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 (Before 20 weeks)
- First stage test FBE, Blood Group, Antibody screen, Rubella, Syphilis, Hepatitis B & C Serology, HIV, UMC, PAP
- More specialised tests Triple Test (14-20 weeks)
Ante-natal screen (For 26 - 28 Weeks)
- First stage test FBE, Blood Group, Antibody screen, Rubella, Syphilis, Hepatitis B & C, GTT (check for gestational diabetes)
Ante-natal screen (For 30 - 36 Weeks)
- First stage test FBE, vaginal group B streptococci screen
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 Mycobacterium tuberculosis (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 microscopy and culture
- Second stage test 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 (acute or chronic)
- 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, Monospot
- Second stage test EBV Serology
- 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, toxaplasma, 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, chalmydia, lupus anticoagulant
- More specialised tests Serology for listeriosis, 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 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, 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