Case Information
- Case ID: UTI-010
- Patient Name: Sarah Johnson
- Age: 28
- Gender: Female
- Indigenous Status: Non-Indigenous
- Year: 2025
- ICPC-2 Codes: U71 – Urinary Tract Infection
Competency Outcomes
| Competency Domain | Competency Element |
|---|---|
| 1. Communication and Consultation Skills | Establishing rapport, explaining the diagnosis and treatment options, and addressing patient concerns |
| 2. Clinical Information Gathering and Interpretation | Taking a structured history to differentiate uncomplicated from complicated UTI and ruling out sexually transmitted infections (STIs) |
| 3. Diagnosis, Decision-Making and Reasoning | Identifying UTI based on history and investigations while ruling out pyelonephritis or other conditions |
| 4. Clinical Management and Therapeutic Reasoning | Providing evidence-based treatment, considering antibiotic stewardship, and advising on symptom management |
| 5. Preventive and Population Health | Discussing strategies to reduce UTI recurrence, including hygiene, hydration, and lifestyle modifications |
| 6. Professionalism | Providing patient-centred care, ensuring confidentiality, and discussing sexual health considerations sensitively |
| 7. General Practice Systems and Regulatory Requirements | Ensuring appropriate use of PBS-listed antibiotics and adherence to antimicrobial stewardship guidelines |
| 9. Managing Uncertainty | Recognising when further investigations (urine culture, imaging) or specialist referral is needed |
| 10. Identifying and Managing the Patient with Significant Illness | Recognising red flag symptoms requiring escalation of care (e.g., sepsis, pyelonephritis, or recurrent UTIs) |
Case Features
- 28-year-old female presenting with a 2-day history of dysuria, urinary frequency, and urgency.
- Reports mild lower abdominal discomfort but no fever, flank pain, or nausea.
- No previous history of recurrent UTIs, kidney disease, or diabetes.
- Sexually active, using oral contraceptive pills (OCPs) as contraception.
- Concerned about whether she needs antibiotics and how to prevent future infections.
Candidate Information
Instructions
The candidate is expected to review the following patient record and scenario. The examiner will ask a series of questions based on this information. The candidate has 15 minutes to complete this case.
The approximate time allocation for each question:
- Question 1: 3 minutes
- Question 2: 3 minutes
- Question 3: 3 minutes
- Question 4: 3 minutes
- Question 5: 3 minutes
Patient Record Summary
Patient Details
- Name: Sarah Johnson
- Age: 28
- Gender: Female
- Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- No known drug allergies
Medications
- Oral contraceptive pill (OCP)
Past History
- No recurrent UTIs, kidney disease, diabetes, or immunosuppression
Social History
- Sexually active, monogamous relationship
- Uses OCPs, no history of sexually transmitted infections (STIs)
- Non-smoker, occasional alcohol consumption
Family History
- No family history of renal disease or recurrent UTIs
Vaccination and Preventive Activities
- Influenza vaccine: Up to date
- COVID-19 booster: Received
Scenario
Sarah Johnson, a 28-year-old female, presents with a 2-day history of dysuria, urinary frequency, and urgency. She also reports mild lower abdominal discomfort but denies fever, flank pain, or nausea.
She is sexually active and uses the oral contraceptive pill (OCP) for contraception. She is otherwise healthy with no history of recurrent UTIs.
She is concerned about needing antibiotics and wants to discuss prevention strategies for future UTIs.
On examination:
Blood: Trace
General appearance: Well, no signs of systemic illness
Temperature: 36.8°C
Blood pressure: 118/76 mmHg
Heart rate: 72 bpm
Abdominal examination: No tenderness over the flanks or suprapubic region
Urinalysis (dipstick):
Leucocytes: Positive
Nitrites: Positive
Likely Diagnosis: Uncomplicated Lower Urinary Tract Infection (Cystitis)
Examiner Only Information
Questions
Q1. How would you differentiate an uncomplicated UTI from a complicated UTI or other conditions?
- Prompt: What key features in history help distinguish between simple and complicated UTIs?
- Prompt: What conditions should be considered in the differential diagnosis?
Q2. How would you manage Sarah’s UTI, considering antimicrobial stewardship?
- Prompt: What are the first-line antibiotic choices for an uncomplicated UTI?
- Prompt: When would you consider urine culture or further investigations?
Q3. What advice would you give Sarah regarding symptom relief and supportive care?
- Prompt: What non-antibiotic measures can help manage symptoms?
- Prompt: How long is symptom resolution expected to take?
Q4. What strategies would you discuss for UTI prevention?
- Prompt: What lifestyle changes can help reduce recurrence?
- Prompt: When should prophylactic antibiotics be considered?
Q5. When would you consider referral or further investigations?
Prompt: When would you consider a renal ultrasound or urologist review?
Prompt: What are the red flags for complicated UTI or pyelonephritis?
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Q1. How would you differentiate an uncomplicated UTI from a complicated UTI or other conditions?
The competent candidate should:
- Take a detailed history to distinguish between uncomplicated and complicated UTIs:
- Uncomplicated UTI: Occurs in a healthy, non-pregnant woman with no structural or functional abnormalities of the urinary tract. Presents with dysuria, frequency, urgency, and mild lower abdominal discomfort, as seen in Sarah’s case.
- Complicated UTI: Includes recurrent UTIs, UTIs in pregnancy, immunosuppressed patients, or those with anatomical abnormalities (e.g., renal stones, catheters). Also includes UTIs associated with fever, flank pain, or sepsis features.
- Screen for red flags indicating alternative diagnoses or complications:
- Pyelonephritis: Fever, rigors, flank pain, nausea, vomiting.
- Sexually transmitted infections (STIs): Vaginal discharge, dyspareunia, pelvic pain.
- Interstitial cystitis: Chronic bladder pain, urgency without infection.
- Diabetes or immunosuppression: Recurrent or severe infections.
- Use dipstick urinalysis appropriately:
- Positive leukocytes and nitrites support UTI.
- Presence of blood could indicate cystitis but may warrant further investigation if persistent.
- Order a urine culture if:
- Symptoms persist despite initial treatment.
- There is suspicion of complicated UTI.
- There is concern for antibiotic resistance.
SUMMARY OF A COMPETENT ANSWER
- Differentiates uncomplicated from complicated UTI based on history.
- Considers alternative diagnoses, such as STIs or pyelonephritis.
- Uses urinalysis and clinical findings to guide management.
- Identifies red flags requiring further investigations.
PITFALLS
- Failing to consider alternative diagnoses, such as STIs or interstitial cystitis.
- Not recognising features of complicated UTI, such as fever or recurrent infections.
- Over-reliance on dipstick urinalysis without considering the clinical picture.
- Not considering urine culture when indicated.
REFERENCES
- RACGP Guidelines for UTI Management
- National Institutes of Health on Urinary Tract Infections
- Australian Commission on Safety and Quality in Health Care on Antimicrobial Stewardship
MARKING
Each competency area is on the following scale from 0 to 3.
☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated
1. Communication and Consultation Skills
1.1 Communicates in a patient-centred, culturally appropriate manner.
1.3 Engages the patient to discuss concerns and expectations about diagnosis.
2. Clinical Information Gathering and Interpretation
2.1 Takes a structured and hypothesis-driven history.
2.3 Uses appropriate diagnostic tools, including urinalysis.
3. Diagnosis, Decision-Making and Reasoning
3.1 Identifies key clinical concerns and determines appropriate next steps.
3.5 Uses clinical reasoning to differentiate between uncomplicated and complicated UTI.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD