Are further tests going to be useful to help guide diagnosis?

Looking at what further tests can help guide a diagnosis.

Let’s now have a look at some of the further tests that could guide the diagnosis.

Physical examination

Listening to breathing – Lung auscultation
Respiratory rate
Is there evidence of clubbing? – clubbing is characterised by changes to fingers and toes, such as bulbous enlargement of the finger tips or toes; changes in the angle between the skin and nails; or excessive sponginess of the nail base. Clubbing can develop quickly and can be indicative of various disease processes.

If coughing:

Chronic cough – The Chronic Cough in Adults: Make the Diagnosis and Make a Difference paper is suggested for the diagnosis of a chronic cough
Peak expiratory flow (if asthma is suspected, or COPD if spirometry is unavailable).
Blood test for pneumonia
Imaging scans including chest X-ray (to detect a number of conditions such as lung cancer, TB, interstitial lung disease) or more detailed tests such as high resolution CT scans.
Spirometry if available
Test for pertussis (whooping cough)
Test for TB – using acid-fast bacillus (AFB) stain or a tuberculosis (TB) smear. This is a test to determine if a person has TB or another type of mycobacterial infection.
COVID – depends on availability

If breathless:

This paper gives a detailed assessment process and is suggested for chronic breathlessness.
National Institute for Health and Care Excellence (NICE) Guidelines on breathlessness
Check blood pressure
Blood tests (including full blood count for anaemia)
Temperature
Oxygen saturation
Test for Tuberculosis (TB) – skin test/blood test

When selecting tests, choose the investigations that might give the most information about the diagnosis with the least risk to the person.