FEBU Part 1 common mistakes
FEBU Part 1 · Understand the traps and how to avoid them.
In a man with low libido and a single afternoon total testosterone of 8 nmol/L, starts testosterone replacement without a repeat morning fasting sample, PSA, haematocrit or fertility discussion.
Treats one low value as diagnostic and focuses on the symptom, forgetting that testosterone varies diurnally and that replacement needs caution in prostate cancer, erythrocytosis and active fertility plans.
What to do instead
Require symptoms plus two morning fasting total testosterone values; check PSA, haematocrit and fertility intention; exclude prolactin, iron overload and opioid causes before prescribing.
In a bladder tumour pathology report, assigns T1 to a lesion described as invading muscularis propria because the cystoscopic appearance is broad-based and non-papillary.
Recalls T stages as a list but not the anatomical boundary; lamina propria invasion is T1 and muscularis propria invasion is T2, and the error changes management from bladder preservation to radical cystectomy with neoadjuvant chemotherapy.
What to do instead
Read the pathology sentence for the deepest layer involved: lamina propria is T1, muscularis propria is T2. Use a layer checklist and restage with bimanual examination and imaging before deciding treatment.
For an obstructing 8 mm ureteric stone with fever and hypotension, schedules semi-rigid ureteroscopy and stone extraction as the first priority rather than urgent decompression.
Anchors on stone size and clearance, underestimating that an infected obstructed upper tract is a urological emergency; instrumenting the infected system can precipitate sepsis.
What to do instead
Resuscitate, take cultures, give IV antibiotics and decompress with nephrostomy or stent within hours. Defer definitive stone treatment until the infection has resolved.
Diagnoses bladder outlet obstruction from a filling cystometry trace showing high detrusor pressure, without examining the voiding pressure-flow plot, voided volume or artefacts.
Mixes filling-phase storage pressure with voiding-phase obstruction; high pressure can reflect poor compliance or detrusor overactivity, whereas obstruction requires low flow with high pressure during voiding.
What to do instead
Apply ICS pressure-flow criteria to a valid voiding phase; confirm volume, flow and catheter artefacts, compare with a nomogram, and consider detrusor underactivity when flow is low with low pressure.
In a 6-week-old with febrile UTI, sends urine for culture and discharges on oral antibiotics without admitting for a sepsis screen, IV therapy and imaging planning.
Applies adult ambulatory UTI pathways to infants, ignoring the age-related risk of bacteraemia and serious bacterial infection; also misses the need to assess for obstruction and vesicoureteric reflux after febrile UTI.
What to do instead
Admit infants under 3 months with febrile UTI for full sepsis evaluation and IV antibiotics. After treatment, arrange ultrasound and use selective VCUG based on age, sex, recurrence and ultrasound findings.
In a man with pelvic fracture and blood at the meatus, attempts urethral catheterisation before imaging.
Follows the default reflex to catheterise for monitoring, but the findings suggest posterior urethral injury; blind catheterisation can convert a partial tear to a complete one and worsen bleeding.
What to do instead
Perform retrograde urethrogram first when urethral injury is suspected. If bladder drainage is needed, place a suprapubic catheter and manage the urethral injury through a delayed specialist pathway.
Prescribes ciprofloxacin for asymptomatic bacteriuria in a catheterised 78-year-old with cloudy urine, no fever, no suprapubic pain and no systemic signs.
Equates cloudy or malodorous urine and pyuria with infection; asymptomatic bacteriuria is common in catheterised patients, and treating it selects resistant organisms without improving outcomes.
What to do instead
Do not screen for or treat asymptomatic bacteriuria except in pregnancy or before urological procedures with mucosal trauma. Investigate symptoms, obtain a proper specimen if febrile, and remove or change the catheter.
For a kidney transplant recipient with creatinine rising from 120 to 220 micromol/L, requests an urgent transplant biopsy before ultrasound, urinalysis, culture, drug levels and BK viral PCR.
Anchors on rejection as the single cause; obstruction, urinary leak, infection, calcineurin inhibitor toxicity, BK nephropathy and vascular thrombosis are common and either treatable or contraindicate increased immunosuppression.
What to do instead
Use a structured workup: ultrasound to exclude hydronephrosis or leak, urinalysis and culture, tacrolimus or cyclosporine levels, BK PCR and donor-specific antibodies. Biopsy if these do not explain the decline.
In ischaemic priapism lasting 6 hours, orders penile Doppler ultrasound and awaits radiology before corporal aspiration and irrigation.
Prioritises confirming the subtype over time-critical detumescence; prolonged ischaemia causes smooth muscle necrosis and erectile dysfunction, and Doppler is not needed to start aspiration in a rigid painful penis.
What to do instead
Treat as a compartment syndrome: aspirate the corpora cavernosa and irrigate with saline, then give intracavernosal phenylephrine according to protocol. Use Doppler only if the diagnosis is unclear or after initial management.
On an acid-base question, calculates the expected PaCO2 with the Winter formula but uses bicarbonate in g/L or forgets to correct the anion gap for albumin.
Mixes units and applies the formula mechanically; the exam deliberately gives albumin or unusual units to test whether the candidate checks assumptions before calculating.
What to do instead
Convert bicarbonate to mmol/L, use expected PaCO2 = 1.5 x HCO3 + 8 +/- 2, and use corrected anion gap = measured gap + 2.5 x (4 - albumin in g/dL). State the units before calculating.