Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a Foundation Year Doctor working in the A&E. Your next patient is Roc Johnson – a 51-year-old man who complains of pain during urination. Please take a history and perform a relevant examination.
Patient History:
Roc Johnson - a 51-year-old male - retired teacher.
You started experiencing pain when you urinated three days ago. This started quite suddenly, and the pain has been getting worse. You rate the pain 6/10. You describe the pain as burning. You do feel quite uncomfortable in the area below your belly button. You do not have any groin/loin pain.
You have noticed feeling quite feverish – today recorded 37.6 C. You have also been going to the toilet to empty your bladder more frequently than usual. You also sometimes have a sudden urge to urinate. Therefore, you always ensure a toilet nearby when you go outside. You also sometimes find it difficult to start urine, and the flow also seems to be slower compared to 1 year ago.
No discharge/haematuria/hesitancy/weight loss/nocturia. Not sexually active/ no pain in testicles.
Ideas, Concerns, Expectations:
You recently have been with a new partner and have been sexually active. You have always used barrier contraceptives. You think you have received AIDs from your new partner. You are very concerned about this as you heard many people have died of AIDS in the past. You are thinking of ending the relationship because of this. You hope to find out what is going on and seek treatment as soon as possible.
Past Medical History:
Type 2 Diabetes
Drug History:
Metformin, allergic to penicillin > rash
Family History:
Father has prostate cancer.
Social History:
Smoker – non-smoker
Alcohol – 3-4 pints of lager per week.
Occupation – retired teacher
Live alone.
Examination Findings:
Abdominal discomfort/ tenderness in the suprapubic region
Warm + sweats on palpation
No costovertebral angle tenderness
Enlarged prostate with central sulcus during PR if done (no tenderness / abnormal lumps)
Differentials:
Urinary tract infection (Lower)
STI
Things to rule out BPH/ Stones/ Prostate, Bladder or Renal Cancer/ stricture / Prostatitis
Investigations:
Bedside:
Observation
PR examination / testicular exam
Mid-stream Sample with Urine dipstick - White cells, Haematuria, Nitrites
Urinalysis - microscopy, culture if needed
STI screen
Bloods:
FBC – infection
CRP – infection
U&E & Creatinine – assess renal function
LFT – baseline
PSA
Consider blood culture – infection/ suspect sepsis
Imaging:
Consider CT KUB (non-contrast) – rule out stones if any features of nephrolithiasis or suspected complications
Consider US KUB - as with CT, also useful for assessing urodynamics, especially if recurrent
Management: