Investigations to order based on presentation

Question 1

Chest Pain

Answer 1

• Blood Tests:
  
  1. Complete blood count (CBC) - to assess for signs of infection, anemia, or abnormal white blood cell count.
  2. Cardiac enzymes (troponin, creatine kinase-MB) - to evaluate for myocardial damage or heart attack.
  3. Lipid profile - to assess cholesterol levels and evaluate for any lipid abnormalities.
  4. D-dimer - to rule out pulmonary embolism (a blood clot in the lungs).
  5. B-type natriuretic peptide (BNP) - to evaluate for heart failure.
• Bedside Testing:
  
  1. Electrocardiogram (ECG) - to assess for any abnormal heart rhythms, ischemic changes, or signs of a heart attack.
  2. Blood glucose level (BGL) - to check for diabetes or abnormal blood sugar levels.
  3. Blood pressure measurement - to assess for hypertension or hypotension.
• Imaging:
  
  1. Chest X-ray - to evaluate the heart, lungs, and surrounding structures for any abnormalities.
  2. Echocardiogram (e.g. TTE) - an ultrasound of the heart to assess its structure, function, and detect any abnormalities.
  3. Computed Tomography (CT) scan - to assess the chest, including the lungs, blood vessels, and surrounding structures for conditions such as pulmonary embolism or aortic dissection.
  4. Stress test - to evaluate the heart’s response to physical activity and assess for any abnormalities in blood flow.
  5. POCUS/US - assess possible pericarditis, cardiac tamponade, abdominal aortic aneurysm, DVT
• Other Specific Tests:
  
  1. Coronary angiography - an invasive procedure to visualize the coronary arteries and identify any blockages or narrowings.
  2. Esophagogastroduodenoscopy (EGD) - to assess the esophagus, stomach, and upper gastrointestinal tract for conditions like gastroesophageal reflux disease (GERD) or peptic ulcers.
  3. Pulmonary function tests - to assess lung function and rule out respiratory conditions that may cause chest pain.
  4. H. pylori testing - to check for Helicobacter pylori infection, a common cause of peptic ulcers.

Question 2

Fever

Answer 2

• Blood Tests:
  
  1. Complete blood count (CBC) - to assess for signs of infection, such as elevated white blood cell count or abnormal differentials.
  2. Blood cultures - to identify the presence of bacteria or other infectious agents in the bloodstream.
  3. C-reactive protein (CRP) - a marker of inflammation that can help determine the severity of infection.
  4. Erythrocyte sedimentation rate (ESR) - a non-specific marker of inflammation that can indicate the presence of an underlying condition.
• Bedside Testing:
  
  1. Temperature measurement - to document the presence and degree of fever.
  2. Oxygen saturation (pulse oximetry) - to assess the oxygen levels in the blood, especially in cases of suspected respiratory infection.
  3. Blood glucose level (BGL) - to check for diabetes or abnormal blood sugar levels.
• Imaging:
  
  1. Chest X-ray - to evaluate the lungs and rule out pneumonia or other respiratory infections.
  2. Abdominal ultrasound - to assess the abdominal organs for signs of infection or inflammation.
  3. CT scan - to obtain detailed images of specific body areas, such as the chest, abdomen, or head, to identify potential sources of infection.
  4. MRI - assess brain, spinal cord, bones, joints for possible sources of infection
• Other Specific Tests:
  
  1. Urine analysis and culture - to check for urinary tract infections.
  2. Stool culture - to identify gastrointestinal infections or assess for bacterial pathogens.
  3. Throat swab - to test for streptococcal pharyngitis (strep throat) or other throat infections.
  4. Viral serology - to detect specific viral infections, such as Epstein-Barr virus (EBV) or cytomegalovirus (CMV).
  5. Serologic tests - to assess for specific antibodies related to certain infections, such as Lyme disease or infectious mononucleosis.

Question 3

Cough

Answer 3

• Blood Tests:
  
  1. Complete blood count (CBC): It helps assess for signs of infection (elevated white blood cell count) or other underlying conditions.
  2. C-reactive protein (CRP): Elevated CRP levels may indicate inflammation or infection.
  3. Erythrocyte sedimentation rate (ESR): An elevated ESR may suggest inflammation or infection.
  4. Allergy testing: If an allergic cause is suspected, specific IgE blood tests can be conducted to identify allergens triggering the cough.
• Bedside Testing:
  
  1. Pulse oximetry: Measures oxygen saturation in the blood to assess respiratory function and rule out hypoxemia.
  2. Peak expiratory flow rate (PEFR): Assesses lung function and helps diagnose or monitor conditions like asthma.
  3. Blood glucose level (BGL): Checks for diabetes or abnormal blood sugar levels, which can contribute to respiratory symptoms.
• Imaging:
  
  1. Chest X-ray: Helps identify conditions such as pneumonia, bronchitis, lung masses, or other structural abnormalities.
  2. Chest computed tomography (CT) scan: Provides more detailed images of the chest to evaluate the lungs, airways, and surrounding structures.
  3. Sinus CT scan: If sinusitis is suspected as a cause of the cough, a sinus CT scan can be done to assess the sinuses.
• Other Specific Tests:
  
  1. Pulmonary function tests (PFTs): These tests assess lung function, including spirometry, lung volumes, and diffusion capacity. They help evaluate for conditions like asthma, chronic obstructive pulmonary disease (COPD), or restrictive lung diseases.
  2. Sputum culture and sensitivity: If the cough produces sputum, a sample can be collected and tested to identify the presence of bacteria, fungi, or other pathogens.
  3. Tuberculosis (TB) testing: If tuberculosis is suspected, tests such as a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) can be performed.
  4. Bronchoscopy: In certain cases, a bronchoscopy may be necessary to visualize the airways, collect samples for analysis, or perform a biopsy if there are concerns about an underlying lung pathology.

Question 4

Joint pain

Answer 4

• Blood Tests:
  
  1. Complete blood count (CBC): Can identify signs of inflammation or infection.
  2. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Elevated levels suggest inflammation.
  3. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies: Can help diagnose rheumatoid arthritis.
  4. Antinuclear antibody (ANA) test: Useful in evaluating for autoimmune conditions, such as systemic lupus erythematosus (SLE).
  5. Uric acid level: Elevated levels may indicate gout.
• Imaging:
  
  1. X-rays: Can detect joint abnormalities, such as fractures, arthritis, or joint space narrowing.
  2. Magnetic resonance imaging (MRI): Provides detailed images of the joints, helpful in assessing soft tissue and detecting conditions like ligament tears, cartilage damage, or synovitis.
  3. Ultrasound: May be used to visualize joint structures, assess for inflammation or fluid accumulation, or guide joint aspirations.
• Joint Fluid Analysis:
  
  1. Joint aspiration and synovial fluid analysis: Involves extracting fluid from the affected joint and analyzing it for signs of infection, crystals (as seen in gout or pseudogout), or inflammatory markers.
• Other Specific Tests:
  
  1. HLA-B27 gene test: Can be ordered if ankylosing spondylitis is suspected.
  2. Lyme disease serology: Performed if there is a history of tick exposure and suspicion of Lyme disease.
  3. Hepatitis B and C tests: Considered if viral arthritis is suspected.
  4. STI testing: if gonococcal arthritis is indicated