Urinalysis: dipstick testing and explaining the result
PLAB 2 & PRES 3 · practical skills · easy · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Miss Laura Brennan, 34, has had two days of pain on passing urine, urinary frequency and suprapubic ache. She has provided a urine sample, which is on the side. Please perform dipstick urinalysis on the sample, explain the results to her, and agree a management plan. Verbalise each step as you perform it.
What examiners look for
A dipstick is a timed chemical test, not a mood ring. Each pad has a specified reading time; read early or late and the colours lie. The examiner is watching for the three disciplines: in-date strips, drain the edge, read against the bottle chart at the stated times. Know what the two key pads mean: nitrite is produced by most (not all) urinary bacteria converting dietary nitrate — so nitrite-negative does not exclude UTI — and leucocyte esterase detects white cells, i.e. inflammation, which infection causes but so can other irritation. The pattern plus the symptoms makes the diagnosis; no single square does. In younger women with classic symptoms, the dipstick supports a clinical diagnosis. The same logic inverts in older patients: dipsticks should NOT be used to diagnose UTI in the over-65s or in catheterised patients, because asymptomatic bacteriuria is common and dipstick-driven prescribing there causes real harm. Examiners love this boundary — know which side of it your patient sits on. The sample is part of the test: fresh, midstream, correctly collected. A two-hour-old perineally contaminated sample dipped beautifully is still garbage in, garbage out. Recurrent UTI (three in a year) changes the job from treating to investigating: culture before antibiotics this time, a triggers-and-prevention conversation, and a follow-up/review plan. The patient asked "why does this keep happening?" — the candidate who only treats today's stinging has answered half her consultation. Prescribing safety hides inside practical stations: pregnancy status before the antibiotic choice, allergy history before the prescription. The dipstick took two minutes; the checks around it are the medicine.
Guideline references
Practise this station
Role-play it with an AI patient and get feedback against the full marking scheme. Create a free account — 3 stations per month free.