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Old 03-05-2013
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Default daily prophylaxis or post coital, when partner is away?

A 32 year old woman presents to the office for evaluation of recurrent urinary tract infections. She has had two episodes of cystitis in the last 4 months. In the past she was managed with 3 day course of trimethoprim-sulfamethoxazole. Now, she presents with burning micturition, urgency and frequency. She denies flank pain or fever. She uses diaphragms with spermicide for contraception. She is sexually active with one partner and her last sexual intercourse was 5 months ago since her partner is away on a business tour. Physical examination is normal except for mild supra-pubic tenderness. Which of the following is the most appropriate recommendation to avoid recurrent urinary tract infections in this patient?

A) Post-coital voiding

B) Post-Coital Trimethoprim-sulfamethoxazole

C) Avoid vaginal spermicides

D) CT urogram and Cystoscopy

E) Daily Trimethoprim-Sulfamethoxazole
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Old 03-05-2013
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D) CT urogram and Cystoscopy

To rule out a structural cause assuming that she doesn't have a boyfriend in the closet.
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Old 03-05-2013
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A 32 year old woman presents to the office for evaluation of recurrent urinary tract infections. She has had two episodes of cystitis in the last 4 months. In the past she was managed with 3 day course of trimethoprim-sulfamethoxazole. Now, she presents with burning micturition, urgency and frequency. She denies flank pain or fever. She uses diaphragms with spermicide for contraception. She is sexually active with one partner and her last sexual intercourse was 5 months ago since her partner is away on a business tour. Physical examination is normal except for mild supra-pubic tenderness. Which of the following is the most appropriate recommendation to avoid recurrent urinary tract infections in this patient?
D) CT urogram and Cystoscopy

To rule out a structural cause assuming that she doesn't have a boyfriend in the closet.
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Old 03-06-2013
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Originally Posted by Novobiocin View Post
D) CT urogram and Cystoscopy

To rule out a structural cause assuming that she doesn't have a boyfriend in the closet.
From uworld step 3...there is no rationale to investigate for obstructive causes in a woman without a clear indication for it. she has only mild suprapubic tenderness, no flank pain or fever...why CT urogram and cystoscopy?

I think the question is trying to make us go for continous daily prophylaxis as opposed to post coital prophylaxis

And why is your response here not also to discontinue vaginal spermicides since its a risk factor
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Originally Posted by stfidel View Post
From uworld step 3...there is no rationale to investigate for obstructive causes in a woman without a clear indication for it. she has only mild suprapubic tenderness, no flank pain or fever...why CT urogram and cystoscopy?
but she is having recurrent UTIs without any apparent cause...........so you should rule out something in the bladder tumor/polyp/foreign body etc

Quote:
Originally Posted by stfidel View Post
And why is your response here not also to discontinue vaginal spermicides since its a risk factor
Since she is having recurrent UTIs without sexual intercourse (should not be using vaginal spermicides) since her partner is away.
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Old 03-06-2013
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Default CT urogram or avoid spermicides

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Originally Posted by Novobiocin View Post
but she is having recurrent UTIs without any apparent cause...........so you should rule out something in the bladder tumor/polyp/foreign body etc



Since she is having recurrent UTIs without sexual intercourse (should not be using vaginal spermicides) since her partner is away.


so which is the right one....these questions have no answer...i am just brainstorming....CT urogram and cystoscopy or avoid spermicides?
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Originally Posted by stfidel View Post
so which is the right one....these questions have no answer...i am just brainstorming....CT urogram and cystoscopy or avoid spermicides?
CT urogram and cystoscopy since she should not be using the spermicides in the first place as her partner is away (and you don't really need spermicides to masturbate).
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Originally Posted by Novobiocin View Post
CT urogram and cystoscopy since she should not be using the spermicides in the first place as her partner is away (and you don't really need spermicides to masturbate).
Haha...@ masturbate...however recurrent UTI of 2 or more episodes in 6 months is an indication to start prophylactic antibiotics. I don't feel comfortable with CT Urogram
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Originally Posted by stfidel View Post
...however recurrent UTI of 2 or more episodes in 6 months is an indication to start prophylactic antibiotics.
Yes, that would be right if we knew the cause (frequent intercourse of sexual nature) but in the absence of an obvious cause it would be prudent to look for a cause especially since she has already received those antibiotics in the past. The keyword here is Recurrent complicated UTI.
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Last edited by Novobiocin; 03-06-2013 at 01:07 PM.
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Originally Posted by stfidel View Post
Haha...@ masturbate...however recurrent UTI of 2 or more episodes in 6 months is an indication to start prophylactic antibiotics. I don't feel comfortable with CT Urogram


I would not choose A,B,and C since the other possible cause of the infections is not around unless, we are not being told of anything else.

BUt the thought of having to take an antibiotic on a daily basis could be an inconvenience after awhile. So I would choose the CT Urogram to see other possible causes that might be contributing to the recurrent infections.

D
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Originally Posted by radkur View Post


I would not choose A,B,and C since the other possible cause of the infections is not around unless, we are not being told of anything else.

BUt the thought of having to take an antibiotic on a daily basis could be an inconvenience after awhile. So I would choose the CT Urogram to see other possible causes that might be contributing to the recurrent infections.

D
I understand your point...but in uworld step 3..QID-5325... pls check it up...answer given is prophylactic antibiotics
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Quote:
Originally Posted by stfidel View Post
A 32 year old woman presents to the office for evaluation of recurrent urinary tract infections. She has had two episodes of cystitis in the last 4 months. In the past she was managed with 3 day course of trimethoprim-sulfamethoxazole. Now, she presents with burning micturition, urgency and frequency. She denies flank pain or fever. She uses diaphragms with spermicide for contraception. She is sexually active with one partner and her last sexual intercourse was 5 months ago since her partner is away on a business tour. Physical examination is normal except for mild supra-pubic tenderness. Which of the following is the most appropriate recommendation to avoid recurrent urinary tract infections in this patient?

A) Post-coital voiding

B) Post-Coital Trimethoprim-sulfamethoxazole

C) Avoid vaginal spermicides

D) CT urogram and Cystoscopy

E) Daily Trimethoprim-Sulfamethoxazole
For me, I'll go with E.
A-C is out because husband is away.
D is out for me because she dosent seem to have any compelling indication for it. If it was a child, however then I'll go for D
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Old 03-07-2013
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Originally Posted by OzoneZone234 View Post
For me, I'll go with E.
A-C is out because husband is away.
D is out for me because she dosent seem to have any compelling indication for it. If it was a child, however then I'll go for D
Thank you, you make it more clear for me. True with no history of trauma or similar that would indicate D. True she is not a child to choose D.

So even though it would be an inconvenience or do other tests, the best option for this question is E.
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Originally Posted by radkur View Post
Thank you, you make it more clear for me. True with no history of trauma or similar that would indicate D. True she is not a child to choose D.

So even though it would be an inconvenience or do other tests, the best option for this question is E.
Yes --- and if she continues to have recurrent UTI despite the antibiotic prophylaxis, you then have to go searching for any underlying cause with labs/imaging
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Old 03-08-2013
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thanks buddy i like it .
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