor will feel the epididymis (the sperm-carrying tube), which feels soft, rope-like, and slightly tender to pressure, and is located at the top of the back part of each testicle, and is a normal lump.
When examining each testicle, the doctor will feel for any lumps or bumps along the front or sides. Lumps may be as small as a piece of rice or a pea.
The doctor will also check for any swelling, lumps, or changes in the size or color of a testicle, and ask if the patient has any pain or achy areas in their groin. (T. Ernesto Figueroa,kidshealth.org[online],2009)

What physical examinations of the testicles are looking for:
Cancer of the testicles, also known as testicular cancer, is an uncommon type of cancer that primarily affects younger men. The most common symptom of testicular cancer is a painless lump or swelling in the testicles. Other symptoms can include:
a dull ache in the scrotum (the sac of skin that hangs underneath the penis and contains the testicles).
The different types of testicular cancer are classified by what type of cells the cancer first begins in. The most common type of testicular cancer is known as ‘germ cell testicular cancer’, which accounts for around 95% of all cases. Germ cells are a type of cell that the body uses to help create sperm. Other types of testicular cancer are Leydig cell tumours and Sertoli cell tumours. (NHS Choices,www.nhs.uk[online],2010)


A positive result for a testicular examination would show abnormalities in the testicles, (lumps, swellings, changes in size and colour of the testicles). Cancerous lumps tend to be solid, which means that light is unable to pass through them.
If your GP suspects that the lump in your testicle may be cancerous, you will be referred for further testing at a hospital. (NHS Choices,www.nhs.uk[online],2010)

A negative result for a testicular examination would show no changes in the testicle from when they were last regularly checked, and so would be healthy testicles.


Eye tests for adults
Tonometry

Tonometry may be done as part of a regular eye examination to check for increased intraocular pressure (IOP), which increases your risk of glaucoma, or to check the treatment for glaucoma. Tonometry can be used to see if medicine is keeping your IOP below a certain target pressure set by your doctor. (Healthwise,www.webmd.com[online],2010)

Description of how the test is carried out (procedure) and the scientific basis of the test (what is being looked for)
There are several methods of testing for glaucoma. The most accurate method measures the force needed to flatten a certain area of the cornea.
The surface of the eye is numbed. A fine strip of paper stained with orange dye is touched to the side of the eye. The dye stains the front of the eye to help with the examination. The slit-lamp is placed in front of you, and you rest your chin and forehead on a support that keeps your head steady. The lamp is moved forward until the tip of the tonometer just touches the cornea. The light is usually a blue circle. The health care provider looks through the eyepiece on the lamp and adjusts the tension on the tonometer. There is no discomfort with the test.
Tonometry is a test to measure the pressure inside your eyes. The test is used to screen for glaucoma. (David Zieve,www.nlm.nih.gov[online],2010)

What tonometry looks for:
Glaucoma is a term that describes a group of eye conditions that affect vision. Glaucoma often affects both eyes, usually in varying degrees. One eye may develop glaucoma quicker than the other.
Glaucoma occurs when the drainage tubes (trabecular meshwork) within the eye become slightly blocked. This prevents eye fluid (aqueous humour) from draining properly.
When the fluid cannot drain properly, pressure builds up. This is called intraocular pressure. This can damage the optic nerve, which connects the eye to the brain, and the nerve fibres from the retina (the light-sensitive nerve tissue that lines the back of the eye). (NHS Choices,www.nhs.uk[online],2010)

A normal result, and thus a negative result, means your eye pressure is within the normal range. The normal eye pressure range is 10 - 21 mmHg. (David Zieve,www.nlm.nih.gov[online],2010)

A positive result would show that your eye pressure is not in the normal eye pressure range, and may be due to Glaucoma, Hyphema, or trauma to the eye or head. (David Zieve,www.nlm.nih.gov[online],2010)


Short sightedness

Eye professionals recommend that everyone see an eye doctor at least every three years. Many people should see their eye doctors more often. According to the American Optometric Association and the American Academy of Ophthalmology, factors such as age, eye health and family health history determine how often one should have a complete eye exam. (Michelle Kulas,www.livestrong.com[online],2011)

Myopia is usually diagnosed by reading a standard chart, such as a Snellen chart, from a distance of 3 or 6 metres. These charts have large letters at the top and smaller letters below. If a person can read all of the letters clearly, this is called 6/6 vision. If the bottom lines are fuzzy, but the person can read a higher (larger) line, their vision may be 6/12 or 6/18, or worse (6/12 means that the person can read a line of letters at 6 metres that a person with normal vision can read at 12 metres). (BUPA,www.cyh.com[online],2011)

What eye tests look for:
Short-sightedness is a very common eye condition that causes distant objects to appear blurred, while close objects can be seen clearly. Myopia is the medical term for short-sightedness. Short-sightedness is a refractive eye condition. Refractive eye conditions are caused when problems with the structure of the eye affects how light rays enter your eye.

