Renal Colic


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a foundation doctor on the acute surgical take

Patient:  22 year old female, presented to A&E with left lower back pain

Task:

– Take a focused history from the patient

– After 6 minutes you will be asked a series of questions by the examiner.

– Answer any questions that the patient may have

Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You are a 22 year old who has a three day history of back pain that has not been getting any better. You are struggling to sit still due to the pain. It is extremely painful, you have never had anything like this before. Pain score of 10/10. You have noticed the pain comes in waves moving from your left flank region to groin. You have experienced nausea but no vomiting.

You last opened your bowels today and there has been no change in your bowel habit. You are passing a good volume of urine but it has been a little more painful than usual.

You are getting worried as the pain is getting worse, you think this could be something more serious like cancer.

PMH = anxiety

DH = citalopram 20mg OD, no known drug allergies

SH = you work as a pub manager. You smoke 5 cigarettes per day. You drink socially, 2 pints twice a week

ICE = your friend had something like this and they had to have their appendix out. You want to know If you will need an operation or not.

If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / year / grade
Clarifies who they are talking to
Asks patient for preferred name


HPC History of presenting complaint
Onset of pain (sudden)
Duration of pain (prior 3 days)
Location of pain (unilateral on LHS)
Frequency of pain(intermittent – comes in waves)
Quality of pain (sharp)
Radiation (from loin to groin)
Flank pain


Additional HPC
Recent fever / rigors
Nausea and vomiting
Diarrhoea


Urology
Dysuria
Haematuria
Hesitancy
Stream
Problems with flow – dribbling


PMH Past Medical History
Anxiety


DH Drug History
Citalopram 20mg OD
No known drug allergies


SH Social History
Alcohol (socially)
Smoking (10/day)
Job (pub manager)
Living situation


ICEF Ideas, concerns, expectations, feelings
Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions


Question What investigations would you like to do in this patient?
Routine bloods = FBC, U&Es, CRP
Urine dip +/- MSU
Pregnancy test
CT KUB


Question Given your history, what are your differentials?
Renal colic
Acute appendicitis
Ectopic pregnancy
Ovarian cyst
Abdominal aortic aneurysm
Pyelonephritis
Other appropriate answer


Question Urine dip shows: nitrites –‘ve, leukocytes –‘ve, blood ++. Bloods CRP <4, WCC 10.8. What is your most likely diagnosis?
Renal colic


Question What analgesia would you provide this patient with assuming there are no contraindications?
Diclofenac 50mg TDS



Score