Gynaecology case study with answers.

MEDWAX PUBLISHERS

GYNECOLOGY CASE STUDY

COMPILED BY: SULEIMAN NDORO JNR (DR AUDI)

An 18-year-old girl comes to see you complaining of a 3-day history of urinary frequency, urgency, and dysuria. She panicked this morning when she noticed the presence of bright red blood in her urine. She also reports some midline lower abdominal discomfort. She had intercourse for the first time 5 days ago and reports that she used condoms. On physical exam, there is no discharge from the cervix or in the vagina and the cervix appears normal. Bimanual exam is normal except for mild suprapubic tenderness. There is no flank tenderness, and the patient’s temperature is normal.       

1. What is the most likely diagnosis?

A. Cervicitis
B. Pyelonephritis
C. Cystitis
D. Bladder dysynergia
E. Kidney stone

2. What is the next step in the diagnosis of this patient?

A. Urine culture
B. Intravenous pyelogram
C. Cystoscopy
D. Wet smear

3. What is the likely organism responsible for this patient’s condition?

A. Chlamydia
B. Neisseria gonorrhoae
C. Klebsiella
D. E. coli
E. Candida albicans

4. Which of the following medications is the best to treat this patient’s condition?

A. Dicloxacillin
B. Monistat
C. Bactrim
D. Ciprofloxacin
E. Flagyl

5. To document cure of her infection, how long after initial diagnosis should the patient undergo a repeat urine culture?

A. 3 days
B. 7 days
C. 10 days
D. 3 weeks
E. 4 weeks

6. The patient comes to see you 6 months later complaining of having a similar problem every time she has intercourse. What is the next step in the management of this patient?

A. Referral to a urologist
B. IVP
C. Prophylactic treatment with Bactrim with each episode of intercourse

 

ANSWERS

 The answers are 1-C  2-A  3-D   4-C 5-C  6-C.

Approximately 15 to 20% of women develop urinary tract infections (cystitis) at some point during their lives. Cystitis is diagnosed when a clean-catch urine sample has a concentration of at least 100,000 bacteria per millilitre of urine and when the patient suffers the symptoms of dysuria, frequency, urgency, and pain. The most common etiology of urinary tract infections is E. coli. Treatment of a urinary tract infection involves obtaining a culture and starting a patient on an antibiotic regimen of sulfa or nitrofurantoin, which has good coverage against E. coli and is relatively inexpensive. Patients treated for a urinary tract infection should have a follow-up culture done 10 to 14 days after the initial diagnosis to document a cure. Women who experience recurrent urinary tract infections with intercourse benefit from voiding immediately after intercourse and/or prophylactic treatment with an antibiotic effective against E. coli.