Care module
This visit
General OPD
Step 5
Investigation
CESJUJM2606020
Sam Sam
Module: General OPD
All test results must be entered before continuing to Definitive Diagnosis. A doctor or lab staff can enter results.
2 orders awaiting results. No further actions (Continue to Step 6) are available until every order has a result.
Suggested from Step 4 (differential diagnosis)
Liver function tests
Blood tests — CBC, Hb, coagulation
No blood tests ordered.
Biochemistry — renal function, liver function, etc.
Liver function tests (Ordered) Enter result
No results entered yet.
Liver function tests (Ordered) Enter result
No results entered yet.
Fasting blood sugar (Completed)
Abnormal lab findings — review interpretations below.
- Fasting blood glucose ⚠
- 200.0 mmol/L⬆ ≥126 mg/dLInterpretation: Diabetes mellitusClinical correlation: Type 1 or type 2 diabetes, secondary diabetes (pancreatic disease, endocrinopathies). Confirm on ≥2 occasions when asymptomatic.ICD-11: 5A14
Other lab — Urine, Stool, Infectious, Special
Stool examination (Completed)
Abnormal lab findings — review interpretations below.
- Color
- brown
- Consistency ⚠
- wateryWateryInterpretation: DiarrheaClinical correlation: Infection, malabsorption, IBSICD-11: DA96, 1A40, DD91
- Occult Blood (FOBT)
- Negative
- Gross Blood
- Negative
- Mucus ⚠
- presentPresentInterpretation: InflammationClinical correlation: IBS, IBD, infectionICD-11: DD91, DD7Z
- Fat (Sudan stain)
- negative
- Parasites / Ova ⚠
- PositivePositiveInterpretation: Parasitic infectionClinical correlation: Giardia, Entamoeba, helminthsICD-11: 1A36, 1A31
- Leukocytes
- Postive
- pH
- 5.5
Urine culture (Completed)
Positive
Urinalysis (Completed)
Abnormal lab findings — review interpretations below.
- Color
- Yellow
- Appearance ⚠
- turbidTurbid/cloudyInterpretation: Presence of cells/crystalsClinical correlation: UTI, pyuria, crystalluriaICD-11: GC08
- Specific Gravity ⚠
- 0.8⬇ <1.005Interpretation: Dilute urineClinical correlation: Diabetes insipidus, excessive hydration
- pH
- 5.5
- Protein ⚠
- 2+⬆ PositiveInterpretation: ProteinuriaClinical correlation: Nephrotic syndrome, diabetic nephropathy, glomerulonephritisICD-11: 5A14
- Glucose
- Postive
- Ketones
- Postive
- Blood ⚠
- Positive⬆ PositiveInterpretation: Hematuria/hemoglobinuriaClinical correlation: Glomerulonephritis, stones, trauma, hemolysisICD-11: ND56
- Bilirubin
- begative
- Urobilinogen
- normal
- Nitrite ⚠
- positive⬆ PositiveInterpretation: Bacterial conversion of nitrateClinical correlation: Gram-negative UTI (E. coli, Klebsiella)ICD-11: GC08
- Leukocyte Esterase
- Postive
Radiological investigations
Plain radiography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging
No imaging ordered.
Enter results for all 2 orders above (you or lab staff), then continue.