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 DHM's 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 contextFirst stage test(s)Second stage test(s)More specialised test(s)
Acute inflammationFBC, ESR, C-reactive proteinUrine M/C/S, U&E, LFT 
AlopeciaTFT, iron studies, antinuclear factor, ESRFungal microscopy and cultureSkin biopsy
AmenorrhoeaQuantitative HCG, follicle stimulating hormone, luteinsing hormoneTFT, 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  
ArthritisSerum uric acid, rheumatoid factor, antinuclear factor, extractable nuclear antigen, ESR, C-reactive proteinHLA B27, complement, faeces M/C/S, Ross River virus serology, Barmah Forest virus serology, hepatitis C serologyPCR/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 coughSputum M/C/S, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & ChlamydophilaPCR/Serology for Bordetella pertussis, respiratory viral serology, Q fever serology 
Bleeding tendencyFBC, INR, APTT, fibrinogen, LFTPlatelet function analysis, coagulation factor studies, platelet aggregation 
Chest painTroponin, creatine kinaseRepeat first stage tests 
DementiaFBC, ESR, U&E, TFTVitamin B12, red cell folate, Syphilis serology, blood lead 
DepressionFBC, fasting blood glucose, TFTSerum cortisol, urine drug screen 
Diabetes monitoringHBA1c, urine albumin, lipids, U&E  
DiarrhoeaFaeces M/C/S Reducing substances, Clostridium difficile toxin, rotavirus, adenovirusVasoactive intestinal polypeptide, urine hydroxy indole acetic acid, bowel biopsy
Erectile dysfunctionTestosterone, luteinsing hormone, LFTFasting blood glucose, iron studies, lipids 
Fatigue/weaknessFBC, TFT, U&E, LFTSerum calcium, iron studies, EBV serology, Ross River virus serology, Barmah Forest virus serologyCreatine kinase, antinuclear factor, acetylcholine receptor antibody, short synacthen stimulation test
GynaecomastiaLFT, U&E, TFTTestosterone, luteinsing hormone, follicle stimulating hormoneUrine drug screen (especially THC), prolactin, fine needle aspiration
Hepatomegaly +/- Liver dysfunctionFBC, LFT, hepatitis A, B & C screenIron studies, CMV serology, EBV serologyFasting blood glucose, lipids, antinuclear factor, serum alpha-foetoprotein, carcinoembryonic antigen, malarial parasites, hydatid serology, Q fever serology
HirsutismTestosterone, free testosterone, follicle stimulating hormone, luteinsing hormoneUrine cortisol, 17 hydroxy progesterone 
HyperlipidaemiaLipids, HDL cholesterol, fasting blood glucoseLFT, TFT, U&E 
HypertensionUrine M/C/S, fasting blood glucose, U&ETFT, urine catecholamines, urine cortisolAldosterone/renin
Infertility – femaleOestradiol, progesterone, follicle stimulating hormone, luteinsing hormoneProlactin, TFT, serum cortisolTestosterone, free testosterone, 17 hydroxy progesterone, chromosome studies (blood)
Infertility – maleSemen analysisTestosterone, follicle stimulating hormone, luteinsing hormone, fasting blood glucose, prolactinChromosome studies (blood), iron studies, sperm antibodies, testicular biopsy
LymphadenopathyFBC, ESR, EBV serology, CMV serology, Toxoplasma serologyAngiotensin converting enzyme, Syphilis serology, HIV serologyFine needle aspiration +/- flow cytometry, tissue culture
Malabsorption, failure to thriveFBC, urine M/C/S, reducing substances, faeces M/C/S (including fat globules)Vitamin B12, LFT, HIV serology, iron studiesImmunoglobulin A & G & M, serum carotene, GAD antibodies, endomysial antibody, small bowel biopsy
ObesityFasting blood glucose, TFT, urine cortisolLipidsDexamethasone suppression test
Peripheral neuropathyVitamin B12, fasting blood glucose, U&ELFT, porphyrin screen (urine or faeces)Heavy metals (lead, arsenic, thallium)
PharyngitisThroat swab, FBC, monospotEBV serologyStreptococcal serology
PolyuriaFasting blood glucose, U&E, urine M/C/SOsmolality (serum and urine)Water deprivation test
Pyrexia of unknown originFBC, ESR, C-reactive protein, LFT, urine M/C/SBlood cultures, angiotensin converting enzyme, malarial parasites, faeces M/C/SCMV 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 serologyFasting blood glucose, complement, lymphocyte surface markers (blood) 
Renal impairment/failureUrine M/C/S, urine albumin, U&E, LFT, fasting blood glucose, prostatic specific antigen, serum uric acidCreatinine clearance, urine proteinAntinuclear factor
SplenomegalyFBC, ESR, LFT, rheumatoid factorHepatitis B & C serology, INR, APTT, fibrinogen, angiotensin converting enzyme, antinuclear factor, EBV serology, CMV serology, HIV serologyMalarial parasites, Mantoux test, flow cytometry (blood), osmotic fragility
Suspected illicit drug usageUrine drug screen, LFTHepatitis B & C serology, HIV serology 
Thrombotic tendency/investigation of DVTFBC, INR, APTT, fibrinogen, lupus anti-coagulant, anti-cardiolipin antibodies, prothrombin gene mutation, protein C and S, anti-thrombin III  
Tumour markersCarcinoembryonic antigen, CA 125, CA 19-9Serum alpha-foetoprotein, HCG (tumour marker), CA 15.3BRCA2 (breast cancer gene)
UrethritisUrethral swab, PCR for Chamydia and gonorrhoeaSyphilis serology, HIV serology, Herpes simplex PCR 
Weight lossFBC, TFT, U&ELFT, fasting blood glucoseShort synacthen stimulation test, carcinoembryonic antigen, CA 125, CA 19-9