**Question:** Following trauma, a patient presents with a drop of blood at the tip of urinary meatus. He complains of inability to pass urine. Next step should be -

A. Perform a urine test
B. Inject local anaesthetic
C. Apply pressure to the wound
D. Perform abdominal examination

**Core Concept:**

In the context of a patient with post-traumatic bleeding at the urinary meatus and urinary retention, it is essential to assess the cause and severity of the injury to determine the appropriate management. Urinary retention is the inability to void urine from the bladder, which can be due to various causes such as trauma, neurological disorders, or anatomical abnormalities. In this scenario, the initial step should focus on identifying the cause and extent of the injury.

**Why the Correct Answer is Right:**

The correct answer (A) is chosen due to the patient's symptoms and the location of the injury. Performing a urine test (urine test) is essential to evaluate for blood, infection, or other abnormalities that could contribute to the patient's symptoms. This test helps to identify the presence of hematuria (blood in urine) and any associated infections, which might be the cause of retention.

**Why Each Wrong Option is Incorrect:**

A. Applying pressure to the wound (Option C) is not the correct initial step as it doesn't address the root cause of the patient's symptoms (urinary retention). Pressure on the wound might stop the bleeding temporarily but does not help in diagnosing or managing the underlying issue.

B. Injecting local anaesthetic (Option B) is not relevant in this scenario because the patient is experiencing symptoms of urinary retention and blood at the meatus, which necessitates a thorough evaluation rather than providing analgesia.

D. Performing abdominal examination (Option D) is not the ideal first step as it only provides information about the patient's overall health status but doesn't address the patient's specific symptoms (urinary retention and blood at the meatus).

**Clinical Pearl:**

In cases of post-traumatic blood at the meatus and urinary retention, it is essential to prioritize thorough clinical examination and appropriate investigations to identify the cause of the patient's symptoms. A urine test is crucial in this situation to assess for hematuria and infections, which might contribute to the patient's symptoms. A comprehensive evaluation and targeted investigations will guide the subsequent management plan and ensure accurate treatment.