USMLE Forum Archives - USMLE Step 3 - Obstetrics- Burning urination
Obstetrics- Burning urination
harry206 - 05-12-09 08:34
A 30-year-old Caucasian elementary school teacher who is 34 weeks pregnant with her first child comes to the clinic complaining that "it burns when I urinate." She has also noticed some suprapubic pain and increased urinary frequency and urgency. Her symptoms began two days ago and are causing her extreme discomfort at work. Prior to this, her pregnancy had been uncomplicated. Her temperature is 36.7C (98F), blood pressure is 126/78 mm Hg, pulse is 76/min, and respirations are 15/min. On physical examination, chest is clear to auscultation and heart sounds are normal. There is no evidence of hepatosplenomegaly or costovertebral tenderness. Bowel sounds are normal. Suprapubic tenderness is elicited with deep palpation. Laboratory evaluation reveals the following:
Urinalysis
Color
Yellow
Turbidity
Cloudy
pH
6.7
Specific gravity
1.020
Protein
1+
Glucose
Negative
Ketone
Negative
Bile
Negative
Hemoglobin
Negative
Leukocyte esterase
Positive
Nitrite
Positive
Urobilinogen
< 1 EU/dL
WBC
40+/HPF
RBC
2/HPF
Bacteria
Many
Appropriate action was taken. The next day, the woman returns complaining of flank pain, fever and chills. She has some anorexia and nausea but has not vomited. Her temperature is 38.3C (101F), blood pressure is 110/70 mm Hg, pulse is 96/min, and respirations are 16/min. Her urinary symptoms have improved slightly but still persist. What is the most appropriate next step?
harry206 - 05-12-09 08:34
A 30-year-old Caucasian elementary school teacher who is 34 weeks pregnant with her first child comes to the clinic complaining that "it burns when I urinate." She has also noticed some suprapubic pain and increased urinary frequency and urgency. Her symptoms began two days ago and are causing her extreme discomfort at work. Prior to this, her pregnancy had been uncomplicated. Her temperature is 36.7C (98F), blood pressure is 126/78 mm Hg, pulse is 76/min, and respirations are 15/min. On physical examination, chest is clear to auscultation and heart sounds are normal. There is no evidence of hepatosplenomegaly or costovertebral tenderness. Bowel sounds are normal. Suprapubic tenderness is elicited with deep palpation. Laboratory evaluation reveals the following:
Urinalysis
Color
Yellow
Turbidity
Cloudy
pH
6.7
Specific gravity
1.020
Protein
1+
Glucose
Negative
Ketone
Negative
Bile
Negative
Hemoglobin
Negative
Leukocyte esterase
Positive
Nitrite
Positive
Urobilinogen
< 1 EU/dL
WBC
40+/HPF
RBC
2/HPF
Bacteria
Many
Appropriate action was taken. The next day, the woman returns complaining of flank pain, fever and chills. She has some anorexia and nausea but has not vomited. Her temperature is 38.3C (101F), blood pressure is 110/70 mm Hg, pulse is 96/min, and respirations are 16/min. Her urinary symptoms have improved slightly but still persist. What is the most appropriate next step?
The correct answer and explanation will be available after you answer.
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#1
Re: Obstetrics- Burning urination usmlefever3 - 05-12-09 09:07 My answer is: e.
patient had acute cystitis followed by acute pyelonephritis .is blood culture or urine culture done in UTI ?
#16
Re: Obstetrics- Burning urination conym5 - 04-18-10 09:08 My answer is: c.
Obtain blood cultures, admit to hospital and administer intravenous ceftriaxone in case od suspected UTI or cystitis..
#22
Re: Obstetrics- Burning urination babbu5508 - 09-30-10 00:49 My answer is: c.
the patient probably developed pyelonephritis as ascending infection needed to be treated with intravenous antibiotis, but not sure about blood cultures.
#25
Re: Obstetrics- Burning urination drnoor50 - 10-21-10 22:13 My answer is: c.
Though Cipro is good for UTI,in preg,Ceft is better
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