| Clinical Condition or Context | First stage test(s) | Second stage test(s) | More specialised test(s) |
|---|---|---|---|
| Acute inflammation | FBC, ESR, C-reactive protein | Urine mcs, 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 | |
| Ante-natal screen (before 20 weeks) | FBC, blood group & antibodies, Rubella, Syphilis, HIV, Hepatitis B & C serology, urine mcs, cervical cytology | Maternal serum antenatal screening programme (triple test) | |
| Ante-natal screen (for 26 - 28 Weeks) | Blood group & antibodies, glucose tolerance test | ||
| Ante-natal 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 mcs, 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 mcs, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & Chlamydophila | PCR/Serology for Bortetella pertussis, respiratory viral serology, Q Fever serology | |
| Bleeding tendency | FBC, INR, APTT, fibrinogen, LFT | Platelet function analysis, 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 mcs x2 (Due to HIC requirements only one culture and two microscopies can be performed in 7 days) | 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 mcs, 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 mcs, reducing substances, faeces mcs (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 mcs | Osmolality (serum and urine) | Water deprivation test |
| Pyrexia of Unknown Origin | FBC, ESR, C-reactive protein, LFT, urine mcs | Blood cultures, angiotensin converting enzyme, Malarial parasites, faeces mcs | 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 mcs, urine albumin, U&E, LFT, fasting blood glucose, prostatic specific antigen, serum uric acid | Creatinine clearance, urine protein | Antinuclear factor |
| Splenomegaly | FBC, ESR, LFT, rhematoid 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 |
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