LUTS (Dysuria/problems passing urine/urethral discharge) :: PLAB 2 Symptomatic Differential Stations

• Chlamydia female

  • Other presenting symptoms: 

    • Dysuria (multiple episodes not controlled by nitrofurantoin)

  • Past history and PMAFTOSA: 

    • Sexual history

    • P questions

    • Allergy

  • Social:

    • Life effects

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PV

  • Referral:

    • GUM clinic

  • Treatment: 

    • Antibiotics if confirmed

    • General advice:

      • Voiding before and after sex

      • Plenty of fluids

      • Safe sex

      • Avoid sex till treatment complete

      • Partner notification if confirmed

  • Warning signs:

    • High fever

    • Hematuria

• Gonorrhea male

  • Other presenting symptoms: 

    • Dysuria

    • Urethral discharge

  • Past history and PMAFTOSA: 

    • Sexual history

    • Allergy

  • Social:

    • Life effects, relationships

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Genital 

    • PR

  • Referral:

    • GUM clinic

  • Treatment: 

    • Antibiotics if confirmed

    • General advice:

      • Plenty of fluids

      • Safe sex

      • Avoid sex till treatment complete

      • Partner notification if confirmed

  • Warning signs:

    • High fever

    • Hematuria

• Gonorrhea female

  • Other presenting symptoms: 

    • Dysuria (multiple episodes not controlled by nitrofurantoin)

    • Vaginal discharge

    • Lower abdominal pain

  • Past history and PMAFTOSA: 

    • Sexual history

    • P questions

    • Allergy

  • Social:

    • Life effects

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PV

  • Referral:

    • GUM clinic

  • Treatment: 

    • Antibiotics if confirmed

    • General advice:

      • Voiding before and after sex

      • Plenty of fluids

      • Safe sex

      • Avoid sex till treatment complete

      • Partner notification if confirmed

  • Warning signs:

    • High fever

    • Hematuria

    • Complications

      • PID

      • Ectopic pregnancy

      • Painful sex

• UTI

  • Other presenting symptoms: 

    • Dysuria

    • Lower abdominal pain

    • Frequency

    • Fever

  • Past history and PMAFTOSA: 

    • Sexual history

    • P questions

  • Social:

    • Life effects

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PV

    • Urine dipstick, Pregnancy test

    • Urine culture +/- sensitivity

  • Referral:

    • None

  • Treatment: 

    • Antibiotics (Nitrofurantoin) if confirmed

    • General advice:

      • Voiding before and after sex

      • Plenty of fluids

      • Safe sex

      • Avoid sex till treatment complete

  • Warning signs:

    • High fever

    • Hematuria

• BPH

  • Other presenting symptoms: 

    • Dysuria 

    • Old male

    • Hesitancy, frequency, incomplete voiding, dribbling

    • Fever if UTI

  • Past history and PMAFTOSA: 

    • Sexual history

  • Social:

    • Life effects

    • Work effects

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PR

    • Urine dipstick

    • Urine culture, PSA

  • Referral:

    • Admit under urology (if retention)

  • Treatment: 

    • Antibiotics if UTI

    • Catheter if retention

    • Tamsulosin

    • TURP

    • General advice:

      • Voiding before and after sex

      • Plenty of fluids

      • Safe sex

      • Avoid sex till treatment complete

  • Warning signs:

    • High fever

    • Hematuria

• Urge incontinence 

  • Other presenting symptoms: 

    • Urge incontinence

    • Have to run to pee

    • High-BMI female usually

  • Past history and PMAFTOSA: 

    • Sexual history

    • P questions

    • Rule out cauda equina

  • Social:

    • Life effects

    • Work effects

    • Relationships

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PV

    • Urine dipstick

  • Referral:

    • Continence services specialist routine referral

  • Treatment: 

    • Bladder training

    • Pelvic floor exercises

    • General advice:

      • Avoid excess of water

      • Avoid alcohol, caffeine

      • Weight loss

      • Smoking cessation

  • Warning signs:

    • High fever

    • Hematuria

    • Weakness in limbs, fecal incontinence

• Stress incontinence

  • Other presenting symptoms: 

    • Incontinence when coughing, sneezing or lifting heavy objects

  • Past history and PMAFTOSA: 

    • Sexual history

    • P questions

    • Rule out cauda equina

  • Social:

    • Life effects

    • Work effects

    • Relationships

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PV (look for pelvic organ prolapse)

    • Urine dipstick

  • Referral:

    • GUM clinic

  • Treatment: 

    • Pelvic floor exercises

    • General advice:

      • Incontinence pads if required

      • Avoid excess of water

      • Avoid alcohol, caffeine

      • Weight loss

      • Smoking cessation

  • Warning signs:

    • High fever

    • Hematuria

    • Weakness in limbs, fecal incontinence