Test Advice
The following list is intended as a prompt to assist the busy clinician or healthcare professional. It is neither exhaustive nor authoritative. In individual and specific circumstances, some tests mentioned will be irrelevant; equally, other tests not on the list may not always be appropriate.
The tests are organised into first-stage, second-stage and more specialised tests, to encourage appropriate ordering strategies.
Furthermore, it is a support document that underpins Hobart, Launceston and North West Pathologies eOrdering application which is available in Best Practice and Medical Director.
You may also refer to the Complete Clinical Problem Listing from The Royal College of Pathologists of Australasia manual for guidance in clinical scenarios.
| Clinical condition or context | First stage test(s) | Second stage test(s) | More specialised test(s) |
|---|---|---|---|
| Acute inflammation | FBC, ESR, C-reactive protein | Urine M/C/S, U&E, LFT | |
| Alopecia | TFT, iron studies, antinuclear factor, ESR | Fungal microscopy and culture | Skin biopsy |
| Amenorrhoea | Quantitative HCG, follicle stimulating hormone, luteinsing hormone | TFT, oestradiol, prolactin | |
| Antenatal screen (before 20 weeks) | FBC, blood group & antibodies, rubella, syphilis, HIV, hepatitis B & C serology, urine M/C/S, cervical cytology | Maternal serum antenatal screening programme (triple test) | |
| Antenatal screen (for 26 - 28 Weeks) | Blood group & antibodies, glucose tolerance test | ||
| Antenatal screen (for 30 - 36 Weeks) | FBC, group B Streptococcus screen | ||
| Anti-coagulant therapy (initial monitoring of warfarin therapy) | INR | ||
| Arthritis | Serum uric acid, rheumatoid factor, antinuclear factor, extractable nuclear antigen, ESR, C-reactive protein | HLA B27, complement, faeces M/C/S, Ross River virus serology, Barmah Forest virus serology, hepatitis C serology | PCR/serology for Bordetella pertussis, PCR/serology for influenza A & B & parainfluenza & respiratory syncytial virus, adenovirus PCR, Q fever serology, Mycobacterium tuberculosis culture, iron studies |
| Atypical pneumonia/chronic cough | Sputum M/C/S, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & Chlamydophila | PCR/Serology for Bordetella pertussis, respiratory viral serology, Q fever serology | |
| Bleeding tendency | FBC, INR, APTT, fibrinogen, LFT | Coagulation factor studies, platelet aggregation | |
| Chest pain | Troponin, creatine kinase | Repeat first stage tests | |
| Dementia | FBC, ESR, U&E, TFT | Vitamin B12, red cell folate, Syphilis serology, blood lead | |
| Depression | FBC, fasting blood glucose, TFT | Serum cortisol, urine drug screen | |
| Diabetes monitoring | HBA1c, urine albumin, lipids, U&E | ||
| Diarrhoea | Faeces M/C/S | Reducing substances, Clostridium difficile toxin, rotavirus, adenovirus | Vasoactive intestinal polypeptide, urine hydroxy indole acetic acid, bowel biopsy |
| Erectile dysfunction | Testosterone, luteinsing hormone, LFT | Fasting blood glucose, iron studies, lipids | |
| Fatigue/weakness | FBC, TFT, U&E, LFT | Serum calcium, iron studies, EBV serology, Ross River virus serology, Barmah Forest virus serology | Creatine kinase, antinuclear factor, acetylcholine receptor antibody, short synacthen stimulation test |
| Gynaecomastia | LFT, U&E, TFT | Testosterone, luteinsing hormone, follicle stimulating hormone | Urine drug screen (especially THC), prolactin, fine needle aspiration |
