Haematuria scenario

candidate brief

Mr Robinson has come in with blood in his urine. Please take a history.

80% history, 20% clinical reasoning

examiner brief

  • Introduces Self, confirms patient identify, Washes hands
  • Offers analgesia, ensures comfort of patient
  • Confirms nature of the problem
  • Features of haematuria
    • Gross, initial, terminal
    • Clots
    • Previous episodes
    • Pain, dysuria, suprapubic discomfort
    • Previous urological problems
    • Prostate, catheters, bladder, renal colic
  • Systemic symptoms
    • Weight loss, fever, appetite, lethargy
    • Bleeding elsewhere?
  • Drug History
    • Asks specifically about anticoagulants
    • If on anticoagulants asks about monitoring
  • PMH
  • Social, smoking, occupation, foreign travel
  • Investigations
    • MC+S, Urine dip
    • Bloods specifically U+E, Clotting and FBC
  • Explores for retention
    • If in retention talks about inserting catheter
  • Explains differential for haematuria
    • Bladder tumour, kidney tumour, infection, BPH, anticoagulation
  • Plans appropriate further management
    • Haematuria clinic, Inpatient, TWOC clinic
  • If patient asks if it is cancer gives a good empathetic answer
  • Thanks patient
  • Answers questions
  • global mark from examiner
  • global mark from patient

actor brief

You are Mr Robinson, a 85yo man. You have seen blood in your urine for the last week, and since this morning you have been unable to pass urine. You are now uncomfortable, though you have just had some paracetamol. This has never happened before. You have never seen a urologist.

PMH: AF on apixaban and bisoprolol, bronchiectasis on inhalers and carbocisteine
DHx: apixaban, bisoprolol, carbocisteine

You live alone, independently care for yourself and walk with a stick. You have been slowing down in the last few years but nothing has changed recently.

If asked, you are mostly concerned not being able to pass urine. You have had friends who have had lots of problems with catheters and you are mainly afraid of losing your independence should you need one. You would rather not stay in hospital, but if things are explained clearly you agree with the need for investigations.