Urinary Tract Infection (UTI) History Taking | OSCE Tips
Urinary tract infection (UTI), history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a UTI history during an OSCE.
Presenting complaint (PC):
What brought you here today?
Describe symptoms of suspected UTI?
History presenting complaint (HPC):
You can use SOCRATES to explore pain: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.
Site: where is the pain/discomfort (e.g. flanks, pelvic, lower abdomen)
Onset: when did it start?
Character: how would you describe the pain? (stinging/burning, dull, cramping sensation, sharp pain)
Radiation: does the pain spread anywhere else? (flank, groin, back)
Associate symptoms:
Frequency (increased urge to urinate)
Haematuria (blood in urine)
Nocturia (urinary frequency at night)
Cloudy or change of smell of urine
Fever
Discharge
Timing: are the symptoms getting worse or better
Exacerbating/Relieving factors: does anything make it better or worse? (you can ask if they have tried any over-the-counter medications)
Severity: from a scale from 1 to 10. with 10 being the worse, how would you rate your pain?
Ideas, Concerns & Expectations (ICE):
Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?
Past medical history (PMH):
Ask about any previous episodes of UTI or treatment or investigations for UTI?
Drug history (DH):
Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.
Any recent use of antibiotics? (previous use might increase the chance of getting a UTI).
Allergies:
Are you allergic to any medications? mainly antibiotics?
Family history (FMH):
Is there any family members who have similar symptoms?
Social History (SH):
Ask about living condition, occupation and social support.
Check for risk factors e.g. sexual activity and/or personal hygiene.
Any recent travel.
System review:
Review each body system to check for any other symptoms that might be causing tiredness.
Possible differential diagnosis:
Urethritis:
inflammation of the bladder, which can be caused by a sexually transmitted (e.g. chlaymydia or gonorrhea).
Pyelonephritis:
kidney infection, caused by a bacteria. This causes fever, flank pain and urinary symptoms.
Kidney stones (nephrolithiasis)/bladder stone.
Vaginitis.
Overactive bladder (OAB).
Summaries your findings.
Investigation:
Bedside: urinalysis and urine culture.
Bloods: full blood count (FBC), C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR).
Blood culture: if suspecting sepsis.
Imaging: Kidney, ureter, and bladder (KUB) X-ray, kidney ultrasound, CT scan.
Specialist procedure: cystoscopy.
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