| Hepatomegaly +/- Liver dysfunction | FBC, LFT, hepatitis A, B & C screen | Iron studies, CMV serology, EBV serology | Fasting blood glucose, lipids, antinuclear factor, serum alpha-foetoprotein, carcinoembryonic antigen, malarial parasites, hydatid serology, Q fever serology |
| Hirsutism | Testosterone, free testosterone, follicle stimulating hormone, luteinsing hormone | Urine cortisol, 17 hydroxy progesterone | |
| Hyperlipidaemia | Lipids, HDL cholesterol, fasting blood glucose | LFT, TFT, U&E | |
| Hypertension | Urine M/C/S, fasting blood glucose, U&E | TFT, urine catecholamines, urine cortisol | Aldosterone/renin |
| Infertility – female | Oestradiol, progesterone, follicle stimulating hormone, luteinsing hormone | Prolactin, TFT, serum cortisol | Testosterone, free testosterone, 17 hydroxy progesterone, chromosome studies (blood) |
| Infertility – male | Semen analysis | Testosterone, follicle stimulating hormone, luteinsing hormone, fasting blood glucose, prolactin | Chromosome studies (blood), iron studies, sperm antibodies, testicular biopsy |
| Lymphadenopathy | FBC, ESR, EBV serology, CMV serology, Toxoplasma serology | Angiotensin converting enzyme, Syphilis serology, HIV serology | Fine needle aspiration +/- flow cytometry, tissue culture |
| Malabsorption, failure to thrive | FBC, urine M/C/S, reducing substances, faeces M/C/S (including fat globules) | Vitamin B12, LFT, HIV serology, iron studies | Immunoglobulin A & G & M, serum carotene, GAD antibodies, endomysial antibody, small bowel biopsy |
| Obesity | Fasting blood glucose, TFT, urine cortisol | Lipids | Dexamethasone suppression test |
| Peripheral neuropathy | Vitamin B12, fasting blood glucose, U&E | LFT, porphyrin screen (urine or faeces) | Heavy metals (lead, arsenic, thallium) |
| Pharyngitis | Throat swab, FBC, monospot | EBV serology | Streptococcal serology |
| Polyuria | Fasting blood glucose, U&E, urine M/C/S | Osmolality (serum and urine) | Water deprivation test |
| Pyrexia of unknown origin | FBC, ESR, C-reactive protein, LFT, urine M/C/S | Blood cultures, angiotensin converting enzyme, malarial parasites, faeces M/C/S | CMV serology, EBV serology, Brucella serology, Q fever serology, Toxoplasma serology, syphilis serology, Dengue fever serology, HIV serology, Leprospirosis serology, Beta 2 microglobulin |
| Recurrent/persistent infections (immune deficiency) | FBC, ESR, immunoglobulin A & G & M, protein EPG, HIV serology | Fasting blood glucose, complement, lymphocyte surface markers (blood) | |
| Renal impairment/failure | Urine M/C/S, urine albumin, U&E, LFT, fasting blood glucose, prostatic specific antigen, serum uric acid | Creatinine clearance, urine protein | Antinuclear factor |
| Splenomegaly | FBC, ESR, LFT, rheumatoid factor | Hepatitis B & C serology, INR, APTT, fibrinogen, angiotensin converting enzyme, antinuclear factor, EBV serology, CMV serology, HIV serology | Malarial parasites, Mantoux test, flow cytometry (blood), osmotic fragility |
| Suspected illicit drug usage | Urine drug screen, LFT | Hepatitis B & C serology, HIV serology | |
| Thrombotic tendency/investigation of DVT | FBC, INR, APTT, fibrinogen, lupus anti-coagulant, anti-cardiolipin antibodies, prothrombin gene mutation, protein C and S, anti-thrombin III | ||
| Tumour markers | Carcinoembryonic antigen, CA 125, CA 19-9 | Serum alpha-foetoprotein, HCG (tumour marker), CA 15.3 | BRCA2 (breast cancer gene) |
| Urethritis | Urethral swab, PCR for Chamydia and gonorrhoea | Syphilis serology, HIV serology, Herpes simplex PCR | |
| Weight loss | FBC, TFT, U&E | LFT, fasting blood glucose | Short synacthen stimulation test, carcinoembryonic antigen, CA 125, CA 19-9 |