BioMG in English
Choose a clinical situation: BioMG lists the laboratory tests to order, why each one is ordered and what not to order, with the sources. The content is translated from the French edition, which prevails.
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Cardiovascular
- Acute chest pain seen in the practice
- Acute coronary syndrome / myocardial infarction (follow-up)
- Acute pericarditis managed in the community
- Atrial fibrillation
- Bradycardia or atrioventricular block found
- Deep vein thrombosis / pulmonary embolism
- Fever in a patient with valve disease or a prosthetic valve: suspected endocarditis
- Heart failure
- Hypertension
- Orthostatic hypotension and postural tachycardia (POTS)
- Palpitations
- Peripheral arterial disease
- Retinal vein occlusion: general work-up (and what not to order)
- Stable angina
- Starting or changing the dose of an ACE inhibitor/ARB
- Treatment: amiodarone
- Treatment: antiarrhythmics (flecainide, propafenone, sotalol, digoxin, dronedarone)
- Treatment: antiplatelet agent
- Treatment: direct oral anticoagulant (apixaban, rivaroxaban, dabigatran, edoxaban)
- Treatment: diuretics (thiazides, loop diuretics, mineralocorticoid receptor antagonists and potassium-sparing diuretics)
- Treatment: LMWH (low-molecular-weight heparin)
- Treatment: vitamin K antagonist (VKA)
- Vasovagal faint (typical vasovagal syncope)
Dermatology
- Acanthosis nigricans
- Acute febrile rash (exanthem): when are tests needed? Measles, Kawasaki disease, drug eruption, primary HIV infection
- Alopecia, hair loss
- Boils and furunculosis (recurrent staphylococcal skin infections)
- Chronic urticaria (more than 6 weeks)
- Drug eruption: severity signs and tests
- Erythema nodosum (looking for a cause)
- Hidradenitis suppurativa: comorbidities to screen for
- Itch without skin lesion (pruritus sine materia)
- Leg ulcer (comorbidities, nutritional status)
- Leukonychia (white nails, white spots on the nails)
- Lichen planus (skin, oral or genital): hepatitis C and lipid profile
- Mycological sampling: onychomycosis, tinea
- Psoriasis (cardiovascular risk, tests before systemic treatment)
- Recurrent mouth ulcers (oral aphthosis): tests
- Treatment: acitretin (and alitretinoin)
- Treatment: dapsone (Disulone)
- Treatment: isotretinoin
- Treatment: terbinafine
- Vitiligo: screen for autoimmune thyroid disease
Endocrinology and metabolism
- Acromegaly (suspected) and follow-up of known acromegaly
- Adrenal incidentaloma (adrenal mass found on imaging)
- Asymptomatic hyperuricaemia (raised serum urate without gout)
- Chronic adrenal insufficiency (suspected, stopping long-term corticosteroids)
- Diabetes: hyperglycaemia found (confirm, classify, spot the emergency)
- Dyslipidaemia
- Episodes suggesting hypoglycaemia in a non-diabetic adult
- Gender incongruence: tests before and during hormone treatment (adult)
- Gynaecomastia (adolescent, adult)
- Hypercalcaemia
- Hyperprolactinaemia (raised prolactin, galactorrhoea)
- Hyperthyroidism
- Hypertriglyceridaemia (raised triglycerides)
- Hypocalcaemia (low serum calcium found)
- Hypomagnesaemia (low serum magnesium: PPIs, diuretics, alcohol, diarrhoea)
- Hypothyroidism
- Obesity
- Pituitary adenoma or incidentaloma, anterior pituitary insufficiency (suspected)
- Polyuria-polydipsia syndrome (thirst and passing large volumes of urine) in adults
- Raised PTH with normal calcium (secondary or normocalcaemic primary hyperparathyroidism)
- Suspected Cushing's syndrome (hypercortisolism)
- Thyroid nodule (palpable or found on imaging, multinodular goitre)
- Thyroiditis (subacute De Quervain, postpartum, on immunotherapy)
- Treatment: antithyroid drugs
- Type 1 diabetes: laboratory follow-up in adults and children
- Type 2 diabetes
- Vitamin D (25-OH-D): when to test it, and when not to
Gastroenterology and hepatology
- Acute abdominal pain in adults seen in the community: which tests before referral?
- Acute sigmoid diverticulitis (suspected, managed in the community)
- Anal itching: few tests, chosen according to the context
- Bariatric surgery
- Biliary colic (symptomatic gallstones): spot a complication
- Cholestasis in adults (raised ALP and GGT)
- Chronic diarrhoea
- Coeliac disease: who to test, serology, follow-up on a gluten-free diet
- Constipation (adult and child)
- Helicobacter pylori: test for infection, confirm eradication
- Inflammatory bowel disease
- Irritable bowel syndrome
- Isolated raised bilirubin (unconjugated bilirubin; Gilbert's syndrome)
- Isolated raised GGT
- Long-term PPI: is laboratory monitoring needed?
