CCFP priority topic 101 of 105
Urinary Tract Infection on the CCFP exam
6 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 6 key features for Urinary Tract Infection. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 6
Danger signs
Check each urine infection for kidney spread, sepsis, or a stone blocking an infected kidney.
CFPC skill Clinical reasoningPhase Hypothesis generation, investigationSources Choosing Wisely Canada, Choosing Wisely Canada / national participating organizations
On the exam
A woman has burning, fever, flank pain and a racing pulse. Expect a short menu (pick several from a list) of history and tests.
Pick the history and tests that find danger.
Common mistakes
Treating her as a simple bladder infection, with a short course and no culture. Fever and flank pain mean a kidney infection, which needs a culture first.
Approach
- Ask about fever, chills, flank pain, vomiting and how unwell she feels. These point to a kidney infection (pyelonephritis).
- Check pulse, blood pressure, temperature, breathing rate and alertness. Sepsis is infection with falling blood pressure or failing organs.
- Send a urine culture when there is fever or flank pain.
- Looks septic or unstable: send cultures, then start antibiotics at once. Do not wait for the result.
- No better after 3 days of the right antibiotic: think again, and look for another cause.
Key feature 2 of 6
Imaging in children
Image the kidneys and bladder in any boy with a urine infection, and in girls who keep getting them.
CFPC skill Clinical reasoningPhase Investigation
On the exam
A 2-year-old boy is better after his first kidney infection. Expect a short menu (pick several from a list) of next steps.
Pick the imaging and follow-up he needs.
Common mistakes
Calling it done because he got better on antibiotics. A first infection in a boy can be the only sign of a blocked or abnormal urinary tract.
Approach
- A first infection in a boy needs a look for an abnormal or blocked urinary tract, even once he is better.
- Tell the parents: a new fever means a prompt urine test.
Key feature 3 of 6
Who is high risk
Ask about what makes an infection riskier: pregnancy, weak immunity, a newborn, or a male.
CFPC skill Clinical reasoningPhase Hypothesis generation, historySources Canadian Task Force on Preventive Health Care, Choosing Wisely Canada
On the exam
A 16-year-old girl has two days of burning and frequency. Expect a short menu (pick several from a list) of history questions.
Pick the questions that change her care.
Common mistakes
Spending questions on bubble baths, wiping, tight underwear or energy drinks. None changes her care. Not asking about sex and pregnancy is the real miss.
Approach
- Ask any girl or woman who could be pregnant about her last period and sex. Test for pregnancy if in doubt.
- In pregnancy, screen once in the first trimester with a urine culture, even without symptoms.
- Ask about weak immunity: diabetes, steroids, cancer treatment, transplant drugs.
- Any male needs more thought. In a boy, think of an abnormal urinary tract. In an older man, think of an enlarged prostate.
- Ask about a catheter, stones, past kidney problems and recent urinary procedures.
- A newborn or young baby with fever is high risk. Do not treat the urine as an afterthought.
Key feature 4 of 6
Treatment by risk
Change the drug and its length to fit the patient, and start some before the culture is back.
CFPC skill SelectivityPhase TreatmentSources Choosing Wisely Canada / national participating organizations, Canadian Task Force on Preventive Health Care, Choosing Wisely Canada
On the exam
A woman 10 weeks pregnant has burning and frequency. Expect one best answer for her treatment.
Pick the right first step for her.
Common mistakes
Treating her on the history alone, as for a healthy woman who is not pregnant. Pregnancy needs a urine culture, and bacteria in pregnant urine are treated.
Approach
- In pregnancy, send a urine culture. Treating bacteria in pregnant urine modestly lowers the risk of kidney infection.
- Clear signs of a urinary infection: take the urine sample, then start antibiotics. Do not wait for the culture result.
- In long-term care, a male, a catheter or an abnormal urinary tract makes a bladder infection complicated. Treat for 7 days.
- Pick the drug by allergy, kidney function and local resistance.
- Reassess within 3 days. Stop if the culture taken before treatment is negative.
- In a long-term care resident who has improved, do not repeat the culture to prove cure.
| Infection | Who | Length |
|---|---|---|
| Simple bladder infection | A woman with no catheter or urinary tract problem | 3 to 5 days, by drug |
| Complicated bladder infection | A male, a catheter, or an abnormal urinary tract | 7 days |
| Kidney infection | Fever or flank pain | Generally 7 days |
Key feature 5 of 6
Vague illness
Think of a urine source when a baby or an older adult is vaguely unwell.
CFPC skill Clinical reasoningPhase Hypothesis generation, investigationSources Choosing Wisely Canada / national participating organizations, Choosing Wisely Canada
On the exam
A nursing home resident without a catheter is newly confused. Staff want a urine culture. Expect a short menu (pick several from a list) of next steps.
Pick what to check before any urine test.
