CCS Interactive Case 1

Question 1

25 y/o F presents w/urinary frequency, urgency, burning, suprapubic tenderness. Afebrile, hemodynamically stable. Denies vaginal discharge or flank pain, sexually active with husband. Does not practice contraception, LMP 24 days ago. Current smoker.

DDx?

Answer 1

Acute cystitis vs. pyelonephritis vs. PID vs. urethritis/cervicitis/vaginitis

Question 2

Initial exam?

Answer 2

General
Chest/lung
CV
Abdominal
Genital 
[Complete also acceptable]

Question 3

Exam results: suprapubic tenderness, otherwise normal. No abnormalities on pelvic exam. No fever or flank pain.

Next steps + location?

Answer 3

Pregnancy test
UA

Office, then Home

Question 4

Pregnancy test +
UA with +nitrite, +leukocyte esterase

Next steps?

Answer 4

ABX (nitrofurantoin)
Pregnancy counseling
Prenatal vitamins
Prenatal follow-up
Urine culture, repeat 1-2 weeks s/p treatment

Question 5

Rx cystitis (uncomplicated)

Answer 5

Uncomplicated = normal healthy nonpregnant women

3-days TMP-SMX
If allergic, 3 days FQ (ciproxfloxacin)

Question 6

Rx cystitis (complicated)

Answer 6

Complicated = male, diabetes, anatomic abnormality, indwelling catheter, symptoms >7 days, recurrent UTI, >65 years

7- days TMP-SMX

Question 7

Rx cystitis (pregnancy)

Answer 7

7 days nitrofurantoin
If allergic, 7 days amoxicillin-clavulanate
Avoid TMP (folic acid antagonist)
Avoid FQ (cartilage damage)