Return to Scenario ListShow Learning Points most relevant to Phase 1:

Gross haematuria

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Urology, Renal Medicine
Progress Test Topic(s)
A 56 year old Māori man, who is a smoker and used to work in a clothes dyeing factory, presents with an episode of passing blood and dark red clots in his urine. He has no associated pain or urinary frequency. His GP has referred him urgently to the Urology Outpatient Clinic.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Structure and function of the urinary tract
   - Describe the different epithelial cells along the urinary tract
   - Understand the progression of cancer; pre-cancerous to cancer to metastatic disease
   - Carcinogenesis, including occupational and environmental predisposition to formation of urothelial and renal tumours
   - Histopathology of bladder cancer
Clinical and Communication Skills 
   - History from a patient with frank haematuria; assess risk factors for renal and bladder cancer, including a detailed employment and family history
   - Compassionate communication with patient and family/whānau when discussing cancer
   - Perform a focused genitourinary examination
   - Recognise clinical signs of anaemia
   - Interpret midstream urine, urine cytology, pathology report of biopsy (taken at cystoscopy)
   - Role of imaging with ultrasound, intravenous urogram and CT in diagnosis and staging
   - Manage clot retention
   - Define polycystic kidney disease and outline its different forms, complications, and prognosis
   - Stage renal cell carcinoma and bladder cancer using the TNM system and outline the impact on treatment choices and prognosis
   - Outline management of renal cell carcinoma and bladder cancer: surgery (including ileal conduit formation), oncology, palliative care
Personal and Professional Skills 
   - Reflect on own background and values and their potential impact on one's practice in a patient who has a smoking-related illness
   - Demonstrate empathy when discussing distressing symptoms
Hauora Māori 
   - Understanding of inequities in access to health services, quality of medical care and cancer outcomes for Māori compared with non-Māori, and application of this to clinical decision making and management
   - Consideration of access to cultural/spiritual support for patient and whānau
   - Understanding of the role of kaupapa Māori health services and research in reducing cancer inequalities
Population Health 
   - Influence of tobacco smoking and occupational exposure on the epidemiology of genitourinary tract cancers
   - Service provision in the health service: criteria for urgent referral (patient focus)
   - Family screening for polycystic kidney disease, including ethics
Conditions to be considered relating to this scenario
bladder transitional cell carcinoma, renal cell carcinoma, drugs (rifampicin), autosomal dominant polycystic kidney disease
Less common but 'important not to miss'
coagulopathies, thrombocytopenia, rhabdomyolysis
ureteric transitional cell carcinoma, post-streptococcal glomerulonephritis, IgA nephropathy, trauma, haemolysis, porphyria, arterio-venous malformation