Lower urinary tract infection


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in A&E

Patient: 21 year old female patient has presented to A&E with pain on urination

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 21 year old women, who has been feeling generally unwell for the past 2 days. You have noticed some pain when passing urine. You have been voiding a lot more than usual. There is no blood and you have not had any fevers / night sweats / nausea or vomiting. You have never had anything like this before.

You are not currently sexually active. You had an STI check 3 weeks ago which was negative. You are not experiencing any discharge or abnormal PV bleeding. Your last period was 2 weeks ago and your cycles are regular.

PMH:

No past medical history

No previous operations

DH:

No regular medications

No known drug allergies

SH

You do not smoke but use a ‘vaper’ / e-cigarette

You drink 2 bottles of rose per week

You live with your parents

You work for a local charity in the social media department

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


PC Presenting complaint
Dysuria
Frequency


Urology symptoms
Nocturia
Hesitancy / terminal dribbling
Poor urinary stream
Incomplete voiding


Associated features
Recently unwell
Nausea and vomiting
Renal angle tenderness
Weight loss
Anorexia
Lethargy


PMH Past medical history
No past medical history
No previous operations
Candidate specifically asks about: DM, immunosuppression


DH Drug history

No regular medications
No known drug allergies


SH Social History
Alcohol
Smoking
Job
Living situation


ICEF
Explores ideas, concerns, expectations, feelings


Question
Please review the patients observations and then decide what investigations would you like to do in this patient

Urine dip
MC&S if urine dip positive
Pregnancy test
Blood tests not indicated for a simple UTI


Question
Review the following investigation and state what your most likely diagnosis is

Lower urinary tract infection


Question Does this patient need admission to hospital?
No


Question
What would be your management for this patient. Show candidate prescribing guidelines if mentions antibiotics

Antibiotics - Nitrofurantoin PO 50mg 6 hourly for 3 days
Analgesia if required - paracetamol


Questions What simple measures can be used to prevent urinary tract infections?
Drink > 2L a day of water
Voiding at 2-3h intervals
Double voiding
Voiding before bedtime and after sexual contact
Wipe front to back after micturition


Question What are the worrying features of a urinary tract infection?
Decreased blood pressure / features of shock
Temperature > 40
Renal impairment



Score