Clinicians must make individual
decisions in consultation with their patients based on individual
clinical circumstances. Obviously, in individual and specific
circumstances, some tests mentioned will be irrelevant; equally,
other tests not on the list may be very appropriate. The tests are
organised into first-stage, second-stage and more specialised
tests, to encourage appropriate ordering strategies.
Alopecia |
|
- First stage test |
TFT, iron studies, antinuclear factor, ESR |
- Second stage test |
Testosterone, SHBG, Fungal microscopy and culture |
- More specialised tests |
Skin biopsy |
|
Amenorrhoea |
|
- First stage test |
Quantitative HCG, follicle stimulating hormone, luteinsing hormone, oestradiol, TFT, |
- Second stage test |
Prolactin, testosterone SHBG |
|
Ante-natal screen (before 20 weeks) |
|
- First stage test |
FBE, blood group & antibodies, Rubella, Syphilis, HIV, Hepatitis B & C serology, urine mcs, cervical cytology |
- More specialised tests |
First trimester and second trimester Downs screening tests |
|
Ante-natal screen (for 26 - 28 Weeks) |
|
- First stage test |
Blood group & antibodies, glucose tolerance test |
|
Ante-natal screen (for 30 - 36 Weeks) |
|
- First stage test |
FBE, group B Streptococcus screen |
|
Anti-coagulant therapy (initial monitoring of warfarin therapy) |
|
- First stage test |
INR |
|
Arthritis |
|
- First stage test |
Serum uric acid, rheumatoid factor, antinuclear factor, extractable nuclear antigen, ESR, C-reactive protein |
- Second stage test |
HLA B27, complement, faeces mcs, Ross River virus serology, Barmah Forest virus serology, Parvovirus B19 serology, Hepatitis B serology |
- More specialised tests |
Iron studies |
|
Atypical pneumonia / chronic cough |
|
- First stage test |
Sputum mcs, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & Chlamydophila pneumoniae. |
- Second stage test |
PCR/Serology for Bordetella pertussis, PCR/serology for influenza A & B & parainfluenza & respiratory syncytial virus, adenovirus PCR, Q Fever serology |
- More specialised tests |
Mantoux |
|
Bleeding tendency |
|
- First stage test |
FBE, INR, APTT, fibrinogen, LFT |
- Second stage test |
Platelet function analysis, coagulation factor studies, platelet aggregation |
|
Chest pain |
|
- First stage test |
Troponin, creatine kinase |
- Second stage test |
Repeat first stage tests, D dimer |
|
Dementia |
|
- First stage test |
FBE, ESR, U&E, TFT, TFT calcium, Vitamin B12 |
- Second stage test |
Red cell folate, Syphilis serology, blood lead |
|
Depression |
|
- First stage test |
FBE, fasting blood glucose, TFT, calcium, Vitamin B12 |
- Second stage test |
24 hour urinary cortisol, urine drug screen |
|
Diabetes monitoring |
|
- First stage test |
HBA1c, urine albumin, lipids, U&E |
- Second stage test |
Vitamin B12, TFTs |
|
Diarrhoea |
|
- First stage test |
Faeces mcs x2 (Due to HIC requirements only one culture and two microscopies can be performed in 7 days) |
- Second stage test |
Reducing substances, Clostridium difficile toxin, rotavirus, adenovirus |
- More specialised tests |
Vasoactive intestinal polypeptide, platelet serotonin, coeliac serology, bowel biopsy |
|
Erectile dysfunction |
|
- First stage test |
Testosterone, SHBG, luteinsing hormone, LFT, fasting glucose, lipids |
- Second stage test |
Iron studies, |
|
Fatigue / weakness |
|
- First stage test |
FBE, TFT, U&E, LFT, fasting glucose |
- Second stage test |
Serum calcium, iron studies, EBV serology, Ross River virus serology, Barmah Forest virus serology, CMV serology, Parvovirus B19 serology |
- More specialised tests |
Creatine kinase, antinuclear factor, acetylcholine receptor antibody, 8-9am cortisol |
|
Gynaecomastia |
|
- First stage test |
LFT, U&E, TFT, Oestradiol, Testosterone SHBG |
- Second stage test |
Luteinsing hormone, follicle stimulating hormone, prolactin |
- More specialised tests |
Urine drug screen (especially THC), fine needle aspiration |
|
Hepatomegaly +/- Liver Dysfunction |
|
- First stage test |
FBE, LFT, Hepatitis A, B & C screen |
- Second stage test |
Iron studies, CMV serology, EBV serology, fasting glucose |
- More specialised tests |
Fasting blood glucose, lipids, antinuclear factor, serum alpha-foetoprotein, carcinoembryonic antigen, Hydatid serology, Q Fever serology |
|
Hirsutism |
|
- First stage test |
Testosterone, free testosterone, follicle stimulating hormone, luteinsing hormone, DHEAS androstenedione |
- Second stage test |
24 hour urinary cortisol, 17 hydroxy progesterone |
|
Hyperlipidaemia |
|
- First stage test |
Lipids, HDL cholesterol, fasting blood glucose |
- Second stage test |
LFT, TFT, U&E |
|
Hypertension |
|
- First stage test |
Urine mcs, fasting blood glucose, U&E |
- Second stage test |
TFT, urine catecholamines, urine cortisol, renin, aldosterone |