A positive result would show the person being screened being unable to read all of the letters on the Snellen chart clearly, and thus having some form of Myopia.

A negative result would mean that the person being screened had perfect or near perfect vision, being able to read all of the letters or numbers on the Snellen chart. (NHS Choices,www.nhs.uk,2011)


Long sightedness

It is important that your child has regular eye examinations as they grow up. Routine vision tests are given at birth, aged three and before your child starts school, but you can go to an optician at any time for an eye test if you are concerned about your child’s sight. Eye tests for children are free up to the age of 16.
Most eye conditions can be successfully corrected, but if left untreated they could cause more serious complications and affect your child's vision permanently.
It is also important that adults visit their optician regularly. The College of Optometrists recommends at least every two years. Regular eye check-ups will identify conditions such as long-sightedness early on so that corrective treatment can be given. (NHS Choices,www.nhs.uk[online],2010)

The inside of your eye is examined using an opthalmoscope, a torch that shines light through your pupil. This also tests your pupil reflexes (whether your pupils shrink in response to light). Eye movements and co-ordination are also checked to make sure that both of your eyes are working together. Other tests may be carried out depending on your age and medical history. Eye conditions that your optician will be looking for include glaucoma (pressure changes in the eye, which can damage the optic nerve) and diabetic retinopathy (where high blood pressure and high blood sugar levels cause new blood vessels to be produced in the eye, which can obscure vision).
Your optometrist will usually assess your distance vision, your near vision (for reading and close work) and your intermediate vision (for using a computer). You will be probably asked to read from a "Snellen chart", which is a series of letters that become progressively smaller on each line. (NHS Choices,www.nhs.uk[online],2010)

What eye tests look for:
Long-sightedness, or far-sightedness, is a sight problem that affects your ability to see close-up objects. People who are long-sighted can usually see distant objects clearly, but nearby objects appear blurred. The medical name for long-sightedness is hyperopia. Some children are born with long-sightedness, although this normally corrects itself as they grow older and their eyes develop. (NHS Choices,www.nhs.uk[online],2010)

A positive result for a long-sightedness, or Hyperopia test would show the person being tested being able to see things far away, but not as well close up, for example on the Snellen chart, they would be able to read the smallest letters, but not necessarily the larger letters. The patient would therefore need have further treatment to help them see better, usually through glasses, contacts or occasionally surgery.

A negative result for a long-sightedness test would show the person being able to read all the letters from the Snellen chart, therefore having normal vision, and responding well to other tests carried out by the optician and therefore not needing further treatment.


Astigmatism

This test can be done as part of a routine eye exam. The purpose is to determine whether you have a refractive error (a need for glasses or contact lenses).
For people over age 40 who have normal distance vision but difficulty with near vision, a refraction test can determine the right power of reading glasses. Astigmatism is easily diagnosed by a standard eye exam with refraction test. Special tests are not usually required. Children or others who cannot respond to a normal refraction test can have their refraction measured by a test that uses reflected light (retinoscopy). (A.D.A.M. Medical Encyclopedia,www.ncbi.nlm.nih.gov[online],2010)

This test is performed by an ophthalmologist or optometrist. You sit in a chair that has a special device (called a phoroptor or refractor) attached to it. You look through the device and focus on an eye chart 20 feet away. The device contains lenses of different strengths that can be moved into your view. The test is performed one eye at a time. The eye doctor performing the test will ask if the chart appears more or less clear when different lenses are in place. (A.D.A.M. Medical Encyclopedia,www.ncbi.nlm.nih.gov[online],2010)

Description of how the test is carried out (procedure) and the scientific basis of the test (what is being looked for)

What eye tests look for:
Astigmatism is a minor condition of the eye that causes blurred vision. It occurs when the cornea is not a perfectly curved shape. Most people who wear glasses have astigmatism. (NHS Choices,www.nhs.uk[online],2011)

A positive result would mean that the refractive error as more than zero, and you have a refractive error if you need a combination of lenses to see 20/20.

A negative result would show the refractive error as zero (plano) and your vision should be 20/20. A value of 20/20 is perfect vision, meaning you are able to read 3/8-inch letters at 20 feet. A small type size is also used to determine normal near vision. (A.D.A.M. Medical Encyclopedia,www.ncbi.nlm.nih.gov[online],2010)