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Investigations in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Possible blood tests (and some suggested causes for abnormal results) include:

  • full blood count
    • low hematocrit, low hemoglobin level
      • anaemia, cancer, malnutrition
    • altered red cell indexes
      • nutritional deficiencies (e.g., vitamin B12)
    • elevated white blood cell count
      • infection
    • rasied eosinophil count - allergy

  • ESR - infection, neoplasm, inflammatory disease e.g. Sjogren's, SLE
  • CRP - infection, neoplasm, inflammatory disease

  • renal biochemstry
    • renal disease, Cushing's, adrenocortical deficiency

  • early morning cortisol - Cushing's, adrenocortical deficiency

  • HbA1c, fasting glucose -diabetes mellitus

  • liver function tests
    • elevated liver enzyme level
      • viral hepatitis, liver disease
    • elevated bilirubin level, elevated alkaline phosphatase level
      • liver disease

  • clotting screen
    • elevated prothrombin time
      • malnutrition, liver disease

  • thyroid function tests

  • raised IgE - allergy

Imaging if suggested from history and examination and available to order from primary care:

Computed tomographic (CT) scanning

  • most useful and cost-effective technique for assessing sinonasal tract inflammatory disorders
  • coronal CT scans are particularly valuable in assessing paranasal anatomy

MRI

  • use of intravenous contrast media helps to better identify vascular lesions, tumors, abscess cavities and meningeal or parameningeal processes
  • MRI is superior to CT scanning in the evaluation of soft tissues, but it poorly defines bony structures
  • MRI is the technique of choice for assessing the olfactory bulbs, olfactory tracts, facial nerve and intracranial causes of chemosensory dysfunction
    • also the preferred technique for evaluating the skull base for invasion by sinonasal tumors
  • Gadolinium enhancement is useful for detecting dural or leptomeningeal involvement at the skull base

Reference:

  • Bromley SM. Smell and Taste Disorders: A Primary Care Approach.Am Fam Physician. 2000 Jan 15;61(2):427-436.
  • Prescriber 1999; 10 (12): 94.
  • Pulse 2004; 63 (47): 80.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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