MBBS OSCE · General Medicine
OSCE — Urinary Tract Infection & Pyelonephritis
Eight-minute OSCE station on Urinary Tract Infection & Pyelonephritis: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Urinary Tract Infection & Pyelonephritis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Urinary tract infection (UTI) is microbial invasion and multiplication in the normally sterile urine and urothelium, classified by site into lower (cystitis — dysuria, frequency, urgency, suprapubic pain) and upper (pyelonephritis — fever, rigors, flank pain, systemic illness), and by complexity into uncomplicated (non-pregnant woman, no abnormality) versus complicated (man, pregnancy, obstruction, catheter, diabetes, immunocompromise). Escherichia coli causes 75 to 85 percent; others include Staphylococcus saprophyticus (young sexually active women), Klebsiella, Proteus (struvite stones), Enterococcus, Pseudomonas (catheter/recurrent), Candida (diabetic/catheter). Diagnose with urinalysis (
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Urosepsis with hypotension, raised lactate, or organ dysfunction — emergency; Su |
| Safety | Pyonephrosis — an obstructed infected kidney; emergency nephrostomy or stent; an |
| Safety | Pyelonephritis with no improvement after 48 to 72 hours of antibiotics — abscess |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.