The following checklist is submitted
for your consideration, following requests for advice on
appropriate pathology tests from many doctors over the years.
This list is neither exhaustive nor
authoritative, and should only be regarded as a prompt to assist
the busy practitioner. 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. Medicare restrictions apply to
those tests marked with a *.
You may also refer to the Complete Clinical Problem Listing from
The Royal College of Pathologists of Australasia manual for
guidance in clinical scenarios.
| Acute inflammation |
|
| - First stage test |
FBE, ESR, CRP |
| - Second stage test |
UMC, EUC, LFT |
|
| Alopecia |
|
| - First stage test |
TFT, iron studies, ANF, ESR |
| - Second stage test |
Fungal microscopy and culture on skin scraping/plucked hairs |
| - More specialised tests |
Skin biopsy for histology |
|
| Amenorrhoea |
|
| - First stage test |
B-HCG, FSH, LH |
| - Second stage test |
TFT, oestradiol, prolactin
|
|
| Ante-natal screen (26-28 weeks) |
|
| - First stage test |
Blood group, antibody screen, GTT (check for gestational diabetes), rubella IgG serology, FBE, hepatitis serology, syphilis serology |
|
| Ante-natal screen (30-36 weeks) |
|
| - First stage test |
FBE, vaginal group B streptococci screen |
|
| Ante-natal screen (before 20 weeks) |
|
| - First stage test |
Blood group, antibody screen, GTT (check for gestational diabetes), rubella IgG serology, FBE, hepatitis serology, syphilis serology, HIV, UMC, PAP |
| - More specialised tests |
Triple test (14 -20 weeks) |
|
| Anti-coagulant therapy (initial monitoring of warfarin therapy) |
|
| - First stage test |
INR |
|
| Arthritis |
|
| - First stage test |
UA, RF, ANF, ENA, ESR, CRP
|
| - Second stage test |
HLA B27, complement, faeces culture, Hep C, arbovirus (Ross River virus, Barmah Forest virus) |
| - More specialised tests |
Bordetella pertussis, influenza serology, influenza A+B parainfluenza, respiratory syncytial virus, Q fever, TB, iron studies. |
|
| Atypical pneumonia / chronic cough |
|
| - First stage test |
Sputum culture (including TB), legionella, mycoplasma, chlamydia PCR
|
| - Second stage test |
Bordetella pertussis (PCR/Serology), influenza serology, respiratory syncytial virus, Q fever
|
| - More specialised tests |
TB |
|
| Bleeding tendency |
|
| - First stage test |
FBE, INR/APTT/fibrinogen, LFT
|
| - Second stage test |
Von Willebrand’s factor screen |
| - More specialised tests |
Platelet aggregation, platelet function analysis |
|
| Chest pain |
|
| - First stage test |
Troponin, CK |
|
| Dementia |
|
| - First stage test |
FBE, ESR, EUC, TFT
|
| - Second stage test |
B12, red cell folate, syphilis serology, blood lead |
|
| Depression |
|
| - First stage test |
FBE, fasting glucose, TFT
|
| - Second stage test |
Cortisol (am), urine drug screen |
|
| Diabetes monitoring |
|
| - First stage test |
HbA1c, urinary microalbumin, lipids, EUC |
|
| Diarrhoea |
|
| - First stage test |
Faeces culture |
| - Second stage test |
Faecal reducing substances, Clostridium difficile toxin, rotavirus |
| - More specialised tests |
Vasoactive intestinal polypeptide, urinary 5-HIAA, bowel biopsy |
|
| Erectile dysfunction |
|
| - First stage test |
Testosterone, LH, LFT |
| - Second stage test |
Fasting glucose, iron studies, lipids |
|
| Fatigue / weakness |
|
| - First stage test |
FBE, TFT, EUC, LFT |
| - Second stage test |
Calcium, iron studies, EBV, arbovirus (Ross River virus, Barmah Forest virus) |
| - More specialised tests |
CK, ANF, acetylcholine receptor abs, short synacthen. |
|
| Gynaecomastia |
|
| - First stage test |
LFT, EUC, TFT
|
| - Second stage test |
Testosterone, LH, FSH
|
| - More specialised tests |
Urine drug screen, prolactin, cytology.