- Metabolic dysfunction-associated steatotic liver disease (MASLD): look for advanced fibrosis
- Raised alkaline phosphatase
- Raised lipase without abdominal pain (incidental hyperlipasaemia or hyperamylasaemia)
- Raised transaminases (hepatocellular injury)
- Uncomplicated cirrhosis
General symptoms
- Chronic exposure to a metal (cadmium, arsenic, mercury, chromium): biomonitoring in the community
- Fatigue
- Night sweats and hyperhidrosis (daytime sweating)
- Peripheral oedema
- Preoperative tests (planned surgery or procedure under anaesthesia, adult)
- Prolonged symptoms after Covid-19 (long Covid) in adults
- Superficial lymphadenopathy
- Suspected carbon monoxide poisoning (headaches in several people, in winter)
- Tests after age 50
- Unintentional weight loss (unexplained weight loss)
- Vegetarian and vegan diets
Genetics
- Carrier of a pathogenic BRCA1/BRCA2 variant or Lynch syndrome: follow-up and role of the GP (including PSA in men with BRCA2)
- Family history of cancer: when to refer to a cancer genetics clinic (breast, ovary, colon, endometrium, prostate, pancreas, melanoma)
- Genetic testing: what the GP can order, and how (consent, certificate, informing relatives)
- Myotonic dystrophy (Steinert's disease)
- Pharmacogenetics: tests before certain drugs (DPD and plasma uracil, HLA-B*57:01, HLA-B*15:02, TPMT, HLA-B*58:01)
- Relative of a patient with a common genetic disease: which screening (haemochromatosis, familial hypercholesterolaemia, polycystic kidney disease, Wilson's disease, haemoglobinopathies, cystic fibrosis)
Gynaecology and obstetrics
- Abnormal vaginal discharge (bacterial vaginosis, candidiasis, trichomoniasis), including in pregnancy
- Acute pelvic pain in women: rule out pregnancy, look for pelvic inflammatory disease
- Asymptomatic bacteriuria and urinary tract infection in pregnancy
- Bleeding or pelvic pain in early pregnancy (ectopic pregnancy, miscarriage)
- Cervical cancer screening (cytology, HPV test) and management after an abnormal result
- Diabetes (type 1 or 2) and pregnancy planning
- Emergency contraception: pregnancy test and STI screening
- Fever in pregnancy (listeriosis, pyelonephritis, chorioamnionitis, malaria)
- Gestational diabetes: screening and postpartum follow-up
- Heavy menstrual bleeding
- Hirsutism
- Hypertension in pregnancy (gestational hypertension, suspected pre-eclampsia, chronic hypertension)
- Infertility, first consultation
- Irregular bleeding (spotting, intermenstrual bleeding) on hormonal contraception
- Itching in pregnancy (intrahepatic cholestasis of pregnancy)
- Medical abortion in the community: tests before and check of success
- Menopause and hot flushes
- Ovarian cyst or mass found on ultrasound
- Polycystic ovary syndrome (PCOS): diagnosis and metabolic screening
- Positive red cell antibody screen (red cell alloimmunisation) in a pregnant woman
- Postpartum: postnatal check (anaemia, gestational diabetes, hypertension, thyroid)
- Pregnancy
- Pregnancy: exposure (chickenpox, measles, parvovirus B19, CMV) or serology to interpret (toxoplasmosis, rubella, CMV)
- Recurrent miscarriage: tests
- Secondary amenorrhoea
- Tests before assisted reproduction (couple referred to a fertility centre)
- Thyroid and pregnancy (targeted screening, treated hypothyroidism, Graves' disease)
- Treatment: combined hormonal contraception
- Treatment: intrauterine device (IUD)
- Treatment: progestogen-only contraception (progestogen-only pill, implant, injectable)
Haematology
- Anaemia
- Basophilia
- Bicytopenia or pancytopenia found on an FBC
- Follow-up after transfusion: delayed antibody screen, chronically transfused patient
- Haemochromatosis
- Hypereosinophilia (eosinophils > 0.5 G/L)
- Hyperferritinaemia
- Iron deficiency (low ferritin, with or without anaemia): confirm and look for the cause
- Isolated monocytosis
- Isolated prolonged aPTT
- Low prothrombin time (prolonged Quick time) without known anticoagulant treatment
- Low vitamin B12 or suspected B12 deficiency (metformin, PPI, vegan diet, older person, pernicious anaemia)
- Lymphocytosis (lymphocytes > 4 G/L in adults)
- Lymphopenia (lymphocytes < 1 to 1.5 G/L depending on the definition)
- Macrocytosis without anaemia (isolated raised MCV)
- Microcytosis without anaemia (suspected thalassaemia trait)
- Monoclonal peak on electrophoresis (monoclonal gammopathy, MGUS)
- Neutropenia
- Neutrophilia, leucocytosis
- Polycythaemia (raised haemoglobin or haematocrit)
- Purpura, easy bruising, mucocutaneous bleeding (adult, child)
- Raised LDH (lactate dehydrogenase) found on routine tests
- Sickle cell disease
- Splenomegaly in adults and children (found on examination or ultrasound)
- Thrombocytopenia (adult, including pregnancy)
- Thrombocytosis (platelets > 450 G/L)
- Thrombophilia
- Treatment: hydroxyurea (hydroxycarbamide: Hydrea, Siklos)
Infectious diseases
- Acute diarrhoea (adult and child): when to test the stool?
