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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