Common mistakes
Sending urine for confusion alone, then treating the positive culture. Bacteria are common in older urine, and treating them harms. Missing the urine in a febrile baby is the opposite error.
Approach
- Confusion alone is not a urinary infection in a resident without a catheter. Look for other causes first.
- Check the skin around the genitals, and offer fluids if the urine is dark or strong-smelling. Write it down and reassess.
- Send urine only when the signs in the table are met. Do not treat bacteria in an older adult without urinary symptoms.
- Do not use urine dipsticks to look for infection in long-term care or in adults over 65. They mislead and drive overtreatment.
- A catheter in place more than 14 days: replace it, then take the sample from the new one.
- A baby or child not yet toilet trained, with fever and no clear source: get urine by catheter, not a bag. A positive bag culture cannot confirm infection.
| No catheter | Catheter | |
|---|---|---|
| Enough to send urine | New burning alone, or 2 or more other signs | Any one sign, once other causes are ruled out |
| Signs that count | Fever, new or worse urgency, frequency, pain above the pubic bone, visible blood, flank pain, incontinence | Fever, flank pain, shaking chills, new delirium |
| Fever means | Above 37.9 °C, or 1.5 °C over baseline, twice in 12 hours | The same |
| Confusion | Not a sign of urinary infection on its own | New delirium counts |
Key feature 6 of 6
Other causes of burning
Before calling burning a bladder infection, rule out the other conditions that cause it.
CFPC skill Clinical reasoningPhase Hypothesis generation, diagnosisSources Choosing Wisely Canada
On the exam
A 24-year-old woman has burning, a new discharge and a new partner. Expect a short menu (pick several from a list) of history and tests.
Pick the history, exam and tests.
Common mistakes
Prescribing for a bladder infection without asking about discharge, partners or flank pain. A sexually transmitted infection or a yeast infection is then missed.
Approach
- Ask about discharge, itch, new partners and pain with sex. These point to vaginitis or a sexually transmitted infection (STI).
- Discharge or a new partner: think of an STI and examine her. Do not treat the urine alone.
- Flank pain that comes in waves, with blood in the urine, points to a stone.
- In a man, fever with pain between the legs and a tender prostate points to prostatitis.
- Bladder pain and burning that keep coming back with negative cultures suggest bladder pain syndrome (interstitial cystitis).
- Outside pregnancy, culture urine only when symptoms point to the bladder or kidney, or there is fever with no other clear source. Cloudy or smelly urine alone is no reason.
- Typical burning and frequency without discharge, in a healthy woman who is not pregnant, can be treated on the history alone.
Flashcards
Answer it first, then check.
KF 1Urine infection with fever, flank pain and low blood pressure. Wait for the culture?
No. Send cultures, then start antibiotics now. An unstable patient does not wait for the result. Source: Choosing Wisely Canada / national participating organizations
KF 2A boy has his first urinary infection and is now better. Is he done?
No. A first infection in a boy can signal an abnormal urinary tract. Look for one.
KF 3How do you screen a pregnant woman for bacteria in her urine, and when?
A urine culture, once, in the first trimester, even when she has no symptoms. Source: Canadian Task Force on Preventive Health Care
KF 4A man in long-term care has a bladder infection. How long do you treat it?
7 days. A bladder infection in a male counts as complicated, so the short course is too short. Source: Choosing Wisely Canada / national participating organizations
KF 5A resident without a catheter is confused, with no urinary signs. Send urine?
No. Confusion alone is not a urinary infection. Look for other causes first, and reassess. Source: Choosing Wisely Canada / national participating organizations
KF 5What counts as a fever when deciding to send urine from a resident?
Above 37.9 °C, or 1.5 °C above baseline, on 2 readings over 12 hours. Source: Choosing Wisely Canada / national participating organizations
KF 5A toddler's bag urine grows bacteria. Is that a urinary infection?
Not proven. Bag samples are often contaminated by skin germs. Confirm with a catheter sample. Source: Choosing Wisely Canada
KF 6Burning, a new discharge and a new partner. What must you think of?
A sexually transmitted infection or vaginitis. Examine her before treating a bladder infection.
FAQ
Does every bladder infection need a urine culture?
No. A healthy woman who is not pregnant, with typical burning and frequency, can be treated on the history alone. Culture with fever, flank pain, pregnancy, or when treatment fails.
Should I treat bacteria in the urine when there are no symptoms?
Usually not. In older adults it brings harm and no benefit. Pregnancy is the main exception: screen once with a culture and treat what you find.
Are urine dipsticks still used in older adults?
No. Choosing Wisely Canada advises against dipsticks to look for infection in long-term care and in adults over 65. They are often positive without infection and lead to needless antibiotics.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada
- Using antibiotics wisely in long-term careChoosing Wisely Canada / national participating organizations
- Published prevention guidelinesCanadian Task Force on Preventive Health Care