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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the common signs and symptoms of uncomplicated urinary tract infections

  • Describe factors that may affect empiric therapy for uncomplicated urinary tract infections

  • Develop an appropriate plan for treatment of an uncomplicated urinary tract infection

  • Evaluate factors that may decrease risk of recurrent urinary tract infections

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PATIENT PRESENTATION

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Chief Complaint

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"I have to go to the bathroom more often and it is getting really annoying."

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History of Present Illness

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Elizabeth Wilson is a 26-year-old woman who presents to the emergency department with complaints of increased urinary urgency over the past 4 days. The patient reports that she had been diagnosed with a urinary tract infection at the age of 14 years but has had no other urinary tract issues since that time. The patient states that she heard cranberry juice may help with urinary tract infections (UTIs) and has drank about 10 cups of cranberry juice over the past couple days but her urinary urgency symptoms seem to be getting worse.

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Past Medical History

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UTI at age 14 years (treated with trimethoprim–sulfamethoxazole)

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History of generalized tonic–clonic seizures (last reported seizure 3.5 years ago)

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Hypothyroidism

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Seasonal allergies

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Family History

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Mother and father are both alive. Father is 49 and has a history of HTN. Mother is also 49 and has a history of hypothyroidism.

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Social History

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Patient works currently as a waitress at a local sandwich cafe but does not have health insurance. She is currently single and broke up with her previous boyfriend 2 weeks ago. She denies smoking, alcohol, and intravenous drug abuse.

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (unknown reaction)

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Valproic acid (rash)

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Medications

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Cetirizine 10 mg PO daily PRN seasonal allergies

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Levothyroxine 50 mcg PO daily

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Phenytoin extended-release 300 mg PO daily

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Review of Systems

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Denies chest pain, SOB, abdominal pain; (+) Dysuria;(+) increase in urinary frequency or urgency (every 1–3 hours during the past 2 days)

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Physical Examination

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General
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Well appearing, obese 26-year-old Caucasian woman in no acute distress

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Vital Signs
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BP 122/78 mm Hg, P 72, RR 16, T 38.5°C

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Weight 175 lb (80 kg)

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Height 61 in. (155 cm)

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Skin
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Dry appearing skin; (−) rashes or lesions

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HEENT
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PERRLA, EOMI; (−) sinus tenderness; TMs appear normal

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Neck and Lymph Nodes
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