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.

 

 

Acute inflammation
- First stage test FBE, ESR, C-reactive protein
- Second stage test Urine mcs, U&E, LFT
Alopecia
- First stage test TFT, iron studies, antinuclear factor
- Second stage test Fungal microscopy and culture
- More specialised tests Skin biopsy
Amenorrhoea
- First stage test Quantitative HCG, follicle stimulating hormone, luteinsing hormone
- Second stage test TFT, oestradiol, prolactin
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 Maternal serum antenatal screening programme (triple test)
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, Hepatitis C serology
- More specialised tests 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
- First stage test Sputum mcs, Mycobacterium tuberculosis culture, Legionella serology and culture, serology for Mycoplasma & Chlamydia
- Second stage test PCR/Serology for Bortetella 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
Dementia
- First stage test FBE, ESR, U&E, TFT
- Second stage test Vitamin B12, red cell folate, Syphilis serology, blood lead
Depression
- First stage test FBE, fasting blood glucose, TFT
- Second stage test Serum cortisol, urine drug screen
Diabetes monitoring
- First stage test HBA1c, urine albumin, lipids, U&E
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, urine hydroxy indole acetic acid, bowel biopsy
Erectile dysfunction
- First stage test Testosterone, luteinsing hormone, LFT
- Second stage test Fasting blood glucose, iron studies, lipids
Fatigue / weakness
- First stage test FBE, TFT, U&E, LFT
- Second stage test Serum calcium, iron studies, EBV serology, Ross River virus serology, Barmah Forest virus serology
- More specialised tests Creatine kinase, antinuclear factor, acetylcholine receptor antibody, short synacthen stimulation test
Gynaecomastia
- First stage test LFT, U&E, TFT
- Second stage test Testosterone, luteinsing hormone, follicle stimulating hormone
- More specialised tests Urine drug screen (especially THC), prolactin, 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
- More specialised tests Fasting blood glucose, lipids, antinuclear factor, serum alpha-foetoprotein, carcinoembryonic antigen, Malarial parasites, Hydatid serology, Q Fever serology
Hirsutism
- First stage test Testosterone, free testosterone, follicle stimulating hormone, luteinsing hormone
- Second stage test Urine 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
- More specialised tests Aldosterone/renin
Infertility – female
- First stage test Oestradiol, progesterone, follicle stimulating hormone, luteinsing hormone
- Second stage test Prolactin, TFT, serum 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
- More specialised tests Chromosome studies (blood), iron studies, sperm antibodies, testicular biopsy
Lymphadenopathy
- First stage test FBE, EBV serology, CMV serology, Toxoplasma serology
- Second stage test Angiotensin converting enzyme, Syphilis serology, HIV serology
- More specialised tests Chlamydia serology, fine needle aspiration +/- flow cytometry, tissue culture
Malabsorption, failure to thrive
- First stage test FBE, urine mcs, reducing substances, faeces mcs (including fat globules)
- Second stage test Vitamin B12, 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, urine 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)
- More specialised tests Heavy metals (lead, arsenic, thallium)
Pharyngitis
- First stage test Throat swab, FBE, monospot
- Second stage test EBV serology
- More specialised tests Streptococcal serology
Polyuria
- First stage test Fasting blood glucose, U&E, urine mcs
- Second stage test Osmolality (serum and urine)
- More specialised tests Water deprivation test
Pyrexia of Unknown Origin
- First stage test FBE, ESR, C-reactive protein, LFT, urine mcs
- Second stage test Blood cultures, angiotensin converting enzyme, Malarial parasites, faeces mcs
- More specialised tests 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)
- First stage test FBE, immunoglobulin A & G & M, protein EPG, HIV serology
- Second stage test Fasting blood glucose, complement, lymphocyte surface markers (blood)
Recurrent miscarriage
- First stage test 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 Urethral swab, PCR for Chamydia and Gonorrhoeae
- Second stage test Syphilis serology, HIV serology
Weight Loss
- First stage test FBE, TFT, U&E
- Second stage test LFT, fasting blood glucose
- More specialised tests Short synacthen stimulation test, carcinoembryonic antigen, CA 125, CA 19-9