Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are currently a doctor working in the emergency department. Your next patient is Megan Dox – a 35-year-old woman presenting with a fever. Please take a history and perform a relevant examination.
Patient History:
Megan Dox - a 35-year-old female - office worker.
You have been feeling unwell for the past few days. Today you took a temperature which was found to be 38.0 degrees C as you had some shivering. Before the fever started, you remember developing a sudden worsening back pain on the lower left side which is associated with nausea and vomiting (no blood or faecal matter – just food). Pain comes in waves and is sharp – rating it a 7/10 pain score. Your urine also looks darker than usual and smells nasty, with blood in it. You have been going to the toilet more often than usual. You feel unwell. You currently have a poor appetite.
Not known to use a catheter. No diarrhoea. No cough. No breathlessness. No flu-like symptoms. No weight loss. No night sweats. Haven't eaten anything abnormal lately.
Ideas, Concerns, Expectations:
You have no idea what is going on. You think you have an infection but do not know what might be causing it. It might be renal stones. You are concerned because of not feeling your usual self. You want to receive some antibiotics.
Past Medical History:
High BMI, diabetes type 2 + renal stones (no known urological problems/ procedure in the past) + HIV (positive)
Drug History:
Metformin NKDA
Family History:
Renal stones
Social History:
You live alone in a flat.
Ex-smoker – used to smoke 10 cigarettes a day for 10 years.
You do not drink.
You currently work as an office worker.
Examination Findings:
Renal angle tenderness (left) + suprapubic tenderness without guarding.
No obvious lymphadenopathy.
Differentials:
Pyelonephritis
Cystitis / Urethritis
Renal stones / hydronephrosis / post renal problems
LUTI
Pelvic inflammatory disease/ gynae problems
Investigations: