CASE 2 - Hematuria Flashcards
They told me that having blood in my urine is because of my old age. Is that true?
No. Bloody urine is rarely normal.
We will need to run a few more tests to determine the cause of this finding.
Specific questions about bloody urine:
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- How did you know it was blood?
- Pain or burning on urination?
- Polyuria, frequency?
- Straining during urination?
- Nocturia?
- Weak stream?
- Dribbling?
- Renal stones?
PEx:
- CV ==> A.
- Pulmonary ==> A.
- Abdominal ==> A + P + P + checked for CVA tenderness.
- Extremities ==> Inspection.
Closure — what to do?
- Discuss initial diagnostic impressions.
- Discuss initial management plans ==> Examinee mentioned the need for a GENITAL exam and a RECTAL exam for the prostate.
- Ask if the SP had any other questions or concerns.
Sample closure:
Mr. Fisher, the blood in your urine could be caused by a variety of factors, so I would like to do a few tests to elicit an answer.
First I will draw some blood, and then I will perform a genital exam as well as a rectal exam to assess your prostate.
I will then order a urine test to look for signs of infection.
Depending on the results we obtain, I may also order some imaging studies to determine if there is a stone in your kidney, an anatomic abnormality, or a tumor.
Do you have any questions for me?
DDx 1 — Bladder cancer:
Hx:
- Hematuria.
- Straining on urination.
- Weak urinary stream and dribbling.
- Works as painter (exposure to industrial solvents).
- Hx of smoking 1PPD x 30y.
DDx 2 — Urolithiasis:
- Hematuria.
- Straining on urination.
- CVA tenderness.
DDx 3 — BPH:
- Polyuria, nocturia.
- Weak urinary stream and dribbling.
- Straining on urination.
Workup:
- Genital exam.
- Rectal exam.
- Cystoscopy.
- US renal.
- UA.
- CT abdomen/pelvis.
- PSA.
Additional DDx:
- Prostate cancer.
- RCC.
- Glomerulonephritis.
- UTI.
What did I forget?
- Ask about how did he know it was blood.
- History of nephrolithiasis.
- FH you idiot!
- Workup ==> US + UA + PSA.
