Visible haematuria — CCE clinical encounter

CCE-style clinical encounter: a 58-year-old smoker with one episode of visible haematuria who is convinced it was 'just the infection'. The candidate must take the fear seriously without catastrophising, confirm the pathway with risk numbers, and secure urological workup despite his reluctance.

clinical encounter with role-player (CCE format)2 min readVerification in progress

Prompt

A 58-year-old forklift driver attends about 'a waterworks thing'. Two days ago he passed bright red urine once; it has been normal since. He had a urine infection six months ago. Smoker, 35 pack-years. He says: 'It's gone now, doc. My mate had this and it was nothing.'

Objectives

Take a structured haematuria history: timing in stream, clots, pain, trauma, exercise, infection timeline. ^[2]
Assess and quantify cancer risk honestly using visibility, age and smoking. ^[3]
Complete examination and investigations: BP, abdomen, urinalysis, microscopy, culture, renal function. ^[2]
Refer appropriately despite the symptom resolving — and explain why in numbers the patient can hold onto. ^[3]
Address the mate's story: acknowledge it while explaining why averages don't decide individual cases.

References4Show

[3]Price SJ, Shephard EA, Stapley SA et al. Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. The British journal of general practice : the journal of the Royal College of General Practitioners, 2014.PMID 25179073
[2]Grossfeld GD, Wolf JS Jr, Litwan MS et al. Asymptomatic microscopic hematuria in adults: summary of the AUA best practice policy recommendations. American family physician, 2001.PMID 11277551
[5]Woldu SL, Ng CK, Loo RK et al. Evaluation of the New American Urological Association Guidelines Risk Classification for Hematuria. The Journal of urology, 2021.PMID 33356483
[4]Tan WS, Sarpong R, Khetrapal P et al. Does urinary cytology have a role in haematuria investigations? BJU international, 2019.PMID 30003675

Visible haematuria — CCE clinical encounter

clinical encounter with role-player (CCE format)2 min readVerification in progress

Objectives

Take a structured haematuria history: timing in stream, clots, pain, trauma, exercise, infection timeline. ^[2]

Assess and quantify cancer risk honestly using visibility, age and smoking. ^[3]

Complete examination and investigations: BP, abdomen, urinalysis, microscopy, culture, renal function. ^[2]

Refer appropriately despite the symptom resolving — and explain why in numbers the patient can hold onto. ^[3]

Address the mate's story: acknowledge it while explaining why averages don't decide individual cases.

References4Show

[3]Price SJ, Shephard EA, Stapley SA et al. Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. The British journal of general practice : the journal of the Royal College of General Practitioners, 2014.PMID 25179073
[2]Grossfeld GD, Wolf JS Jr, Litwan MS et al. Asymptomatic microscopic hematuria in adults: summary of the AUA best practice policy recommendations. American family physician, 2001.PMID 11277551
[5]Woldu SL, Ng CK, Loo RK et al. Evaluation of the New American Urological Association Guidelines Risk Classification for Hematuria. The Journal of urology, 2021.PMID 33356483
[4]Tan WS, Sarpong R, Khetrapal P et al. Does urinary cytology have a role in haematuria investigations? BJU international, 2019.PMID 30003675