- Antituberculosis treatment (active tuberculosis): tests and monitoring
- Blood or sexual exposure: initial tests and follow-up
- Erysipelas (non-necrotising bacterial cellulitis): are tests needed?
- Fever after exposure to fresh water or animals (leptospirosis, Q fever, brucellosis, tularaemia)
- Fever after return from a tropical country
- Genital or anal ulcer (herpes, syphilis, mpox, lymphogranuloma venereum, chancroid)
- Hepatitis B: reading the serology, work-up and follow-up of the HBsAg carrier
- Hepatitis C: follow-up after treatment
- Hepatitis C: screening, positive serology and tests before treatment
- HIV
- Intestinal parasites (threadworms, giardiasis, taeniasis…): which test?
- Latent tuberculosis infection: contact, before immunosuppressant, at-risk populations
- Lyme borreliosis: tick bite, erythema migrans, disseminated forms
- Newly arrived migrant
- Positive syphilis serology: interpretation and follow-up after treatment
- Positive urine culture without symptoms (asymptomatic bacteriuria, urinary colonisation)
- Recent sexual violence: initial tests, follow-up and drug-facilitated assault
- Sexually transmitted infections (STIs)
- Suspected infectious mononucleosis (febrile sore throat, fatigue, lymphadenopathy)
- Symptomatic urethritis or cervicitis: samples before treatment and test of cure
- Treatment: PrEP (HIV pre-exposure prophylaxis)
- Urinary tract infection in men (cystitis, acute prostatitis, pyelonephritis, epididymo-orchitis)
- Urinary tract infection in women (simple cystitis, at risk of complications, recurrent, pyelonephritis)
- Useful vaccine serology (hepatitis B in healthcare workers, chickenpox, hepatitis A, catch-up)
- Whooping cough (suspected)
Internal medicine and immunology
- Abnormal protein electrophoresis without monoclonal peak (polyclonal hypergammaglobulinaemia, beta-gamma bridging, hypoalbuminaemia)
- Acrosyndromes (Raynaud's phenomenon and related disorders)
- Antinuclear antibodies: when to order them, what to do if positive
- Biologic or JAK inhibitor: tests before treatment and monitoring (anti-TNF, anti-IL6R, anti-IL17, ustekinumab, abatacept, rituximab)
- Giant cell arteritis: suspicion and follow-up in the community
- Hypogammaglobulinaemia in adults (found on electrophoresis)
- Livedo: benign livedo reticularis (no tests) or livedo racemosa (initial work-up)
- Porphyrias: acute hepatic porphyria attack (suspected), porphyria cutanea tarda (blisters on exposed skin), known porphyria
- Recurrent ENT or respiratory infections in adults: suspected immunodeficiency
- Sarcoidosis: initial laboratory tests and monitoring
- Sicca syndrome (dry mouth or eyes): suspected Sjögren's disease
- Systemic lupus: initial tests and laboratory monitoring in the community
- Treatment: leflunomide, sulfasalazine, azathioprine, mycophenolate (tests before treatment and monitoring)
- Treatment: long-term corticosteroids
- Unexplained biological inflammation (persistently raised CRP without a clue)
- Uveitis (looking for a cause)
- Vasculitic purpura in adults (suspected vasculitis)
Nephrology
- Abnormal serum phosphate (hypophosphataemia or hyperphosphataemia)
- Chronic kidney disease
- Creatinine before a contrast CT (iodinated contrast) or a gadolinium-enhanced MRI
- Hyperkalaemia (raised serum potassium)
- Hypernatraemia (serum sodium > 145 mmol/L)
- Hypokalaemia (serum potassium < 3.5 mmol/L)
- Hyponatraemia (serum sodium < 135 mmol/L)
- Leucocytes in urine without bacteria on culture (sterile pyuria)
- Low or high bicarbonate (total CO2) on serum electrolytes
- Proteinuria (positive dipstick, raised urine protein:creatinine or albumin:creatinine ratio)
- Raised creatinine or low eGFR found (acute or chronic?)