|
Infertility – female |
|
- First stage test |
Oestradiol, progesterone, follicle stimulating hormone, luteinsing hormone |
- Second stage test |
Prolactin, TFT, 8 - 9am cortisol |
- More specialised tests |
Testosterone, free testosterone, 17 hydroxy progesterone, chromosome studies (blood) |
|
Infertility – male |
|
- First stage test |
Semen analysis |
- Second stage test |
Testosterone, follicle stimulating hormone, luteinsing hormone, fasting blood glucose, prolactin, TFTs |
- More specialised tests |
Chromosome studies (blood), iron studies, sperm antibodies, testicular biopsy |
|
Inflammation |
|
- First stage test |
FBE, ESR, C-reactive protein |
- Second stage test |
Urine mcs, U&E, LFT |
|
Lymphadenopathy |
|
- First stage test |
FBE, ESR, EBV serology, CMV serology, Toxoplasma serology |
- Second stage test |
Angiotensin converting enzyme, Syphilis serology, HIV serology, TFTs |
- More specialised tests |
Fine needle aspiration +/- flow cytometry, culture
including atypical mycobacteria, PCR for Bartonella henselae |
|
Malabsorption, failure to thrive |
|
- First stage test |
FBE, urine mcs, reducing substances, faeces mcs (including fat globules) |
- Second stage test |
Vitamin B12, folate, LFT, HIV serology, iron studies |
- More specialised tests |
Immunoglobulin A & G & M, serum carotene, GAD antibodies, endomysial antibody, small bowel biopsy |
|
Obesity |
|
- First stage test |
Fasting blood glucose, TFT, 24 hour urinary cortisol |
- Second stage test |
Lipids |
- More specialised tests |
Dexamethasone suppression test |
|
Peripheral neuropathy |
|
- First stage test |
Vitamin B12, fasting blood glucose, U&E |
- Second stage test |
LFT, porphyrin screen (urine or faeces), ) Vitamin B6, Serum protein electrophoresis, urine Bence Jones protein |
- More specialised tests |
Heavy metals (lead, arsenic, thallium) |
|
Pharyngitis |
|
- First stage test |
Throat swab for MC&S, resp virus PCR, FBE, monospot |
- Second stage test |
EBV serology |
|
Polyuria |
|
- First stage test |
Fasting blood glucose, U&E, urine mcs, serum calcium |
- Second stage test |
Osmolality (serum and urine, collect early morning urine) |
- More specialised tests |
Water deprivation test |
|
Pyrexia of Unknown Origin |
|
- First stage test |
Blood cultures, FBE, ESR, C-reactive protein, LFT, urine mcs, Malarial parasites & Dengue Fever serology (if relevant travel) |
- Second stage test |
Angiotensin converting enzyme, faeces mcs |
- More specialised tests |
CMV serology, EBV serology, Brucella serology, Q Fever serology, Toxoplasma serology, Syphilis serology, HIV serology, Leprospirosis serology, Beta 2 microglobulin, Rickettsial serology |
|
Recurrent / persistent infections (immune deficiency) |
|
- First stage test |
FBE, ESR, immunoglobulin A & G & M, protein EPG, HIV serology, fasting glucose |
- Second stage test |
Complement, lymphocyte surface markers (blood) |
|
Recurrent miscarriage |
|
- First stage test |
Testosterone, SHBG, TFT, antinuclear factor, anti-cardiolipin antibodies |
- Second stage test |
Fasting blood glucose, Chlamydia PCR, lupus anti-coagulant |
- More specialised tests |
Chromosome studies (blood), culture for Listeria |
|
Renal impairment / failure |
|
- First stage test |
Urine mcs, urine albumin, U&E, LFT, fasting blood glucose, prostatic specific antigen, serum uric acid |
- Second stage test |
Creatinine clearance, urine protein |
- More specialised tests |
Antinuclear factor |
|
Splenomegaly |
|
- First stage test |
FBE, ESR, LFT, rhematoid factor |
- Second stage test |
Hepatitis B & C serology, INR, APTT, fibrinogen, angiotensin converting enzyme, antinuclear factor, EBV serology, CMV serology, HIV serology |
- More specialised tests |
Malarial parasites, Mantoux test, flow cytometry (blood), osmotic fragility |
|
Suspected illicit drug usage |
|
- First stage test |
Urine drug screen, LFT |
- Second stage test |
Hepatitis B & C serology, HIV serology |
|
Thrombotic tendency / investigation of DVT |
|
- First stage test |
FBE, INR, APTT, fibrinogen, lupus anti-coagulant, anti-cardiolipin antibodies, prothrombin gene mutation, protein C and S, anti-thrombin III |
|
Tumour markers |
|
- First stage test |
Carcinoembryonic antigen, CA 125, CA 19-9 |
- Second stage test |
Serum alpha-foetoprotein, HCG (tumour marker), CA 15.3 |
- More specialised tests |
BRCA2 (breast cancer gene) |
|
Urethritis |
|
- First stage test |
First void urine, PCR for Chamydia and Gonorrhoeae; MSU for MC&S |
- Second stage test |
Syphilis serology, HIV serology |
|
Weight Loss |
|
- First stage test |
FBE, TFT, U&E, fasting glucose |
- Second stage test |
LFT, CRP, 8-9am cortisol |
- More specialised tests |
Short synacthen stimulation test, carcinoembryonic antigen, CA 125, CA 19-9 |
|