Case #1: A 55-year-old woman presents to the office with bloody urine and dysuria
of 12-hour duration. She was recently married and has never had similar
symptoms. She denies chills and fever. On physical examination she is afebrile, has normal vital signs, and has mild tenderness in the midline above the pubis. Her urinalysis shows too many to count (TNTC) red blood cells.se
- What is the definition of bacteriuria?
- What additional history do you need to make a diagnosis?
- What diagnostic studies would you order and why?
Case #2: A 23-year-old woman was married a year ago. Since then, she has experienced five attacks of acute cystitis, all characterized by dysuria, increased frequency, and urgency. Each infection responded to short-term treatment with trimethoprim sulfamethoxazole. The recurrences occurred at intervals of 3 weeks to 3 months following completion of antibiotic therapy. For the past two days, the woman has been experiencing acute flank pain, microscopic hematuria, dysuria, increased frequency, and urgency.
Her vital signs are T = 37.9°C, P = 106, R = 22, and BP = 130/75 mm Hg. Physical examination reveals costovertebral tenderness, mild tenderness to palpation in the suprapubic area, but no other abnormalities.
- What are possible reasons for this woman’s pain? List possible differential diagnosis and explain each?
- What diagnostic tests should you order to confirm diagnosis?
- What are the possible causes of recurrent lower UTIs?
- What are the differences when comparing prerenal acute renal failure, intrarenal acute renal failure, and postrenal acute renal failure? Give examples of each.
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