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Flank pain and dysuria

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Infectious Diseases, Urology, Emergency Medicine, General Surgery, Renal Medicine
Progress Test Topic(s)
A 35 year old Tongan woman presents with severe right sided flank pain radiating down to her groin, pain while passing urine, and haematuria. She had a similar episode 6 years ago.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and function of the renal tract
   - Common pathologies of the renal tract, including common sites of calculi
   - Composition of normal urine and its alteration in disease
   - Metabolism of calcium and phosphate and mechanism of renal calculi formation
   - The aetiology and pathogenesis of cystitis and pyelonephritis
   - Pathophysiology of septic shock
   - Types of stones formed and the relationship between the stone composition and other diseases
   - Non-pharmacological management of severe pain
   - Pharmacology of analgesic agents including opioids
   - Pharmacology of gentamicintrimethoprim, aminoglycosides, cephalosporinsnitrofurantion and fluoroquinolone antibiotics
Clinical and Communication Skills 
   - Communication with a patient in severe pain
   - Recognition and early management of septic shock
   - Elicit a relevant history; include family history of renal calculus and other renal disease
   - Perform a focused abdominal examination; seek evidence of any conditions that may present with renal calculus disease
   - Differential diagnosis of unilateral abdominal pain
   - Interpretation of usual midstream urine results in important renal diseases: urinary tract infection, renal calculi, glomerulonephritis, renal trauma
   - Indications for ultrasound and CT in renal tract imaging
   - Indications for conservative and surgical intervention including position of calculus in renal tract
   - Pharmacological and non-pharmacological therapies to prevent stone formation
   - Complications and prognosis of renal calculi
   - Antimicrobial stewardship: appropriate selection of antimicrobial agents
Personal and Professional Skills 
   - Management of a patient with severe pain and communication with patient and family/whānau
   - Empathy for patient in severe pain
   - Awareness of this as a possible presenting complaint for people with drug-seeking behaviour
   - Consideration of personal biases and assumptions about patients presenting with severe pain
   - Managing own stress with patient in acute pain
   - Awareness of limitation in managing patient in severe pain and when to seek help
Hauora Māori 
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand for renal calculus and renal failure
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management (mobile lithotripsy buses to rural centres)
Population Health 
   - Epidemiology and prognosis of renal calculus disease
Conditions to be considered relating to this scenario
renal calculi, pyelonephritis
Less common but 'important not to miss'
ureteric obstruction and hydronephrosis, renal vein thrombosis, renal artery embolus, pyonephrosis, perforated viscus, ruptured abdominal aortic aneurysm
renal papillary necrosis
Related Scenarios
[Acute abdominal pain], [Dysuria]