- Renal colic
Neurology
- Acquired diplopia or ptosis: laboratory tests (myasthenia gravis, microvascular cause, giant cell arteritis, orbitopathy)
- After an ischaemic stroke or a TIA: tests and follow-up for secondary prevention
- Delirium (acute confusion, especially in older people)
- First seizure in an adult (patient seen after the seizure)
- Multiple sclerosis
- Neurocognitive disorders
- Parkinson's disease
- Peripheral facial palsy: tests
- Peripheral neuropathy (length-dependent polyneuropathy)
- Raised CK (creatine kinase)
- Restless legs syndrome (Willis-Ekbom disease)
- Treatment: antiepileptics (valproate, carbamazepine, oxcarbazepine, lamotrigine, phenytoin, phenobarbital)
- Tremor: first-line tests
Oncology
- Breast cancer
- Colorectal cancer
- Colorectal cancer screening (faecal immunochemical test)
- Lung cancer
- Ovarian cancer
- Prostate cancer
- Raised tumour marker outside cancer follow-up (CEA, CA 19-9, CA 125, AFP)
- Testicular cancer
- Thyroid cancer: follow-up after treatment (TSH, thyroglobulin, calcitonin)
- Treatment: cancer immunotherapy (anti-PD-1, anti-PD-L1, anti-CTLA-4)
- Treatment: hormone therapy for breast cancer (tamoxifen, aromatase inhibitors)
Paediatrics
- Acute fever without a focus in infants and children
- Arthritis or bone and joint pain in children
- Chronic or recurrent abdominal pain in children
- Delayed puberty (no breasts at 13 years, no testicular enlargement at 14 years) and primary amenorrhoea
- Early adiposity rebound (child BMI curve)
- Enuresis and voiding disorders in children
- Faltering growth (short stature, drop across centiles)
- Global developmental delay in children: laboratory tests before specialist advice
- IgA vasculitis (Henoch-Schönlein purpura) in children: initial tests and renal monitoring
- Lead poisoning: when to measure blood lead and what to do with the result (child, pregnant woman)
- Neonatal jaundice after discharge from the maternity unit and prolonged jaundice (more than 14 days)
- Precocious puberty
- Recurrent fever in children (PFAPA or Marshall syndrome, cyclic neutropenia, other autoinflammatory diseases)
- Suspected immunodeficiency in children
- Urinary tract infection in children (fever without focus, pyelonephritis, cystitis)
Psychiatry and addiction medicine
- Alcohol misuse: laboratory markers (identification and follow-up, outside withdrawal)
- Anorexia nervosa
- Depression
- Hallucinations (young adult, older person): look for an organic cause
- Outpatient alcohol withdrawal
- Treatment: antidepressants (SSRIs, SNRIs, tricyclics, mianserin, agomelatine), especially in older people
- Treatment: antipsychotic
- Treatment: clozapine
- Treatment: lithium
- Treatment: opioid substitution treatment (buprenorphine, methadone)
Respiratory medicine and allergy
- Allergy (respiratory, food, hymenoptera venom) and anaphylaxis: specific IgE and tryptase
- Angioedema without urticaria (suspected bradykinin-mediated angioedema)
- Asthma
- Chronic breathlessness in adults: first-line tests
- Chronic obstructive pulmonary disease (COPD)
- Community-acquired pneumonia in adults managed in the community
- Minor haemoptysis seen in the community
- Pleural effusion found (tests before aspiration)
- Sleep apnoea syndrome
Rheumatology
- Acute monoarthritis in adults (septic arthritis to rule out, gout, chondrocalcinosis)
- Ankylosing spondylitis
- Chondrocalcinosis (calcium pyrophosphate crystal disease): look for a metabolic cause
- Fibromyalgia (suspected)
- Gout: diagnosis and initial tests
- Idiopathic leg cramps
- Low back or spinal pain: when to order tests (red flags)
- Osteoporosis
- Polymyalgia rheumatica
- Recent polyarthritis or oligoarthritis in adults (early inflammatory arthritis, before diagnosing RA)
- Rheumatoid arthritis
- Stress fracture in a young or athletic person
- Treatment: methotrexate (low weekly dose)
- Treatment: urate-lowering therapy (allopurinol, febuxostat)
Urology and andrology
- Balanitis or balanoposthitis (acute, recurrent or chronic)
- Benign prostatic hyperplasia
- Epididymo-orchitis (painful, inflamed scrotum)
- Erectile dysfunction
- Haematospermia
- Haematuria (positive dipstick, microscopic or visible haematuria)
- Nocturia in adults
- Post-occupational follow-up after exposure to bladder carcinogens (aromatic amines, rubber, dyes)
- PSA: request for prostate cancer screening and raised PSA
- Testosterone deficiency in men (hypogonadism: suspicion and monitoring on testosterone)
French edition (302 pages, interactive tool with prescription and cost)