Management of Haematuria

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Question 1 of 10

1. Question
Which of the following would not deter you from performing an intravenous urogram (IVU) in the emergency department?
- The patient takes metformin for her diabetes
- The patient is 11 weeks pregnant
- The patient has macroscopic haematuria
- The patient has a creatinine of 179
- Contrast allergy some years ago
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Question 2 of 10

2. Question
A female patient attends the emergency department with frequency and dysuria. You await her urine dipstick result. Regarding the use of urine dipsticks, which of the following statements is false?
- Urine dipsticks are 100% sensitive and specific for the diagnosis of UTI
- Taken alone, the sensitivity of nitrites on dipstick in UTI is 81
- Taken alone, the sensitivity of leukocyte esterase (LE) on dipstick in UTI is 77%
- If both leukocyte esterase and nitrites are positive, the sensitivity increases to 94%
- Nitrites are more specific for the diagnosis of UTI than leukocyte esterase
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Question 3 of 10

3. Question
Regarding the use of urine culture in the emergency department, which one of the following statements is correct?
- In young women with uncomplicated cystitis it is generally not indicated to perform a urine culture
- Pyelonephritis commonly is culture negative
- There is no urgency to deliver the sample to the laboratory
- Antibiotics may be administered before culture is obtained
- The under and overtreatment rates for UTI when comparing the performance of laboratory urine analysis and dipstick are radically different
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Question 4 of 10

4. Question
A 24 year old runner has been troubled by painless frank haematuria. He has no muscle pains, the blood is fresh and his creatine kinase (CK) is within normal limits as is his renal function. Which of the following statements is correct regarding exercise haematuria?
- It is thought to result from trauma between the bladder wall and urethra
- It occurs exclusively in runners
- It needs admission and bladder washout until it resolves
- It is commonly associated with rhabdomyolysis
- If the condition settles over the next 48 h it requires no further follow up
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Question 5 of 10

5. Question
A 55 year old male has microscopic haematuria found on dipstick in your emergency department. He has a normal physical examination and normal sized prostate on rectal exam. Which of the following is the correct course of action?
- He should be asked to see his GP who will repeat the test and reassure him if the repeat is normal
- A urine culture should be sent and the results communicated to his GP. If negative, he may be reassured
- A CT KUB (CT kidney, ureter and bladder) should be performed to seek renal calculi
- He should be referred to a two week wait urology clinic
- He should be referred initially to renal outpatients
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Question 6 of 10

6. Question
In investigating microscopic haematuria, several investigations are used. Each may have its own advantages and disadvantages. Which of the following statements regarding ultrasound and intravenous urogram (IVU) is incorrect?
- IVU has a limited sensitivity in detecting small masses of 2-3 cm and less than 2 cm in diameter
- IVU has a lower radiation dose and cost compared with CT
- Ultrasound is less sensitive than IVU at detecting uroepithelial tumours
- Ultrasound can visualise the bladder wall morphology, assess bladder emptying and renal structure and vasculature
- CT contrast enhancement can determine whether cystic lesions are malignant by examining the change in Hounsfield units
Correct

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Question 7 of 10

7. Question
A gentleman attends your emergency department complaining of suprapubic colicky pain and frank haematuria. He is passing clots and is in a great deal of pain. You discover he has had a TURBT (A trans urethral resection of a bladder tumour) 3 days earlier. You correctly diagnose clot retention. Appropriate management would consist of:
- Resuscitate and place a single lumen foley catheter in to relieve the retention
- Push clear fluids to keep the urine clear
- Provide analgesia and antibiotics and refer the patient to the next urological clinic
- Resuscitate as required with iv access and fluids. Insert a three way irrigation catheter of sufficient gauge to allow irrigation and dispersal of the clots
- Insert a suprapubic catheter as first line measure to irrigate the bladder to decrease the risk of introducing infection
Correct

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Question 8 of 10

8. Question
Regarding the role of urine cytology in the management and diagnosis of microscopic haematuria, which of the following statements is incorrect?
- The sensitivity of urine collection for cytological analysis is increased by using collection on three consecutive mornings’ first void
- Sensitivity of urine cytology is high for evaluation of bladder cancer
- The sensitivity of urine cytology is highest for detection of high grade lesions in the bladder and carcinoma in situ
- Urine cytology is limited in its ability to detect low grade lesions in the bladder and renal cell cancer
- The usefulness is improved by using washings from the upper tract at ureteroscopy
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Question 9 of 10

9. Question
Urological cancer may be present in between 0.5 and 8.3% of patients with microscopic haematuria. Key to the management is to determine whether the patient falls into a high or low risk group. Which of the following are risk factors for uroepithelial cancer?
- Beetroot and rhubarb consumed in large doses
- Age >40 years
- Chronic smoking
- Cyclophosphamide
- Schistomiasis
Correct

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Question 10 of 10

10. Question
A 65 year old male patient attends your emergency department stating he sees blood in his urine. You take a detailed history. Which of the following statements is correct?
- The timing of the haematuria through his stream is key to determining the initial and continuing investigations
- If the patient is on warfarin and his International Normalised Ratio (INR) is raised it obviates the need for further investigation
- Being male, if he has leucocytes and nitrites in his urine and symptoms of UTI, he can be treated with culture sensitive antibiotics and discharged without follow up
- The bleeding may be caused by benign prostatic hypertrophy
- An emergency IVU should be performed to rule out malignancy
Correct

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Management of Haematuria

Management of Haematuria

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