User:Bron766/Haematuria management/Diagnostic clues from history

On the previous pages, we looked at learning the causes of haematuria and organising these causes by various systems. The next step is to learn how to diagnose a cause of haematuria by recognising and looking for diagnostic clues.

Diagnostic clues are individual snippets of information that do not make a diagnosis on their own, but they help to point you in the right direction. Each diagnostic clue needs to trigger two responses in your brain:
 * 1) This is a relevant piece of information
 * 2) It is relevant because its presence increases the risk of...

For example, if a patient presents with Haematuria and tells you they have smoked a pack of cigarettes a day for the last 60 years, it doesn't mean they must have bladder cancer, but you MUST consider cancer more likely.

Diagnostic clues for haematuria include: Note: this table format is readily adaptable for brain training using flashcards and spaced repetition, because at this stage you are aiming to create a single synaptic link between one trigger and one response for each card. Try importing a table like this into Anki to make a set of flashcards.

Once you can explain each of these clues, you need to look for them while taking the history. This involves knowing what questions to ask (and why), and having a system so you don't forget to ask the relevant questions. Questions to ask on history might include: (click each clue for more details)

Note: if you do not understand the abbreviations used here, you can read more about them on this page (coming soon).

Once you understand why each of these questions might be asked (and you have a way of asking them in your own words), you need to remember to ask them!

You could revise this style of knowledge with questions like:


 * 1) The patient has told me about their smoking, alcohol and overseas travel history. What else should I ask about in the Social History?
 * 2) What medications are particularly important to ask about?
 * 3) What family history apart from renal disease could be relevant?

Can you write some more questions in this style, so that they make your brain learn to group the clues together? You should be able to recall all the clues in a section AND be able to tell what is missing from an incomplete list... This important because patients tell you information in all sorts of order and you need to filter this to work out which questions you will specifically ask about to complete the picture.

Another way of processing this information is by recalling all the associated clues for one diagnosis.


 * 1) What clues are red flags for cancer?
 * 2) What clues suggest infection?

Let's start putting this together with some (fictional) sample cases to analyse:

The traditional 'answer' to a scenario like this would be 'this man has renal colic'. A better answer is to understand each of the diagnostic clues so that when cases are not so clear cut, you can weigh various possibilities. Which of the above findings are suggestive of renal colic? What other questions could have been asked about the haematuria?

Here's a blank table for you to add the next example:

Another step towards diagnostic mastery of haematuria is being able to weight individual clues according to the evidence for their importance. (e.g. likelihood ratios).