Hematuria is blood in the urine. There are two types of blood in the urine exist. Hematuria may be grossly visible (macroscopic hematuria) or detectable only on urine examination (called microscopic hematuria). Hematuria is common. In many patients, particularly young adult patients, the hematuria is transient and of no consequence. However there is an appreciable risk of malignancy in patients over age 35 years with hematuria, even if transient.
Having trouble remembering all the important questions to ask during your patient encounter? Then try this Hematuria Mnemonic for USMLE Step 2 CS.
Physical Examination for Hematuria:
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- Cardiovascular exam: Auscultation
- Pulmonary exam: Auscultation
- Abdominal exam: Auscultation, Palpation, Percussion, Check for CVA tenderness.
- Genital Exam (not required for actual USMLE Step 2 CS exam)
Differential Diagnosis for Hematuria:
- Bladder cancer
- Coagulation disorder
- Prostate Cancer
- Polycystic kidney disease
- Renal Cell Carcinoma
- IgA nephropathy (Berger Disease)
- Pyelonephritis (Acute / Chronic)
- Urinary Tract Infection (UTI)
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Differential Diagnosis ‘MNEMONIC‘
Diagnostic Work-up for Hematuria:
- Genital exam
- Rectal exam (check for BPH or Prostate cancer)
- CBC, PT/PTT
- Urine Culture
- Urine cytology
- Kidney ultrasound
- CT of abdomen and pelvis
- Intravenous pyelogram (IVP)
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