An 18-year-old female patient presents with repeated urinary ...

[AEWBW]

An 18-year-old female patient presents with repeated urinary tract infections. She has no risk factors in her history, and her physical examination is unremarkable. She also has a normal pelvic exam.
 
  Which of the following should be obtained if anatomic abnormalities are suspected?
  A. Intravenous pyelogram
  B. Ultrasound of the kidneys
  C. Cystoscopy
  D. Transvaginal ultrasound of the bladder

Question 2

A 33-year-old female patient visits the clinic multiple times over the last year complaining of dysuria, frequency, urgency, suprapubic pain, and dyspareunia. Her physical examination, including a pelvic exam, is normal.
 
  Urinalysis and urine culture is repeatedly negative. Her intravenous pyelogram is also normal. The clinician should recognize that this presentation is consistent with symptoms of:
  A. Asymptomatic bacteriuria
  B. Upper urinary tract infection
  C. Interstitial cystitis
  D. Polycystic kidneys

[blfontai]

Answer to Question 1

ANS: A
Risk factors for the development of a UTI include increasing age, recent sexual intercourse, a history of UTI, use of a diaphragm or cervical cap, and anatomic abnormalities. Urine cultures should be considered in the patient with recurrent UTI or refractory UTI and in the patient who appears toxic. Blood for CBC and electrolyte tests should also be drawn based on the overall clinical presentation. If anatomic causes are suspected, diagnostic imaging, such as KUB or IVP, should be arranged based on the suspected cause and patient's presentation.

Answer to Question 2

ANS: C
Patients with IC suffer from chronic symptoms that include a combination of dysuria, suprapubic pain, chronic pelvic pain, dyspareunia, and negative urine cultures. Patients may become debilitated by this disease; they may be making up to 40 trips to the bathroom in 24 hours. IC is also marked by periods of remission and flare-up throughout a patient's lifetime. Typical age at onset varies from 30 to 70, and most patients visit an average of five physicians and wait 4 years before the correct diagnosis is made.

[AEWBW]

Excellent

[rachel]

TYSM