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Question

Difficulty: EasyOrdering Laboratory Tests

Match each patient's clinical presentation with the most appropriate initial diagnostic laboratory test or procedure.

  • A 45-year-old man with a body mass index of 33 kg/m² presenting with new-onset polyuria and polydipsiaHemoglobin A1c and fasting blood glucose
  • A 28-year-old woman presenting with heat intolerance, palpitations, and unexplained weight lossThyroid-stimulating hormone (TSH) and free T4
  • A 60-year-old man presenting with an acutely swollen, erythematous, and exquisitely tender first metatarsophalangeal jointArthrocentesis for synovial fluid crystal analysis
  • A 32-year-old woman presenting with progressive fatigue, pallor, and a history of heavy menstrual bleedingComplete blood count (CBC) and serum ferritin

Answer

The presentations are matched as follows: the patient with polyuria/polydipsia requires HbA1c/fasting glucose; the patient with heat intolerance/weight loss requires TSH/free T4; the patient with acute podagra requires arthrocentesis for crystal analysis; and the patient with menorrhagia/fatigue requires a CBC and serum ferritin.
Each diagnostic test is paired with the clinical presentation that it most specifically and appropriately investigates according to standard guidelines: endocrine testing for suspected diabetes and thyroid disease, joint aspiration for acute monoarticular arthritis, and hematologic workup for suspected anemia.

Step-by-Step Solution

1
Analyze the chief complaint and history for each patient to formulate the most likely clinical diagnosis.
Patient 1 has diabetes mellitus, Patient 2 has hyperthyroidism, Patient 3 has acute gout, and Patient 4 has iron deficiency anemia.
Establishing a strong presumptive diagnosis guides the selection of the most specific and accurate confirmatory laboratory tests.
2
Select the gold standard or recommended initial diagnostic test that matches each identified condition.
HbA1c/glucose for diabetes, TSH/free T4 for hyperthyroidism, arthrocentesis for gout, and CBC/ferritin for anemia.
Choosing the appropriate initial test avoids unnecessary healthcare costs, prevents diagnostic delays, and establishes the diagnosis accurately.

Key Concept

Selecting the most appropriate initial laboratory tests for classic clinical presentations in the outpatient setting.
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Topics

Ordering Laboratory Tests

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