Case 2 - 57 yo M with bloody urine

Question 1

Information gathering

Answer 1

CC
How did you know it was blood?
Onset
Progresson
Pain/burning during urination
Fever
Abdominal/flank pain
Polyuria, frequency
Straining during urination
Nocturia
Weak stream, dribbling
Prior episodes
Hx of kidney stones
Other symptoms (N/V/D/C)
Constitutional symptoms (weight loss, appetite changes, night sweats)
PMHx
PSHx
FHx
Social Hx (occupation, tobacco, alcohol, drug use, diet, exercise, sexual activity)
Current medications
Drug allergies

Question 2

Physical examination

Answer 2

CV exam
Pulmonary exam
Abdominal exam (including checking for CVA tenderness)
Extremities

Question 3

Closure

Answer 3

Mention need for genital and rectal exam for prostate

Question 4

Differential diagnosis

Answer 4

Bladder cancer
Urolithiasis
BPH

Question 5

Diagnostic work-up

Answer 5

Genital exam
Rectal exam
Cystoscopy (bladder cancer)
US - renal (masses and stones)
UA, urine culture
Urine cytology (bladder cancer)
CT - A/P (masses, stones)
PSA
BUN/Cr
IVP (replaced by CT urography to avoid contrast)