A 78-year-old female comes to the office because she has pain when she urinates. She has been seen three times for this problem in the last 3 months. Each time she was told she had a UTI and was given antibiotics.
She carefully followed the instructions but has had no relief of symptoms. Last sUA:
WBCs: 2-3/high-power field
RBCs: 0-2/high-power field
Epithelial cells: Few
Nitrite: Negative
Leuckocyte esterase: Negative
Which of the following should be done next?
A. Obtain a clean catch urine for UA and urine for C&S
B. Perform a pelvic examination
C. Reassure the patient that she has asymptomatic bacteriuria and does not need antibiotics
D. Order a pelvic ultrasound
Question 2
Mrs. Smith, a 65-year-old woman presents to clinic for the first time and complains of urinary incontinence and dyspareunia. She went through menopause 10 years ago without any hormone replacement therapy and had a hysterectomy for a fibroid.
Her mother had a hip fracture at 82 years of age. The patient's most recent mammogram was 5 years ago and no known family history of breast cancer. She is not taking any medications. Her physical examination is unremarkable except for findings consistent with atrophic vaginitis. You decide to begin topical hormone replacement therapy. Which of the following evaluations would be necessary prior to initiating hormone replacement therapy?
A. Mammogram
B. Endometrial biopsy
C. Bone mineral density measurement
D. Papanicolaou smear
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