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PATIENT PRESENTATION

Chief Complaint

“I have painful and frequent urination.”

History of Present Illness

VZ is a 19-year-old Hispanic female who presents to the urgent care walk-in clinic with dysuria and polyuria for 3 days duration.

Past Medical History

Seasonal allergies

Surgical History

None

Family History

Mother has HTN; father has HTN, type 2 diabetes mellitus, and dyslipidemia

Social History

Currently attending college as a sophomore. Smokes tobacco and marijuana cigarettes socially on weekends for the past 2 years; drinks alcohol (beer and wine) socially on weekends for the past year. Sexually active with her boyfriend of 8 months; uses condoms

Allergies

Sulfas-rash and blisters

Home Medications

Ethinyl estradiol/etonogestrel 0.015 mg/0.12 mg unwrap and insert one ring intravaginally and remove every 21 days then repeat 7 days later

Cetirizine 10 mg PO daily PRN seasonal allergies

Triamcinolone acetonide 55 mcg/spray 1–2 sprays EN PRN seasonal allergies

Phenazopyridine hydrochloride 200 mg PO TID after meals

Physical Examination

Vital Signs

Temp 98.4°F, P 62, RR 10 breaths per minute, BP 112/82 mm Hg, pO2 98%, Ht 5′6″, Wt 52.3 kg

General

Thin, well-nourished female, lying in bed, NAD, AAO × 3

HEENT

EOMI, PERRLA, normocephalic, no pharyngeal exudate. Neck, supple. Thyroid palpable, no nodules. No lymphadenopathy

Pulmonary

CTAB without wheezing or crackles

Cardiovascular

NSR, no m/r/g

Abdomen

Soft, non-distended, non-tender, positive bowel sounds hyperactive, no rebound or guarding

Genitourinary

Normal female genitalia, complaints of dysuria, denies hematuria. No malodorous discharge noted from vagina

Neurology

PERRLA, no focal deficits noted

Extremities

Edema present in lower extremity bilaterally. Pedal pulses palpable

Back

No tenderness to palpation on lower lumbar region

Laboratory Findings

Dipstick Urinalysis:

  • Macroscopic: urine midstream, clean catch. Yellow, cloudy, large leukocytes, positive nitrites, urine pH = 8, urine hemoglobin, protein, glucose, ketones, and bilirubin negative, specific gravity = 1.012

  • Microscopic: WBCs >100, RBCs 0, squamous epithelial cells 0, few WBC clumps

Urine Gram Stain

Many gram-negative rods

QUESTIONS

1. Which of the following symptom(s) is/are suggestive of cystitis? Select all that apply.

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