|
|
| Hepatomegaly +/- liver dysfunction |
|
| - First stage test |
FBE, LFT, hepatitis |
| - Second stage test |
Iron studies, EBV, CMV |
| - More specialised tests |
Fasting glucose, lipids, ANF, alpha-foetoprotein, CEA, malarial parasites, hydatid, Q fever
|
|
| Hirsutism |
|
| - First stage test |
Free testosterone, FSH, LH |
| - Second stage test |
Urinary cortisol, 17 OH progesterone |
|
| Hyperlipidaemia |
|
| - First stage test |
Lipids, fasting glucose |
| - Second stage test |
LFT, TFT, EUC |
| - More specialised tests |
CK |
|
| Hypertension |
|
| - First stage test |
UMC, fasting glucose, EUC
|
| - Second stage test |
24h urine catecholamine, TFT, 24h urinary cortisol
|
| - More specialised tests |
Aldosterone-renin ratio |
|
| Infertility – female |
|
| - First stage test |
Oestradiol, progesterone, LH, FSH |
| - Second stage test |
Prolactin, TFT, cortisol (am) |
| - More specialised tests |
Free testosterone, 17 OH progesterone, chromosome studies |
|
| Infertility – male |
|
| - First stage test |
Semen analysis |
| - Second stage test |
FSH, prolactin, fasting glucose, testosterone, LH
|
| - More specialised tests |
Iron studies, semen IBT, chromosome studies |
|
| Lymphadenopathy |
|
| - First stage test |
FBE, ESR, EBV, CMV, toxoplasma |
| - Second stage test |
Angiotensin converting enzyme, syphilis, HIV |
| - More specialised tests |
Chlamydia, cytology, tissue culture (routine and mycobacterial) |
|
| Malabsorption, failure to thrive |
|
| - First stage test |
FBE, UMC, faecal culture and reducing substances
|
| - Second stage test |
B12, LFT, HIV, iron studies |
| - More specialised tests |
Immunoglobulins, carotene, tissue transglutaminase, gliadin antibodies, small bowel biopsy giardia antigens |
|
| Obesity |
|
| - First stage test |
Fasting glucose, 24h urinary cortisol, TFT, lipids |
| - Second stage test |
Dexamethasone suppression test |
|
| Peripheral neuropathy |
|
| - First stage test |
B12, fasting glucose, EUC
|
| - Second stage test |
LFT, urine porphyrin, faecal porphyrin |
| - More specialised tests |
Heavy metals (lead, arsenic, thallium) |
|
| Pharyngitis |
|
| - First stage test |
Throat swab, FBE, IM
|
| - Second stage test |
EBV
|
| - More specialised tests |
Streptococcal serology |
|
| Polyuria |
|
| - First stage test |
Fasting glucose, EUC, UMC |
| - Second stage test |
Serum and urine osmolality |
|
| Pyrexia of unknown origin |
|
| - First stage test |
FBE, ESR, CRP, LFT, UMC |
| - Second stage test |
Blood cultures, angiotensin converting enzyme, malarial parasites, faeces culture |
| - More specialised tests |
Beta 2 microglobulin, CMV, EBV, brucella, Q fever, leptospirosis, toxoplasma, syphilis, HIV, dengue fever serology |
|
| Recurrent / persistent infections (immune deficiency) |
|
| - First stage test |
FBE, ESR, immunoglobulins, protein electrophoresis, HIV |
| - Second stage test |
Fasting glucose, complement C3/C4, cell markers |
|
| Recurrent miscarriage |
|
| - First stage test |
TFT, ANF, cardiolipin antibodies |
| - Second stage test |
Fasting glucose, chlamydia, lupus anticoagulant |
| - More specialised tests |
Culture for Listeria, chromosome studies |
|
| Renal impairment / failure |
|
| - First stage test |
UMC, EUC, UA, microalbumin, LFT, fasting glucose, PSA |
| - Second stage test |
24 hr creatinine clearance and protein |
| - More specialised tests |
ANF |
|
| Splenomegaly |
|
| - First stage test |
FBE, ESR, LFT, RF |
| - Second stage test |
Hepatitis, PAF, angiotensin converting enzyme, ANF, EBV, CMV, HIV |
| - More specialised tests |
Malarial parasites, mantoux test, eosin 5 maleimide, cell markers |
|
| Suspected illicit drug usage |
|
| - First stage test |
Urinary drug screen, LFT |
| - Second stage test |
Hepatitis, HIV |
|
| Thrombotic tendency / investigation of DVT |
|
| - First stage test |
FBE, INR/APTT/fibrinogen, protein C*, protein S*, antithrombin*, lupus, cardiolipin, factor V leiden* |
| - More specialised tests |
Homocysteine |
|
| Tumour markers |
|
| - First stage test |
CEA, CA125, CA19.9 |
| - Second stage test |
Alpha-foetoprotein, B-HCG, CA15.3 |
|
| Urethritis |
|
| - First stage test |
Urethral swab, UMC, chlamydia, gonorrhoea |
| - Second stage test |
Syphilis serology, HIV |
|
| Weight loss |
|
| - First stage test |
FBE, TFT, EUC |
| - Second stage test |
LFT, fasting glucose |
| - More specialised tests |
Short synacthen, CEA, CA125, CA19.9 |
|