Please see sample papers graded with high quality, Make sure each question is answered with in text citations.
A 28 year old G0 calls the office with complaints of lower abdominal pressure and urinary frequency. She has been in the office four times over this past year for dysuria and has been treated for UTI. She is sexually active on Apri for contraception. She has a negative GYN history. She feels her UTI symptoms seem to be occurring within 12 hours of intercourse.
PMH – PCOS
Medications – Loestrin 1/20, Mvi, Omega 3
Allergies – Ciprofloxacin
Vitals: T=98.4, B/P=118/72, Pulse = 84
| Color, Urine | yellow |
| Clarity, Urine | Turbid |
| pH, Urine | 5.5 |
| Glucose, Urine | Negative |
| Protein, Urine | 100 mgdL |
| Ketones, Urine | Negative |
| Blood, Urine | Large |
| Nitrite | Positive |
| Leukocytes Urine | Large |
| Specific Gravity, Urine | 1.020 |
| White Blood Cells, Urine | 818 |
| Red Blood Cells, Urine | >900 |
| Bacteria, Urine | Many |
| Hyaline Casts | <=10 |
Culture results with >100,000 CFU/ML Escherichia coli
| Escherichia coli Not Specified | |
| Ampicillin | <=8 ug/ml Sensitive |
| Ampicillin + Sulbactam | <=1/.5 ug/ml Sensitive |
| Cefazolin | <=2 ug/ml Sensitive |
| Cefepime | <=2 ug/ml Sensitive |
| Ceftriaxone | <=1 ug/ml Sensitive |
| Ciprofloxacin | <=1 ug/ml Sensitive |
| Gentamicin | <=1 ug/ml Sensitive |
| Nitrofurantoin | <=32 ug/ml Sensitive |
| Tobramycin | <=1 ug/ml Sensitive |
| Trimethoprim + Sulfamethoxazole | <=2/38 ug/ml Sensitive |
- What would you include in your focused physical exam?
- What diagnostic tests would you include today?
- What is your interpretation of these results?
- Would you select to treat this patient?
- What does MIC mean? How does it influence choosing a treatment?
- Explain your reasoning for selecting the treatment you chose.
- What would your choice be if she was pregnant?
- Explain why women are at higher risk for urinary tract infections.
- As you finish your visit she asks, “What can I do to prevent this from happening?” How do you answer this question, and what can she do to prevent them from happening in conjunction with sexual relations?
References are below with hyperlinks
- Urinalysis: A Comprehensive Overview – AAFP
- ACOG practice bulletin – Treatment of Urinary Tract Infections in Non-pregnant women
- ACOG vide- Recurrent Urinary Tract Infection Prevention
- ACOG – FAQ Urinary Tract Infections
- Managing acute UTIs in postmenopausal women
- American Cancer Society – Prostate Cancer Screening Guidelines
- American Urological Association – Prostate Cancer Screening Guidelines
- American Urological Association – Evaluation and Management of Testosterone Deficiency
- American Urological Association – Kidney Stones
- United States Preventative Task Force – Prostate Cancer Screening
- American Academy of Clinical Endocrinologists – Reproductive Medicine – Male Sexual Dysfunction
- American Academy of Clinical Endocrinologists – Reproductive Medicine – Evaluation and Treatment of Hypogonadism in Male Patients
